Search Results (14,407)

Heart failure (HF) remains a leading cause of morbidity and mortality globally, with increasing prevalence driven by aging populations and comorbidities such as diabetes mellitus. Recent advances have highlighted sodium-glucose cotransporter-2 (SGLT2) inhibitors, particularly empagliflozin and dapagliflozin, as effective agents in HF management across a broad spectrum of ejection fractions. Initially developed for glycemic control in type 2 diabetes, both drugs have demonstrated significant cardiovascular benefits, including reductions in HF hospitalizations and improvements in symptoms and quality of life. Their mechanisms extend beyond glucose lowering, involving natriuresis, osmotic diuresis, improved myocardial energetics, reduced sympathetic activation, and anti-inflammatory effects. While empagliflozin and dapagliflozin share a core renal mechanism via selective SGLT2 inhibition, subtle differences in pharmacokinetics, potency, and tissue selectivity may influence their clinical profiles. Emerging evidence suggests empagliflozin may confer stronger benefits in heart failure with reduced ejection fraction (HFrEF), while dapagliflozin could offer enhanced efficacy in heart failure with preserved ejection franction (HFpEF), although head-to-head comparisons are lacking. This review synthesizes current evidence comparing the mechanisms of action and clinical performance of empagliflozin and dapagliflozin in HF, providing insight into agent selection and future directions in therapy personalization. Full article

Background: Immunization coverage has increased substantially in the Western Pacific Region, saving millions of lives and supporting disease elimination efforts. However, gaps in coverage and inequitable vaccine access persist, leaving millions unvaccinated. Wealth-based inequalities remain a critical barrier to achieving equitable immunization coverage and maximizing the health benefits of vaccination programs. Methods: We analyzed full immunization coverage among 1-year-olds in 10 middle-income countries of the Western Pacific Region using data from the WHO Health Inequalities Data Repository. National and wealth quintile-specific coverage rates and within-country inequalities were assessed using absolute and relative measures (difference, ratio, slope index of inequality, and relative index of inequality). Trends over time were examined in countries with longitudinal data (n = 5), identifying pro-rich or pro-poor changes based on shifts in quintile-specific coverage. We also calculated the population attributable risk (PAR) and fraction (PAF) to estimate the potential increase in national coverage if wealth-based inequalities were eliminated. Findings: Substantial gaps in immunization coverage persist across all countries studied (n = 10), but with substantial between- and within-country disparities. Coverage was higher among the richest quintiles in half of the countries, with the rest showing no significant disparities. Trends in inequalities were mixed: Cambodia, Mongolia, and Viet Nam experienced pro-poor improvements over time; the Philippines saw widening pro-rich inequalities; and Lao PDR showed little change. Population attributable risks (PAR) showed that eliminating wealth-based inequalities could increase national coverage significantly in five countries (Fiji, Lao PDR, Papua New Guinea, Samoa, and Tonga), with relative gains that could increase national coverage by up to 50% while achieving equity gains. Conclusions: Addressing wealth-based inequalities in immunization could drive substantial gains in national coverage across the Western Pacific Region. Sustained, equity-oriented approaches are essential to achieving universal vaccine access and ensuring no population is left behind. Inequality patterns can guide equity-focused policies to reach underserved and disadvantaged populations. Full article

