Search Results (179)

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

Background: Diabetes mellitus is associated with worse outcomes after cardiac arrest. Hyperglycemia, diabetes treatments and other long-term sequalae may contribute to this association. We sought to determine the acute effect of diabetes on the return of spontaneous circulation (ROSC) and post-arrest cardiac function in a rat cardiac arrest model. Methods: Eighteen male Wistar rats were utilized, and 12 underwent the induction of type II diabetes for 10 weeks through a high-fat diet and the injection of streptozotocin. The carotid artery flow and femoral arterial pressure were measured. Seven minutes of asphyxial cardiac arrest was induced. An external cardiac compression was performed via an automated piston. Post-ROSC, epinephrine was titrated to a mean arterial pressure (MAP) of 70 mmHg. Data was analyzed using the Mann–Whitney test. The significance was set at p ≤ 0.05. Results: The rate of the ROSC was significantly lower in animals with diabetes, 50% compared to 100% in non-diabetics. Additionally, it took significantly longer to achieve the ROSC in diabetics, p = 0.034. In animals who survived, the cardiac function was reduced, as indicated by an increased epinephrine requirement, p = 0.041, and a decreased cardiac output at the end of the experiment, p = 0.017. The lactate, venous and arterial pressures, heart rate and carotid flow did not differ between groups at 2 h. Conclusions: Diabetes negatively affects the survival from cardiac arrest. Here, the critical difference was the rate of the conversion to a life-sustaining rhythm and the achievement of the ROSC. The post-ROSC cardiac function was depressed in diabetic animals. Interventions targeted at improving defibrillation success may be important in diabetics. Full article

Cardiogenic shock (CS) in the setting of severe aortic stenosis (AS) presents a critical and high-risk scenario with limited therapeutic options and poor prognosis. Transcatheter aortic valve implantation (TAVI), initially reserved for inoperable or high-risk surgical candidates, is increasingly being considered in patients with CS due to improvements in device technology, operator experience, and supportive care. This review synthesizes current evidence from large registries, observational studies, and meta-analyses that support the feasibility, safety, and potential survival benefit of urgent or emergent TAVI in selected CS patients. Procedural success is high, and early intervention appears to confer improved short-term and mid-term outcomes compared to balloon aortic valvuloplasty or medical therapy alone. Critical factors influencing prognosis include lactate levels, left ventricular ejection fraction, renal function, and timing of intervention. The absence of formal guidelines, logistical constraints, and ethical concerns complicate decision-making in this unstable population. A multidisciplinary Heart Team/Shock Team approach is essential to identify appropriate candidates, manage procedural risk, and guide post-intervention care. Further studies and the development of TAVI-specific risk models in CS are anticipated to refine patient selection and therapeutic strategies. TAVI may represent a transformative option for stabilizing hemodynamics and improving outcomes in this otherwise high-mortality group. Full article

The determination of the live body weight of camels (required for their successful breeding) is a rather difficult task due to the problems with handling and restraining these animals. Therefore, the main aim of this study was to predict the ABW of eight indigenous camel (Camelus dromedarius) breeds of Pakistan (Bravhi, Kachi, Kharani, Kohi, Lassi, Makrani, Pishin, and Rodbari). Selected productive (hair production, milk yield per lactation, and lactation length) and reproductive (age of puberty, age at first breeding, gestation period, dry period, and calving interval) traits served as the predictors. Six data mining methods [classification and regression trees (CARTs), chi-square automatic interaction detector (CHAID), exhaustive CHAID (EXCHAID), multivariate adaptive regression splines (MARSs), MLP, and RBF] were applied for ABW prediction. Additionally, hierarchical cluster analysis with Euclidean distance was performed for the phenotypic characterization of the camel breeds. The highest Pearson correlation coefficient between the observed and predicted values (0.84, p < 0.05) was obtained for MLP, which was also characterized by the lowest root-mean-square error (RMSE) (20.86 kg), standard deviation ratio (SD_ratio) (0.54), mean absolute percentage error (MAPE) (2.44%), and mean absolute deviation (MAD) (16.45 kg). The most influential predictor for all the models was the camel breed. The applied methods allowed for the moderately accurate prediction of ABW (average R² equal to 65.0%) and the identification of the most important productive and reproductive traits affecting its value. However, one important limitation of the present study is its relatively small dataset, especially for training the ANN (MLP and RBF). Hence, the obtained preliminary results should be validated on larger datasets in the future. Full article

