Search Results (9,419)

Background and Objectives: Breast cancer surgery is increasingly performed in older patients with multimorbidity, in whom cardiovascular disease and frailty may substantially modify perioperative risk, including vulnerability to heart failure decompensation and other major medical complications. However, most available studies report global perioperative complication rates and composite medical endpoints, with heart failure events only rarely captured as dedicated outcomes, and operative technique, cardiovascular comorbidity, and frailty are often treated as separate domains rather than components of an integrated risk framework. Materials and Methods: We conducted a systematized narrative review with a structured literature search in PubMed/MEDLINE, Scopus, and Web of Science from inception to 31 January 2026, including original studies of adult patients undergoing breast-conserving surgery, mastectomy, and/or reconstruction that reported early postoperative outcomes in relation to comorbidities, cardiovascular risk, or frailty. Eligibility assessment, data extraction, and qualitative synthesis followed key PRISMA 2020 principles, and findings were organized into three prespecified domains: surgical complexity, cardiovascular vulnerability (including patients with heart failure where reported), and frailty. Results: Nineteen studies (retrospective cohorts, registry-based analyses, and large database studies, primarily ACS NSQIP) met inclusion criteria, encompassing diverse breast surgery populations, including elderly, metastatic, and reconstructive cohorts. Across datasets, escalation from breast-conserving surgery to mastectomy and then to increasingly complex reconstruction was associated with a stepwise increase in perioperative complications, reoperations, bleeding, and, in selected series, catastrophic events. Preexisting cardiovascular disease and systemic vascular pathology significantly amplified postoperative morbidity even in procedures considered low or intermediate cardiac risk, with signals that patients with underlying heart failure carry particularly heightened vulnerability, although HF-specific events were infrequently reported as separate endpoints. Frailty, mainly assessed using modified frailty indices, consistently emerged as a strong, age-independent predictor of 30-day complications, mortality, and readmissions across surgical types, including both breast-conserving and reconstructive procedures. Conclusions: Early postoperative outcomes after breast cancer surgery are associated with the interaction between surgical complexity, cardiovascular comorbidity (with limited HF-specific reporting), and frailty rather than by operative technique alone. In this context, our synthesis primarily reflects overall cardiovascular vulnerability in comorbid and frail patients, with heart failure risk inferred indirectly from the available data. These findings support a patient-centered, risk-adapted surgical strategy in which the extent and timing of surgery and reconstruction are tailored to each patient’s cardiovascular profile and frailty status, with preferential use of breast-conserving or less complex procedures in vulnerable individuals. Integrating standardized frailty assessment and cardio-oncologic evaluation into preoperative workflows, and prospectively validating this tri-axial framework in dedicated cohorts, may improve perioperative risk stratification and reduce the burden of postoperative medical complications in an aging breast cancer population. Full article

Solid oxide fuel cells (SOFCs) are a promising near-zero-emission propulsion source for Northern Sea Route (NSR) vessels, but their yttria-stabilized zirconia (YSZ) electrolyte and Ni-cermet anode are susceptible to thermomechanical degradation under repetitive start–stop thermal cycling. We develop a hierarchical Bayesian competing-risk framework built on a dual degradation model that decomposes area-specific resistance (ASR) growth into cycle-induced fatigue and time-dependent electrochemical aging and apply it across six NSR duty-cycle scenarios spanning f = 1–27 cycles/month. Posterior inference via the No-U-Turn Sampler (NUTS) yields 17 estimated parameters meeting standard convergence criteria (R̂ ≤ 1.01, ESS_bulk ≥ 479, zero divergent transitions). The analysis identifies a failure-mode transition at f ≈ 3–6 cycles/month: high-frequency routes are crack-dominated (S1a: 10/15 cells fail by crack within the 600-cycle window with 5/15 right-censored), whereas low-frequency routes are ASR-dominated (S3b: 100% ASR). Global sensitivity analysis indicates the time-dependent rate coefficient k_time as the primary remaining-useful-life driver (S_T = 0.37–0.46). Cycle-based maintenance thresholds span 160 cycles (S3b) to ≥600 cycles (S2b), bracketed by S1a (270 cycles, 10.0 months, crack-dominant) and S3a (480 cycles, 160 months, transition regime); qualitative consistency with published experimental data supports physical plausibility. Full article