The effects of soil acidification on the phoD-harboring microbial community and the fractions of soil phosphorus in tea plantation soils are still unclear. In this study, tea plantations with different soil pH were used as the research object to analyze changes in soil phosphorus fractions, phoD gene abundance, phoD-harboring microbial community composition, and their relationship with tea yield and quality. The results showed that the content of tea polyphenols, caffeine, free amino acids, theanine, and tea yield decreased significantly after acidification. Moreover, the content of total phosphorus in the acidified soil also decreased significantly. Further analysis of soil phosphorus fractions showed that the acidification of the tea plantation soil resulted in a significant decrease in the content of different types of labile and moderately labile phosphorus, whereas the content of non-labile phosphorus exhibited the opposite trend. As the content of soil NaHCO₃-Po, NaOH-Po, Resin-Pi, NaHCO₃-Pi, NaOH-Pi, and HCl-Pi decreased significantly after acidification, its organic and inorganic phosphorus content also decreased significantly. Its phosphorus activation capacity decreased by 4.75% after soil acidification. Soil acidification significantly reduced the diversity of phoD-harboring microbial communities by 61.89%. Analysis of the phoD-harboring microbial community composition suggested that the microbial abundance of Acidobacteria and Proteobacteria showed a decreasing trend in acidified soils, while for Nitrospirae, Verrucomicrobia, Actinobacteria, and Planctomycetes, it showed an increasing trend. Correlation analysis showed that microorganisms with significantly decreasing abundance in tea plantation soils were significantly and positively correlated with soil pH, labile phosphorus, moderately labile phosphorus, phosphorus activation coefficients, and tea yield and quality after soil acidification. It is evident that soil acidification inhibited soil phosphorus availability by shifting phoD-harboring microbial community composition in tea plantation soils, thus affecting the yield and quality of above-ground tea leaves. Full article

Background/Objectives: Aortic stenosis (AS) leads to progressive left ventricular (LV) pressure overload, adverse myocardial remodeling, and eventual functional decline. While traditional parameters such as left ventricular ejection fraction (LVEF) may remain preserved until advanced stages, they are insufficiently sensitive to early dysfunction. Global longitudinal strain (GLS) offers improved detection but remains load-dependent. In contrast, non-invasive myocardial work (MW)—derived from pressure-strain loops—offers a more load-independent assessment of myocardial function. This systematic review and meta-analysis aimed to evaluate the effects of transcatheter aortic valve implantation (TAVI) on MW indices in patients with severe AS. Methods: We performed a systematic review and meta-analysis of studies reporting non-invasive myocardial work parameters before and after TAVI (PROSPERO ID: CRD420250517138). Databases were searched through 31 March 2025. Pooled mean differences in global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were calculated using random-effects models. Sensitivity analyses and meta-regression were conducted to explore heterogeneity and the influence of baseline characteristics. Results: Eleven studies encompassing 1493 patients were included. TAVI was associated with a significant reduction in GWI (−236.67 mmHg% [95% CI: −373.82 to −99.52]; I² = 97.0%; p = 0.002) and GCW (−243.71 mmHg% [95% CI: −407.38 to −80.03]; I² = 97.4%; p = 0.006). No significant changes were observed in GWW or GWE. Meta-regression showed age and baseline LVEF significantly influenced GWE changes, but not other parameters. Conclusions: TAVI leads to a significant reduction in GWI and GCW, reflecting decreased myocardial workload and afterload relief. These findings support the utility of MW indices as valuable tools for assessing myocardial adaptation post-TAVI and potentially guiding clinical decision-making. Full article

Background/Objectives: Germ Cell Neoplasia In Situ (GCNIS) is considered the precursor lesion for the majority of testicular germ cell tumors (TGCTs). The aim of this study was to evaluate whether first-order radiomics features derived from volumetric diffusion tensor imaging (DTI) metrics—specifically apparent diffusion coefficient (ADC) and fractional anisotropy (FA) histogram parameters—can detect GCNIS. Methods: This study included 15 men with TGCTs and 10 controls. All participants underwent scrotal MRI, including DTI. Volumetric ADC and FA histogram metrics were calculated for the following tissues: group 1, TGCT; group 2: testicular parenchyma adjacent to tumor, histologically positive for GCNIS; and group 3, normal testis. Non-parametric statistics were used to assess differences in ADC and FA histogram parameters among the three groups. Pearson’s correlation analysis was followed by ordinal regression analysis to identify key predictive histogram parameters. Results: Widespread distributional differences (p < 0.05) were observed for many ADC and FA variables, with both TGCTs and GCNIS showing significant divergence from normal testes. Among the ADC statistics, the 10th percentile and skewness (p = 0.042), range (p = 0.023), interquartile range (p = 0.021), total energy (p = 0.033), entropy and kurtosis (p = 0.027) proved the most significant predictors for tissue classification. FA_energy (p = 0.039) was the most significant fingerprint of the carcinogenesis among the FA metrics. These parameters correctly characterized 88.8% of TGCTs, 87.5% of GCNIS tissues and 100% of normal testes. Conclusion: Radiomics features derived from volumetric ADC and FA histograms have promising potential to differentiate TGCTs, GCNIS, and normal testicular tissue, aiding early detection and characterization of pre-cancerous lesions. Full article