Arginine vasopressin (AVP) and oxytocin (OXT) are neuropeptides traditionally recognized for their roles in the control of osmoregulation, blood pressure, lactation, and parturition in mammals. However, growing evidence suggests that AVPand OXT also regulate gonadal functions in teleost fish. Their expression in both male and female gonads, the presence of their receptors in ovaries and testes, and their interactions with steroids and other gonadal factors indicate a role in modulating gametogenesis and steroidogenesis via autocrine and paracrine mechanisms. Here, we review the current findings on AVP and OXT in teleost gonads, compared to the observed functions in mammals, emphasizing their systemic interactions within the hypothalamic–pituitary–gonadal (HPG) axis. While highlighting the roles of gonadal AVP and OXT in fish reproduction, we underscore the need for further research to unravel their complex multifactorial regulatory networks. Insights into the vasopressinergic system could enhance aquaculture practices by improving spawning success and reproductive efficiency. Full article

Background/Objectives: The establishment of early gut microbiota is crucial for host health. Lactoferrin (LF), which is present in breast milk, positively impacts gut microbiota composition. However, the effect of lactation LF on the establishment and composition of early gut microbiota in different disease models in adulthood remains unclear. Methods: Lactation-LF-deficient mice were established using systemically LF–knocked-out maternal mice. This study assessed the maturity of the gut microbiota in LF feeding-deficient mice in relation to age and changes in the gut microbiota in adult high-fat diet (HFD)-induced obesity, dextran sodium sulfate (DSS)-induced acute colitis, and chronic unpredictable mild stress (CUMS)-induced depression models. Results: Compared to LF intake during lactation, LF deficiency during lactation increased the abundance of potentially pathogenic bacteria in the gut, resulting in abnormal microbial maturation. LF intake during lactation aggravated gut microbiota dysbiosis induced via HFD, DSS, and CUMS in adulthood and may change the function of Enterorhabdus, GCA-900066575, Peptococcus, Tuzzerella, Akkermansia, and Desulfovibrio. Comparing the different models revealed that bacteria that were jointly upregulated via HFD and DSS exhibited increased levels of inflammation and oxidation. LF deficiency during lactation may weaken the association between an HFD and inflammatory bowel disease (IBD). The changing trends in many gut microbes caused by DSS and HFD were opposite to those that changed with age. Conclusions: Lactoferrin deficiency increases the abundance of potential pathogens and disrupts microbial maturation. This lack of LF exacerbates dysbiosis in models of obesity, colitis, and depression. Regulating the gut microbiota according to the rules of microbial succession during the maturation process of gut microbiota may improve gut microbiota dysbiosis in patients with obesity and IBD. Full article

Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE. Full article

We are reporting the development of a high-performance, non-enzymatic electrochemical biosensor for selective lactate detection, integrating laser-induced graphene (LIG), gold nanoparticles (AuNPs), and a molecularly imprinted polymer (MIP) synthesized from poly(3,4-ethylenedioxythiophene) (PEDOT). The LIG electrode offers a highly porous, conductive scaffold, while electrodeposited AuNPs enhance catalytic activity and signal amplification. The PEDOT-based MIP layer, electropolymerized via cyclic voltammetry, imparts molecular specificity by creating lactate-specific binding sites. Cyclic voltammetry confirmed successful molecular imprinting and enhanced interfacial electron transfer. The resulting LIG/AuNPs/MIP biosensor demonstrated a wide linear detection range from 0.1 µM to 2500 µM, with a sensitivity of 22.42 µA/log(µM) and a low limit of detection (0.035 µM). The sensor showed excellent selectivity against common electroactive interferents such as glucose and uric acid, long-term stability, and accurate recovery in artificial saliva (>95.7%), indicating strong potential for practical application. This enzyme-free platform offers a robust and scalable strategy for continuous lactate monitoring, particularly suited for wearable devices in sports performance monitoring and critical care diagnostics. Full article

Objectives: Low tidal volume ventilation (LTVV) is a ventilatory strategy with the advantages of minimizing diaphragm movements and reducing hypercapnia and barotrauma risks. This preliminary study aims to report on the safety and effectiveness of LTVV applied during percutaneous US-guided liver ablations of focal malignancies. Methods: Patients affected by focal liver malignancies treated with percutaneous microwaves ablation were retrospectively included in this single-center analysis. Arterial gas analysis was performed immediately before and after ablation to evaluate the arterial pH, partial pressure of carbon dioxide (pCO₂), partial pressure of oxygen (pO₂), and plasma lactate levels. The primary endpoint of this study was to evaluate the safety and efficacy of LTVV during percutaneous liver cancer ablation. The secondary endpoint was to assess the procedural technical success in terms of correct needle probe targeting without the need for repositioning. Results: Ten patients affected by a single liver lesion had been analyzed. The ASA score was three in all patients, with three patients also suffering from COPD. The procedural technical success was 100%: ablations were performed with a single liver puncture without the need for changing access or repositioning the needle. No variations in post-ablation arterial gas analysis requiring anesthesiological management remodulation occurred. Lactate levels remained stable and hemodynamic balance was preserved during all procedures. No switch to standard volume ventilation was required. Conclusions: In this preliminary study, LTVV was a safe and effective anesthesiological protocol in patients treated with percutaneous ablations of liver malignancies, offering an ideal balance between patient safety and percutaneous needle probe positioning precision. Larger prospective studies are needed to confirm these findings. Full article