The interaction between crude oil prices and exchange rates is central to understanding global financial stability and macro-economic balances. Contrary to traditional static analyses, the heterogeneous market hypothesis argues that market participants have different time horizons and that multi-scale analysis is necessary to capture dynamic changes in crisis periods. This study examines volatility spillovers between WTI crude oil and the Russian ruble using wavelet coherence, phase difference, and predictive information flow analysis in a time–frequency framework. The analysis separates short-term [2–32 days] transient shocks from long-term [32–256 days] structural changes. Findings show that a negative spillover, initially led by WTI, with evidence of dynamic, frequency-dependent leadership shifts during the 2020 shock, was interpreted as a result of the overnight price gap and a failure of microstructural synchronisation. With the outbreak of the 2022 Russia–Ukraine war, the relationship shifted to a strong, positive, and high-intensity risk transfer, consistent with contagion theory. Crucially, by 2024, a structural decoupling emerged due to geoeconomic fragmentation, signalling that the ruble no longer exhibits traditional petro-currency behaviour. These results offer critical signals for policymakers regarding reserve management and for market participants regarding new liquidity risks. Full article

In the evolving landscape of next-generation wireless networks, ensuring seamless mobility and high-quality service delivery for millions of devices and end users in dynamic scenarios, where the speed of a wireless device keeps changing with time, is important. The mobility, seamless and continuous connectivity, and ultra-dense deployment of wireless networks pose a significant challenge. Seamless and successful transition of a wireless device from point A to point B in variable-speed scenarios is one of the major challenges in future networks. This paper presents a novel Deep Q-Network (DQN)-based reinforcement learning (RL) framework integrated with Software-Defined Networking (SDN) for intelligent mobility management in hybrid 5G cellular networks consisting of macro and small base stations. The proposed system architecture utilizes a SDN controller to receive real-time user measurement reports, including Reference Signal Received Power (RSRP), Signal-to-Interference Noise Ratio (SINR), and user velocity, thereby classifying user mobility into distinct subclasses and dynamically determining optimal handover parameters. Leveraging the DQN’s capability to learn adaptive strategies, the model enables seamless transitions between macro and small cells based on mobility profiles, thereby enhancing Quality of Service (QoS) metrics such as latency, throughput, and handover efficiency. Simulation results demonstrate consistent performance improvements over baseline and existing models in ultra-dense network environments, with handover success rates 10–15% higher across SINR and different speed scenarios, while maintaining a packet failure rate of 9% across different speed scenarios, allowing more users to transition during various environmental changes seamlessly. Our proposed model is compared with our previous work and Learning-based Intelligent Mobility Management (LIM2) models. Specifically, our previous work focused on adaptive handover management primarily for high-speed train scenarios using a learning-assisted approach tailored to fixed high-mobility scenarios, with a limitation to single mobility conditions. This work contributes to the field of merging SDN’s centralized control with the predictive power of RL, paving the way for more resilient and responsive mobile networks in high-mobility scenarios. The proposed approach incorporates subclass-based mobility action abstraction, joint optimization of TTT and hysteresis margin, and dynamic target cell selection using global network information available at the SDN controller. Full article

