Search Results (1,078)

Early detection is crucial for preventing heart disease. Advances in health technology, particularly wearable devices for automated heartbeat detection and machine learning, can enhance early diagnosis efforts. However, previous studies on heartbeat classification inference systems have primarily relied on batch processing, which introduces delays. To address this limitation, a real-time system utilizing stream processing with a distributed computing architecture is needed for continuous, immediate, and scalable data analysis. Real-time ECG inference is particularly crucial for immediate heartbeat classification, as human heartbeats occur with durations between 0.6 and 1 s, requiring inference times significantly below this threshold for effective real-time processing. This study implements a real-time heartbeat classification inference system using distributed stream processing with LSTM-512, LSTM-256, and FCN models, incorporating RR-interval, morphology, and wavelet features. The system is developed as a distributed web-based application using the Flask framework with distributed backend processing, integrating Polar H10 sensors via Bluetooth and Web Bluetooth API in JavaScript. The implementation consists of a frontend interface, distributed backend services, and coordinated inference processing. The frontend handles sensor pairing and manages real-time streaming for continuous ECG data transmission. The backend processes incoming ECG streams, performing preprocessing and model inference. Performance evaluations demonstrate that LSTM-based heartbeat classification can achieve real-time performance on distributed edge devices by carefully selecting features and models. Wavelet-based features with an LSTM-Sequential architecture deliver optimal results, achieving 99% accuracy with balanced precision-recall metrics and an inference time of 0.12 s—well below the 0.6–1 s heartbeat duration requirement. Resource analysis on Jetson Orin devices reveals that Wavelet-FCN models offer exceptional efficiency with 24.75% CPU usage, minimal GPU utilization (0.34%), and 293 MB memory consumption. The distributed architecture’s dynamic load balancing ensures resilience under varying workloads, enabling effective horizontal scaling. Full article

This study reviews the scientific use of chest-strap wearables, analyzing their advantages and limitations, following PRISMA guidelines. Eligible studies assessed chest-strap devices in adults and reported physiological outcomes such as heart rate, heart rate variability, R–R intervals, or electrocardiographic waveform morphology. Studies involving implanted devices, wrist-worn wearables, or lacking validation against reference standards were excluded. Searches were conducted in PubMed, Scopus, Web of Science, and ScienceDirect for studies published in the last 10 years. The quality of the studies was assessed using the Mixed Methods Appraisal Tool, and results were synthesized narratively. Thirty-two studies were included. The most frequently evaluated devices were the Polar H10 and Zephyr BioHarness 3.0, which showed strong correlations with electrocardiography at rest and during light-to-moderate activity. Reported limitations included motion artefacts, poor strap placement, sweating, and degradation of the skin–electrode interface. None of the devices had CE or FDA approval for clinical use, and most studies were conducted in controlled settings, limiting generalizability. Ergonomic concerns such as discomfort during prolonged wear and restricted mobility were also noted. Overall, chest-strap sensors showed good validity and were widely used in validation studies. However, technical refinements and large-scale field trials are needed for broader clinical and occupational application. This review is registered in PROSPERO and is part of the SIREN project. Full article

(1) Background: Physical activity, altered metabolic parameters, and socio-economic status may affect electrocardiographic (ECG) parameters in children. However, a direct comparison of their effects on resting ECG has not yet been performed. (2) Methods: A total of 139 participants (60 male), aged 10–17 years, were recruited. Resting 1-minute ECG recordings and clinical and laboratory investigations were obtained, while socio-economic status and physical activity were assessed using a questionnaire. Associations between these factors and ECG parameters were analyzed using analysis of covariance (ANCOVA). (3) Results: Age, sex, metabolic syndrome, and physical activity significantly influenced the average RR interval (η² = 0.292, 0.070, 0.078, and 0.070, respectively). Similar effects were observed on the T_end–P interval. The PR, QRS, QTc, and T_peak–T_end intervals were moderately influenced by age (η² = 0.084, 0.056, 0.072, and 0.049, respectively). QTc was additionally affected by sex (η² = 0.060). None of the modifiable factors had any effect on depolarization or repolarization parameters. Socio-economic status had no significant effect on resting ECG. (4) Conclusions: Physical activity exerts similar effects on resting ECG in both sexes, while metabolic syndrome is an independent determinant of several ECG parameters. Further studies are warranted to clarify the clinical relevance of these findings. Full article

