Search Results (655)

Background/Objectives: Patients with non-valvular heart failure frequently develop valvular disease. However, the prevalence of valvular disease across patients with different heart failure etiologies remains underexplored. This study aimed to investigate the burden of VHD among patients with non-valvular heart failure, and secondly evaluate its association with cardiopulmonary test. Methods: We analyzed data from patients with non-valvular heart failure (HF) who were evaluated as outpatients at the HF clinic between February 2020 and November 2024. Patients were categorized into three groups: coronary artery disease-related HF (CAD-HF), dilated cardiomyopathy (DCM), and other causes (e.g., hypertension, diabetes, and various cardiomyopathies). Demographic and clinical characteristics, as well as echocardiographic and cardiopulmonary exercise testing (CPET) results, were evaluated. Results: Among all groups mild mitral regurgitation (MR) was the most common valvular disease, followed by mild tricuspid regurgitation (TR). Patients with CAD-HF frequently had mild aortic regurgitation (AR) compared to DCM (23.6% vs. 14.9%, p = 0.05). In the CPET subgroup, which included 41 patients who consented to participate, in patients with moderate-to-severe VHD had significantly lower VO₂/HR (oxygen pulse), VO₂max, and OUES, indicating worsened functional capacity despite similar left ventricular ejection fraction. Hypertension and atrial fibrillation were independently associated with greater valvular disease severity on multivariable analysis. Conclusions: No significant differences in valvular disease between patients with DCM and CAD-HF were documented, apart from a higher prevalence of mild AR in the CAD-HF group. Patients with moderate-to-severe valvular regurgitation demonstrated worse cardiopulmonary performance, regardless of ejection fraction, highlighting the important role of CPET in evaluating the functional impact of valvular heart disease in this population. Full article

Background/Objectives: Biological aging phenotypes in coronary artery disease (CAD) include coronary atherosclerosis, vascular aging, and endothelial dysfunction. The aim of the present study was to investigate the potential links between aging phenotypes, regulatory immune cells, and features of the thymus in patients with CAD. Methods: A single-center, cross-sectional, comparative study was conducted. Patients were stratified according to the severity of coronary atherosclerosis: patients with a Gensini score ≥ 65 points and patients with a Gensini score < 65 points. Peripheral blood and thymus biopsy were obtained. Imaging flow cytometry, ELISA, and immunohistochemical analysis were used for analysis. Results: Thymic morphology ranged from total fatty involution to a preserved structure of the thymus (20–80% area in 31% of obtained samples) but was not associated with the severity of atherosclerosis. Meanwhile, patients with a Gensini score ≥ 65 had impaired thymus cellular composition compared to patients with a Gensini score < 65 points; increased frequency of CD8+ T lymphocytes and NK cells; and decreased frequency of CD4 + CD8+ T lymphocytes. In peripheral blood, the main determinants of a Gensini score ≥ 65 points were low absolute counts of eMDSCs and CD25^low Tregs with FoxP3 nuclear translocation, while advanced vascular aging was associated with elevated eMDSC absolute counts. Advanced coronary atherosclerosis was also associated with decreased numbers of endothelial progenitor cells in circulation. Conclusions: Thymus dysfunction accompanies CAD progression and is manifested in changes in cellular composition rather than morphology. In CAD patients, MDSC and Treg lymphocytes are equally involved in the progression of coronary atherosclerosis, which is aggravated by the decreased regulatory potential of the endothelium. Vascular aging represents a distinct phenotype of biological aging in CAD patients, characterized by the expansion of eMDSCs. Full article

