Search Results (539)

Introduction/Objectives: Although contemporary guidelines strongly support intensive low-density lipoprotein cholesterol (LDL-C) lowering and the use of advanced lipid biomarkers for cardiovascular risk stratification, implementation in daily clinical practice remains inconsistent. This study aimed to assess current practices, knowledge, and perceived barriers in dyslipidemia management across medical specialties. Methods: We conducted a cross-sectional, anonymous online survey from August to September 2025 among physicians actively involved in lipid management. The questionnaire evaluated the use of Systematic Coronary Risk Evaluation 2 (SCORE2)-based risk assessment, familiarity with LDL-C targets, treatment intensification strategies, awareness and use of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)], perceived barriers to LDL-C goal attainment, and responses to a standardized clinical vignette. Descriptive analyses and chi-square testing were conducted. Results: Ninety-five physicians completed the survey, the majority practicing in Europe (92.7%), including 83.2% from Portugal (41.1% general practice/family medicine; 14.7% cardiology; 14.7% internal medicine/geriatrics; 14.7% vascular surgery; 9.5% endocrinology). SCORE2 calculators were used “often” or “always” by 52.6%, with significant inter-specialty variation (p < 0.001). Familiarity with LDL-C targets was high (76.8%), and 89.4% reported frequent therapy intensification when goals were not achieved; however, consistent escalation (“always”) differed markedly across specialties (p < 0.001). Although 69.5% were aware of recommendations for lifetime assessment of apoB/non–HDL-C/Lp(a), only 17.9% implemented them routinely. Most clinicians reported never or rarely using advanced biomarkers for residual risk assessment, and in a clinical vignette only 12.6% would consistently intensify therapy despite elevated Lp(a) and apoB (p = 0.004). Patient non-adherence (86.3%) was the most frequently perceived barrier. Conclusions: Despite the widespread awareness of LDL-C targets, important gaps persist in the consistent application of guideline-directed therapy and in the use of advanced biomarkers. The underutilization of apoB and Lp(a), together with therapeutic inertia and structural barriers, limits effective residual risk management. Bridging this gap will require coordinated efforts focused on implementation, access, and multidisciplinary care. Full article

Introduction: Optical coherence tomography (OCT) is the gold standard for retinal nerve fibre layer (RNFL) assessment; its high cost and limited accessibility hinder widespread use. This study aims to develop deep learning models that generate RNFL thickness maps from fundus images, providing a cost-effective alternative to OCT. Methods: A dataset of 5000 fundus-OCT image pairs from 5000 unique glaucoma patients was used to train and compare the following four U-Net-based deep learning models: ResU-Net, R2U-Net, Nested U-Net, and Dense U-Net. All models were trained for up to 1000 epochs with early stopping (patience = 50 epochs). Performance was evaluated using Mean Squared Error (MSE), Mean Absolute Error (MAE), Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), and Fréchet Inception Distance (FID). Results: ResU-Net demonstrated the best performance, achieving MSE = 0.00061, MAE = 0.01877, SSIM = 0.9163, PSNR = 32.19 dB, and FID = 30.08. These results represent a 108% improvement in SSIM and a 67% improvement in PSNR compared to previously published benchmark for this task. Conclusions: This study demonstrates that deep learning models, particularly ResU-Net, can generate high-fidelity RNFL thickness maps from fundus photographs, substantially outperforming prior published benchmarks. This approach represents a potential contribution toward accessible glaucoma assessment, contingent upon prospective clinical validation and regulatory evaluation. Full article

Obesity is considered a chronic disease that co-occurs with other disorders, including type 2 diabetes; therefore, the prevention and treatment of obesity are of utmost importance. The present review analysed the effects of bioactive compounds found in culinary herbs on the regulation of inflammatory processes through the modulation of inflammation and microbiota-dependent metabolic pathways. A total of 137 publications from 2010 to 2025 were reviewed. Few studies address the impact of culinary herbs on the gut microbiota in relation to obesity; however, analysing data on the effects of active compounds present in various herbs allows an assessment of their potential role in obesity prevention. This is a significant issue, as obesity is widespread, and the introduction of readily usable everyday food products may represent an important element of preventive strategies. Plant secondary metabolites, such as polyphenols, saponins, alkaloids, and flavonoids, exert strong antioxidant and anti-inflammatory activity, thus contributing to their beneficial effects on human health. Effective weight loss depends on the consistent maintenance of a healthy lifestyle, a requirement that can often be highly challenging. The daily use of herbs in meal preparation may reduce the risk of developing obesity or mitigate its severity. Herbs enhance the flavour of dishes and, additionally, help to reduce salt intake, thereby lowering the risk of cardiovascular disease, which is also an integral component of a healthy lifestyle. Full article

