Search Results (191,061)

Minimal access cardiac surgery (MACS) can mitigate the increasing risk profile of cardiac surgery patients and is associated with improved postoperative outcomes. One of the ways to manage the steep learning curve of MACS is the use of surgical simulation training. We conducted a narrative review to identify the relevant literature discussing MACS simulation training. We identified 20 studies using our search strategy. Various platforms were represented: high-fidelity (n = 8), low-fidelity (n = 6), and animal studies (n = 6). Virtual reality (VR) appeared in two wet-lab studies as an adjunct. The surgical approach was video-assisted thoracoscopic surgery (VATS) in 11 and robotic-assisted thoracoscopic surgery (RATS) in nine. The most simulated procedure was minimal access mitral valve (MV) repair (n = 16). Most studies (n = 16) evaluated the impact of simulation training on the surgical skill of participants with varying baseline MACS experience. A small proportion of included studies (n = 4) carried out only fidelity testing. While some standardised assessment tools were used, there was considerable variation in how surgical skill and fidelity were assessed. There are an increasing number of publications on MACS simulation training, with equal focus on bench and animal models. MV procedures were the most simulated, suggesting a drive towards increasing the scope of minimal access MV training. Full article

Steel moment-resisting frames exhibiting vertical geometric irregularities, particularly those with setback configurations, experience increased seismic demands due to stiffness discontinuities and complex dynamic interactions. These conditions present significant challenges for conventional vibration control strategies. This study introduces a performance-based optimization framework that utilizes the Circle-Inspired Optimization Algorithm (CIOA) to enhance the design of tuned liquid dampers (TLDs) in irregular steel structures. Structural responses are simulated in OpenSees, with a rheological model based on the Housner method employed to accurately capture fluid–structure interaction. Seismic performance is evaluated using a suite of real subduction-type ground motions, selected to represent the seismic hazard level of Armenia, Colombia, in accordance with the Conditional Scenario Spectra (CSS) methodology and the National Seismic Risk Model for Colombia. The optimization process considers the mean response across multiple ground-motion records to ensure robustness against seismic variability. Multiple time-domain objective functions are examined, including peak interstory drift, maximum displacement, and peak acceleration. The results indicate that objective functions related to interstory drift and displacement provide the most effective, stable, and consistent reductions in seismic demand across all scenarios, while acceleration-based objectives display greater sensitivity to record-to-record variability. These outcomes underscore the importance of objective function selection in determining both optimization stability and control effectiveness. The CIOA demonstrates rapid convergence, numerical robustness, and reliable performance, confirming its suitability as a computationally efficient and resilient optimization tool for the design of passive control systems in irregular steel structures exposed to high seismic hazard. Full article

Background and Objectives: Stroke remains a major contributor to global morbidity and mortality, with substantial geographic variation in incidence and outcomes. Although declining trends in stroke incidence and mortality have been documented in several Western European populations, countries in Eastern Europe have historically experienced a disproportionately high cardiovascular disease burden. Comprehensive long-term evaluations assessing simultaneous trends in stroke attack rates, mortality, and case-fatality in Lithuania are limited. This study aimed to investigate 24-year trends (2000–2023) in stroke epidemiology among working-age residents of Kaunas city. Materials and Methods: Data were derived from the Kaunas population-based stroke registry and included individuals aged 25–64 years. Age-standardized attack rates, mortality rates, and case-fatality rates per 100,000 population were calculated using the World Health Organization standard population. Temporal trends were assessed using Joinpoint regression analysis to estimate annual percentage changes (APCs) with corresponding 95% confidence intervals (CIs). Analyses were stratified by sex, age group (25–54 and 55–64 years), and stroke subtype (ischemic and hemorrhagic). Results: During 2000–2023, overall stroke attack rates declined significantly in both sexes, with a more pronounced reduction observed among females. Stroke mortality decreased significantly among females over the entire study period, whereas no significant overall change was observed among males, largely due to increases during 2010–2021 that attenuated earlier and subsequent improvements. Case-fatality rates demonstrated no significant overall long-term trend in either sex but exhibited marked temporal variability, including significant increases during 2010–2021 followed by substantial declines after 2021. Age-stratified analyses confirmed significant reductions in attack rates across both age groups. Ischemic stroke incidence declined significantly in both sexes, while hemorrhagic stroke mortality decreased significantly among males and females. The period 2021–2023 was characterized by pronounced reductions in mortality and case-fatality across multiple subgroups. Conclusions: Over the past two decades, the stroke burden among working-age residents of Kaunas has declined substantially, particularly among females. Despite period-specific deteriorations, recent improvements underscore the impact of advances in stroke prevention and acute care. Sustained risk factor control and continued healthcare system development remain essential to maintain favourable trends. Full article