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

The rapid accumulation of public debt raises global concern over its implications for financial markets. This study examines the effect of domestic public debt on financial development in Middle East and North Africa (MENA) countries, a region marked by sharp heterogeneity in institutions, debt dynamics, and oil dependence, using annual panel data for 16 countries over the period (2000–2020). Our analysis employs a fractional response model (FRM), which accounts for the bounded nature of the dependent variable, corrects for heteroskedasticity, and incorporates country fixed effects. The findings reveal a significant negative effect of domestic public debt on financial development, consistent with the lazy banks and crowding-out hypotheses. This adverse relationship persists across different income groups and debt percentiles, with modest attenuation at higher debt levels. Oil rents are also found to exert a robust negative effect, highlighting the structural vulnerabilities associated with oil dependence. These results emphasize the importance of debt management, fiscal frameworks that account for commodity cycles, and policies to reduce the sovereign–bank nexus in fostering sustainable financial development in the region. Full article

Purity analysis of parent gases used to produce reference gas mixtures is fundamental to assure the metrological traceability of the certified gas composition, and the use of purity data in the calculation of the mixture composition should be performed in accordance with the requirements of international standards. Purity analysis can be difficult to realize since limited measurement standards are available for the determination of trace levels of gaseous compounds. The first step of purity analysis is the definition of the impurities considered critical or significant to the final composition of a mixture. In this work, we present the activity carried out for the identification and quantification of impurities of carbon dioxide and water in some ultrapure gases used for the preparation of primary certified reference gas mixtures of carbon dioxide at atmospheric amount fraction (400–800 µmol·mol⁻¹), by means of different spectroscopic techniques (Fourier Transform IR, Non-Dispersive IR and Cavity Ring-Down). Dynamic dilution was used for the generation of reference mixtures for the calibration of the analyzers by using calibrated Mass Flow Controllers. The certified reference gas mixtures produced with the tested pure gases will also be applied to characterization studies and calibration protocols for gas sensors used both for outdoor and indoor monitoring. Full article

Berry pomace is a valuable source of dietary fiber (DF) with promising applications in functional food development. This study aimed to evaluate and compare the technological and rheological properties of soluble (SDF) and insoluble (IDF) fiber fractions isolated from cranberry, black currant, lingonberry, and sea buckthorn pomace. SDF fractions demonstrated higher water solubility and lower swelling capacity, compared with IDF fractions. Meanwhile, water and oil retention capacities depended on fiber type and the sources of pomace. Fractionation notably affected color parameters, with SDFs generally being lighter. Rheological analysis revealed pseudoplastic, shear-thinning behavior in all SDF samples, with viscosity dependent on both pH and shear rate. In particular, the black currant SDF demonstrated higher yield stress compared to other SDFs, suggesting enhanced resistance to deformation and superior structural stability under low shear conditions. The consistency coefficient varied across samples, indicating differences in gel-forming potential. These findings highlight the importance of berry source and fiber fraction in determining functionality. The distinct hydration, binding, and rheological properties suggest that both SDF and IDF from berry pomace can be strategically applied as thickeners, stabilizers, or texture enhancers in food systems. This study supports the valorization of berry by-products as sustainable and functional ingredients in the formulation of fiber-enriched foods. Full article