Endocrine-disrupting chemicals (EDCs) perturb hormonal homeostasis, dysregulating multiple biological pathways and subsequently resulting in adverse health outcomes, including impaired reproductive function. Bisphenols represent an important subclass of EDCs with widespread use in polycarbonate plastics, thermal paper formulations, epoxy resins, and various everyday consumer products. Bisphenol A (BPA) was the first bisphenol to be synthesized, with extensive industrial applications. However, the concerns over its potential health risks, most notably reproductive dysfunction, prompted the development and introduction of several structurally related BPA analogues. That said, studies on the potential hormonal effects of these BPA analogues remain limited. Therefore, strengthening the evidence base on their reproductive safety evaluation remains an essential priority for ensuring their safe application, and this study contributes to that broader objective. The study aimed to explore the potential endocrine-disrupting activity of two commonly used BPA analogues, bisphenol F (BPF) and bisphenol S (BPS), on reproductive hormone signalling, contributing to ongoing safety assessment efforts. The molecular interactions of these analogues with the estrogen receptor-α (ERα) and estrogen receptor-β (ERβ) were analyzed through structural binding characterization employing the induced fit docking (IFD) approach using the Schrödinger 2019 suite. The overall results revealed that the two indicated BPA analogues were placed successfully in the ligand-binding pockets of ERα and ERβ. Their binding pattern and molecular interactions showed certain similarities; however, they did not fully replicate the amino acid residue environment of the native ligands of ERα and ERβ, estradiol. Notably, the binding energy estimations revealed that BPF and BPS showed substantially lower values than those calculated for native ligands of ERα and ERβ. In summary, this study suggests that BPF and BPS exhibit lower predicted binding affinity toward ERα and ERβ under the applied molecular docking conditions. However, these computational findings do not establish receptor activation, endocrine potency, or safety outcomes, and the potential involvement of other reproductive signalling pathways warrants further investigation. Full article

Introduction: Pelvic floor disorders (PFDs) are a very widespread clinical phenomenon and are known to affect millions of women worldwide, significantly impairing their quality of life. New technologies and innovations such as electrotherapy and photobiostimulation are currently revolutionizing what concerns conservative treatment, allowing clinicians to tailor therapy to every woman. The aim of this study was to evaluate the feasibility of use of electrotherapy and photobiostimulation in PFD management and the initial results of treatment in clinical practice. Methods: This prospective study (IRB code: GSM-RF 2025) aimed to analyze the impact of the innovative DAFNE system to treat PFDs through electrotherapy and photobiostimulation. We enrolled patients with mild pelvic organ prolapse and stress urinary incontinence who desired a conservative treatment for their conditions. The following validated scales were used for assessing baseline quality of life before and after treatment: Urinary Distress Inventory-6 (UDI-6), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Female Sexual Function Index-6 (FSFI-6), 0–100 VAS Scale, and Vaginal Health Index. Electrotherapy was delivered through 4 gold rings, providing Functional Electrical Stimulation (FES), Transcutaneous Electrical Nerve Stimulation (TENS) and/or Microcurrent Electrical Neuromuscular Stimulation (MENS). The photobiostimulation system consisted of 24 LEDs per wavelength (420 nm UVA; 630 nm RED; 870 nm NIR/INFRARED) positioned at 360° along the entire length of the handpiece for antimicrobial purposes, microcirculation improvement, and anti-inflammatory action. The cycle of treatment consisted of 3–5 sessions, according to necessity. Overall improvement was measured through the Patient Global Impression of Improvement (PGI-I). Statistical analysis was performed using Student’s t-Test. A value of p < 0.05 was considered as significant. Results: In the period of interest, 32 women were treated with the DAFNE system. The mean age was 57.0 ± 16.6 years. Indications for treatment were stress urinary incontinence (16/32), mild pelvic organ prolapse (14/32), or both (2/32). The mean number of treatments per patient was 4. Quality of life improved as a consequence of the treatment according to the considered scales. Specifically, 87.5% of patients considered themselves improved. Conclusions: The DAFNE system has been successful in managing mild pelvic organ prolapse and stress urinary incontinence, improving quality of life scores. Embracing new technologies such as electrotherapy and photobiostimulation appears to be successful in conservatively managing a variety of PFDs. Full article