Background/Objectives: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Identifying reliable biomarkers that reflect the underlying immune pathophysiology of sepsis and support early risk stratification remains a major clinical priority. This prospective study aimed to evaluate the prognostic value of interleukin-6 (IL-6) measured at ICU admission in patients with sepsis and septic shock. Methods: This prospective observational study included adult patients with sepsis and septic shock admitted to the Intensive Care Unit (ICU) of the Clinical Hospital of Infectious Diseases Constanța between 2021 and 2025. Receiver operating characteristic (ROC) curve analysis with DeLong comparisons, Kaplan–Meier survival analysis, and Cox proportional hazards regression modeling were performed to assess the association between baseline IL-6 levels, in-hospital mortality, and time to death. Results: Among the analyzed biomarkers, IL-6 demonstrated the highest discriminatory performance for in-hospital mortality (AUC = 0.956; 95% CI: 0.893–0.987; p < 0.0001). The optimal cut-off value (>135.14 pg/mL) yielded a sensitivity of 87.65% and specificity of 92.86% (Youden index = 0.805). However, despite this excellent discrimination between survivors and non-survivors, baseline IL-6 levels were not significantly associated with time-to-death in Cox proportional hazards regression analysis. Conclusions: Admission IL-6 showed excellent discriminatory performance for mortality risk stratification but was not associated with survival duration in time-to-event analyses. These findings suggest that IL-6 should be interpreted primarily as an early risk stratification biomarker rather than a predictor of survival duration in patients with sepsis. Full article

Rheumatoid arthritis (RA) has traditionally been managed after the onset of clinically apparent synovitis; however, accumulating evidence indicates that disease-related immune abnormalities precede clinical diagnosis by several years. This preclinical phase is characterized by systemic autoimmunity, early musculoskeletal symptoms, and subclinical inflammation in genetically and environmentally susceptible individuals. In this review, we summarize current concepts regarding the pathogenesis, risk stratification, and therapeutic interception of preclinical RA. Particular attention is given to the mucosal origin hypothesis and to the roles of immunosenescence, peripheral helper T cells, and fibroblast-like synoviocytes in early disease evolution. Recent advances in clinical, serological, and imaging-based risk stratification have improved the identification of individuals at high risk of progression to clinical RA, and emerging intervention trials have shown that selected therapies may delay disease onset or reduce early inflammatory burden. Although complete prevention of RA has not yet been achieved, these findings support a paradigm shift from the treatment of established RA toward earlier, risk-adapted intervention before irreversible joint damage occurs. Future efforts should focus on refining predictive biomarkers, optimizing the timing and intensity of intervention, and establishing safe, individualized preventive strategies. Full article

Ceramides are central bioactive sphingolipids that regulate diverse cellular processes, including membrane organization, energy metabolism, and stress signaling. Emerging evidence has implicated that ceramide dysregulation is associated with the onset and progression of heart failure. This review introduces the understanding of ceramide metabolism, focusing on its biosynthesis, and functional roles in cardiomyocytes. In addition, the contribution of systemic ceramides derived from circulating lipoproteins and peripheral tissues to cardiovascular risk is also discussed. In parallel, it is highlighted that cardiomyocyte-intrinsic ceramide synthesis plays physiological and pathological roles in the heart. Particularly, excessive ceramide accumulation is detrimental for cardiac function, through multiple mechanisms, such as lipotoxic effects, mitochondrial impairment, inflammation, and cell death. The current review discusses the potential diagnostic and therapeutic strategies targeting ceramide metabolism, as well as the open questions about ceramide association with heart disease. Full article

Plant-derived sweet proteins are promising low-calorie natural sweeteners that may reduce dietary sugar intake and prevent non-communicable diseases. Although seven have been identified—thaumatin, miraculin, monellin, mabinlin, brazzein, pentadin, and curculin (neoculin)—only thaumatin is currently approved as a food additive. The development of others requires comprehensive safety assessments, particularly regarding allergenicity. This systematic review aims to investigate and synthesize allergenicity assessment methods (in silico, in vitro, in vivo, and clinical) applied to these seven sweet proteins. The literature searches were conducted following PRISMA guidelines across Scopus, PubMed, and Wiley Online Library databases, up to 30 November 2025, with no time restrictions. The risk of bias in selected studies was evaluated using GRADE. After the selection process, 14 out of 2634 studies met the inclusion criteria. Thaumatin, miraculin, monellin, and brazzein emerged as the most extensively studied proteins. In silico approaches (sequence and structural homology) and in vitro assays (digestibility and cell-based methods) were the most commonly employed methods. In contrast, in vivo studies (animal models) and clinical evaluations (skin prick tests, oral food challenges) were rarely reported. Allergenicity studies on pentadin, mabinlin, and curculin (neoculin) are limited, indicating a research gap that requires further study to support regulatory approval and consumer acceptance. Full article

