Search Results (189)

Glatiramer acetate (GA) is a first-line disease-modifying therapy for multiple sclerosis (MS) with well-established moderate efficacy and high safety, yet its mechanisms of action remain incompletely understood. DNA methylation plays a significant role in MS development and is modulated by various environmental factors, including therapeutic drugs. In this pilot study, we report the first prospective analysis of genome-wide DNA methylation changes in peripheral blood mononuclear cells (PBMCs) from four female relapsing-remitting MS patients before GA initiation and after approximately four and eight months of therapy. We identified 365 loci that are characterized by differential methylation, distinguishing post-treatment time points from baseline, with significant enrichment in CpG islands, shores, and promoter regions. Two distinct temporal patterns emerged: (1) non-monotonic DNA methylation changes peaking at four months and associated with response to foreign antigenic stimuli, and monotonic changes progressively increasing by eight months and related to mTOR-associated pathways relevant to chronic inflammation and neurodegeneration. Integration of DNA methylation and transcriptomic data revealed significant methylation-expression correlations for eight genes, including HLA-DMA, PDE4A, and SMOX—genes with established roles in MS-associated antigen presentation, immunoregulation, and neuroinflammation. Cell composition of PBMCs remained stable throughout treatment. In general, GA therapy for MS appears to induce dynamic, locus-specific DNA methylation changes in PBMCs, with distinct temporal patterns suggesting a biphasic response of the immune system. However, given that none of the individual DMPs reached genome-wide significance, the results presented in this pilot study strongly require validation in larger independent cohorts. Nevertheless, we believe that our findings provide insights into the immunomodulatory effects of GA and lay the foundation for future hypothesis-driven studies to develop epigenetic biomarkers for therapeutic monitoring and generic GA product assessment. Full article

Background: Fiberoptic bronchoscopy (FOB) is a procedure routinely performed in clinical practice for both diagnostic and therapeutic purposes. FOB frequently impairs respiratory function, which may exacerbate respiratory failure. Currently, conventional oxygen therapy (COT) is the most commonly used form of respiratory support; however, non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) are being used increasingly. The optimal settings and indications for NIV and HFNC in patients with respiratory acidosis undergoing FOB have not yet been determined. Methods: This is a prospective, multicenter, randomized controlled trial including two parallel study populations defined by the indication for bronchoscopy and the type of respiratory acidosis. Therapeutic FOB (Study 1): Patients with decompensated type 2 respiratory failure (pH < 7.35 and PaCO₂ > 45 mmHg) will be randomized to receive one of four methods of respiratory support during bronchoscopy: COT, NIV, HFNC, or invasive mechanical ventilation (IMV) (n = 315). Diagnostic FOB (Study 2): Patients with chronic respiratory acidosis (pH ≥ 7.35, PaCO₂ > 45 mmHg, and/or HCO₃⁻ > 27 mmol/L) will be randomized to receive COT, NIV, or HFNC during bronchoscopy (n = 210). Before FOB, patients in both groups will undergo arterial blood gas (ABG) analysis. During FOB, vital signs will be continuously monitored, including SpO₂, FiO₂, TcCO₂, ECG, and heart rate. After FOB, ABG analysis will be repeated, and study endpoints and complications, if any, will be recorded. The planned study period is from April 2026 to April 2029. Results: Based on the study results, we aim to evaluate the effectiveness and safety of different respiratory support strategies during flexible bronchoscopy, with the primary objective of comparing the rate of treatment failure among COT, HFNC, NIV, and IMV. Treatment failure is defined as the need for endotracheal intubation, premature termination of the procedure, or escalation of respiratory support. Additionally, we aim to identify the optimal NIV and HFNC settings, as well as complication rates in both study groups. Conclusions: The results of this study will help define the role of optimal respiratory support in patients with respiratory acidosis undergoing FOB, potentially leading to a shorter time from admission to diagnosis, better tolerance of the procedure, and faster recovery afterward. Full article