Background and Objectives: Stroke is widely recognised for its physical consequences. However, cognitive and emotional impairments, such as depression, anxiety, and vascular cognitive impairment (VCI), are often under-recognised and under-treated. Our study aimed to identify and characterise cognitive and emotional sequelae in patients hospitalised for acute ischemic stroke. Materials and Methods: We conducted a cross-sectional study involving 73 patients within seven days of an acute ischemic stroke. Patients were assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Hachinski Ischemic Score (HIS), and the Clinical Assessment of Depression (CAD) questionnaire, which includes four subscales (Depressed Mood (DM), Anxiety/Worry, Disinterest, and Physical Fatigue). K-means clustering was applied to ten standardised clinical and psychometric variables. In addition, multiple linear regression was performed to determine independent predictors of cognitive and affective outcomes, with MoCA and CAD-DM as dependent variables. Results: Three distinct patient profiles emerged: (1) Mild Impairment Profile, characterised by minimal cognitive or emotional symptoms; (2) Depressive Profile, marked by elevated emotional symptom scores despite mild physical impairment; and (3) Vascular Cognitive Impairment Profile, comprising older patients with the most severe cognitive and functional deficits. ANOVA confirmed significant differences between groups in NIHSS, mRS, MoCA, HIS, and CAD scores, but not for age or education. Linear regression revealed that older age (β = –0.10, p = 0.012) and higher NIHSS at discharge (β = –0.72, p = 0.020) predicted lower MoCA scores, whereas years of education (β = 0.58, p = 0.013) predicted better cognition (R² = 0.29). No demographic or clinical factors predicted depressive symptoms (all p > 0.29). Conclusions: Our study highlights the heterogeneity of post-stroke outcomes. Neuropsychiatric impairments may be present even in patients with minimal physical deficits and require targeted evaluation and management. Full article

Background and Objectives: Coronary atherosclerosis remains a leading cause of global morbidity and mortality. Chronic systemic inflammation has emerged as a key factor in atherosclerosis development. Tooth loss—often the final consequence of periodontitis—has been proposed as a potential clinical marker of systemic inflammation and cardiovascular risk. Objective: This narrative review synthesizes the available literature on the relationship between tooth loss and coronary artery disease (CAD) severity, exploring biological mechanisms, key epidemiological findings, and clinical implications. Materials and Methods: We reviewed observational studies, meta-analyses, and clinical reports assessing whether tooth loss is predictive of CAD severity and adverse outcomes. Results: A consistent association is reported between tooth loss and increased coronary involvement. Proposed mechanisms include periodontal inflammation, dysbiosis, systemic inflammatory responses, and translocation of oral bacteria. However, confounders such as smoking, diabetes, and socioeconomic status complicate causality. Conclusions: Tooth loss may serve as a simple, non-invasive clinical indicator of systemic inflammation and CAD severity. Incorporating oral health evaluation into cardiovascular risk assessment could enhance early detection and prevention strategies. Further longitudinal and interventional studies are required to establish causality and inform clinical guidelines. Full article

Background and Objectives: Factor VIII (FVIII) and the von Willebrand factor (vWF) are key components of hemostatic balance. Disruption of the vWF-ADAMTS13 axis, characterized by elevated vWF and reduced ADAMTS13 activity has been implicated in thrombotic disorders, including COVID-19-asscoiated coagulopathy, where this imbalance correlates with disease severity and mortality. This study evaluated the relationship between plasma FVIII and vWF levels and the severity of coronary artery disease (CAD), as assessed by the SYNTAX score. Methods: We enrolled 82 patients with chronic coronary syndrome (CCS) and a positive treadmill test who underwent elective coronary angiography. Based on the SYNTAX score, patients were divided into three groups: Group I (≤22), Group II (23–32), and Group III (≥33). Results: FVIII levels varied significantly (Group I: 2.25 ± 0.75; Group III: 2.97 ± 0.95; p = 0.007), with an OR of 3.632 (95% CI: 1.116–11.826; p = 0.03). vWF levels differed significantly across SYNTAX groups (Group I: 1.16 ± 0.59; Group II: 1.52 ± 0.62; Group III: 1.49 ± 0.80; p = 0.040). vWF > 1.75 was more frequent in Groups II and III, with an odds ratio (OR) of 4.909 (95% CI: 1.429–16.864; p = 0.01) for Group III vs. Group I. Fibrinogen and C-reactive protein (CRP) were elevated in patients with SYNTAX scores ≥33. In multinomial logistic regression analysis, FVIII emerged as the sole independent predictor of CAD complexity (p = 0.004), while the vWF showed significance in pairwise comparison (Group II vs. Group I; OR = 3.433, p = 0.049). Conclusions: This study demonstrated significant differences in hemostatic and inflammatory biomarkers across SYNTAX score categories reflecting CAD severity in CCS patients. FVIII emerged as an independent predictor of CAD complexity, while the vWF demonstrated significant associations in specific subgroup comparisons. The observed vWF-ADAMTS13 axis dysregulation supports the rationale for investigating vWF-targeted therapeutics, including agents such as caplacizumab, in cardiovascular disease management. These findings require validation in larger studies. Full article