Introduction: Clinical diagnosis of chronic heart failure (HF) in ambulatory patients can be difficult. Echocardiography is the most widespread diagnostic imaging technique, although the usefulness of the global longitudinal strain (GLS) of the left ventricle (LV) in this clinical setting is less clear. Methods: We performed a cross-sectional study of stable outpatients and GLS was obtained with an automatic software that uses the three apical planes of the LV. We analyzed the improvement of the diagnostic capacity of including GLS above all the clinical and echocardiographic parameters using reclassification indexes. Results: We included 1362 patients, including 12.9% with HF who presented lower values of ejection fraction (EF) and GLS and worse diastolic function. Most patients (92.8%) with HF had a GLS < −14 as compared to patients without HF (36.1%). LV EF (OR: 0.93) and GLS (OR: 1.27 CI 95% 1.20–1.35) were associated with the presence of HF. The AUC was significantly higher (p < 0.001) in the logistic model that included GLS vs. without GLS, and the reclassification index for GLS was 19.8%. GLS was more affected in patients with HFpEF vs. controls as well as diastolic function parameters. The logistic regression model only identified age (OR: 1.07 95% CI 1.02–1.06) and GLS (OR: 1.29 95% CI 1.21–1.38) as independently associated with the presence of HFpEF. The AUC of the model for the presence of HFpEF with GLS was significantly higher (p < 0.01). The reclassification index for GLS was 38.8%. Conclusions: LV GLS assessment increased the diagnostic discrimination of chronic HF in stable patients. Full article

Confocal laser endomicroscopy (CLE) is an innovative diagnostic modality that facilitates real-time in vivo optical biopsies of various tissues within luminal and ductal structures. Since its introduction in 2004, the application of this tool has broadened from diagnostic purposes to encompass management and prognostic evaluation in fields such as gastroenterology, neurosurgery, urology, and dermatology. This comprehensive review examines the current applications of endomicroscopy in Barrett’s esophagus (BE), inflammatory bowel disease (IBD), and colorectal lesions. Evidence from the literature suggests that CLE offers a potential solution to the diagnostic limitations associated with white-light endoscopy and histology. With a diagnostic accuracy nearly equivalent to that of histology, CLE is emerging as a promising tool to mitigate the delays related to awaiting histology results for clinical and therapeutic decision-making. However, its use is mainly as a complementary diagnostic method rather than an alternative to histopathology or other ancillary studies. Nevertheless, its widespread adoption remains limited, and further research is necessary to ascertain its overall benefits and cost implications of integrating it into patient care. Full article

Enterobiasis, caused by the nematode Enterobius vermicularis, remains a widespread public health issue, yet data regarding its genetic structure in Southeast Europe are scarce. This study presents the first molecular and phylogenetic characterization of E. vermicularis isolates from Bulgaria. Between 2022 and 2025, perianal tape test samples were collected from 128 individuals (92.2% of whom were children) with enterobiasis from 17 regions of the country. Molecular identification was performed via nested PCR targeting a 324 bp fragment of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene, followed by Sanger sequencing. Phylogenetic relationships were analyzed using Maximum Likelihood (IQ-TREE), and population genetic indices were calculated using DnaSP v6. Phylogenetic analysis revealed that all 128 Bulgarian isolates belong to genotype B, clustering closely with sequences from other European and Asian countries. Genetic diversity analysis showed remarkably low variation, with a haplotype diversity (Hd) of 0.1507 ± 0.0416 and a nucleotide diversity (π) of 0.00082 ± 0.00015. Among the 11 identified haplotypes, a single dominant haplotype (Hap_1) accounted for 92.2% of all samples and was distributed across all sampled geographic regions. Tajima’s D was significantly negative (−2.314, < 0.05), suggesting a recent population expansion or purifying selection. The dominance of genotype B and the extremely low genetic diversity suggest a recent introduction or clonal expansion of E. vermicularis in Bulgaria. These findings provide essential baseline data for monitoring transmission dynamics and implementing effective control strategies in the Balkan region. Full article