Exercise training improves maximum aerobic capacity, in part, through improvements in skeletal muscle function. This study aimed to investigate adaptations to improved aerobic capacity training through non-invasive and non-exhaustive tests of hyperemic muscle blood flow and near-infrared spectroscopy (NIRS) muscle oxygenation kinetics. An experimental study was conducted on 18 participants (age, 28.2 ± 5.3 yr; _absVO_2max, 3.60 ± 0.67 L·min⁻¹). Before and after the intervention of a 6-week of high-intensity interval training (HIIT), participants underwent three tests: (1) a graded cardiopulmonary exercise test; (2) a vascular occlusion test; and (3) a steady-state exercise (SSE) at 60% of PPO. Expired gas analysis, superficial femoral blood flow (occlusion test only) and SmO₂ kinetics were measured. The intervention increased maximal aerobic capacity _absVO_2max (p < 0.001, d = 0.65) and PPO (p < 0.001; d = 0.41). Moreover, steady-state _absVO₂ (p = 0.006; d = 0.37) and HR (p = 0.001; d = 0.65) were reduced. With the cuff test, the SmO₂ desaturation slope increased (p = 0.04; d = 0.52), while peak muscle blood flow (p = 0.02; d = 0.51) and the SmO₂ 10 s reoxygenation rate increased (p < 0.001 d = 1.11; 0.74 ± 0.28 to 1.17 ± 0.45%/s). During steady-state exercise, SmO₂ decreased less (p = 0.02; d = 0.43), and the 10s recovery kinetics rate was slowed (p = 0.01 d = 0.30; 0.28 ± 0.20 to 0.22 ± 0.21%/s). The improvement in VO_2max had a moderate correlation with the SmO₂ recovery rate post-steady-state exercise (p = 0.05, r = −0.54). HIIT changed maximal aerobic capacity alongside improvements in skeletal muscle hyperemic blood flow, SmO₂ post-occlusive reactive hyperemia and SmO₂ post-exercise recovery kinetics. Thus, the findings indicated that non-invasive and non-exhaustive hemodynamic kinetic profiles can monitor adaptations to improved aerobic capacity. Full article

Ciprofloxacin residues in chicken blood pose a potential food safety risk; however, rapid detection methods for complex chicken blood matrices are lacking. This study aimed to establish a surface-enhanced Raman spectroscopy (SERS) method for the rapid detection of ciprofloxacin in chicken blood using gold colloid as the SERS substrate. Gold colloid was synthesized via the Frens method with slight modification, and key SERS detection conditions were systematically optimized to maximize SERS intensities at 1265 cm⁻¹, including the amount of trisodium citrate solution, the electrolyte type, the amount of gold colloid, the amount of NaCl solution, and the adsorption time. Raw SERS spectra were pretreated with adaptive iteratively reweighted penalized least squares (air-PLS) combined with Savitzky–Golay (SG) smoothing. A genetic algorithm (GA) was used to extract characteristic Raman shifts, and a GA-SVR prediction model with radial basis function (RBF) as the kernel was constructed, with its performance compared with multivariate linear regression (MLR) and partial least squares regression (PLSR) models. The GA-SVR model exhibited the best performance, with a coefficient of determination for the calibration set ($R_{\mathrm{c}}^2$) value of 0.9893 and for the prediction set ($R_{\mathrm{p}}^2$) value of 0.9874. The root mean square error of calibration (RMSEC) and prediction (RMSEP) were 1.2953 and 1.8617, respectively, outperforming the MLR and PLSR models. These results demonstrate that the SERS method combined with GA-SVR enables rapid quantitative detection of ciprofloxacin residues in chicken blood, providing a technical reference for monitoring veterinary drug residues in livestock and poultry products. Full article

Background/Objectives: Surfactant has been delivered via less-invasive surfactant administration (LISA) in our neonatal intensive care unit (NICU) since 2020. Data have been monitored and the literature regularly reviewed to improve our LISA practice. The purpose of this project is to share the clinical practice changes made to help other NICU providers fine-tune their LISA practice. Methods: The original LISA criteria included babies with GA 27–36 6/7 w, on > 21% O₂, on continuous positive airway pressure (CPAP), pCO₂ < 70 if a blood gas was obtained, and radiographic and/or clinical evidence of respiratory distress syndrome (RDS). Current criteria include GA 25–35 6/7 w and minimum CPAP + 6. This manuscript highlights the changes made since 2023. To monitor these changes, targeted data from the entire cohort were examined before and after each change. Results: LISA was attempted on 399 babies (average (SD) GA 31.7 (2.7), birth weight 1752 (590), with a procedural success rate of 97%. Overall, 18% required intubation within 7 days after LISA. The median (IQR) for FiO₂ was 32 (28, 40) prior to LISA and 23 (21, 30) post-LISA and the hour of age of LISA was 4 (2.5, 9.9). LISA procedure success rate was increased by the use of video laryngoscopy as well as reinforcement of the use of sucrose sedation and swaddling; our first attempt success increased overall from 39% to 52%. After the introduction of a clinical RDS score (Downes), there was an expected and logical increase in the number of infants requiring intubation within 7 days of LISA indicating likely over-treatment prior to this change. After implementation of a clearly described plan for babies <28 w gestation there was a decrease in the hour of age of LISA from 3 (2.5, 4.5) to 2 (0.8, 3) h. Conclusions: It is critical to continually evaluate a new practice and identify strategic changes. We offer our changes to assist others starting or using LISA. Full article

