Search Results (4,294)

Varuna litterata is an estuarine crab species widely distributed across the Indo-Pacific region, commonly dwelling in brackish waters, mangrove forests, and tidal estuaries. In Bangladesh, while four Scylla species dominate the commercial crab market, the locally consumed V. litterata remains a biologically overlooked gem of the coastal waters. These crabs are frequently captured as a byproduct during shrimp fry collection from coastal estuaries. In this context, the current study investigates the reproductive biology, morphometric dynamics, and market potential of V. litterata collected from the Pasur River, a coastal mangrove forest-adjacent estuary of southern Bangladesh. A total of 75 individuals were collected from March to April 2023, comprising 35 males and 40 females, resulting in a sex ratio of 1:1.14 (♂:♀), with a predominance of females. A visual observation of ovary development revealed four distinct maturation stages, with Stage IV (fully mature) being the most prevalent (43%), indicating peak reproductive activity during the sampling period. Morphometric analysis revealed that the average carapace width (CW) was 31.2 ± 5.7 mm and 31.9 ± 5.8 mm and the mean carapace length (CL) was 29.3 ± 4.7 mm and 30.1 ± 4.9 mm in males and females, respectively. However, the mean body weight (BW) was 13.1 ± 4.3 g in males and 12.7 ± 3.8 g in female crabs. The dominant CW class ranges from 33 to 33.99 mm (males) and 28.99–29.99 mm (females), appear to be the most vulnerable to fishing pressure. BW-CW and CL-CW relationships demonstrated negative allometric growth, with high correlations in both sexes. Significant sexual dimorphism was observed, with males having larger cheliped dimensions, while females had broader abdomens, likely supporting reproductive functions that are essential to their conservation. The marketing of this crab remains largely informal, yet rising local demand and prices highlight its emerging commercial potential. Therefore, incorporation into aquaculture and coastal fishery development of this crab species could enhance food security, support livelihoods, and contribute to sustainable blue economy initiatives in Bangladesh. Full article

Background/Objectives: Screening for late-onset and term preeclampsia (PE) is essential, as the early identification of women at high risk enables closer monitoring and reduces adverse outcomes. The existing algorithms combining maternal factors, biophysical and biochemical markers have not been validated outside the populations in which they were originally developed. This study aimed to evaluate the predictive performance of the Fetal Medicine Foundation (FMF) third-trimester algorithm in our population and develop a novel model to improve the predictions. Methods: An observational, analytical, prospective cohort follow-up study was conducted at the Health Department of Alicante, Dr. Balmis General University Hospital, including 1580 singleton pregnancies recruited between February 2022 and November 2023 during routine third-trimester ultrasounds. Maternal clinical characteristics, blood pressure, the uterine artery pulsatility index (UtA-PI), and the sFlt-1/PlGF ratio were recorded. The FMF third-trimester algorithm was retrospectively applied at the end of pregnancy using clinical, biophysical, and biochemical data from 30 + 0 to 37 + 6 weeks via the freely accessible online calculator. The data analysis was performed using SPSS v.28 and R v.4.3.1. Results: A total of 1580 women were included, with a prevalence of late-onset PE of 2.9%. The FMF model achieved an area under the curve (AUC) of 0.87 (95% CI: 0.81–0.92), while our own model showed a superior performance, with an AUC of 0.94 (95% CI: 0.92–0.97). Conclusions: The FMF third-trimester algorithm demonstrated a good predictive performance for late-onset PE. Our newly developed model achieves an even higher predictive accuracy and offers a simplified approach to excluding the UtA-PI, which facilitates its use in routine clinical practice. Full article