Background: Elite athletes are frequently subjected to high-intensity training regimens, which can result in cumulative physical stress, overtraining, and potential health risks. Monitoring autonomic responses to such load is essential for optimizing performance and preventing maladaptation. Objective: The present study aimed to assess changes in autonomic regulation immediately and two hours after training in athletes, using an integrated framework (combining time- and frequency-domain HRV indices with nonlinear and recurrence quantification analysis). It was investigated how repeated assessments over a 4-month period can reveal cumulative effects and identify athletes at risk. Special attention was paid to identifying signs of excessive fatigue, autonomic imbalance, and cardiovascular stress. Methods: Holter ECGs of 12 athletes (mean age 21 ± 2.22 years; males, athletes participating in competitions) over a 4-month period were recorded before, immediately after, and two hours after high-intensity training, with HRV calculated from 5-min segments. Metrics included HRV and recurrent quantitative analysis. Statistical comparisons were made between the pre-, post-, and recovery phases to quantify autonomic changes (repeated-measures ANOVA for comparisons across the three states, paired t-tests for direct two-state contrasts, post hoc analyses with Holm–Bonferroni corrections, and effect size estimates η²). Results: Immediately after training, significant decreases in SDNN (↓ 35%), RMSSD (↓ 40%), and pNN50 (↓ 55%), accompanied by increases in LF/HF (↑ 32%), were observed. DFA α1 and Recurrence Rate increased, indicating reduced complexity and more structured patterns of RR intervals. After two hours of recovery, partial normalization was observed; however, RMSSD (−18% vs. baseline) and HF (−21% vs. baseline) remained suppressed, suggesting incomplete recovery of parasympathetic activity. Indications of overtraining and cardiac risk were found in three athletes. Conclusion: High-intensity training in elite athletes induces pronounced acute autonomic changes and incomplete short-term recovery, potentially increasing fatigue and cardiovascular workload. Longitudinal repeated testing highlights differences between well-adapted, fatigued, and at-risk athletes. These findings highlight the need for individualized recovery strategies and ongoing monitoring to optimize adaptation and minimize the risk of overtraining and health complications. Full article

Sleep posture has received limited attention in studies of autonomic nervous system (ANS) activity during sleep, particularly in clinical populations. We analyzed data from 130,885 individuals (56.1% female) in the Allostatic State Mapping by Ambulatory ECG Repository (ALLSTAR), a nationwide Japanese database of 24 h Holter ECG recordings obtained for clinical purposes. Sleep posture was classified as supine, right lateral, left lateral, or prone using triaxial accelerometer data. Heart rate variability (HRV) indices—including heart rate (HR), standard deviation of RR intervals (SDRR), high-frequency (HF), low-frequency (LF), very low-frequency (VLF) components, cyclic variation in heart rate (CVHR), and HF spectral power concentration index (Hsi)—were calculated for each posture and stratified by age and sex. HR was consistently lowest in the left lateral posture and highest in the right lateral posture across most age groups. Other HRV indices also showed consistent laterality, although the effect sizes were generally small. Posture distribution differed slightly by estimated sleep apnea severity, but the effect size was negligible (η² = 0.0013). These findings highlight sleep posture as a statistically significant and independent factor influencing ANS activity during sleep, though the magnitude of differences should be interpreted in the context of their clinical relevance. Full article

Background/Objectives: Human papillomavirus (HPV)-attributable cancers are a major public health problem worldwide. However, HPV vaccination rates vary significantly and are often not optimal. This study aimed to assess the effects of multilevel interventions on improving HPV vaccination. Methods: A systematic literature review and a meta-analysis were carried out, taking into account randomized controlled trials. Outcomes of interest were HPV vaccination initiation and completion. A random-effect meta-analysis using the generic inverse variance method was carried out, with a risk ratio (RR) with a 95% confidence interval (CI) as the pooled effect estimate. Results: A literature search identified 15 relevant studies, all conducted in high-income countries. Multilevel interventions significantly improved HPV vaccination coverage and initiation (RR = 1.26, 95% CI 1.16–1.38, p < 0.00001 and RR = 1.14, 95% CI 1.04–1.24, p = 0.004, respectively) compared to usual care. Sensitivity analyses showed that the results remained relatively robust. Subgroup analysis by targeted levels of intervention indicated that multilevel interventions had an effect across all comparisons and outcomes except for HPV vaccination completion for interventions that targeted four levels of influence. Conclusions: Based on evidence from high-income settings, multilevel interventions are effective in improving HPV vaccination rates. Future studies should expand the focus to areas with limited resources too and aim to provide more detailed data, avoid registering outcomes via self-report, and create sustainable strategies that can persist beyond a study’s duration and possibly become part of policies for improving HPV vaccination coverage. Full article