Deposition of fibrous connective tissue within the extracellular matrix is initially an adaptive and reversible wound-healing process. However, persistent dysregulation of fibrotic signaling pathways induces irreversible cellular dysfunction, tissue degeneration and organ failure. Despite the high mortality rate associated with fibrotic diseases, there are very limited approved anti-fibrotic treatments and there is no therapeutic drug effective enough to completely invert the fibrotic process. Accordingly, new therapeutic agents that will attenuate ongoing fibrosis and, at the same time, promote regeneration of injured tissue are urgently needed. The search for new therapies has been revolutionized by recent advances in stem cell biology. Mesenchymal stem cells (MSCs) are promising candidates for the therapy of organ fibrosis because of their differentiation capabilities and immunomodulatory properties. The capacity of MSCs to suppress chronic inflammation and promote tissue repair and regeneration underlies their therapeutic effects in diseases such as liver cirrhosis, idiopathic pulmonary fibrosis, cardiac fibrosis, systemic sclerosis, and renal fibrosis. In this review, we summarize the present understanding of fibrotic disease, highlight promising research avenues, including MSC-based treatment options, and discuss the challenges involved with the clinical application of MSCs. Full article

Recent years have witnessed the rapid proliferation of Industry 4.0 technologies in smart grids, leading to a revolution in energy generation and management, which provides improved operational efficiency and intelligent automation for smart grids. Nevertheless, this highly integrated infrastructure, while making energy more secure and reliable, simultaneously creates greater vulnerability to sophisticated cyber threats such as Distributed Denial of Service (DDoS) attacks, data manipulation and unauthorized access. The task of addressing these challenges requires innovative approaches that maintain the resilience as well as security of critical energy infrastructures. A novel Blockchain-Enhanced Cybersecurity Framework (BCF) specific to Industry 4.0-enabled smart grid systems is presented in this paper. The proposed framework integrates advanced security protocols with real-time threat detection capabilities through the decentralized, transparent and tamper-resistant nature of blockchain technology. Authentication, data validation and secure communication are accomplished through smart contracts to automate it, eliminating human intervention and single points of failures. The framework is able to allow for high transaction volumes, typical of modern smart grid networks, whilst maintaining integrity via a hybrid consensus mechanism that ensures scalability. In addition, the framework is further augmented with a Machine Learning-Based Intrusion Detection System (ML-IDS) to detect and mitigate cyber-attacks in real time. The proposed system achieves excellent performance in identifying malicious activities with high accuracy, precision and recall on the UNSW-NB15 dataset. Analysis with traditional methods indicates that the Blockchain Enhanced Cybersecurity Framework significantly lowers false positive rates and increases detection reliability. The framework is justified in terms of its strength to secure the systems in Industry 4.0-enabled smart grids against emerging cyber threats through extensive simulations and case studies. The value of this work is that it shows that blockchain and machine learning can be used to improve cybersecurity in renewable energy systems, and concrete insights and recommendations on implementing secure and cost-effective systems of energy infrastructure are provided. The proposed framework creates an enabling environment on which the creation of resilient and future-ready smart grids to facilitate the global goal of sustainable and secure energy can be developed. Full article

Maritime cross-domain unmanned system-of-systems (MCUSoS), featuring multi-domain collaboration, wide-area coverage, and flexible deployment, plays a vital role in missions such as maritime search and rescue, marine environmental monitoring, and terrain reconnaissance. MCUSoS enables collaborative detection by coordinating heterogeneous unmanned clusters across the aerial, surface, and underwater domains. However, this capability is vulnerable to degradation under cross-domain heterogeneity, communication constraints, and external disturbances such as node failures, link disruptions and malicious interference. To address these challenges, this paper proposes an integrated framework for collaborative detection capability evaluation and resilience enhancement of MCUSoS in multi-disturbance environments. Firstly, a system-of-systems architecture is established by incorporating formation detection modes and multi-level collaborative relationships to characterize its collaborative detection capabilities. Second, a capability evaluation model is developed from the capabilities of collaboration and detection. Based on this, a multi-stage resilience evaluation mechanism is proposed to quantify MCUSoS resilience under three disturbance modes. Additionally, a resilience enhancement strategy combining internal reconfiguration with the external deployment of supplementary detection nodes is designed to recover MCUSoS performance in multi-disturbance environments. Finally, a case study involving 12 clusters of MCUSoS is conducted to validate the effectiveness of the proposed methods. The results demonstrate that the proposed resilience enhancement strategy achieves a recovery rate of up to 74% in the disintegration circle attack scenario and consistently improves the resilience of the MCUSoS under targeted attacks, with the resilience value under low-frequency attacks being 148% higher than that under high-frequency attacks. These findings provide a quantitative basis for resilience evaluation and enhancement in dynamic scenarios. Full article