Background: The rising prevalence of neurodegenerative conditions such as dementia underscores the impact of population aging. Consequently, long-term care needs have increased and are often met by family members through informal caregiving, thereby supporting formal care systems by reducing associated costs. These caregivers face physical and mental health challenges, raising concerns about their psychological well-being and prompting interest in both clinical and psychosocial research. Ryff’s eudaimonic model offers a robust framework for the assessment of psychological well-being; yet, in Romania, data on this population segment remain limited. Objective: This study aimed to compare the psychological well-being of Romanian dementia family caregivers with a reference population from the Romanian adaptation of the 54-item Ryff Psychological Well-Being Scale, and to explore how sociodemographic characteristics relate to relevant differences across well-being dimensions. Methods: A cross-sectional study was conducted among 70 Romanian family caregivers recruited from a single clinical hospital in Bucharest, Romania. Caregivers completed the 54-item Ryff Scale (Romanian adaptation), and scores were compared to reference values using one-sample t-tests with bootstrap confidence intervals. The most relevant dimension (purpose in life) was dichotomized and further examined in relation to sociodemographic and caregiving variables using Chi-squared and Fisher’s exact tests. Results: Caregivers reported significantly lower scores compared to the reference population in purpose in life (p < 0.001, d = −1.01), personal growth (p < 0.001, d = −0.91), and positive relations (p = 0.01, d = −0.30). The most pronounced deficit was observed in purpose in life, with 85.7% of caregivers scoring below the reference mean. This dimension was further examined in relation to caregiver characteristics. Retirement status showed a statistically significant association with Purpose in Life, with retired caregivers more likely to report lower scores (χ² (1) = 4.04, p = 0.04), supported by the likelihood ratio test (p = 0.01) and a linear trend (p = 0.05). Additional marginal associations were found for household income (p = 0.14) and whether the patient slept in a separate room (p = 0.15), suggesting possible links between caregiver well-being and economic or environmental conditions. Conclusions: The study findings highlight notable psychological vulnerabilities among Romanian dementia caregivers, particularly in purpose in life and personal growth. Associations with structural and contextual factors such as retirement status, income, and caregiving environment suggest that caregiver well-being is shaped by broader socioeconomic conditions. While the magnitude of these deficits may be underestimated due to elevated stress levels in the reference group, the findings underscore the need for targeted clinical, social, and policy-level interventions aimed at strengthening existential meaning and personal development in culturally specific settings. Full article

Background: Parkinson’s disease (PD) is characterized not only by motor dysfunction but also by widespread degeneration across cortico-striatal, limbic, and cortical circuits. Mounting evidence suggests that tau and α-synuclein pathology underlie these processes, though how these proteinopathies translate into affective and cognitive outcomes remains uncertain. Depression and anxiety are highly prevalent in PD, yet the biological correlates of these affective disturbances are poorly defined. Methods: This is a retrospective analysis of existing data from the Parkinson’s Progression Markers Initiative (PPMI). Montreal Cognitive Assessment (MoCA), geriatric depression scale (GDS), and State-Trait Anxiety Inventory (STAI) were used to assess cognition, depression, and anxiety in PD, respectively. The CSF biomarkers evaluated were Aβ42, t-tau, and p-tau181, using Elecsys electro-chemiluminescence immunoassays on the cobas e601 platform (Roche Diagnostics). Results: From the 4380 patients who had GDS information, the MoCA test was collected from 438 patients, and 445 from the GDS test for depression, and the STAI screening for anxiety. There were no significant differences in biomarker levels between patients with depression (GDS ≥ 5) and those without (GDS < 5), nor between patients with anxiety (STAI > 40) and those with lower anxiety scores (STAI ≤ 40). In contrast, cognitive outcomes showed clear associations. Patients with cognitive impairment (MoCA < 26) demonstrated higher levels of pTau (p = 0.02) and tTau (p = 0.01), as well as elevated pTau/Aβ42 (p = 0.003) and tTau/Aβ42 (p = 0.002) ratios compared to those with MoCA ≥ 26. In multivariate analysis, both pTau/Aβ42 > 0.022 (OR 4.64, 95% CI 1.67–13.8) and tTau/Aβ42 > 0.26 (OR 4.18, 95% CI 1.6–11.5) remained significantly associated with cognitive decline. In a longitudinal analysis in the first 3 years of follow-up, cognition in PD remained lower than in controls, while CSF p-tau and Aβ42 remained higher in controls. Conclusions: In our cohort, no associations were found between CSF biomarkers and depression or anxiety, underscoring that mood disturbances in PD are likely mediated by alternative mechanisms such as monoaminergic dysregulation, neuroinflammation, and psychosocial factors. By contrast, cognitive performance (MoCA) was clearly linked to tau-related pathology, rather than α-synuclein or Aβ42 alone. While Aβ42 and α-synuclein remain useful for staging and assessing global disease risk, our findings highlight the specificity of tau-related pathology for cognitive outcomes in PD. Full article

