Search Results (720)

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

Cardiopulmonary Exercise Testing (CPET) is the gold standard for the functional assessment in patients with heart failure (HF), providing objective parameters that reflect the integrated response of the cardiovascular, respiratory, and muscular systems, in addition several CPET-derived variables have shown independent prognostic value in patients with both reduced (HFrEF) and preserved ejection fraction (HFpEF) HF. This review aims to critically analyze the main CPET prognostic variables in heart failure, highlighting their underlying pathophysiological mechanisms, their predictive capacity for mortality and hospitalizations, and their integration into clinical decision-making models. Parameters such as peak oxygen uptake (VO₂), minute ventilation/carbon dioxide production (VE/VCO₂) slope, periodic breathing (or exercise oscillatory ventilation—EOV), anaerobic threshold (AT), oxygen pulse, and VO₂/work slope provide complementary insights into clinical risk; moreover, the combination of multiple CPET variables allows for more accurate risk stratification compared to the isolated use of each parameter. Multiparametric prognostic models such as the Metabolic Exercise Cardiac Kidney Index (MECKI) score, the Seattle Heart Failure Model, and the Heart Failure Survival Score (HFSS) incorporate these variables alongside clinical and laboratory data to guide advanced management and therapeutic decisions, including heart transplantation or left ventricular assistant device (LVAD) implantation. For these reasons, CPET-derived variables are essential prognostic tools in heart failure. Beyond improving risk stratification, their integration into multiparametric models supports a more personalized therapeutic approach, including tailored pharmacological management. Full article

This paper presents a CMOS-based hybrid system capable of noninvasively quantifying the total hemoglobin (tHb), the oxygen saturation (SpO₂), and the heart rate (HR) by utilizing five-wavelength (670, 770, 810, 850, and 950 nm) photoplethysmography. Conventional pulse oximeters are limited to the measurements of SpO₂ and heart rate, therefore hindering the real-time estimation of tHb that is clinically essential for monitoring anemia, chronic diseases, and postoperative recovery. Therefore, the proposed hybrid system enables us to distinguish between the concentrations of oxygenated (HbO₂) and deoxygenated hemoglobin (Hb) by using the absorption characteristics of five wavelengths from the visible to near-infrared range. This CMOS hybrid mixed-signal architecture includes a light emitting diode (LED) driver as a transmitter and an optoelectronic receiver with on-chip avalanche photodiodes, followed by a field-programmable gate array (FPGA) for a real-time signal processing pipeline. The proposed hybrid system, validated through post-layout simulations and algorithmic verification, achieves high precision with ±0.3 g/dL accuracy for tHb and ±1.5% for SpO₂, while the heart rate is extracted via 1024-point Fast Fourier Transform (FFT) with an error below ±0.2%. These results demonstrate the potential of a CMOS-based hybrid system as a feasible solution to achieve real-time, low-power, and high-accuracy analysis of bio-signals for clinical and home-use applications. Full article

Cardiopulmonary exercise testing (CPET) is recommended as part of routine care in people with congenital heart disease. A significant difference has been observed in many CPET parameters, depending on the ergometer and exercise protocol used. The aim of this study is to investigate such differences in Fontan patients. All Fontan patients (<40 years old, NYHA class I/I–II) underwent two consecutive CPETs on different ergometers (treadmill with ramped Bruce protocol versus cycle ergometer with ramp protocol) within less than 12 months. The exclusion criterion was the presence of significant clinical/anthropometric changes between the two tests. Anthropometric, surgical, clinical, electrocardiogram (ECG) and CPET data were collected. 47 subjects were enrolled (25 males, mean age 16.4 at first test). Peak heart rate (HR) tended to be higher on the treadmill (p = 0.05 as % of predicted, p = 0.062 in absolute value). Peak oxygen consumption (VO₂) (mL/min, mL/kg/min, and % of predicted) was significantly higher on the treadmill (p < 0.01), as well the VO₂ at the ventilatory anaerobic threshold (VAT) and the peak oxygen pulse. A different kinetics of the oxygen pulse wave was observed in the same patient comparing the two testing modalities. Maximal respiratory-exchange-ratio values (>1.1) were reached more frequently on the cycle ergometer (p < 0.001). The minute ventilation–carbon dioxide output slope (VE/VCO₂ slope) was not different between the two tests (p = 0.400). Many parameters of CPET may differ depending on the ergometer used. These should be considered in clinical evaluation of Fontan patients and when exercise is to be prescribed. Full article