The introduction of new materials for fixed dental prostheses (FDPs) necessitates the demonstration of excellent physical and mechanical properties alongside biocompatibility to fulfill their intended function. This systematic literature review sought to assess studies that compare the biocompatibility and toxicity of CAD/CAM milling dental materials. PubMed, Scopus, and Web of Science were screened to locate English-language, full-text articles published between 1 January 2014, and 31 October 2024. Initially, 1050 records were identified, and after a thorough screening, 78 full texts were evaluated, resulting in the inclusion of 33 studies. The reports were heterogeneous regarding materials, cell lines, and methodologies; thus, comparisons were made within studies rather than between them. The majority of the reviewed studies indicated that CAD/CAM milled materials generally exhibited lower toxicity than conventionally fabricated materials. Additionally, several novel experimental CAD/CAM materials demonstrated promising biocompatibility results. Full article

Urban green spaces play a crucial role in mitigating the biodiversity loss caused by dense development and land-use transformation. This study explores the ecological and spatial potential of Fort Augustówka, a neglected military fortification in Warsaw, Poland, as a multifunctional green space that enhances local biodiversity. Through field surveys, vegetation assessments, SWOT analysis, and user profiling, we identified key ecological features and constraints of the site, located within a Vistula River riparian zone. This study employed phytosociological analysis (Braun–Blanquet method), spatial mapping (using AutoCAD and SketchUp), and stakeholder observations to assess the value of semi-natural habitats including ruderal vegetation, meadows, and aquatic zones, as well as urban tree stands and conventionally managed greenery. Our results show that semi-natural habitats, including meadows and reed beds, achieved higher ecological value scores than conventionally managed greenery, while invasive species significantly reduced biodiversity in several zones. Based on these findings, we propose a spatial revitalisation model grounded in native species restoration, ecological connectivity, and low-impact recreational design. This study highlights an innovative approach that integrates existing vegetation, historical structures, and human well-being, creating a design concept beneficial for residents and visitors alike. This work also demonstrates how post-military landscapes can support biodiversity in metropolitan areas and offers a transferable model for ecological urban design rooted in place-based analysis. The findings contribute to broader discussions on nature-based solutions and urban rewilding in post-socialist urban contexts. Full article

Chest X-ray (CXR) imaging is essential for diagnosing thoracic diseases, and computer-aided diagnosis (CAD) systems have made substantial progress in automating the interpretation of CXR images. However, some existing methods often overemphasize local features while neglecting global context, limiting their ability to capture the broader pathological landscape. Moreover, most methods fail to model label correlations, leading to insufficient utilization of prior knowledge. To address these limitations, we propose a novel multi-label CXR image classification framework, termed the Label Masking-enhanced Residual Attention Network (LMeRAN). Specifically, LMeRAN introduces an original label-specific residual attention to capture disease-relevant information effectively. By integrating multi-head self-attention with average pooling, the model dynamically assigns higher weights to critical lesion areas while retaining global contextual features. In addition, LMeRAN employs a label mask training strategy, enabling the model to learn complex label dependencies from partially available label information. Experiments conducted on the large-scale public dataset ChestX-ray14 demonstrate that LMeRAN achieves the highest mean AUC value of 0.825, resulting in an increase of 3.1% to 8.0% over several advanced baselines. To enhance interpretability, we also visualize the lesion regions relied upon by the model for classification, providing clearer insights into the model’s decision-making process. Full article