Background: IgM antiphospholipid antibodies (aPL) were de-emphasised in the 2023 ACR/EULAR criteria, yet their precise clinical significance remains uncertain. Methods: A rapid scoping review of PubMed (Jan 2000–June 2025) identified original human studies reporting IgM aCL, aβ₂GPI, or aPS/PT prevalence or outcomes; 40 studies met the eligibility criteria. Prevalence and odds ratios (ORs) of clinical associations were extracted. Results: IgM aPL are common across APS phenotypes. Obstetric cohorts showed aCL-IgM prevalences of 3–82%, often equal to or exceeding those of IgG, while aβ₂GPI-IgM reached a prevalence of 2–63%. In mixed thrombotic–obstetric cohorts, aPS/PT-IgM was the most frequent isotype (31–79%). Purely thrombotic studies still reported 0–59% aβ₂GPI-IgM, with PS/PT-IgM at 55% and 62% in two large series. Significant outcome signals from clinical associations of IgM aPL were inconsistent but noteworthy in (i) pregnancy loss for high-titre aCL, aβ₂GPI, and aPS/PT, (ii) thrombosis driven by aPS/PT and (iii) organ-specific arterial events (retinal thrombosis and stroke) in isolated IgM phenotypes. Conclusions: The role of aPL-IgM remains uncertain. The findings advocate for a nuanced approach to IgM interpretation, supporting its reconsideration in specific clinical settings and emphasising the significance of ongoing research into the mechanistic and prognostic utility of IgM aPL. Full article

Background and Objectives: Diabetic foot gangrene remains a major cause of lower limb amputation, driven by vascular, neuropathic, and infectious mechanisms. Identifying predictors for amputation type is essential to optimizing outcomes and reducing disability. We aimed to analyze the burden of diabetic foot gangrene and the patients’ characteristics according to the type of surgery, minor or major amputations. Methods: We conducted a retrospective observational study including 295 diabetic patients who underwent surgery for foot lesions at a Romanian tertiary center (January 2023–December 2024). Patients were classified according to surgical outcome as minor (toe/foot-level) or major (below/above-knee) amputations. Clinical, demographic, and pathological variables were compared between groups. Statistical analysis was performed with IBM SPSS Statistics 20.0. Categorical variables were expressed as frequencies and percentages, and continuous variables as mean ± SD or median (min–max). Group comparisons used Student’s t-test, Mann–Whitney U, Chi-square, or Fisher’s exact test, and binary logistic regression was applied to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: Among the patients included (mean age 64.8 ± 10.8 years; 69.2% male), 191 (64.7%) underwent minor amputations/debridement and 104 (35.3%) required major amputations. Patients with major amputations were older (66.8 ± 11.3 vs. 63.7 ± 10.4 years, p = 0.012) and less frequently male (56.7% vs. 75.9%, p = 0.001). Lesion extension to the foot or beyond strongly predicted major amputation (p < 0.001). Peripheral arterial disease was more prevalent in the major group (85.6% vs. 65.4%, OR = 3.13, 95% CI = 1.68–5.84), while neuropathy was associated with minor procedures (12.6% vs. 3.8%, p = 0.015). Anemia (70.2% vs. 56.5%, p = 0.021) and leukocytosis (68.3% vs. 49.2%, p = 0.002) were also independent predictors of major amputation. Conclusions: The study highlights the need for early detection, coordinated multidisciplinary care, and personalized assessment of diabetes burden and its complications to minimize the risk of major limb amputation. Full article

