Cardiac metastases are uncommon clinically, and intracavitary right ventricular involvement from gynecologic malignancies is exceedingly rare. We report a 69-year-old woman with multiple cardiovascular comorbidities and a recently diagnosed FIGO (International Federation of Gynecology and Obstetrics) grade 3 endometrioid carcinoma after having an exploratory laparotomy for a pelvic mass, resulting in total hysterectomy and bilateral salpingo-oophorectomy, with findings consistent with an ovarian mass and biopsy results showing endometrioid carcinoma. She was referred to the hospital after routine oncologic imaging raised concern for a right ventricular mass with associated thrombus. This patient had no symptoms on initial presentation and underwent further evaluation in the inpatient setting. Cardiac magnetic resonance imaging demonstrated a right ventricular structure extending into the right ventricular outflow tract with suspected enhancement at the attachment site to the interventricular septum, concerning for intracardiac metastatic disease with superimposed thrombus. Computed tomography of the chest demonstrated innumerable pulmonary nodules, concerning for hematogenous dissemination. Given prohibitive operative risk, surgical resection was deferred, and this was treated as presumed intracardiac metastasis with superficial thrombus. The patient was started on Warfarin for anticoagulation due to the cost-prohibitive effects of DOAC (direct oral anticoagulant) for the thrombotic component and discharged with oncology follow-up. This case highlights an exceptionally rare pattern of gynecologic malignancy involving the right ventricle, with diagnostic and therapeutic challenges related to distinguishing tumor from thrombus and balancing embolic risk against surgical morbidity.
Endometrial cancer is among the most commonly diagnosed malignant neoplasms of the female reproductive system, with peak incidence occurring in the perimenopausal and postmenopausal periods. The pathogenesis of this disease is multifactorial and associated with several well-established risk factors, including hormonal imbalance, obesity, and late onset of menopause. We report the case of a 64-year-old woman diagnosed with grade I endometrioid adenocarcinoma, stage IA according to the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification. The patient initially underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. More than three years after surgery, disease recurrence was detected during routine follow-up. Subsequent molecular analysis revealed a loss-of-function mutation in the NF1 (neurofibromin 1) gene. Based on the molecular profile of the tumor, the patient was qualified for off-label targeted therapy with everolimus, an inhibitor of the mammalian target of rapamycin (mTOR) pathway. Treatment with everolimus resulted in complete remission, which has been sustained to date. However, therapy was associated with significant metabolic toxicity, including severe dyslipidemia requiring pharmacological management, ultimately leading to treatment discontinuation. To our knowledge, this is the first case report to demonstrate a successful mutation-driven therapeutic decision in this specific clinical setting of endometrioid adenocarcinoma, where the identification of a pathogenic NF1 loss-of-function mutation provided the only viable targeted pathway in a tumor lacking standard biomarkers such as estrogen or progesterone receptor expression or microsatellite instability. This case serves as a paradigm for mechanism-driven precision oncology, illustrating that everolimus monotherapy can achieve durable clinical benefit in NF1-deficient recurrent endometrial cancer, with remission persisting even after treatment discontinuation. These findings highlight the clinical relevance of comprehensive molecular diagnostics and support the integration of personalized treatment strategies into modern gynecologic oncology.
River biofilms are frequently exposed to invasion by antibiotic-resistant bacteria (ARB) due to episodic or chronic wastewater inputs, yet the ecological processes governing the fate of invaders and their resistance plasmids remain poorly understood. We experimentally exposed river-grown biofilms from sites differing in microbial diversity and wastewater impact to a genetically tagged ARB Escherichia coli carrying a transferable IncPα plasmid with the nptII resistance gene. Over two weeks, we tracked invader and plasmid dynamics using qPCR and plasmid-to-genome ratios as a proxy for horizontal gene transfer (HGT), complemented by 16S rRNA gene sequencing and metagenomics. Both quantification approaches yielded consistent results: the invader transiently established in all biofilms, peaking within 48 h and declining to near-background levels after 14 days. Decreasing plasmid-to-genome ratios indicated limited HGT and progressive plasmid loss. Biofilms impacted by wastewater showed slower declines, suggesting greater plasmid persistence in disturbed environments and increased abundance of specific indigenous antimicrobial resistance genes of public health concern. While the overall resistome exhibited short-lived shifts, and indigenous resistomes remained largely stable. These findings demonstrate that invader-biofilm interactions are dynamic and shaped by community context, supporting the One Health framework and highlighting how environmental conditions modulate antimicrobial resistance risks in freshwater ecosystems.