Hemotherapy in small ruminants is indicated for several acute and chronic conditions; however, its clinical use is often limited by the difficulty in identifying suitable donors, particularly regarding blood volume availability and hematologic compatibility. Xenotransfusion in small ruminants with bovine blood may represent a practical alternative in emergency situations involving severe anemia when homologous donors are unavailable. This study evaluated the clinical, hematologic, biochemical, and blood gas responses of sheep subjected to acute blood loss followed by bovine whole blood xenotransfusion. Six healthy adult castrated male sheep (mean body weight 44.3 ± 7.2 kg) underwent removal of 40% of their estimated total blood volume. Parameters were assessed before hemorrhage induction (T0) and at times T30, T6h, T12h, T24h, T48h, T72h, T96h, T5d, T6d, T7d, T8d and T16d after transfusion. Acute blood loss significantly reduced packed cell volume and erythrocyte count at T0 (p < 0.05). After xenotransfusion, packed cell volume increased at T30min, T6h, and T12h and remained stable until T72h (p < 0.05), with progressive erythrocyte recovery and sustained macrocytosis. Total leukocyte count remained unchanged, whereas platelets increased at T7D (p < 0.05). Total protein decreased at T0 and subsequently increased. Transient elevations in urea, creatinine, glucose, pO₂, and SO₂ were observed (p < 0.05), without acid–base imbalance. Clinical parameters progressively stabilized, and no severe transfusion reactions occurred. Bovine whole blood xenotransfusion may represent a promising therapeutic alternative for sheep subjected to acute blood loss under the experimental conditions evaluated in this study. The procedure was associated with improvements in clinical, hematological, and biochemical parameters, and no severe transfusion reactions were observed during the monitoring period. These findings support the potential clinical applicability of this approach as an emergency intervention in situations where homologous donors are not readily available. Full article

Background: Polysubstance use, particularly the combination of opioids and stimulants, represents a growing public health concern due to its high risk of severe multisystem complications and mortality. Here, we present a case illustrating the lethal synergy of opioid–stimulant co-use. Methods: A 37-year-old male with chronic Hepatitis C and documented polysubstance use reported recent use of fentanyl, cocaine, methamphetamine, and cannabis. He presented with generalized weakness, left lower limb pain, tense edema, and anuria. Clinical assessment included monitoring of vital signs, physical examination, capillary blood gas analysis, extended laboratory panels (muscle and cardiac enzymes, electrolytes, and coagulation parameters), urinalysis, and Doppler imaging. Management over five days included intravenous hydration, diuretics, urinary alkalinization, electrolyte correction, anticoagulation, metabolic and vitamin therapy, hemodialysis, and comprehensive supportive care. Results: Laboratory evaluation revealed massive rhabdomyolysis (peak CK 161,050 U/L), severe hyperkalemia (K⁺ 8.4 mmol/L), metabolic acidosis, acute kidney injury with oligoanuria, and left-sided deep vein thrombosis. Despite intensive multidisciplinary interventions, the patient’s repeated refusal of ongoing treatment critically contributed to a fatal outcome. Conclusions: This case underscores the high mortality risk associated with opioid–stimulant co-use and the crucial impact of treatment refusal. Clinicians and public health stakeholders should recognize the rapid progression of multisystem dysfunction in polysubstance users and prioritize early, aggressive interventions combined with patient engagement strategies to mitigate fatal outcomes. Full article