Three-dimensional (3D) modeling and printing technologies are increasingly used in pediatric surgery, offering improved anatomical visualization, surgical planning, and personalized approaches to complex conditions. Compared to standard imaging, patient-specific 3D models—virtual or printed—provide a more intuitive spatial understanding of congenital anomalies, tumors, and vascular anomalies. This review compiles evidence from pediatric surgical fields including oncology, abdominal, and thoracic surgery, highlighting the clinical relevance of 3D applications. The technological workflow—from image segmentation to computer-aided design (CAD) modeling and multimaterial printing—is described, emphasizing accuracy, reproducibility, and integration into hospital systems. Several clinical cases are presented: neuroblastoma, cloacal malformation, conjoined twins, and two cases of congenital diaphragmatic hernia (one with congenital pulmonary airway malformation, CPAM). In each, 3D modeling enhanced anatomical clarity, increased surgeon confidence, and supported safer intraoperative decision-making. Models also improved communication with families and enabled effective multidisciplinary planning. Despite these advantages, challenges remain, such as production time, cost variability, and lack of standardization. Future directions include artificial intelligence-based automation, expanded use of virtual and mixed reality, and prospective validation studies in pediatric cohorts. Overall, 3D modeling represents a significant advance in pediatric precision surgery, with growing evidence supporting its safety, clinical utility, and educational value. Full article

Advancements in Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) have promoted the development of novel dental materials for several types of definitive restorations. The aim of this study was to evaluate the surface characteristics of resin-based CAD/CAM restorative materials, fabricated using both subtractive and additive manufacturing techniques. The materials tested included Filtek Z550 (FZ), Vita Enamic (VE), Shofu HC (SH), and VarseoSmile TriniQ (TQ). For each material, 24 specimens were prepared; half were manually polished following the manufacturer’s recommendations, while the other half underwent standardized metallographic polishing. The surface roughness, wettability, and molecular composition were assessed. A statistical analysis was performed using IBM SPSS 29.0 at a 95% confidence level (α = 0.05). Statistically significant differences in surface properties were observed between direct and indirect restoratives following manual polishing, with SH performing favorably in terms of surface roughness. The polishing method significantly influenced the surface characteristics of each material, except for certain roughness parameters in SH. Both surface roughness and wettability were dependent on the material and the polishing technique, highlighting the need for improved material-specific polishing protocols. Full article

Diabetic Retinopathy (DR) is a leading cause of vision impairment globally, underscoring the need for accurate and early diagnosis to prevent disease progression. Although fundus imaging serves as a cornerstone of Computer-Aided Diagnosis (CAD) systems, several challenges persist, including lesion scale variability, blurry morphological patterns, inter-class imbalance, limited labeled datasets, and computational inefficiencies. To address these issues, this study proposes an end-to-end diagnostic framework that integrates an enhanced preprocessing pipeline with a novel deep learning architecture, Hierarchical-Inception-Residual-Dense Network (HIRD-Net). The preprocessing stage combines Contrast Limited Adaptive Histogram Equalization (CLAHE) with Dilated Difference of Gaussian (D-DoG) filtering to improve image contrast and highlight fine-grained retinal structures. HIRD-Net features a hierarchical feature fusion stem alongside multiscale, multilevel inception-residual-dense blocks for robust representation learning. The Squeeze-and-Excitation Channel Attention (SECA) is introduced before each Global Average Pooling (GAP) layer to refine the Feature Maps (FMs). It further incorporates four GAP layers for multi-scale semantic aggregation, employs the Hard-Swish activation to enhance gradient flow, and utilizes the Focal Loss function to mitigate class imbalance issues. Experimental results on the IDRiD-APTOS2019, DDR, and EyePACS datasets demonstrate that the proposed framework achieves 93.46%, 82.45% and 79.94% overall classification accuracy using only 4.8 million parameters, highlighting its strong generalization capability and computational efficiency. Furthermore, to ensure transparent predictions, an Explainable AI (XAI) approach known as Gradient-weighted Class Activation Mapping (Grad-CAM) is employed to visualize HIRD-Net’s decision-making process. Full article