Thermal imaging is a non-contact method for monitoring respiration activity during sleep. In this study, we evaluated its clinical application during overnight recordings in a sleep clinic. Five thermal cameras were used to detect breaths, the estimated respiration rate (RR), and inter-breath intervals (IBIs) in seven adults undergoing diagnostic polysomnography (PSG). Forty-five minutes of recordings were selected, consisting of 12 motionless and event-free segments. The thermal videos were processed using an adapted pre-existing thermal video processing algorithm. The respiration signals generated with the thermal cameras were validated against simultaneously recorded signals from the PSG system, the current gold standard for monitoring sleep. The results show a mean absolute error (MAE) ranging between 0.64 and 0.91 breaths per minute for the RR. Breath detection showed a sensitivity of 96.3%, and a precision of 94.1%. The MAE obtained between IBIs was 0.48 s, and the mean IBI variability difference recorded was 3.9 percentage points. In addition, the results from this clinical study show that the use of all five cameras and a single camera revealed no statistically significant differences, demonstrating the work towards a robust system. This first study of thermal cameras for the assessment of respiration in a clinical setting shows us the potential application of thermal imaging in clinical practice for respiration monitoring and establishes a foundation for further implementation in assessing sleep-disordered breathing. Full article

Background: Left ventricular thrombus (LVT) remains a well-recognized complication following myocardial infarction (MI). Whilst vitamin K antagonists (VKAs) have traditionally been the cornerstone of management, direct oral anticoagulants (DOACs) have been increasingly utilized despite limited data to support this. We sought to perform an up-to-date meta-analysis of all randomized controlled trials (RCTs) comparing DOACs to VKAs for LVT resolution. Methods: A systematic search of major scientific databases was performed to identify RCTs published until May 2025. The primary efficacy endpoint was complete LVT resolution at 3 months. The risk ratio (RR) and 95% confidence intervals (CIs) of the individual RCTs were pooled via the inverse-variance method and random-effects model. Results: Seven RCTs involving 554 patients with a mean age of 54 years were included in the meta-analysis. At 3 months, there was no difference in the rate of LVT resolution between those in the DOAC arm and the warfarin arm (86% vs. 81%, RR 1.01 [95%CI 0.93–1.10], p = 0.76). There was low heterogeneity at I² = 15%. There was no difference in major or clinically significant bleeding or in the composite of stroke or thromboembolic complications, although the 95%CIs were wide. Conclusions: DOACs appear to be comparable to warfarin in achieving LVT resolution at 3 months. These findings support the consideration of DOACs as alternatives to VKAs in selected patients for LVT resolution. Further adequately powered trials and head-to-head comparisons between DOACs are required to confirm their safety. Full article

Background: As we age, our autonomic function declines, resulting in altered autonomic balance during postural transitions. These changes can affect the dynamic interplay between sympathetic and parasympathetic modulation, compromising short-term compensatory responses to active standing. Objectives: This study aimed to compare heart rate variability (HRV) at baseline, cardiac parasympathetic modulation (CPM), and cardiac baroreflex gain (CRG) between younger adults (YA) and older adults (OA) following active standing orthostatic stress. A secondary objective was to analyze the incidence of orthostatic intolerance (OI) symptoms. Methods: Participants (n = 76) completed sit-to-stand and lie-to-stand maneuvers with continuous beat-to-beat blood pressure and heart rate (HR, electrocardiogram). HRV at baseline was analyzed in both time and frequency domains. CPM was measured by the HR 30:15 ratio on standing. CBG was determined as the ratio of HR and SBP changes (ΔHR/ΔSBP) at specific phase time points (30 s, 60 s, 180 s, and 420 s). Results: At baseline, OA showed reduced Standard Deviation of RR intervals (SDRR), Root Mean Square of Successive Differences (RMSSD), low-frequency (LF), and high-frequency (HF) power, and elevated LF/HF ratio (all p < 0.05), indicating a shift toward sympathetic dominance. During active standing orthostatic stress, OA demonstrated a lower HR30:15 ratio and CBG in later phases (phases 2–4) (all p < 0.05). Also, OA reported more symptoms (14%) of OI than YA (0%) (p = 0.041). Conclusions: These findings indicate that older adults have impaired autonomic function characterized by reduced HRV, CPM and CBG responses. These impairments lead to diminished autonomic regulation under active-standing orthostatic stress and a higher incidence of OI symptoms. Full article