Diabetes mellitus (DM) is a complex chronic disease, with a prevalence that has reached alarming proportions in recent decades. In this study, we aimed to analyze the association of type 2 diabetes mellitus (T2DM) with certain insulin resistance (IR) indicators, according to the gender of the participants enrolled in the PREDATORR study. Biomarkers such as the triglyceride–glucose (TyG) index and its derivates, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-c), and metabolic score for insulin resistance (METS-IR), as well as recent indicators, like cholesterol, HDL, the glucose (CHG) index and its derivates, CHG–body mass index (CHG-BMI), and CHG–waist circumference (CHG-WC), as well as its newly proposed derivates, such as CHG–waist-to-height ratio (CHG-WHtR), CHG–neck circumference (CHG-NC), and CHG–neck-to-height ratio (NHtRs were analyzed in 2080 subjects, divided into two groups, according to gender). Univariate and multivariate logistic regression was used to identify the relationships between IR indicators and T2DM. Regardless of gender, all the analyzed indicators presented statistically significantly higher values in T2DM (+) compared to T2DM (−). For both studied groups, CHG–WHtR had the largest AUROC curve: in males, the AUROC curve was 0.809, the cut-off value being 3.22, with a 70.7% sensitivity and 75.3% specificity; in females, the AUROC curve was 0.840, the cut-off value was 3.20, with a 79.3% sensitivity and 75.5% specificity, respectively. Regardless of gender, the age-adjusted model for multivariate logistic regression analysis demonstrated that TyG and CHG were predictive factors for T2DM. Full article

Background/Objectives: The Jiangnan diet—a traditional dietary pattern prevalent in Eastern China—is a newly proposed dietary pattern. This study provides additional epidemiological evidence for the promotion of the Jiangnan diet through examining the association between the Jiangnan diet and mild cognitive impairment (MCI). Methods: A multicenter cross-sectional study was carried out during 2020 among 1084 community-dwelling adults aged 55 years and above across multiple sites in Zhejiang Province, China. Data collection encompassed basic information of the population, cognition (using the Montreal Cognitive Assessment), dietary intake information (using the Food Frequency Questionnaire, FFQ), life pattern, depressive symptoms (using the Mental Health Assessment Scale for the Elderly), and physical examinations (e.g., height, weight). The dietary patterns were assessed using a validated semi-quantitative FFQ. Factor analysis was used to analyze the 16 categories of food intake of the participants, and dietary patterns and the “Jiangnan diet” were extracted. The Jiangnan diet scores were categorized into quartiles: Q1 (lowest) to Q4 (highest). Multivariate logistic regression was employed to examine the association between adherence to the Jiangnan diet and the prevalence of MCI, with results expressed as odds ratios (OR) and 95% confidence intervals (CI). Results: The estimated prevalence of MCI in the study population was 24.6%. The dietary pattern characterized by whole grains, low salt, and low oil was identified as the “Jiangnan diet”. Participants with the highest adherence to the “Jiangnan diet” pattern had 79.2% lower odds of MCI than those with the lowest adherence (odds ratio = 0.208, 95% CI = 0.120~0.362, p < 0.0001) after adjusting for age, frequency of social activities, depression, hypertension, alcohol consumption, and energy intake. Conclusions: High adherence to the Jiangnan diet was associated with lower odds of MCI. To further verify the relationship between the Jiangnan diet and MCI, future studies will focus on longitudinal research exploring different dietary patterns and disease outcomes across various regions. Full article