Background: Aortic stenosis (AS) is a prevalent acquired heart valve disease with increasing incidence, particularly among older adults. Gender-specific differences in AS presentation, comorbidities, and outcomes remain underexplored, necessitating further investigation to optimize personalized treatment strategies. Objective: To evaluate the clinical and demographic characteristics, comorbidities, and survival outcomes of patients with AS, stratified by gender and aortic valve morphology. Methods: A retrospective analysis of 145,454 echocardiographic examinations (2009–2018) at the Federal State Budgetary Institution “V.A. Almazov National Medical Research Centre” identified 84,851 patients meeting the inclusion criteria (Vmax ≥ 2.0 m/s, age ≥ 18 years). Patients were stratified by gender and valve morphology (bicuspid aortic valve [BAV] vs. tricuspid aortic valve [TAV]). Survival was assessed in 475 pts with AS over a 16-year period (2009–2025) using Kaplan–Meier analysis. Statistical comparisons utilized STATISTICA v. 10.0, with p-values derived from P-tests. Results: Of the cohort, 4998 men and 6322 women had AS. Men with AS were older (median 64 vs. 57 years, p < 0.0001) and had higher systolic blood pressure (140 vs. 130 mmHg, p < 0.0001) than men without AS. Women with AS were also older (median 70 vs. 58 years, p < 0.0001) with higher systolic (140 vs. 130 mmHg, p < 0.0001) and diastolic blood pressure (80 vs. 80 mmHg, p < 0.0001). Men with AS had higher rates of hyperlipidemia (HLP) (26.3% vs. 10.3%, p < 0.0001), while women with AS had increased coronary artery disease (CAD) (35.7% vs. 26.4%, p < 0.0001), diabetes mellitus (DM) (13.4% vs. 10.2%, p < 0.0001), and obesity (10.9% vs. 10.2%, p = 0.06). Chronic heart failure (CHF) was more frequently reported in patients with AS, regardless of gender, compared to patients without AS (in men 53.4% vs. 41.8%, p < 0.0001; in women 54.5% vs. 37.5%, p < 0.0001). BAV was associated with higher AS prevalence (54.5% in men, 66.4% in women). Survival analysis revealed higher mortality. Over the 16-year follow-up period, the mortality rate was 21.7%. Conclusions: Mortality in a representative AS cohort reached 21.7%, underscoring the progressive nature of the disease and its long-term impact. Survival was negatively affected by age over 68.5 years, as well as the presence of aortic regurgitation (AR), increased peak aortic jet velocity, and enlarged maximum aortic diameter. Aortic valve replacement demonstrates an insignificant effect on patient survival rates. Beta-blocker therapy in patients with varying degrees of aortic AS severity has not only demonstrated its safety but has also shown a positive effect on reducing mortality (improving survival). In contrast, the combination of angiotensin II receptor blockers (ARBs) with calcium channel blockers (CCBs) is quite dangerous for patients with AS and reduces their survival. Aortic valve replacement demonstrates an insignificant effect on patient survival rates. In contrast, the absence of fibrinolytic therapy and anticoagulant treatment is associated with an improved prognosis. Conversely, the administration of antiarrhythmic agents and statins is correlated with enhanced survival outcomes, potentially attributable to their influence on coexisting comorbidities. Further research is required to delineate their precise mechanisms and contributions. These results emphasize the importance of early identification, comprehensive risk assessment, and individualized management strategies in improving outcomes for patients with AS. Full article