Cardiovascular diseases have high mortality rates and present a high burden on society and the global healthcare system. A large quantity of drugs have been developed, such as aspirin, ACE inhibitors, beta-blockers, and statins. Although these traditional drugs have decreased the morbidity and mortality of cardiovascular diseases, they still have multiple limitations. Due to their shortcomings, researchers have continued to search for novel targets for drug treatment. The tripartite motif (TRIM) protein family is a superfamily with E3 ubiquitin ligase activity and involves diversified processes including proliferation, development, signal transduction, and immune regulation. The latest research has shown that TRIM proteins participate in the progression of cardiovascular diseases, such as cardiac hypertrophy, cardiac ischemia–reperfusion injury, heart failure, hypertension, atherosclerosis, and so on. In this review, we summarize the structure and function of TRIM proteins, as well as the mechanisms of their involvement in various cardiovascular diseases, aiming to raise awareness of the importance of TRIM proteins in cardiovascular disease research and treatment. Advancing our understanding of mechanisms mediated by TRIM proteins may emphasize their contributions to cardiovascular diseases and provide the opportunity to develop novel and targeted therapeutic strategies to combat cardiovascular diseases. Full article

Background: Despite significant advances in heart failure (HF) management, mortality and readmission rates remain persistently high. Low adherence has been recognised as a contributing factor, although supporting data remain limited. Objective: This study aimed to evaluate the impact of medication adherence on outcome following a HF hospitalisation. Methods: Patients who were discharged after HF hospitalisation were included in the study from a national multicentre HF cohort, and their records were matched with the National Healthcare System database, which includes all health-related claims and clinical events. Adherence to beta blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists were measured using the proportion of days covered (PDC). Low adherence was defined by PDC < 80% for at least one of the three HF drug classes. We then analysed the relationship between the PDC and outcome during a two-year follow-up period. Results: A total of 448 patients (median age: 73 years; 67% male; mean ejection fraction: 40%) were included. Of these patients, 152 (34%) were classified as having low adherence. The two-year mortality rate was comparable between the two groups (16.9% vs. 19.1% in adherent and low-adherent groups, respectively, p = 0.6). However, the rates of all-cause and HF rehospitalisations at two years were lower in the adherent group than in the group with low adherence (85.9% vs. 92.8%, p ≤ 0.01; 48.5% vs. 58.2%, p = 0.04, respectively). Conclusions: In patients discharged after acute HF, low adherence to HF drugs is frequent and worsens outcome, particularly the risk of rehospitalisation. Full article

Background/Objectives: Coronary artery ectasia (CAE) presents challenges, specifically in the context of percutaneous coronary intervention (PCI), and has been associated with adverse events, particularly in the setting of acute myocardial infarction (AMI). The objective of the present study was to assess whether CAE is associated with increased occurrence of major adverse cardiovascular events (MACEs) in patients with AMI. Methods: A systematic review and meta-analysis of observational studies were conducted. We systematically searched MEDLINE via PubMed, Scopus, the Cochrane Library (CENTRAL), ClinicalTrials.gov, and reference lists to identify eligible studies. Baseline characteristics, comorbidities, angiographic data, and rates of MACEs and their individual components (all-cause or cardiovascular mortality, repeat AMI, repeat revascularization, stroke, and heart failure) have been extracted. The results were synthesized as odds ratios (ORs) using random-effects models. Results: Ten studies and 13,908 patients were included. CAE was found to be predictive of higher odds of MACEs [OR: 2.12, 95% CI: 1.34 to 3.36]. No difference was found regarding the odds of all-cause and cardiac death. The presence of ectasia was associated with higher odds of recurrent AMI, compared with controls [OR: 2.76, 95% CI:1.62 to 4.71]. The groups were comparable regarding the need for repeat revascularization, while the reports on stroke and heart failure were scarce. Conclusions: The results highlight the compounding effect of CAE on future MACE events in patients with AMI. Patients with AMI and CAE have higher odds of repeat AMI compared to patients without CAE, while mortality and repeat revascularization rates are similar. This might indicate the need for more aggressive treatment strategies in these patients. Full article