Interprofessional education (IPE) prepares healthcare professionals (HCP) for interprofessional collaborative practice (IPCP) by fostering knowledge, skills, values, and attitudes. Attitudes trigger approach or avoidance motivation, making engagement with IPCP more likely when HCPs hold positive attitudes. As research has struggled to consistently demonstrate a positive, long-term impact of IPE on healthcare students' attitudes, we investigated attitude development longitudinally in three undergraduate cohorts studying to become dieticians, midwives, nurses, or physiotherapists at a university of applied sciences in Switzerland. Specifically, we examined (1) whether related interprofessional attitude dimensions influenced each other over time, (2) how stable these dimensions were, (3) the impact of student characteristics, and (4) whether attitudes improved across time. We conducted a longitudinal study using structural equation modeling (SEM) to estimate cross-lagged panel models (CLPM) based on two out of three dimensions of the German version of the Interprofessional Attitudes Scale (G-IPAS): Teamwork, Roles, Responsibilities (TRR) and Community-Centeredness (CC). Of 879 undergraduate students who began their studies between 2018 and 2021, 234 provided data at least twice and were included in the final analyses. No cross-lagged effects were found between TRR and CC, however they showed moderate to moderate-to-strong stability across time. Student characteristics influenced attitudes: semester of study was positively associated with CC, male sex was negatively associated with CC, dietetics students reported more positive CC attitudes, and physiotherapy students reported more negative TRR attitudes. TRR attitude scores decreased significantly over time, while a change in CC could not be verified due to inadequate model fit. IPE did not produce the expected positive effect on interprofessional attitude development during undergraduate healthcare studies, in contrast to much previous research. The absence of reciprocal effects between attitude dimensions across time may indicate that they are serving different underlying psychological functions, with TRR being more utilitarian and CC being more value-oriented. Tailoring IPE curricula to the underlying psychological functions that interprofessional attitudes serve in different learner groups may enhance their effectiveness, thereby fostering positive and durable attitudinal change.
Amputation is one of the leading causes of permanent physical disability. Adjustment to amputation and prosthesis use involves complex physical and psychosocial challenges. To investigate the associations between physical activity, psychosocial adjustment, and prosthesis satisfaction in people with lower limb amputation. Ninety-three people with lower limb amputation were initially recruited; however, 64 remained in the final sample, with a mean age of 50.29 ± 14.29 years. Physical activity was assessed using the Physical Activity Scale for Individuals with Physical Disabilities; psychosocial adjustment, restriction to activities, and prosthesis satisfaction were assessed using the Trinity Amputation and Prosthesis Experience Scale - Revised. Associations were identified between physical activity and social adjustment, restriction to physical activity, and aesthetic satisfaction with the prosthesis. Age and use of walking aid devices were also significant predictors, with these variables collectively accounting for 34% of the variance in physical activity (R2 = 0.34; F = 5.46; p < .001). Greater social adjustment and higher aesthetic prosthesis satisfaction were associated with higher physical activity levels among people with lower limb amputations. Moreover, ambulation without assistive devices was associated with higher physical activity; conversely, as age advances, physical activity in this population tends to decline.