Vulvovaginal candidiasis (VVC) represents a widespread gynaecological challenge, affecting approximately 75% of women at some point during their reproductive years, with a significant subset progressing to recurrent forms (RVVC). Classical azoles and polyenes remain the cornerstone of therapy. However, their clinical utility is undermined by the rise of azole-resistant non-Candida albicans species, the capacity of Candida to form biofilms, and a complex variety of host-related factors that complicate disease expression and therapeutic response. This narrative review provides a critical up-to-date examination of the therapeutic landscape, integrating current diagnostic algorithms with pharmacological strategies for both acute, recalcitrant and recurrent VVCs. We assess the efficacy and safety of established antifungal agents alongside the breakthrough introduction of novel drug classes, with a particular interest in the oral triterpenoid ibrexafungerp and the tetrazole oteseconazole, which offer new mechanisms of action for cases that fail to respond to standard regimens. Furthermore, we address the management of a special clinical scenarios, including pregnancy and lactation, and explore promising emerging innovative approaches such as mucoadhesive formulations, immunomodulatory approaches, and alternative non-antifungal therapies. Ultimately, this review aims to support clinical decision-making by balancing the accessibility and user-friendliness of conventional treatments with the targeted precision offered by modern antifungal agents. Full article

Introduction: Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), has demonstrated unprecedented efficacy in the treatment of type 2 diabetes mellitus (T2DM) and obesity. However, its rapid clinical widespread use has ignited a debate regarding long-term safety, particularly concerning the risk of specific neoplasms and its ability to modulate cardiovascular health, not only as primary prevention but also as a potential agent to mitigate cardiotoxicity. Objectives: This narrative review aims to analyze the most recent evidence from clinical trials and post-marketing surveillance to evaluate the correlation between semaglutide use and the incidence of cancer, as well as the drug’s efficacy in reducing cardiotoxicity induced by anticancer therapies. Results and Discussion: While preclinical rodent models suggested a link to medullary thyroid carcinoma, human epidemiological data remain reassuring, though caution is advised in patients with genetic predisposition. Regarding pancreatic cancer, current meta-analyses do not confirm a significant increase in risk, suggesting that metabolic benefits outweigh potential concerns. Conclusions: Semaglutide is confirmed as a therapeutic tool with a highly favorable benefit–risk profile. While oncological monitoring must continue, the drug’s cardioprotective and anti-inflammatory properties open new frontiers not only in metabolic management but also in safeguarding cardiovascular integrity in complex clinical scenarios. Full article

The stream pipeline idiom provides a fluent and composable way to express computations over collections. It gained widespread popularity after its introduction in .NET in 2005, later influencing many platforms, including Java in 2014 with the introduction of Java Streams, and continues to be adopted in contemporary languages such as Kotlin. However, the set of operations available in standard libraries is limited, and developers often need to introduce operations that are not provided out of the box. Two options typically arise: implementing custom operations using the standard API or adopting a third-party collections library that offers a richer suite of operations. In this article, we show that both approaches may incur performance overhead, and that the former can also suffer from verbosity and reduced readability. We propose an alternative approach that remains faithful to the stream-pipeline pattern: developers implement the unit operations of the pipeline from scratch using a functional yield-based traversal pattern. We demonstrate that this approach requires low programming effort, eliminates the performance overheads of existing alternatives, and preserves the key qualities of a stream pipeline. Our experimental results show up to a 3× speedup over the use of native yield in custom extensions. Full article

Maritime nations around the world proactively engage in preparedness, response, and recovery activities related to marine oil spills. In addition to an individual nation’s capabilities, there are a number of response organizations that are actively engaged in the surveillance, monitoring, and remote sensing of spilled oil. A global survey was conducted of these organizations to better understand surveillance/remote sensing capabilities operationally employed today from four aerial platforms: satellites, fixed-wing aircraft, helicopters, and remotely piloted aircraft systems (RPASs). Satellite remote sensing continues to be used for both routine surveillance of coastal environments and in support of response to oil spills. Additionally, there is a strong continued use of fixed-wing aircraft, and in some cases helicopters, particularly to support operational response to oil spills. Many of these fixed-wing aircraft are outfitted with sensor suites optimized for oil spill detection and documentation. Of particular interest is the recent introduction and widespread use of RPASs for the response of marine oil spills and oiled shorelines. Respondents identified operational gaps in remote sensing capabilities to support oil spill response, including the accurate measurement of oil spill thickness and volume, differentiation between petroleum oil and biogenic materials, and the detection of water-in-oil emulsions. Survey respondents also shared remote sensing capabilities used for oiled shorelines, as well as identifying research and operational gaps in the surveillance of oil spills. Full article