Purpose: To investigate the association between COVID-19 infection and the 1-year risk of acute urinary retention (AUR) and related urological complications in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTs). Materials and Methods: Using the TriNetX global network, patients with BPH and LUTs between January 2020 and January 2024 were identified. Participants were classified into a COVID-19 cohort (N = 32,948) and a non-COVID control cohort (N = 434,123). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory parameters. The primary outcome was AUR within one year. Secondary outcomes included Foley catheterization, urinary tract infection (UTI), gross hematuria, bladder stones, and prostate-related surgery. Results: After matching, 32,918 patients remained in each cohort. The COVID-19 group showed a significantly higher 1-year incidence of AUR compared with controls (2.18% vs. 0.32%; aHR 6.89, 95% CI 5.62–8.45; p < 0.0001). Increased risks were also observed for Foley catheterization (aHR 4.10), UTI (aHR 3.52), and prostate-related surgery (aHR 6.02). Kaplan–Meier analysis demonstrated persistent divergence in AUR-free survival. Conclusion: COVID-19 infection is independently associated with a markedly increased risk of AUR and urological complications in patients with BPH, highlighting the need for closer post-infection monitoring. Full article

Laparoscopic cholecystectomy is now established as the worldwide gold standard for the treatment of benign gallbladder disease. Despite technical advancements, bile duct injury (BDI) remains a major concern, especially in patients with obesity. It is well known that in patients with a Body Mass Index (BMI) ≥ 30 kg/m², identification of Calot’s triangle and the achievement of the Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) are made more challenging due to excessive visceral adiposity and concomitant hepatic steatosis reducing the workspace. Near-Infrared Fluorescence Cholangiography (NIRF-C) with Indocyanine Green (ICG) has emerged as an innovative, safe and effective technique to visualize the biliary anatomy and minimize the risk of iatrogenic BDI. However, its specific benefit in patients with obesity remains under-discussed compared to the general population. The main aim of this narrative review is to evaluate whether the intraoperative use of ICG in patients with obesity may reduce operative times and the risk of BDI. A focused review of the literature is performed on articles from 2010 to 2025 published on PubMed, Scopus and Web of Science. The application of ICG fluorescence in LC for patients with obesity represents a tangible clinical advantage, not only for anatomical identification and significant improvement of procedural efficiency, but also for the reduction in operative time. Full article

Background/Objectives: Managing postoperative drainage and reducing the length of hospital stays continue to represent significant challenges in thoracic surgery. While systemic antifibrinolytics are effective, concerns persist regarding neurotoxicity and thromboembolic risks. In this study, we evaluated the efficacy and safety of a unique, high-volume topical tranexamic acid (t-TXA) lavage protocol designed to optimize pleuroparenchymal contact and stabilize local hyperfibrinolysis. Methods: A retrospective comparative study was conducted involving 52 patients undergoing major lung resection, divided into a t-TXA group (n = 26) and a control group (n = 26). The t-TXA group received an intrathoracic lavage consisting of 5 g of tranexamic acid (TXA) diluted in 500 mL of saline, while the control group received 500 mL of saline alone. The primary outcomes included postoperative day (POD) 1 drainage volumes and length of stay (LOS). The secondary outcomes were focused on hematological parameters and safety profiles, including a structured one-year follow-up for all patients. Due to the study’s exploratory nature, primary outcomes were assessed using 95% confidence intervals for hypothesis generation rather than a priori sample size calculations. Results: No significant differences were observed between groups regarding sex, surgical approach, or resection type. The t-TXA group demonstrated a significantly shorter LOS (4.20 ± 1.23 days) compared to the control group (5.88 ± 2.23 days; p = 0.001). While POD 1 drainage was numerically lower in the t-TXA group (189.23 ± 235.06 mL) versus the control (284.23 ± 169.40 mL), this difference did not reach statistical significance (p = 0.101). However, exploratory correlation analysis revealed a moderate negative association between t-TXA application and POD 1 drainage (r = −0.412; p = 0.002). Postoperative platelet counts were significantly lower in the t-TXA group (p = 0.009). No thromboembolic events, late complications, or deaths occurred in either group during the one-year follow-up period. Conclusions: High-volume t-TXA lavage is a promising adjuvant associated with significantly shorter hospital stays and a trend toward reduced postoperative drainage. While our 12-month follow-up confirmed a favorable safety profile with no adverse events, these findings should be interpreted as preliminary and hypothesis-generating. The retrospective nature of this study precludes definitive recommendations, underscoring the need for well-powered prospective randomized trials to establish the long-term safety and clinical utility of t-TXA in thoracic surgery. Full article