Preclinical imaging has recently been expanded through the use of ostrich embryos as an alternative in vivo model. In ovo experiments represent a promising substitute for conventional rodent-based animal testing. For artifact-free dynamic nuclear medicine imaging, reliable immobilization of embryos is essential. Although previous studies have demonstrated the feasibility of isoflurane anesthesia, the kinetics and uptake mechanisms of isoflurane in ostrich embryos remain insufficiently characterized. The aim of this study was to characterize gas exchange dynamics in ostrich eggs and to quantify isoflurane uptake using two complementary approaches: indirect consumption measurements in a closed system and direct quantification by serial blood sampling. Fourteen ostrich eggs, including seven fertilized and seven unfertilized specimens, were analyzed at developmental stages up to day 37 of incubation. Gas exchange was assessed in a sealed container using a clinical anesthesia gas monitoring system to measure oxygen consumption and carbon dioxide excretion. Isoflurane uptake was evaluated during exposure to concentrations of 2%, 4%, or 6%. In a separate experimental series, serial blood samples were collected during and after exposure to the same concentrations to determine systemic uptake. Fertilized embryos showed progressive increases in metabolic activity, with a maximal oxygen consumption and carbon dioxide excretion of 116 mL/h/kg and 93 mL/h/kg on day 37. Indirect measurements demonstrated isoflurane uptake rates of up to 1.1 mL/min at 6%, with proportionally lower values at 4% and 2%. Blood analyses confirmed systemic absorption, peak concentrations of 160 µg/mL, and detectable residual levels for up to 120 min after exposure. These findings refine in ovo imaging. Full article

Epilepsy remains one of the most prevalent neurological disorders, characterised by complex aetiology encompassing genetic, structural, metabolic, and inflammatory factors. Despite advances in neuroimaging and neurophysiological diagnostics, there is a persistent lack of sensitive and specific biomarkers to enable early diagnosis, risk stratification, and monitoring of therapeutic efficacy. Key epilepsy biomarkers include neurotransmitters, energy–related compounds, tryptophan pathway metabolites, and choline derivatives. Their determination employs liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS), high–performance liquid chromatography (HPLC) with electrochemical or fluorescence detection, gas chromatography with tandem mass spectrometry (GC–MS/MS), high–resolution mass spectrometry (HRMS), and proton nuclear magnetic resonance (¹H–NMR) spectroscopy, revealing metabolic disturbances in neurotransmission, energy metabolism, and oxidative stress associated with epileptogenesis. Among these techniques, LC–MS/MS currently provides the highest analytical sensitivity and specificity for quantifying low–abundance epilepsy–related metabolites, while HPLC with conventional detection remains a simpler and more cost–effective alternative for routine clinical laboratories. This review presents the current state of knowledge regarding chromatographic techniques applied to the analysis of mentioned metabolites, as well as therapeutic drug monitoring of antiepileptic drugs. Key sample preparation stages are also discussed. Various biological matrices–plasma, serum, urine, cerebrospinal fluid (CSF), dried blood spots (DBSs), and brain tissue—are evaluated. Novel approaches are also presented, including hair samples, microsampling techniques, and headspace analysis of volatile metabolites. Chromatographic techniques constitute the foundation of contemporary metabolomic research in epileptology, enabling biomarker identification and supporting personalised medicine. Further standardisation and translational validation remain necessary, as current evidence is insufficient for routine clinical implementation. Full article

Background: Continuous non-invasive hemoglobin monitoring (SpHb) may provide real-time information during surgery, but its accuracy in neurosurgery remains uncertain. We evaluated the agreement, trending ability, and diagnostic performance of SpHb compared with arterial blood gas hemoglobin during elective intracranial neurosurgery. Methods: In this prospective observational study, 60 adults undergoing elective neurosurgery with invasive arterial monitoring were included. SpHb (Masimo Radical-7) was compared with paired arterial hemoglobin values. Agreement was assessed using repeated-measures Bland–Altman analysis and mixed-effects modeling. Trending ability was evaluated using four-quadrant concordance with an exclusion zone of ±0.5 g/dL. Discrimination for severe anemia (Hb < 8 g/dL) was assessed using ROC analysis with patient-level cluster bootstrapping. Results: A total of 190 paired measurements were analyzed. Mean bias was +0.23 g/dL, with wide limits of agreement (−3.26 to +3.72 g/dL). Agreement was worse under low-perfusion-index conditions. Trending performance was preserved, with an overall concordance rate of 85.5%. SpHb showed moderate discrimination for severe anemia (AUC 0.78; 95% CI 0.61–0.93), although severe anemia events were infrequent. Conclusions: SpHb showed limited reliability for absolute hemoglobin quantification during neurosurgery but provided useful trend information. SpHb should not replace invasive hemoglobin measurements for clinical decision-making. Full article