Background: The influence of osteoporotic conditions on dental implant outcomes remains uncertain, with conflicting evidence regarding implant survival, failure, and marginal bone loss. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251021400). PubMed and Scopus databases were searched for comparative human studies published between 2014 and 2024. Eligible studies compared implant outcomes in osteoporotic and non-osteoporotic patients. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Results: Fourteen studies met the inclusion criteria, and seven provided sufficient data for quantitative synthesis. The pooled analysis demonstrated no significant difference in implant survival between patients with osteoporotic conditions and control groups (RR = 1.00, 95% CI: 0.97–1.02). Implant failure rates were also comparable (RR = 0.96, 95% CI: 0.59–1.56). Marginal bone loss showed no significant difference (MD = 0.22 mm, 95% CI: −1.69 to 2.12); however, substantial heterogeneity (I² = 86%) was observed, requiring cautious interpretation. Conclusions: Osteoporotic conditions alone do not appear to negatively affect dental implant survival or failure. However, limited evidence and methodological variability highlight the need for prospective, standardized trials to confirm these findings and to clarify the role of antiresorptive therapy. Full article

Extensive green roofs (EGRs) are recognized as a promising passive cooling strategy due to their low areal mass, yet their thermal performance is strongly influenced by water availability. While prior studies have focused primarily on continuous irrigation or small-scale modules, the response of EGRs to temporary irrigation outages remains underexplored. This study presents a full-scale experimental investigation on an industrial roof segment in Dubnica nad Váhom, Slovakia, conducted during summer 2024. The thermal behavior of an EGR was compared to a conventional reflective flat roof (RR) and a roof with a hydroaccumulative layer covered with photovoltaic panels (PV). The experiment analyzed an unplanned irrigation interruption and the subsequent recovery, selecting representative three-day intervals from each phase. During non-irrigated periods under peak solar radiation, evapotranspiration (ET) was minimal, resulting in increased heat flux into the interior. After irrigation resumed, ET accounted for nearly 70% of net solar radiation, reducing interior heat flux to 32% of the non-irrigated value. Heat gain reductions between irrigated and non-irrigated days were 1% for RR, 38% for PV, and 68% for EGR, correlating with energy consumed for ET. These results highlight that active irrigation substantially enhances the cooling performance of EGRs, demonstrating their potential as an effective adaptation measure for buildings under extreme summer conditions. Full article

Cardiovascular diseases are the leading cause of death worldwide, with arrhythmia being a prevalent and potentially fatal condition. The multi-lead electrocardiogram (ECG) is the primary tool for detecting arrhythmias. However, existing detection methods have shortcomings: they cannot dynamically integrate inter-lead correlations with multi-scale temporal changes in cardiac electrical activity. They also lack mechanisms to simultaneously focus on key leads and time segments, and thus fail to address multi-lead redundancy or capture comprehensive spatial-temporal relationships. To solve these problems, we propose a Multi-Scale Lead-Temporal Co-Attention Framework (MS-LTCAF). Our framework incorporates two key components: a Lead-Temporal Co-Attention Residual (LTCAR) module that dynamically weights the importance of leads and time segments, and a multi-scale branch structure that integrates features of cardiac electrical activity across different time periods. Together, these components enable the framework to automatically extract and integrate features within a single lead, between different leads, and across multiple time scales from ECG signals. Experimental results demonstrate that MS-LTCAF outperforms existing methods. On the PTB-XL dataset, it achieves an AUC of 0.927, approximately 1% higher than the current optimal baseline model (DNN_zhu’s 0.918). On the LUDB dataset, it ranks first in terms of AUC (0.942), accuracy (0.920), and F1-score (0.745). Furthermore, the framework can focus on key leads and time segments through the co-attention mechanism, while the multi-scale branches help capture both the details of local waveforms (such as QRS complexes) and the overall rhythm patterns (such as RR intervals). Full article