Background: Cemented and cementless fixation techniques in total hip arthroplasty (THA) each present distinct biomechanical properties and perioperative risk profiles. While cementless fixation has gained increasing popularity, large-scale nationally representative comparisons of perioperative outcomes between cemented and cementless elective THA remain limited. This study aimed to compare complication rates, healthcare utilization, and temporal trends between cemented and cementless elective THA using the National Inpatient Sample. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2016 to 2021. Adult patients undergoing elective primary total hip arthroplasty were identified using ICD-10-PCS codes and categorized into cemented and cementless fixation groups. Patient demographics, comorbidities, indications, postoperative complications, length of stay, hospital charges, and in-hospital mortality were compared. Multivariate logistic regression analysis was performed to evaluate the independent association between fixation type and postoperative complications while adjusting for demographic, clinical, and hospital-level variables. Results: A total of 81,668 elective THAs were identified, including 40,290 cemented (49.33%) and 41,378 cementless (50.67%) procedures. Cemented THA was associated with a shorter length of stay (2.09 ± 1.88 vs. 2.26 ± 2.47 days, p < 0.001) and lower total hospital charges ($65,584.53 ± 48,797.21 vs. $72,186.84 ± 49,860.20, p < 0.001). Unadjusted analyses demonstrated higher rates of acute kidney injury and sepsis in the cementless group. After multivariate adjustment, cemented fixation was associated with lower odds of acute kidney injury (OR 0.87, 95% CI 0.79–0.96, p = 0.004). However, cemented THA was associated with higher odds of postoperative delirium (OR 1.20, 95% CI 1.02–1.42, p = 0.030), blood transfusion (OR 1.27, 95% CI 1.17–1.37, p < 0.001), and periprosthetic fracture (OR 1.32, 95% CI 1.02–1.71, p = 0.035). Rates of myocardial infarction, pneumonia, venous thromboembolism, urinary tract infection, and in-hospital mortality were similar between groups. Temporal analysis demonstrated comparable utilization trends, with a decline in elective procedures during 2020–2021. Conclusions: In this nationwide analysis, cemented total hip arthroplasty was associated with lower risk of acute kidney injury, shorter length of stay, and lower hospital charges, but higher odds of postoperative delirium, blood transfusion, and periprosthetic fracture compared with cementless fixation. These findings highlight distinct perioperative risk profiles between fixation strategies and may assist surgeons in individualized decision-making for elective total hip arthroplasty. Full article

Background: Stroke–heart syndrome (SHS), particularly acute myocardial injury, is a critical complication following acute ischemic stroke (AIS). The C-reactive protein–triglyceride–glucose index (CTI) integrates inflammatory and metabolic parameters but remains unexplored in the context of post-stroke cardiac complications. This study investigated whether CTI predicts cardiac injury patterns and 90-day clinical outcomes in AIS patients. Methods: A two-center retrospective cohort study was conducted in AIS patients undergoing endovascular treatment (EVT). Cardiac troponin I (cTnI) trajectories were classified into: no injury, non-dynamic elevation, and dynamic elevation. The primary endpoint was poor functional status at 90 days (modified Rankin Scale [mRS] 3–6); the secondary endpoint was 90-day all-cause death. Results: Among 493 individuals (median age 69 years, 42% female), higher baseline CTI was associated with a greater likelihood of dynamic troponin elevation (adjusted odds ratio [aOR] per 1-unit increase = 1.56 (1.26–1.94); p < 0.001). Patients with dynamic elevation had significantly worse outcomes compared to those with no injury. Elevated CTI was an independent predictor of 90-day poor functional outcome (Q4: aOR = 3.04 (1.53–6.05); p < 0.001) and mortality (Q4: aOR = 2.82 (1.33–6.00); p = 0.007). Conclusions: In EVT-treated AIS patients, the CTI is a predictor of SHS and adverse 90-day outcomes. This easily calculable index may help identify individuals at higher risk of cardiac complications after AIS. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a multisystemic disease with overlapping metabolic, renal, and cardiovascular effects. Within the Diabetic@ project, which aims to characterize individuals with T2DM using real-world data extracted from electronic health records (EHRs), this substudy sought to develop a predictive model for two-year heart failure (HF) risk. Methods: Multicenter, retrospective study including T2DM individuals across eight Spanish hospitals (2013–2018). Data were extracted exclusively from EHRs’ unstructured free text using clinical natural language processing (cNLP) and mapped to SNOMED CT. At inclusion, individuals were categorized as having or not prevalent HF (pHF). Predictive modeling was performed in non-pHF to assess two-year risk of developing HF, termed incident HF (iHF). Logistic regression (LR), decision trees, random forest, and XGBoost were compared, selecting for accuracy and interpretability. Results: Of 588,756 individuals with T2DM, 84,197 (14.3%) had pHF. Among non-pHF, 353,371 (60%) were used for model development (90.7% training, 9.3% validation). iHF occurred in 13.6% of the training set and 11.4% of the validation set. Ischemic heart disease was present in 16.2% overall, 37.9% in pHF, and 12.6% in non-pHF. Glycosylated hemoglobin data was rarely reported (<15%). LR achieved the best performance (AUC-ROC 0.73) using 27 predictors. Reduced 12- and clinically refined 9-predictor models performed similarly, with the latter implemented in a web-based tool. Conclusions: Unstructured data from EHRs enabled development of a two-year HF risk model for individuals with T2DM, underscoring the potential of cNLP for risk stratification across the cardiovascular–renal–metabolic spectrum. Full article