Background: The cerebral compliance (or compensatory reserve) index, RAP, is a critical yet underutilized physiological marker in the management of moderate-to-severe traumatic brain injury (TBI). While RAP offers promise as a continuous bedside metric, its broader cerebral physiological context remains partly understood. This study aims to characterize the burden of impaired RAP in relation to other key components of cerebral physiology. Methods: Archived data from 379 moderate-to-severe TBI patients were analyzed using descriptive and threshold-based methods across three RAP states (impaired, intact/transitional, and exhausted). Agglomerative hierarchical clustering, principal component analysis, and kernel-based clustering were applied to explore multivariate covariance structures. Then, high-frequency temporal analyses, including vector autoregressive integrated moving average impulse response functions (VARIMA IRF), cross-correlation, and Granger causality, were performed to assess dynamic coupling between RAP and other physiological signals. Results: Impaired and exhausted RAP states were associated with elevated intracranial pressure (p = 0.021). Regarding AMP, impaired RAP was associated with elevated levels, while exhausted RAP was associated with reduced pulse amplitude (p = 3.94 × 10⁻⁹). These two RAP states were also associated with compromised autoregulation and diminished perfusion. Clustering analyses consistently grouped RAP with its constituent signals (ICP and AMP), followed by brain oxygenation parameters (brain tissue oxygenation (PbtO₂) and regional cerebral oxygen saturation (rSO₂)). Cerebral autoregulation (CA) indices clustered more closely with RAP under impaired autoregulatory states. Temporal analyses revealed that RAP exhibited comparatively stronger responses to ICP and arterial blood pressure (ABP) at 1-min resolution. Moreover, when comparing ICP-derived and near-infrared spectroscopy (NIRS)-derived CA indices, they clustered more closely to RAP, and RAP demonstrated greater sensitivity to changes in these ICP-derived CA indices in high-frequency temporal analyses. These trends remained consistent at lower temporal resolutions as well. Conclusion: RAP relationships with other parameters remain consistent and differ meaningfully across compliance states. Integrating RAP into patient trajectory modelling and developing predictive frameworks based on these findings across different RAP states can map the evolution of cerebral physiology over time. This approach may improve prognostication and guide individualized interventions in TBI management. Therefore, these findings support RAP’s potential as a valuable metric for bedside monitoring and its prospective role in guiding patient trajectory modeling and interventional studies in TBI. Full article

Complex Regional Pain Syndrome (CRPS) type 1 is a painful and disabling localized syndrome with a pathogenesis that is still unclear. The last revised diagnostic criteria for CRPS-1 syndrome were developed in 2012 (the so-called Budapest criteria), based only on clinical features, while the presence of bone marrow edema (BME) and the response to treatments were completely absent. As BME is usually present on magnetic resonance imaging (MRI) in the early (“warm”) phase of CRPS-1, this criterion should be added as a necessary criterion to Budapest criteria. In addition, hyperalgesia and/or allodynia are also commonly present in the warm phase. Therefore, both of these symptoms should be included as essential criteria. Furthermore, the response to bisphosphonates may be another important parameter to add to the list of treatment options, as well as hyperbaric oxygen therapy. Finally, it must be clear that BME is not an exclusive finding of CRPS-1. Therefore, a correct clinical history and, if needed, further radiological studies and laboratory tests should be performed to avoid a false diagnosis. In this paper, the “Bone Marrow Edema Diagnosis and Therapeutic Treatment” Italian Group (GEODEIT) proposes a revision of Budapest’s criteria to make them more meaningful and effective in reaching a correct and quick diagnosis of the disease. Full article