Orthognathic surgery, particularly maxillomandibular advancement (MMA), has emerged as an effective therapeutic option for patients with moderate to severe OSA who are refractory to conventional treatments. The wedge osteotomy of the maxilla, often performed in combination with mandibular surgery, can be a surgical treatment for obstructive sleep apnea (OSA). This case series report describes 6 OSA patients without anteroposterior maxillary deficiency who were treated with wedge osteotomy of the maxilla. Material and Methods: We conducted a retrospective analysis of 6 patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2018 and 2024 at the Maxillofacial Surgery of San Camillo-Forlanini Hospital, in Rome, Italy. Patients were evaluated using a CAD/CAM-assisted approach. A pre- and postoperative comparative analysis was conducted to assess the effectiveness of the surgical treatment in improving OSA-related parameters. Maxillary wedge osteotomy and bilateral sagittal split osteotomies (BSSO) of the mandibular ramus were digitally planned. Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions generated using dedicated software, revealed a counterclockwise rotation of the occlusal plane, resulting in a mandibular advancement of approximately 13 mm. The CT shows a significant increase in airway volume following the skeletal repositioning. The airway volume increased from 20.665 ± 546 mm³ to 27.177 ± 446 mm³. Conclusions: Counterclockwise rotational orthognathic surgery without maxillary advancement has been shown to effectively enlarge the posterior pharyngeal space while also delivering excellent esthetic outcomes. Full article

Background/Objectives: Coronary CT angiography (CCTA) is a cornerstone in evaluating stable coronary artery disease (CAD), but conventional energy-integrating detector CT (EID-CT) has limitations, including calcium blooming and limited spatial resolution. Photon-counting detector CT (PCD-CT) may overcome these drawbacks through enhanced spatial resolution and improved tissue characterization. Methods: In this retrospective, propensity score–matched study, we compared CCTA findings from 820 patients (410 per group) who underwent either EID-CT or PCD-CT for suspected stable CAD. Primary outcomes included stenosis severity, high-risk plaque features, and downstream invasive coronary angiography (ICA) referral and yield. Results: The matched cohorts were balanced in demographics and cardiovascular risk factors (mean age 67 years, 63% male). PCD-CT showed a favorable shift in stenosis severity distribution (p = 0.03). High-risk plaques were detected less frequently with PCD-CT (22.7% vs. 30.5%, p = 0.01). Median coronary calcium scores did not differ (p = 0.60). Among patients referred for ICA, those initially evaluated with PCD-CT were more likely to undergo revascularization (62.5% vs. 44.1%), and fewer underwent potentially unnecessary ICA without revascularization (3.7% vs. 8.0%, p = 0.001). The specificity in diagnosing significant stenosis requiring revascularization was 0.74 with EID-CT and 0.81 with PCD-CT (p = 0.04). Conclusions: PCD-CT improved diagnostic specificity for CAD, reducing unnecessary ICA referrals while maintaining detection of clinically significant disease. This advanced CT technology holds promise for more accurate, efficient, and patient-centered CAD evaluation. Full article

The design of fixtures is a complex and instinctive process. A proficient fixture design system customized for particular applications reduces manufacturing costs and lead times. Various computer-aided systems are available to assist in the many manufacturing stages in today’s industry. A fixture design system should facilitate the seamless movement of information among several domains to enhance product design and production processes. The fixture design system should be easily transferable and compatible with many operating platforms. This study discusses creating an Internet-enabled interactive fixture design system that enables seamless communication among different disciplines in product development. Utilizing the Internet and Virtual Reality Modelling Language (VRML) allows for the exchange of information and expertise among computer-aided manufacturing systems. The CAD model of fixturing pieces is first turned into VRML coding. The VRML code for the model can be modified to vary the size and dimensions of the CAD model, facilitating alterations such as scaling fixture components, repositioning mounting points, and resizing clamping parts to align with specific design needs. The VRML model of the fixturing system was created with Java and built on an FTTP server architecture. It guarantees that the system performs consistently across different platforms. This work has also established a mechanism for comprehensive fixture design independent of a locating scheme. Establishing a library for storing previous fixture designs can prevent the need to recreate the current model. Full article