Aquatic ecological issues have garnered significant attention in recent years, driving the demand for convenient, effective, and systematic assessment methods in environmental risk evaluation. This review provides a comprehensive introduction to methodologies for assessing the toxicity of chemicals toward aquatic microorganisms, which include viruses, bacteria, fungi, protozoa, and algae. Among these, microalgae are commonly used as model organisms due to their relative simplicity. The article details conventional biological methods, general chemical techniques, modern instrumental analyses, and informatics approaches, with a particular focus on algae and bacteria as model organisms for toxicity assessment. The principles, advantages, and limitations of each method are discussed, along with examples of their application in various contexts. Biological methods offer direct visualization, convenience, and rapid results, while modern instrumental techniques enable mechanistic insights at molecular and biochemical levels. Informatics methods facilitate toxicity evaluation in complex systems. While aquatic microorganisms encompass viruses, fungi, protozoa, bacteria, and algae, this review primarily focuses on bacteria and algae as model organisms due to their ecological relevance, sensitivity, and widespread use in standardized assays. Full article

Land degradation issues are getting complicated worldwide. Kazakhstan’s land use has sharply deteriorated over several decades, necessitating comprehensive assessment and restoration. Farmlands in Kazakhstan are grappling with multiple challenges related to climate change, intense anthropogenic disturbances, and aggressive industrial agricultural practices involving monoculture crop production. Soil depletion is widespread in Kazakhstan due to flood erosion and drought expansion, causing desertification. The land sustainability of farmland improvement, including the soil, geology, and water retention assessment, is currently under investigation through our project activities in North Kazakhstan. Nature-based methods for forest plantation along contour strips and topography-based design landscapes are rarely applied or are absent in many rural areas these days. The land use issues have resulted in the loss of the soil moisture protective functions and a reduction in agricultural efficiency. Geodesy geomatics tools were applied for a topography investigation with digital elevation, digital terrain model preparation, and potential retention ponds’ location identification for managed aquifer recharge introduction. The combination of effective water accumulation methods, considering topography, with the development of protective forest shelterbelts should enhance the land use strategies for sustainable development. This strategy is expected to reduce soil erosion, promote moisture accumulation, by improving the soil’s quality as a sponge in water collection, and increase crop yields. Alongside this, a system for developing the retention ponds with managed aquifer recharge locations for proper water collection to improve the agrolandscapes was presented. Full article

Introduction: Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system, frequently associated with visual and oculomotor disturbances. Quantitative analysis of eye movements represents a non-invasive method for assessing central nervous system dysfunction beyond conventional imaging; however, the diagnostic and predictive value of oculomotor metrics remains insufficiently defined. Objectives: The aims of this study were to compare smooth pursuit gain and reflexive saccade parameters (latency, velocity, and precision) between individuals with MS and healthy controls, and to evaluate their ability to discriminate disease status. Methods: This cross-sectional study included 46 clinically stable patients with MS (EDSS ≤ 6.5) and 46 age- and sex-matched healthy controls. Oculomotor function was assessed using videonystagmography under standardized conditions. Group differences across horizontal and vertical gaze directions were analyzed using linear mixed-effects models. Random forest models were applied to assess the discriminative performance of oculomotor parameters, with permutation-based feature importance and receiver operating characteristic (ROC) curve analysis. Results: Patients with MS showed significantly reduced smooth pursuit gain across most horizontal and vertical directions compared with controls. Saccadic latency was significantly prolonged in all tested movement directions. Saccadic velocity exhibited selective directional impairment consistent with subtle medial longitudinal fasciculus involvement, whereas saccadic precision did not differ significantly between groups. A random forest model combining pursuit and saccadic parameters demonstrated only moderate discriminative performance between MS patients and controls (AUC = 0.694), with saccadic latency contributing most strongly to classification. Conclusions: Quantitative eye-movement assessment revealed widespread oculomotor abnormalities in MS, particularly reduced smooth pursuit gain and prolonged saccadic latency. Although the overall discriminative accuracy of oculomotor parameters was limited, these findings support their potential role as complementary markers of central nervous system dysfunction. Further longitudinal and multimodal studies are required to clarify their clinical relevance and prognostic value. Full article