Advanced oxidation processes (AOPs) utilising a hydroxyl radical (•OH), a strong oxidant, are seen as a promising solution for removing hazardous and recalcitrant pollutants from waste streams. Among AOPs, non-thermal plasmas, especially pulsed corona discharge (PCD), enable the abatement of hazardous volatile organic compounds (VOCs) with high energy efficiency. This study demonstrates the viability of upscaling PCD technology with water sprinkling in degrading the VOC toluene using a semi-pilot scale plasma reactor. A toluene–air mixture was treated with varying gas-phase toluene concentrations (30–100 ppm) and pulse repetition frequencies (25–800 pps), achieving toluene removal of 5–55% in PCD and an additional 10–18% in PCO, as well as excellent toluene removal energy efficiencies from 9.0 to 37.1 g kW⁻¹ h⁻¹. The process design with water sprinkling provides additional advantages compared to dry reactors—the water surface serves as a source of hydroxyl radicals and scrubs the air from degradation by-products resulting from the incomplete oxidation of target pollutants. Transformation products of toluene were identified, and an oxidation pathway via hydroxylation of the aromatic ring was suggested as the major route towards ring-opening reactions. A photocatalytic oxidation reactor with TiO₂ catalyst plates, following PCD as a post-treatment, enabled additional removal of residual contaminants, also converting residual ozone to oxygen. The PCD reactor with water sprinkling and post-plasma photocatalysis shows promising results for upscaling the process. Full article

The health and safety of agricultural workers are critical concerns due to their exposure to extreme environmental conditions, physically demanding tasks, and limited access to immediate medical assistance. This study presents the design and development of a novel smartphone application that integrates multiple wearable physiological sensors—a fingertip pulse oximeter, a skin patch thermometer, and an inertial measurement unit (IMU)—via Bluetooth Low Energy (BLE) technology for real-time health monitoring and alert notifications. Unlike many existing platforms, the proposed system offers direct access to raw sensor data, modular multi-sensor integration, and a scalable software framework based on the Model–View–ViewModel (MVVM) architecture with Jetpack Compose for a responsive user interface. Experimental results demonstrated stable BLE connections, accurate extraction of oxygen saturation, heart rate, body temperature, and trunk inclination data, as well as reliable real-time alerts when the system detects anomalies based on predetermined thresholds. The system also incorporates automatic reconnection mechanisms to maintain continuous monitoring. Beyond agriculture, the proposed framework can be adapted to broader occupational safety domains, with future improvements focusing on additional sensors, redundant sensing, cloud-based data storage, and large-scale field validation. Full article

Background: In exercise testing, the ventilatory threshold 1 (VT1) and ventilatory threshold 2 (VT2) are used in lifestyle-related diseases, cardiac rehabilitation, and athletic training. We investigated a VT2 measuring method using a pulse oximeter. Methods: Thirty-four adults (men: 15; women: 19) performed a bicycle ergometer Ramp Test. VT1 values were determined using expiratory gas data. The bifurcation of the curve obtained by designating the pulse rate (PR) as an independent variable and SpO₂/PR as a dependent variable was calculated using the residual sum of squares and defined as the SpO₂ threshold (ST) (SpO₂-Slope method). A second bifurcation with ST as the origin was further defined (ST2). ST2 validity was assessed by comparing and analyzing the differences and correlations with each VT2 obtained by expiratory gas analysis. Results: The correlation between ST2 determined by the SpO₂-Slope method using PR as an index and VT2 obtained from respiratory gas analysis was significant, showing a positive correlation (r = 0.74~0.92; p < 0.01), with most data points falling within the 1.96 ± SD in the Bland–Altman analysis. Conclusions: ST2 values derived from SpO₂ and pulse rate measurements by pulse oximeter may be a valuable VT2 measuring method. Full article