Background/Objectives: Skipping breakfast is common among adolescents. Providing breakfast at school is a potential solution; however, its effectiveness remains unclear. This study aimed to compare breakfast skipping between dormitory- and home-residing high school students, analyze trends over time, and identify reasons for skipping breakfast. Methods: This study analyzed data from high school students who participated in the Korea Youth Risk Behavior Survey between 2018 and 2024, and who lived either in dormitories (n = 11,394) or at home (n = 164,446). The frequency of breakfast consumption over the previous seven days was surveyed; breakfast skipping was defined as missing breakfast on at least five of these seven days. Results: Students living in dormitories had more breakfast days than those living at home (4.6 ± 0.04 vs. 3.7 ± 0.01, p < 0.001). The prevalence of breakfast skipping among students living in dormitories was approximately half of that among students living at home. The association between breakfast skipping and residence type remained significant after adjusting for potential confounders (odds ratio: 0.37; 95% confidence interval: 0.34–0.39). The prevalence of breakfast skipping increased more rapidly between 2018 and 2024 among students living in dormitories (15.1–25.0%, annual percent change = 8.7%, p < 0.05) than in those living at home (35.3–45.3%, annual percent change = 4.0%, p < 0.05). In 2022, the main reasons for skipping breakfast among students living in dormitories and at home were oversleeping (32.2%) and lack of time (39.6%), respectively. Conclusions: Students living in dormitories were less likely to skip breakfast than those living at home. However, even when breakfast is provided, a substantial and increasing proportion of adolescents skip breakfast. These findings suggest that creating a supportive environment alone is insufficient and that strategies are needed to enhance awareness of the importance of breakfast. Full article

Background: Some studies suggest that, thanks to the mechanisms of immune-mediated attenuation, influenza vaccination reduces severity of influenza illness in breakthrough infections. This study aimed to assess whether influenza vaccination attenuates severity of laboratory-confirmed influenza among Italian adults. Methods: This secondary analysis included all influenza cases detected during respiratory surveillance studies conducted in outpatient and inpatient settings in Genoa (Italy), throughout the 2023/2024 and 2024/2025 seasons. Here, we compared viral load and the count of influenza-related symptoms in outpatients, alongside all-cause in-hospital mortality and radiologically confirmed pneumonia in inpatients, between vaccinated and unvaccinated adults. Results: The study included 188 influenza cases diagnosed in primary care and 281 influenza cases identified among inpatients. Of these, 37.2% and 31.7%, respectively, were vaccinated, constituting breakthrough infections. Compared to unvaccinated adults, vaccinated outpatients had a slightly lower viral load (difference in cycle threshold values of 1.36 corresponding to about 0.51 log₁₀ reduction in the number of copies/mL; p = 0.077), primarily driven by influenza A(H1N1)pdm09. Vaccinated outpatients also reported 9% fewer influenza-related symptoms than unvaccinated counterparts [prevalence ratio 0.91; 95% confidence interval (CI): 0.84, 0.99]. Among hospitalized older adults, influenza vaccination was associated with 64% reduced odds of in-hospital death (odds ratio 0.36; 95% CI: 0.12, 0.94). Conversely, no association between vaccination and development of pneumonia was found. Conclusions: This study corroborates the idea that influenza vaccination attenuates disease severity in breakthrough infections. These effects are, however, dependent on the measure of severity used. Full article