Background: Rheumatic diseases (RDs) are associated with increased cardiovascular morbidity, including a 40% higher risk of atrial fibrillation (AF). While ablation has become the cornerstone of rhythm control, its safety in patients with rheumatic diseases remains poorly defined. Methods: Adults with a primary admission diagnosis of AF catheter ablation from 2016 to 2022 were identified using the National Inpatient Sample. We excluded patients with other forms of supraventricular tachycardia, pacemaker/defibrillator procedures, and atrioventricular junction ablations. Sociodemographic, clinical characteristics, and outcomes were compared between groups. Multivariate logistic regression adjusted for age, race, sex, and potential comorbid confounders was used to assess for independent associations. Results: A weighted total of 48,855 patients were included, 2.5% of which had RD. These patients were predominantly female, older, and had higher rates of renal dysfunction, hypertension, heart failure, history of stroke, ischemic heart disease, heart failure, and obstructive sleep apnea (all p < 0.001). Patients with RD had higher complication rates (12.9% vs. 8.8%, p < 0.001); specifically, bleeding (p < 0.001), infection (p = 0.008), pericardial (p = 0.003), and respiratory complications (p < 0.001). RDs were not found to be an independent predictor of complications, though there was a trend towards more complications (odds ratio 1.43, 95% confidence interval 0.97–2.11, p = 0.070). Conclusions: Patients with RD undergoing AF ablation were older, female, and had higher rates of comorbidities. This translated to higher unadjusted periprocedural complications in patients with rheumatic diseases. While RDs were not independently associated with adverse outcomes, a trend towards increased complications was observed. Full article

Mitochondrial reactive oxygen species (ROS) play a central role in cardiac ischemia/reperfusion injury, heart failure, and arrhythmogenesis, while also serving essential signaling functions under physiological conditions. Among the eleven identified mitochondrial ROS-producing sites, complexes I and III are considered the major contributors, particularly under conditions of impaired electron flow. However, much of the existing knowledge comes from rodent models or cultured cells and is often assumed to apply to humans. Here, ROS production from complexes I and III was measured directly in human myocardial and skeletal muscle biopsies and compared with corresponding rat tissues under identical experimental conditions. Hydrogen peroxide generation was quantified using Amplex UltraRed, with simultaneous monitoring of mitochondrial respiration using a Clark-type oxygen electrode. Across all examined mechanisms—reverse and forward electron transport at complex I and the ubiquinol oxidation site of complex III, rat tissues produced more ROS than human tissues, consistent with their higher respiratory rates. However, the dominant ROS-producing sites differed: in rats, complex III was the primary source, whereas in human tissues the highest ROS production occurred during reverse electron transport at complex I. When normalized to respiration, human tissues showed relatively greater ROS generation at complex I but markedly lower production at complex III. These direct measurements of mitochondrial ROS production in human myocardium provide new insight into cardiac redox physiology and may explain the limited clinical translation of cardioprotective strategies targeting mitochondrial ROS production, such as interventions aimed at modulating reperfusion injury or preconditioning. Full article