Natural food colourants are gaining momentum in the food industry due to their clean-label appeal, safety, and potential health benefits. However, their practical application is often constrained by instability under environmental stressors such as pH fluctuations, heat, light, and oxygen. In response, both traditional and innovative strategies have emerged to improve pigment stability, with some studies reporting up to 50–80% retention of colour intensity under optimised conditions. Most existing research focuses on extraction, with limited emphasis on post-processing stability. This article reviews a wide range of food processing strategies aimed at enhancing the stability of natural pigments. It covers conventional and emerging approaches, including natural chemical stabilisers such as co-pigments, antioxidants, and metal ion chelators, physicochemical methods such as micro- and nanoencapsulation using biopolymers, and physical interventions involving drying technologies, particle size modification, and protective packaging. Modern technologies such as high-pressure processing, pulsed electric fields, ultrasound, and cold plasma are discussed as promising non-thermal alternatives, demonstrating 20–70% improvement in pigment retention compared to untreated controls. By integrating these diverse approaches, this article highlights current advancements, identifies knowledge gaps, and discusses future directions to support the development of stable, sustainable, and functional natural colourant systems for next-generation food products. Collectively, these approaches demonstrate significant potential to improve the performance and resilience of natural pigments in complex food systems. Full article

Monitoring vital signs in the Neonatal Intensive Care Unit (NICU) typically relies on wired skin sensors, which can limit mobility, cause skin issues, and interfere with parent–infant bonding. Wireless sensors offer promising alternatives, but evaluations to date often emphasize accuracy alone, lack NICU-specific validation, and rarely use standardized frameworks. Our objective was to develop and apply a comprehensive framework for evaluating the feasibility, safety, and accuracy of wireless monitoring technologies using a wireless pulse oximeter, the Anne limb (Sibel Health, USA), in real-world NICU conditions. A prospective study was conducted on a diverse NICU population. A custom system enabled synchronized data recordings from both standard and wireless devices. Feasibility was assessed as signal coverage across a variety of daily care activities and during routine procedures. Safety was evaluated through skin assessments after extended wear. Accuracy was examined sample-by-sample and interpreted using the Clarke Error Grid for clinical relevance. The wireless oximeter device showed high feasibility with reliable Bluetooth connection across a range of patients and activities (median wireless PPG coverage = 100%, IQR: 99.85–100%). Skin assessments showed no significant adverse effects. Accuracy was strong overall (median bias 1.34%, 95% LoA −3.63 to 6.41), with most data points within clinically acceptable Clarke error grid zones A and B, though performance declined for infants on supplemental oxygen. This study presents a robust, multidimensional framework for evaluating wireless monitoring devices in NICUs and offers recommendations for future research design and reporting. Full article

Background: Expert guidelines recommend using pulse oximetry (PO) in the delivery room to monitor oxygen saturation (SpO₂) and heart rate (HR). Umbilical cord pulse oximetry (UCP) is a novel concept that, despite being postductal, could provide accurate measurements of SpO₂ and HR, as it overcomes barriers associated with skin pigmentation. Methods: This pilot study used NONIN pulse oximetry on an intact umbilical cord that underwent deferred cord clamping (DCC) to evaluate umbilical cord SpO₂ in a preterm asphyxiated ovine model (N of 5) with an HR of <100 bpm. The UCP HR served as a surrogate marker for umbilical vessel flow. A receiver operator characteristic (ROC) curve was used to evaluate UCP parameters with arterial saturations (SaO₂) and carotid HR between 2 and 10 min. Results: Following asphyxia, five preterm lambs underwent DCC for 4 min. A significant relationship was noted between SaO₂ and umbilical SpO₂ (area under the curve (AUC) of 0.907, CI 0.857–0.968, p < 0.0001) along with carotid and umbilical HR (AUC) of 0.842 (CI 0.663–0.902, p < 0.0001). Conclusions: In a translational preterm model, UCP accurately predicted preductal SaO₂ and carotid HR (a surrogate for umbilical flow). Using UCP in the delivery room will help guide supplemental oxygen and determine the optimal duration of clamping the umbilical cord. These proof-of-concept studies/pilot findings require validation with larger animal cohorts and newborn infants. Full article