Objectives: Antimicrobial resistance is a major global health threat. This study aimed to assess the impact of antimicrobial-resistant bacterial pneumonia on in-hospital mortality and length of hospital stay in Spain using a large, nationally representative cohort. Methods: A retrospective cohort study that used data from Spain’s Registry of Specialized Health Care Activity (RAE-CMBD) between 2017 and 2022. Hospitalized adults with bacterial pneumonia were included. Hospitalization episodes with bacterial antimicrobial resistance, defined according to ICD-10-CM codes for antimicrobial resistance (Z16.1, Z16.2), were analyzed versus hospitalization episodes without these codes. Multivariate logistic regression models, adjusted for potential confounders (e.g., age, comorbidity, intensive care unit admission) and sensitivity analyses (Poisson regression and propensity score matching test), were performed. Results: Of the 116,901 eligible hospitalizations, 6017 (5.15%) involved antimicrobial-resistant bacteria. Patients with antimicrobial-resistant bacterial pneumonia were older (median 75 vs. 72 years), had greater comorbidity (Elixhauser–van Walraven index: 8 vs. 5), and were more frequently admitted to the intensive care unit (22% vs. 14%). Crude in-hospital mortality was higher in the antimicrobial resistance group (18.46% vs. 10.05%, p < 0.0001), with an adjusted odds ratio of 1.47 (95% confidence interval, 1.36–1.58), p < 0.0001. Length of hospital stay was prolonged in antimicrobial resistance patients (median 14 vs. 8 days; adjusted incident rate ratio of 1.46; 95% confidence interval of 1.41 to 1.50). The most prevalent antimicrobial resistant pathogens were Staphylococcus aureus and Gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli). Conclusions: Antimicrobial resistance is associated with longer hospital stays and an up to 50% higher risk of mortality. Despite the implementation of control policies in place over the past decade, policymakers must strengthen AMR surveillance and ensure adequate resource allocation. Clinicians, in turn, must reinforce antimicrobial stewardship and incorporate rapid diagnostic tools to minimize the impact of antimicrobial resistance on patient outcomes. Full article

To address the prevalent issues of oscillation and overshoot in high-voltage circuit breaker motor direct-drive mechanisms under classical PI control, this paper proposes an optimized PI speed loop with active damping characteristics. By first establishing a detailed kinematic and dynamic model of the mechanism, we reveal the inherent coupling between tracking performance, disturbance immunity, and the damping ratio within the classical PI speed loop. Our novel method introduces a speed feedback channel at the output of the PI controller to synthesize equivalent viscous damping, thereby enhancing system stability without compromising responsiveness. Through rigorous simulation and experimental validation, the proposed controller’s effectiveness is demonstrated. Compared with the traditional PI controller, the ADPI method reduces the velocity overshoot to only 5.76% in the startup phase, and the maximum velocity tracking error of the velocity is only 18.62% and the cumulative position tracking error is only 0.632 rad under the actual working condition, which is a reduction of 42.7% in the positional error relative to the traditional PI method. The controller also exhibits low sensitivity to changes in the system’s equivalent rotational inertia. This work provides a low-complexity and easy-to-implement speed loop performance enhancement scheme, ideally suited for the short-duration, high-dynamic-load conditions of high-voltage circuit breaker applications. Full article

Background: Bloodstream infections (BSIs) complicate COVID-19 inpatients, increasing morbidity, mortality, and healthcare burden. This systematic review and meta-analysis evaluated prevalence, antimicrobial resistance (AMR), risk factors, and outcomes of BSIs in RT-PCR-confirmed COVID-19 cases. Methods: We searched PubMed, Google Scholar, ScienceDirect, and MDPI journals (January 2020–August 2025) following PRISMA 2020 guidelines. Twenty-two observational studies (~123,500 patients, ~602,000 blood cultures) were included: 10 prospective and 12 retrospective. Random-effects models estimated pooled prevalence, odds ratios (ORs), and mean differences, with subgroup analyses (ICU, non-ICU, pediatric) and meta-regression.Results: Pooled BSI prevalence was 8.2% (95% CI: 5.7–11.0; I² = 50%). Subgroup prevalence was higher in ICU (12.5%) than non-ICU (5.2%) populations. Pediatric cohorts (n = 3) showed a prevalence of 10.8%. Gram-negative pathogens predominated (61%), particularly Klebsiella pneumoniae (26%) and Acinetobacter baumannii (21%). AMR rates were 36% for MRSA and 31% for ESBL-producing Enterobacterales. Risk factors included mechanical ventilation (OR: 2.6), immunosuppression (OR: 2.3), and corticosteroid use (OR: 2.4). BSIs were associated with increased mortality (OR: 2.6), prolonged hospitalization (+6.8 days), and higher ICU admission (OR: 3.1).Conclusions: BSIs, largely driven by multidrug-resistant pathogens, substantially worsen COVID-19 outcomes. Variability in diagnostic criteria (CDC vs. ECDC) and reliance on retrospective designs are limitations, though moderate heterogeneity (I² = 50%) enhances generalizability across diverse populations. Strengthened infection prevention and antimicrobial stewardship are urgently required. Full article