Background/Objectives: Pediatric neurosurgical procedures often involve significant blood loss and rapid hemodynamic shifts, necessitating accurate hemoglobin (Hb) monitoring. While continuous non-invasive Hb (SpHb) monitoring offers real-time trending, its accuracy in high-risk pediatric populations remains debated. We aimed to evaluate the diagnostic accuracy and clinical utility of SpHb compared to invasive arterial blood gas (ABG) analysis in pediatric patients undergoing cranial and spinal surgeries. Methods: This prospective, observational study enrolled 60 pediatric patients (aged 0–16 years) scheduled for high-risk neurosurgery. SpHb was measured continuously and compared with intermittent ABG-Hb values. Statistical analysis included Bland–Altman agreement, Pearson’s correlation, and Error Grid Analysis. Subgroup analyses assessed the impact of the Perfusion Index (PI), hypotension, and metabolic acidosis on device performance. Results: Data from 57 patients (median age: 12 months, interquartile range: 6–42 months; 70.2% aged <24 months) were analyzed. SpHb demonstrated a moderate correlation with ABG-Hb (r = 0.567, p < 0.001) but exhibited systematic overestimation with a mean bias of +1.60 ± 1.54 g/dL. Crucially, SpHb showed 0% sensitivity for detecting critical anemia (Hb < 8.0 g/dL). Device performance was significantly compromised by physiological extremes: severe metabolic acidosis significantly increased bias to +2.27 g/dL (p = 0.038), and intraoperative hypotension significantly widened the limits of agreement (SD of bias: 1.79 g/dL vs. 1.45 g/dL in normotension). Furthermore, hemodynamic analysis revealed a loss of autoregulation during hypotension, where the pressure-perfusion coupling strengthened (r = 0.44) compared to the normotensive state (r = 0.15). Conclusions: SpHb monitoring provides fair Hb trending but is limited by systematic overestimation and poor sensitivity for critical anemia. Accuracy worsens during severe acidosis and hemodynamic instability. Therefore, SpHb should function as a complementary “early warning” trend monitor rather than a sole transfusion trigger, with invasive validation remaining essential for intraoperative decision-making. Full article

Background: Higher body mass index (BMI) is associated with a greater burden of cardiometabolic comorbidities that may potentially increase the risk of sedation-related complications. However, the impact of BMI on sedation safety during complex electrophysiological procedures (CEPs) remains uncertain. Methods: In this study conducted at Ulm University Heart Center, patients undergoing CEPs were stratified into three BMI groups: normal weight, overweight, and obesity. Primary and secondary endpoints were analyzed using univariable and multivariable logistic regression analyses. The primary composite endpoint (PCE) was the occurrence of sedation-related complications, defined as oxygen saturation below 90% combined with abnormal peripheral venous blood gas results—specifically, a venous carbon dioxide level exceeding 70 mmHg, an increase of more than 30% from baseline, or a pH drop below 7.25. Secondary endpoints included sedative and opioid requirements as well as occurrence of individual components of the PCE. Results: A total of 726 patients were included, with 299 (42.3%) being female. The study population comprised 236 patients (32.5%) of normal weight, 265 (36.5%) overweight, and 225 (31.0%) obese. Patients with higher BMI presented with a greater burden of comorbidities and lower baseline oxygen saturation at the start of the procedure. While absolute sedative and opioid doses remained stable or even increased with BMI, relative doses (mg/kg) were higher in normal-weight patients. No significant differences were observed between BMI groups for either the primary or secondary endpoints. Female sex emerged as an independent predictor of adverse sedation events, with a higher incidence of reaching the PCE (p = 0.046, OR 1.411). Conclusions: BMI alone was not associated with an increased risk of sedation-related complications during CEPs. Despite higher absolute drug requirements and a greater comorbidity burden in overweight and obese patients, procedural safety was comparable across all BMI categories. These findings emphasize that individualized sedation protocols, embedded within standardized monitoring frameworks, are essential to ensure safe and effective sedation in diverse patient populations. Full article