We used the data from a successful therapeutic assay that used icatibant in patients with hypoxemic COVID-19 pneumonia (the ICAT·COVID trial) to explore pathophysiological mechanisms. We performed concurrent-type, criterion-related validity analyses to assess the discriminative ability of a panel of nine potential serum markers (interleukin 6, ferritin, lactate dehydrogenase, C reactive protein, fibrin fragment D (D-dimer), complement 1 esterase inhibitor (antigenic and functional), complement 4 factor, and lymphocyte count) to predict the clinical milestones. Consistent with previous research, we evidenced a significant relationship between interleukin 6, lactate dehydrogenase and the lymphocyte count, and the clinical events. Furthermore, exposure to icatibant, a bradykinin B2 receptor antagonist (which improved pneumonia and mortality in the aforementioned randomised trial), attenuated this relationship, although this effect faded over time. The results reinforce the key role that the angiotensin-converting enzyme 2 has on COVID-19 pathophysiology as a point of convergence between the renin–angiotensin and kallikrein–kinin systems. This was shown clinically by the successful blocking of inflammatory pathways by icatibant at the bradykinin effector loop level early during the acute hyperinflammatory stage of the disease. Full article

The mitochondrial phosphate carrier (mPiC), encoded by the nuclear gene SLC25A3, is synthesized with an N-terminus mitochondrial targeting sequence (MTS), enabling its import into the mitochondria. mPiC imports inorganic phosphate (P_i) into the mitochondrial matrix for ATP production and other matrix phosphorylation reactions, as well as regulates mitochondrial Ca²⁺ uptake and buffering of matrix Ca²⁺. PiC also imports copper (Cu), crucial to COX subunit holoenzyme assembly. Variants in SLC25A3 exist and lead to mPiC deficiency (MPCD), cause a rare autosomal recessive disease with no current cure; patients with MPCD usually die within the first year of life. We have developed a novel therapeutic approach using TAT-mPiC fusion protein for cellular delivery since the TAT peptide enables delivery of proteins across biological membranes. We designed, produced, and purified the TAT-mPiC fusion protein. The fusion protein is delivered into the mitochondria and localizes within the mIM, its natural cellular location, as a processed protein. Treatment of mPiC-knockdown cells with TAT-mPiC fusion protein increased cell growth and improved bioenergetic capabilities, as measured by oxygen consumption rate (OCR), ATP production, and reduction in lactate secretion. Most importantly, TAT-mPiC restored P_i and Cu delivery into the mitochondrial matrix. TAT-mPiC fusion protein also restored the mitochondrial activity of cells harboring various mitochondrial defects. This study presents the first successful delivery of a mitochondrial transmembrane carrier using the TAT-fusion system, offering a potential early treatment strategy for newborns with mPiC deficiency. Full article

Certain strains of Influenza A virus (IAV), a primary cause of influenza, can lead to pneumonia. Patients recovering from influenza pneumonia may experience physical discomfort akin to post-acute sequelae of COVID-19 (PASC). Despite extensive clinical research on viral pneumonia during convalescence, animal model studies are scarce, highlighting the need for a reliable model for pharmaceutical research. In this study, BALB/c mice were divided into three groups: NC (control), MC (infected with IAV), and Model (treated with oseltamivir post-infection for five days). A fatigue model was then induced in the Model group through diet restriction and weight-bearing swimming. The results showed the MC group had a 75% survival rate, while the NC and Model groups had 100%. Both the MC and Model groups experienced rapid weight loss followed by gradual recovery, differing significantly from the NC group. From dpi (days post-inoculation) 6 to dpi9, the MC group lost more weight than the NC group. The MC group had the highest pulmonary index, but there was no significant difference in IAV Nucleoprotein (NP) expression across groups. The Model group had higher IL-10 levels than the NC and MC groups, while the MC group had the highest TNF-α expression. Hematoxylin and eosin (H&E) staining revealed pathological changes in the MC and Model groups, with severe damage and pulmonary fibrosis in the MC group. Oxidative stress markers showed the MC group had the highest lactate dehydrogenase (LDH) and malondialdehyde (MDA) levels and lowest superoxide dismutase (SOD) activity. Electron microscopy indicated mitochondrial damage in both the MC and Model groups. The Model group had the lowest splenic and thymic indices, with histological findings showing larger splenic nodules in the MC group and poor thymocyte density and atrophy in the Model group. The successful creation of this mouse model of influenza pneumonia convalescence phase fatigue, exhibiting fatigue syndrome with various symptoms, holds significance for PASC and other viral pneumonia convalescence phase animal model research. Full article