Background and Objectives: Iron deficiency anemia (IDA) is the most common cause of anemia in pregnant women and can adversely affect both maternal and fetal health. This study aimed to compare pregnancy outcomes between women with and without IDA in Northern Thailand, a region with a high prevalence of anemia. Methods: A retrospective cohort study was conducted on all singleton pregnancies attending antenatal care (ANC) and/or delivering at Maharaj Nakorn Chiang Mai Hospital between 2003 and 2024. The study group consisted of women diagnosed with IDA in the first half of pregnancy, while the control group comprised women with low-risk pregnancies during the same study period. Results: Of the 38,979 pregnancies, after applying exclusion criteria, 634 pregnancies (2.2%) with laboratory-confirmed IDA and 28,132 controls remained available for analysis. Women with IDA had significantly higher parity, lower socioeconomic status, and lower hemoglobin levels throughout pregnancy. Multivariate regression analysis revealed that IDA was significantly associated with increased risks of preterm birth (adjusted odds ratio; aOR 1.04; 95% CI: 1.01–1.07), fetal growth restriction (FGR) (aOR 1.02; 95% CI: 1.00–1.04), and low birth weight (aOR 1.05; 95% CI: 1.03–1.08). Conclusions: IDA, even with treatment, may still slightly increase the risk of adverse pregnancy outcomes, particularly preterm birth, fetal growth restriction, and low birth weight. The residual risk likely reflects incomplete correction of anemia. Optimizing management requires strict compliance, judicious use of parenteral iron, and attention to coexisting nutritional deficiencies, underscoring the need for closer monitoring and improved care strategies. Full article

Background: Non-invasive diagnostic tools for the assessment of pulmonary arterial hypertension (PAH) are currently being intensively studied. Positron emission tomography (PET)/computed tomography (CT) with [18F]-fluorodeoxyglucose ([18F]-FDG) and [13N]-ammonia is the gold standard for assessing myocardial metabolism and perfusion. The relationship between right ventricle (RV) myocardial metabolism and perfusion and cardiopulmonary exercise testing (CPET) has not been studied. Objective: to evaluate correlations between the CPET parameters and RV perfusion and metabolism in IPAH patients. Methods: The study comprised 34 IPAH patients (34.2 ± 8.9 years, 4 males, 6 prevalent). Myocardial metabolism and perfusion were assessed using PET/CT with [18F]-FDG and [13N]-ammonia, respectively. CPET, cardiac MRI and invasive hemodynamics were also evaluated. Results: Significant negative correlations were registered between [18F]-FDG and [13N]-ammonia uptake by the RV (SUVmax _RV/LV) and the oxygen consumption, oxygen pulse and positive correlation with the ratio of minute ventilation to carbon dioxide production. The low-risk IPAH patients significantly differed from the intermediate-to-high-risk group in CPET indices and in SUVmax _RV/LV metabolism and SUVmax _RV/LV perfusion parameters. No reliable differences in CPET indices and [18F]-FDG and [13N]-ammonia uptake by the RV were registered between intermediate- and high-risk patients. Conclusions: CPET is a reliable non-invasive diagnostic tool that could distinguish low-risk young IPAH patients without comorbidities from those at intermediate-to-high risk. Significant correlations between CPET parameters and RV myocardial metabolism and perfusion indices, MRI, and invasive hemodynamics confirm the high diagnostic value for CPET. Full article