Emery–Dreifuss muscular dystrophy (EDMD) is a rare inherited neuromuscular disorder within the spectrum of nuclear envelope diseases, classically characterized by early musculo-tendinous contractures, slowly progressive myopathy, and cardiac involvement dominated by conduction disease and arrhythmias, with variable evolution toward cardiomyopathy and heart failure. This narrative review provides a comprehensive and clinically actionable synthesis of cardiovascular manifestations across EDMD genotypes and phenotypes, outlining pragmatic diagnostic and therapeutic pathways for real-world care. A targeted literature search was performed in PubMed, Embase, and Web of Science, focusing on studies addressing cardiovascular involvement in EDMD. Relevant original studies, case series, registries, guideline documents, and high-quality reviews were selected and synthesized narratively, with particular emphasis on diagnostic strategies, risk stratification, and management approaches. Cardiac involvement in EDMD encompasses a broad and heterogeneous spectrum, including atrial disease and conduction disturbances, ventricular arrhythmias, dilated cardiomyopathy, thromboembolic complications, and sudden cardiac death. Phenotypic expression varies according to the underlying genetic substrate, with distinct atrial- and ventricular-dominant trajectories. Early recognition and structured cardiovascular surveillance are essential to guide timely intervention, including anticoagulation, device therapy, and heart failure management. Despite growing awareness, significant gaps remain in risk prediction and standardized management strategies. EDMD represents a paradigmatic model of cardiomyopathy characterized by prominent electrical instability and systemic involvement. A structured, genotype- and phenotype-informed approach centered on early surveillance, proactive arrhythmia and thromboembolic risk management and timely device therapy may improve clinical decision-making in real-world settings. Future perspectives include the integration of precision medicine and the development of gene- and pathway-targeted therapies, with the potential to shift from symptomatic management toward disease-modifying strategies. Full article

This case-control study investigated the association between polymorphisms in the dedicator of cytokinesis 2 (DOCK2) gene and susceptibility to COVID-19 in a Mexican population. Methods: Genotyping of five single-nucleotide polymorphisms (SNPs) in the DOCK2 gene (rs9307 A/G, rs1045176 G/T, rs1045168 C/T, rs2112703 A/C, and rs2287727 A/C) was performed using TaqMan assays in 248 COVID-19 patients and 288 healthy controls. Results: No significant differences were observed in the allelic or genotypic distributions of rs1045176 G/T and rs2287727 A/C between cases and controls. However, under multiple genetic inheritance models (co-dominant, dominant, recessive, heterozygous, and additive), the rs9307 A, rs1045168 C, and rs2112703 A alleles were significantly associated with a reduced risk of COVID-19 (p < 0.05). Furthermore, sub-analyses stratified by genotype in COVID-19 patients revealed that the rs9307 AA, rs1045168 CC, and rs2112703 AA genotypes correlated with altered plasma concentrations of lactic acid dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and ferritin. Conclusions: The DOCK2 SNPs rs9307 A/G, rs1045168 C/T, and rs2112703 A/C are associated with decreased susceptibility to COVID-19 in this population and influence plasma levels of LDH, ALT, AST, and ferritin, suggesting a potential role in disease pathogenesis and severity. Full article