We determine the efficiency of generating singlet oxygen molecules through Raman excitation in distilled water. Focused nanosecond light pulses in the spectral blue region induce a Raman transition toward the singlet oxygen state, generating a Stokes signal in the red spectral region. The signal is proportional to the number of photons corresponding to the number of excited oxygen molecules. We calculate the efficiency by dividing the number of generated singlet oxygen molecules by the number of incoming pump photons, determining an efficiency of (8 ± 2) × 10⁻⁵ for water when pumping at 410 nm with a pulse energy of 13 mJ. We demonstrate that the Raman method results in no photobleaching, a phenomenon typically observed when photosensitizers are used. Thanks to this property, Raman excitation can continue for as long as the sample is irradiated, generating more singlet oxygen molecules over time than the photosensitization method. Full article

Background and Objectives: Despite the devastating impact of acute exacerbations of fibrotic interstitial lung diseases (AE-fILDs), established treatment strategies are majorly lacking. The therapeutic potential of intravenous immunoglobulin (IVIG) in AE-fILDs was explored considering its anti-inflammatory and immunomodulatory effects, as well as the immunocompromised status of fILD patients and the high frequency of infections that AE-fILDs triggers. Materials and Methods: This was an observational, retrospective study. We investigated the therapeutic potential of IVIG in patients hospitalized for AE-fILDs between May 2021 and November 2024. Results: We included 39 patients diagnosed with AE-fILDs. All patients received IVIG (total dose of 1 g/kg, divided into three daily doses), pulse corticosteroids for three days and broad-spectrum antibiotics. No adverse events were considered to be related to IVIG therapy during the study period. The in-hospital and the 90-day mortality were 10 (26%) and 13 (33%) patients, respectively. Twenty-nine patients (74%) were discharged and 18 of them (62%) were in need of long-term oxygen therapy. The mean PaO₂/FiO₂ ratio (P/F ratio) was 183 mmHg on admission and 294 mmHg on discharge (t-test, p < 0.0001). Conclusions: This study suggests a potential therapeutic signal, indicating that IVIG is a relatively harmless, well-tolerated, and a potentially effective add-on treatment to current therapeutic approaches. Further research is essential to clarify the role of IVIG, determine optimal treatment protocols, and assess its efficacy in different ILD subtypes. Full article

Oxidative stress is a major contributor to skin aging and related disorders. This study comparatively evaluated the bioefficacy of Schinus terebinthifolius Raddi leaf extracts prepared using three extraction techniques: conventional extraction (CE), accelerated solvent extraction (ASE), and pulsed electric field (PEF) extraction, with 50% (v/v) ethanol and water as green solvents. Among all tested conditions, the CE-derived extract (C-4), obtained with 50% (v/v) ethanol for 120 min, exhibited the highest extraction yield (29.7%). It also showed the highest total phenolic (668.56 ± 11.52 mg gallic acid equivalent (GAE)/g dry material (DM)) and flavonoid content (2629.92 ± 112.61 mg quercetin equivalent (QE)/100 g DM), and potent antioxidant activity against 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical (12,645.50 ± 60.31 µmol Trolox equivalent (TE)/g DM) and oxygen radical absorbance capacity assay (ORAC: 7180.27 ± 101.79 µM TE/100 g DM). Liquid Chromatography coupled with Mass Spectrometry (LC-MS) analysis revealed a diverse phytochemical profile rich in polyphenols, including gallic acid, p-coumaric acid, rutin, rosmarinic acid, caffeic acid, and epicatechin. Cellular assays in hydrogen peroxide (H₂O₂)-induced HaCaT keratinocytes demonstrated that C-4 extract significantly enhanced cell viability and upregulated endogenous antioxidant genes (superoxide dismutase (SOD1), catalase (CAT), glutathione peroxidase (GPX)), with effects comparable to established antioxidants such as epigallocatechin gallate (EGCG) and ascorbic acid. These findings highlight the influence of extraction parameters on phytochemical yield and biological activity, supporting the potential application of CE-derived S. terebinthifolius extracts as effective, sustainable ingredients for cosmeceutical formulations targeting oxidative stress-mediated skin aging. Full article