Cytomegalovirus (CMV) establishes lifelong latency following primary infection and can reactivate to cause severe illness in immunocompromised hosts. CMV DNAemia in non-HIV-infected, non-solid organ/bone marrow transplant (NHNT) hosts is poorly characterized, with limited clinical insights. We aim to describe the clinical presentation, prognostic indicators, and outcomes of CMV DNAemia among NHNT patients. We used the TriNetX international patient database to identify adult patients diagnosed with CMV DNAemia from 2016 until March 2023. We evaluated hospitalization, intensive care unit (ICU) level care, and all-cause mortality at 30 days and 1 year. We also completed a post-propensity score analysis comparing clinical characteristics of survivors versus non-survivors at 90 days. We identified 1123 NHNT patients with CMV DNAemia, most of whom had neoplasms (63%). Venous thromboembolism occurred in 31% of the population. The 30-day hospitalization and all-cause mortality rates were 35% and 14%, respectively. After propensity score matching and Bonferroni correction, weakness, purpura, acute respiratory failure, malnutrition, encephalopathy, and hypotension were associated with increased 90-day all-cause mortality. NHNT patients with CMV DNAemia carry a substantial morbidity and all-cause mortality. Further studies are warranted to clarify whether CMV DNAemia is a causative factor or an incidental finding in this population. Full article

This study investigates the hydrogen embrittlement susceptibility of laser melting deposition (LMD)-produced Ti-6Al-4V alloy with different build orientations (0°, 45°, 90°) through electrochemical hydrogen charging, slow strain rate testing, and microstructural characterization. Ti-6Al-4V alloys are widely used in marine and offshore engineering, where cathodic protection and corrosion reactions can generate hydrogen, leading to hydrogen ingress and potential embrittlement. Results show that prolonged hydrogen charging induces hydride formation, α-phase fragmentation, and β-phase dissolution, significantly degrading corrosion resistance and mechanical properties. Hydrogen embrittlement susceptibility exhibits notable anisotropy: elongation reductions for 0°, 45°, and 90° specimens are 40.1%, 40.8%, and 29.4%, respectively. The relatively superior resistance observed in the 90° orientation may be associated with its single-layer structure and more uniform dimple distribution. In contrast, the multilayer interfaces in other orientations are likely to serve as preferential sites for hydrogen accumulation, which may contribute to the increased embrittlement susceptibility. This research reveals the failure mechanism of LMD Ti-6Al-4V in hydrogen environments and supports its application in marine engineering. Full article

The Gulong shale oil reservoir is characterized by high clay content and strong heterogeneity, with substantial variations in mineral composition among different intervals. However, existing fracability evaluation methods for such continental shales remain inconsistent and often rely on oversimplified two-dimensional fracture descriptors, lacking a multi-parameter quantitative framework derived from three-dimensional fracture characterization. In this study, the Q1 and Q9 members of the Gulong shale oil were selected, and laboratory-scale hydraulic fracturing simulation experiments were conducted using supercritical carbon dioxide (SC-CO₂), liquid CO₂, and water as the fracturing media. Within a fractal-theory framework based on CT-derived three-dimensional reconstructions, a multi-scale evaluation index system was established by integrating fractal dimension, fracture density, and spatial connectivity. The experimental results demonstrate that fluid properties exert a decisive influence on rock failure behavior. Owing to its ultra-low viscosity and strong diffusivity, SC-CO₂ can significantly reduce formation breakdown pressure while effectively activating natural weak planes to generate a more complex fracture network. For the Q9 shale, the breakdown pressure under SC-CO₂ is reduced by 11.91% and 8.33% relative to water and liquid CO₂, respectively. Moreover, the fracture fractal dimension reaches 2.41 under SC-CO₂, which is markedly higher than the values obtained under liquid CO₂ (2.18) and water (2.12). Mineral composition and densely developed bedding are the key factors inducing fracture branching and deflection, whereas injection rate and an asymmetric stress field regulate the internal energy-release rate and stress path, thereby influencing fracture crossing capability and aperture evolution. Based on the experimental dataset, a fracture complexity index (FCI) evaluation model was developed: under SC-CO₂ fracturing, the FCI values are 8.92 for the Q9 member and 4.43 for the Q1 member, and the model predictions are in good agreement with physical observations. This work elucidates the failure mechanism of the Gulong shale under multi-field coupling and provides a theoretical basis for optimizing hydraulic fracturing and evaluating fracability in unconventional reservoirs through the proposed FCI-based assessment framework. Full article