Left ventricular (LV) hypertrabeculation is increasingly recognized as a phenotype that may reflect physiological adaptation, particularly in athletes exposed to chronic overload, although its functional relevance remains uncertain. This study evaluated the prevalence of excessive trabeculation and its physiological correlation with LV remodeling. We conducted a single-center, cross-sectional study involving 320 Olympic-level athletes without cardiovascular disease. All underwent cardiac magnetic resonance (CMR). Hypertrabeculation was defined by the Petersen criteria. Athletes meeting these criteria were classified as hypertrabeculated and compared with non-hypertrabeculated matched for age, sex, and sport category. LV morphology, function, strain parameters, and hemodynamic forces (HDFs) were analyzed. Hypertrabeculation was identified in 9% of the cohort. No significant differences were observed between groups for training exposure (p = 0.262), body surface area (p = 0.762), LV volumes (end-diastolic volume indexed p = 0.397 end-systolic volume indexed p = 0.118), ejection fraction (p = 0.101), mass (p = 0.919), sphericity index (p = 0.419), myocardial wall thickness (p = 0.394), tissue characterization (T1 mapping p = 0.366, T2 mapping p = 0.833), global longitudinal strain (GLS p = 0.898), global circumferential strain (GCS p = 0.219), or HDFs. All values were within the normal range. In our cohort, LV hypertrabeculation, evaluated by CMR, was relatively common but not associated with structural or functional abnormalities, supporting its interpretation as a benign variant in asymptomatic athletes with normal cardiac function. Full article

Wet–dry cycles are a key factor aggravating the durability degradation of foam concrete. To address this issue, this study prepared bentonite slurry–steel slag foam concrete (with steel slag and cement as main raw materials, and bentonite slurry as admixture) using the physical foaming method. Based on 7-day unconfined compressive strength tests with different mix proportions, the optimal mix proportion was determined as follows: mass ratio of bentonite to water 1:15, steel slag content 10%, and mass fraction of bentonite slurry 5%. Based on this optimal mix proportion, dry–wet cycle tests were carried out in both water and salt solution environments to systematically analyze the improvement effect of steel slag and bentonite slurry on the durability of foam concrete. The results show the following: steel slag can act as fine aggregate to play a skeleton role; after fully mixing with cement paste, it wraps the outer wall of foam, which not only reduces foam breakage but also inhibits the formation of large pores inside the specimen; bentonite slurry can densify the interface transition zone, improve the toughness of foam concrete, and inhibit the initiation and propagation of matrix cracks during the dry–wet cycle process; the composite addition of the two can significantly enhance the water erosion resistance and salt solution erosion resistance of foam concrete. The dry–wet cycle in the salt solution environment causes more severe erosion damage to foam concrete. The main reason is that, after chloride ions invade the cement matrix, they erode hydration products and generate expansive substances, thereby aggravating the matrix damage. Scanning Electron Microscopy (SEM) analysis shows that, whether in water environment or salt solution environment, the fractal dimension of foam concrete decreased slightly with an increasing number of wet–dry cycle times. Based on fractal theory, this study established a compressive strength–porosity prediction model and a dense concrete compressive strength–dry–wet cycle times prediction model, and both models were validated against experimental data from other researchers. The research results can provide technical support for the development of durable foam concrete in harsh environments and the high-value utilization of steel slag solid waste, and are applicable to civil engineering lightweight porous material application scenarios requiring resistance to dry–wet cycle erosion, such as wall bodies and subgrade filling. Full article