Background: Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, and emergency department (ED) management requires early risk assessment to guide monitoring and disposition. Because key decisions are often needed while diagnostic evaluation is ongoing, the simplified Pulmonary Embolism Severity Index (sPESI) may provide limited discrimination for in-hospital outcomes. We evaluated whether explainable machine-learning (ML) models integrating routine ED variables with validated risk scores can predict in-hospital mortality in adults evaluated for suspected acute PE. Methods: A retrospective single-center cohort study was performed, including 220 consecutive adults evaluated for suspected acute PE in the ED between January 2021 and March 2025, comprising both PE-confirmed and PE-excluded cases. Predictors included demographics, vital signs, arterial blood gas indices, available imaging/echocardiographic findings, and Wells, Revised Geneva, and sPESI scores. Seven ML algorithms were trained and internally evaluated using the area under the receiver operating characteristic curve (AUC) and complementary metrics. Model interpretability was assessed using SHAP (SHAPley Additive exPlanations), and a sensitivity analysis was conducted in the PE-confirmed subgroup. Results: Tree-based ensemble models demonstrated higher discrimination for in-hospital all-cause mortality than simpler classifiers. SHAP analyses consistently highlighted sPESI, oxygenation/arterial blood gas indices, and malignancy as key contributors to mortality risk. Findings were similar in the PE-confirmed sensitivity analysis. Conclusions: Explainable ML models combining established risk scores with routinely collected ED variables may complement risk stratification along the suspected-PE pathway. External multicenter validation and prospective impact studies are warranted before clinical implementation. Full article

Background and Clinical Significance: Metabolic alkalosis is the most common acid–base disturbance in hospitalized and critically ill patients, with extreme alkalemia (pH > 7.65) linked to mortality rates exceeding 80%. Jejunostomy-related intestinal losses can lead to severe hypochloremic metabolic alkalosis, a rare but life-threatening condition. This case report highlights the clinical presentation, diagnostic approach, physiopathology, management, and outcome of a patient with extreme metabolic alkalosis induced by a temporary jejunostomy. Case Presentation: We report the case of a 72-year-old female who presented with severe alkalemia, seizures, and signs of profound dehydration following extensive enteral resection with end-jejunostomy. Serial arterial blood gas and serum electrolyte monitoring guided treatment, prompting the initiation of an aggressive chloride-based rehydration protocol. Concurrent evaluations revealed renal impairment and an intercurrent infection. Initial tests revealed extreme metabolic alkalosis (pH 7.757, HCO₃⁻ 72.7 mmol/L) with severe hypochloremia, hypokalemia, and acute kidney injury. Administration of approximately 5 L of isotonic saline with added potassium chloride over the first 6 h led to rapid improvement in pH to near-normal levels. Over the following six days, continued electrolyte correction restored physiological acid–base balance and renal function. After achieving metabolic stabilization, the jejunostomy was surgically reversed. Conclusions: Extreme metabolic alkalosis secondary to jejunostomy is rare but potentially fatal. Prompt recognition of chloride-responsive alkalosis and rapid initiation of aggressive volume and electrolyte replacement are essential for survival. Definitive management requires addressing the underlying cause, such as restoration of gastrointestinal continuity, to prevent recurrence. Full article

This paper proposes an efficient and automated smart healthcare communication framework that integrates a two-level filtering scheme with a multi-objective Genetic Algorithm (GA) to enhance the reliability, timeliness, and energy efficiency of Internet of Medical Things (IoMT) systems. In the first stage, physiological signals collected from heterogeneous sensors (e.g., blood pressure, glucose level, ECG, patient movement, and ambient temperature) were pre-processed using an adaptive least-mean-square (LMS) filter to suppress noise and motion artifacts, thereby improving signal quality prior to analysis. In the second stage, a GA-based optimization engine selects optimal routing paths and transmission parameters by jointly considering end-to-end delay, Signal-to-Noise Ratio (SNR), energy consumption, and packet loss ratio (PLR). The two-level filtering strategy, i.e., LMS, ensures that only denoised and high-priority records are forwarded for more processing, enabling timely delivery for supporting the downstream clinical network by optimizing the communication. The proposed mechanism is evaluated via extensive simulations involving 30–100 devices and multiple generations and is benchmarked against two existing smart healthcare schemes. The results demonstrate that the integrated GA and filtering approach significantly reduces end-to-end delay by 10%, as well as communication latency and energy consumption, while improving the packet delivery ratio by approximately 15%, as well as throughput, SNR, and overall Quality of Service (QoS) by up to 98%. These findings indicate that the proposed framework provides a scalable and intelligent communication backbone for early disease detection, continuous monitoring, and timely intervention in smart healthcare environments. Full article