Background: Orthopedic trauma during pregnancy is a rare yet complex medical challenge, impacting both maternal and fetal health. Among these, femoral fractures are particularly uncommon but require careful management to minimize maternal and fetal risks. Methods: We report the case of a 28-year-old woman, gravida 4, para 3, at 40 weeks of gestation, who sustained a left mid-femoral diaphyseal fracture following a low-energy fall. A multidisciplinary team approach, including obstetric, orthopedic, anesthetic, and neonatal specialists, was employed. Preoperative imaging by X-ray was performed under lead-apron protection. The patient underwent an emergency C-section, followed by closed reduction and internal fixation with an intramedullary nail. Results: The surgical intervention was successful, with minimal radiation exposure. Postoperative management included thromboprophylaxis, calcium, vitamin D supplementation, and physiotherapy. The patient recovered well, achieving fracture healing within three months. Postpartum bone density assessment was recommended, suspecting pregnancy- and lactation-associated osteoporosis. Conclusions: Managing femoral fractures during pregnancy necessitates a balance between maternal and fetal well-being. A collaborative, multidisciplinary approach ensures optimal outcomes. Early surgical intervention, proper radiation precautions, and postpartum bone health assessment are crucial in these cases. Further research is needed to understand risk factors and preventive strategies for pregnancy-associated osteoporosis. Full article

Flexible, wearable biomedical sensors based on laser-induced graphene (LIG) have garnered significant attention due to a straightforward fabrication process and exceptional electrical and mechanical properties. However, most relevant studies rely on commercial polyimide precursors, which suffer from inadequate biocompatibility and weak adhesion between the precursor material and the LIG layer. To address these challenges, we synthesized cross-linked polyurethanes (PUs) with good biocompatibility and used them as substrates for LIG-based wearable pulse sensors. During fabrication, we employed two methods of LIG transfer to achieve optimal transfer yield. We adjusted the thickness of PU films and tailored their mechanical and physicochemical properties by varying the soft segment content to achieve optimal sensor performance. Our findings demonstrate that the success of LIG transfer is strongly influenced by the structure and composition of the polymeric substrate. Tensile testing revealed that increasing the soft segment content in PU films significantly improved their tensile strength, elongation at break, and flexibility, with PU based on 50 wt.% soft segment content (PU-50) showing the best mechanical properties. LIG exhibited minimal sensitivity to humidity, while PU films maintained high transparency (>80% at 500 nm), and PU-50 was non-toxic, with less than 5% lactate dehydrogenase (LDH) release in endothelial cell cultures, confirming its biocompatibility. Adhesion tests demonstrated that LIG transferred onto PU-50 exhibited significantly stronger adhesion compared to other tested substrates, with only a 30% increase in electrical resistance after the Scotch tape test, ensuring stability for wearable sensors. The optimal substrate, a semicrystalline PU-50, yielded superior transfer efficiency. Among all tested sensors, the LIG/PU-50, featuring a 77 μm thick substrate with good mechanical properties and improved adhesion, exhibited the highest signal-to-noise ratio (SNR). This study showcases a skin-safe LIG/PU-based pulse sensor that has significant potential for applications as a wearable patch in medical and sports monitoring. Full article

Food waste remains a critical global concern, with approximately one third of all food produced being ultimately discarded. Therefore, it is urgent to develop new techniques for the effective repurpose of waste. Aqueous two-phase systems (ATPSs) stand out as a simple and biocompatible liquid–liquid extraction technique for the recovery of bioactive substances from food waste. In ATPSs, the target species partition between two liquid phases, according to affinity, which facilitates its extraction. This work aimed at extracting three polyphenols—chlorogenic acid (CA), ferulic acid (FA), and resveratrol (RV)—through the application of eco-friendly ATPSs composed of water, ethyl lactate (EL), and organic salts, namely disodium succinate (Na₂Succinate) and disodium tartrate (Na₂Tartrate), for future application in the valorisation of food waste. All partitions presented successful results, with values of partition coefficients (K) higher than 1 and extraction efficiencies (E) higher than 50%, indicating a preferential migration of the polyphenols to the top phase. The extraction of FA using the ATPS based on Na₂Tartrate presented the most promising results, with K = 19 ± 6 and E = (94.2 ± 0.9)% for the longest tie-line. Additionally, a comparison with previous works of the research group was drawn, with the extraction of RV exhibiting outstanding performance across all studied ATPSs. Therefore, the assessed ATPSs were shown to hold immense potential for the recovery of polyphenols. Full article