Purpose: This paper aims to calculate the gross tumor volume (GTV) receiving low radiation doses in patients submitted to “metabolism-guided” lattice radiation therapy and relative possible implications with clinical outcomes. Material and Methods: We reviewed plans for treating voluminous masses via “metabolism-guided” LATTICE-01 irradiation. The aim was to deliver high-dose radiation to spherical deposits (vertices) within a bulky tumor mass. These were placed at tumor areas with differing PET metabolism. We evaluated the relationships between GTV volumes and dose-volumetric histograms (mean, maximum, minimum, and % GTV received 0.5, 1, 2, 3 Gy). Results: Sixty-two plans of treatment met the inclusion criteria as established. The median GTV volume was 315.9 cc (range = 10.54–2605.9 cc). A median of two Vertices was allocated within the GTVs (range 1–9) and were planned to receive a dose of ≥10 Gy/1 fraction (median 12 Gy, range 10–15 Gy). Median V3Gy percentage was 51.58% (range 2–100%), median V2Gy percentage was 67.80% (range 1.60–100%), median V1Gy percentage was 83.70% (range 0.80–100%), and median V0.5Gy percentage was 88.49% (range 17.60–100%). Conclusions: In the present series, we performed a dosimetric evaluation of the GTV’s volume exposed to low doses during the metabolic guided lattice irradiation process. Combining high- and low-dose radiotherapy based on a spatially fractionated (LATTICE) approach could reactivate the immune system against cancer cells. These observations could be useful for planning prospective studies on immunotherapy combined with the lattice technique. Full article

This study investigated the physicochemical and rheological properties of floury rice powder (FRP) with different particle sizes and their effects on the quality characteristics of gluten-free butter sponge cake. Soft rice grain (Baromi2 variety) was dry-milled and sieved into four fractions: FR1 (60 mesh overs), FR2 (60–80 mesh), FR3 (80–100 mesh), and FR4 (100 mesh throughs). FRP fractions were analyzed for chemical composition, swelling power, solubility, gelatinization, pasting viscosity, and viscoelastic property. Gluten-free cakes made using a whole-egg foam method were evaluated for morphological structure, baking loss, moisture, specific volume and firmness. With decreasing FRP particle size, there were increasing trends in solubility, pasting viscosity, resistance to deformation, viscoelastic attributes (G′ and G″), and gel rigidity. FR3 and FR4 cakes exhibited flat and puffy loaves compared to FR1 and FR2 cakes with loaf collapses. The finer FRP enhanced the morphological balances of the cakes. Increasing trends in specific volume and firmness were observed as FRP particle size decreased. These results paralleled the solubility, pasting, rheological, and gelling properties of FRP itself. Overall, the results suggest that the rheological and gelling properties of FRP may play a role in determining the quality of gluten-free sponge cakes. In addition, FRP with a particle size of 80–100 mesh appears most appropriate for gluten-free sponge cake. Full article

Osseodensification (OD) has emerged as a favorable osteotomy preparation technique that preserves and compacts autogenous bone along the osteotomy walls during site preparation, enhancing primary stability and implant osseointegration. While OD has demonstrated promising results in low-density trabecular bone, especially when used in conjunction with acid-etched (AE) implant surfaces, its efficacy in high-density cortical bone remains unclear—particularly in the context of varying implant surface characteristics. In this study, Grade V titanium alloy implants (Ti-6Al-4V, 4 mm × 10 mm) with deep threads, designated bone chambers and either as-machined (Mach) or AE surfaces were placed in 3.8 mm diameter osteotomies in the submandibular region of 16 adult sheep using either OD or conventional (Reg) drilling protocols. Insertion torque values (N·cm) were measured at the time of implant placement to evaluate primary stability. Mandibles were harvested at 3-, 6-, 12-, or 24-weeks post-implantation (n = 4 sheep/time point), and histologic sections were analyzed to quantify bone-to-implant contact (BIC) and bone area fractional occupancy (BAFO). Qualitative histological analysis confirmed successful osseointegration among all groups at each of the healing time points. No statistically significant differences were observed between OD and conventional drilling techniques in insertion torque (p > 0.628), BIC (p > 0.135), or BAFO (p > 0.060) values, regardless of implant surface type or healing interval. The findings indicate that neither drilling technique nor implant surface treatment significantly influences osseointegration in high density cortical bone. Furthermore, as the osteotomy was not considerably undersized, the use of OD instrumentation showed no signs of necrosis, inflammation, microfractures, or impaired osseointegration in dense cortical bone. Both OD and Reg techniques appear to be suitable for implant placement in dense bone, allowing flexibility based on surgeon preference and clinical circumstances. Full article

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV₁ (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF_25–75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (R_tot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV₁, FEF_25–75, and R_tot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up. Full article