Recent advances in wearable sensing technology have enabled simultaneous measurement of heart activity and body movement using devices equipped with both ECG recording and 3-axis accelerometers. This study examined whether transient heart rate (HR) responses to physical activity can be accurately characterized under free-living conditions. Continuous RR interval data and activity levels derived from accelerometer signals were analyzed using a multivariate autoregressive (MVAR) model. Results from 12 male participants showed a strong correlation between predicted and observed HR responses (r² = 0.93, r = 0.96, p < 0.001). These findings indicate that up to 93% of transient HR dynamics associated with daily physical activity can be explained by the model. While these results are preliminary due to the limited sample size, the approach provides a promising framework for the noninvasive, continuous monitoring of cardiovascular responses in everyday health and wellness applications. Full article

Background: Ectopic pregnancy (EP) is a serious condition often treated with methotrexate. Letrozole, a safer aromatase inhibitor, may offer an effective alternative. This study presents a meta-analysis comparing the efficacy and safety of single-agent letrozole versus methotrexate for EP management. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Six sources of information underwent screening until 12 June 2025. Risk of bias and evidence certainty of evidence were assessed. Primary outcome was treatment success rate. Results were presented as mean difference (MD) or risk ratio (RR) along with a 95% confidence interval (CI) using a random-effects model. Results: Six studies (three randomized controlled trials and three nonrandomized prospective cohort studies) comprising seven arms and 260 patients (letrozole = 130, methotrexate = 130) were included. Almost all studies (n = 5) had overall moderate or high risk. Treatment success rates were comparable between groups (n = 7 arms; RR = 1.05; 95% CI: [0.94, 1.17]; p = 0.40). Letrozole was associated with significantly lower β-hCG levels on day 4 (n = 5 arms; MD = −95 mIU/mL; 95% CI: [−189.7, −0.91]; p = 0.048), day 7 (n = 5 arms; MD = −86.24 mIU/mL; 95% CI: [−143.1, −29.36]; p < 0.001), and day 14 (n = 3 arms; MD = −9.15 mIU/mL; 95% CI: [−17.24, −1.06]; p = 0.03); however, the differences were not clinically meaningful. Letrozole showed a better safety profile with higher platelet counts and lower liver enzymes. AMH levels were similar between groups. Most analyses were consistent, though secondary outcomes were less stable. Overall evidence certainty was rated ‘very low’ due to seriousness of risk of bias and imprecision. Conclusions: While letrozole shows comparable efficacy to methotrexate and a potentially better safety profile in the management of EP, the certainty of evidence is ‘very low’ due to risk of bias and imprecision. Therefore, these findings should be interpreted with caution, and further high-quality studies are urgently needed to confirm the results. Full article

Female university ice hockey players experience elevated and sustained cardiovascular stress during training and competition. There remains limited research on the “exercise dose–response” in female ice hockey players. The purpose of this study was to examine daily and weekly changes in cardiac autonomic activity across a competitive season, and to examine its association with accumulated exercise stress. Twenty-one female ice hockey players wore chest strap heart rate monitors to quantify exercise heart rate dynamics into a training load (TL) metric and time (min) performing high-intensity activity (HIA) during training and competition. Cardiac autonomic activity was expressed as both resting heart rate (RHR) and the root mean squared of successive R-R intervals (rMSSD) and was recorded immediately upon awakening each morning. The association between HRV and both TL (r = −0.420, p = 0.058) and HIA (r = −0.420, p = 0.058) was observed. The association between RHR and both TL (r = 0.109, p = 0.638) and HIA (r = 0.150, p = 0.516) was observed. rMSSD fell below the typical error for ~50% of games. In conclusion, HRV demonstrated greater sensitivity to exercise stress than RHR for quantifying the dose–response to on-ice exercise stress. Full article