Error-related potentials (ErrPs) have been studied to evaluate wrong decisions or actions in several contexts. An ErrP is an electrical potential on the scalp generated by the perception of errors and occurs unwittingly. In human-robot collaboration (HRC), ErrP detection can be used to trigger a feedback or an action to adapt the system to the user. This contributes to the improvement of HRC, taking into account user performance. However, to our knowledge, the detection of ErrPs in HRC has not been widely explored, resulting in only a few studies. This systematic review will present work on ErrP-based interfaces related to adaptation, control, and neuroergonomics for HRC. Thirteen articles were included after the exclusion criteria of the review stages. The average accuracy of ErrP detection was between 54 and 87.2%. In most cases, the authors simulated the occurrence of unexpected behavior of the robot. The robot mistakes occurred randomly between 20 and 35% of the total trials. Some works focused on the robot learning process and adaptation between humans and robots. The mental model and the robot behavior policy were updated based on the decoded ErrPs during collaborative interactions. Control-related works have included ErrPs detection/features as input inside the control loop or algorithm. Other studies assessed the influence of mental workload variability in the adaptation process, given that a high mental workload affects the cognitive processes needed to perceive errors. Thus, ErrPs present advantages for enhancing HRC, and this review opens the way to further developments in the robotic domain.
This study aimed to evaluate the association between anxiety symptom levels and grazing behavior in individuals with type 2 diabetes. It employed a cross-sectional, descriptive, and analytical design, conducted between August 2023 and June 2024 at a public hospital. The sample consisted of 157 individuals with type 2 diabetes, aged 20 to 64 years, of both sexes, who had been receiving care from the hospital's endocrinology department for at least one year. The Beck Anxiety Inventory was used to assess the severity of anxiety symptoms, while the Repetitive Eating Questionnaire measured the frequency of grazing behavior. In the anthropometric assessment, most participants were classified as overweight; however, arm circumference measurements indicated a higher prevalence of eutrophy. Neck circumference results revealed that the majority of participants were at increased cardiovascular risk. Furthermore, a negative correlation was found between glycated hemoglobin levels and arm circumference values. On average, participants had been living with diabetes for 11± 8.3 years. Most were using insulin and did not have access to ongoing nutritional counseling. The majority had fasting blood glucose levels above the recommended threshold, a pattern also reflected in their glycated hemoglobin levels. A positive correlation was identified between anxiety symptom scores and glycated hemoglobin levels. Although most participants exhibited minimal anxiety symptoms, the total anxiety score showed a statistically significant positive correlation with grazing behavior scores. This study is particularly relevant as it highlights the importance of understanding the relationship between psychological distress and maladaptive eating behaviors, which may compromise effective diabetes management.
Effectiveness of health systems is achieved through universal coverage, while efficiency is reached by minimizing the cost of delivery. This study presents a novel analysis for designing national health systems, considering workforce, equipment, global costs and accessibility in different geographical contexts. Designed to be a medium- and long-term strategic planning tool, our model offers a practical solution by assessing projected health infrastructure and resources and evaluates health requirements using data from the OECD, the World Bank, OpenStreetMap, and national health statistics. Applied to Brazil, Finland, and France, the analysis is in line with UN Sustainable Development Goal 3.8 and the WHO's Human Resources for Health strategy. The findings suggest that regions with dispersed populations, such as central-western Brazil and northern Finland, would benefit from small hospitals, clinics and health centers. Brazil should hire more health professionals, purchase more radiotherapy equipment and invest $7.95 billion in logistics to reduce patient travel times, particularly for the 1,222 municipalities most affected by low accessibility. Finland would benefit from additional hospital beds and CT scanners, while France could benefit from a more centralized health care model, with municipalities providing all levels of care. France should also invest more in nursing staff and mammography equipment.
The aim of this review is to synthesize current evidence on the interaction between Hippo-YAP signaling and EMT in the malignant transformation of oral potentially malignant disorders (OPMDs) to oral squamous cell carcinoma (OSCC) and to examine their potential utility as biomarkers and therapeutic targets. Design: Following PRISMA 2020 guidelines, five electronic databases (PubMed, Web of Science, Scopus, LIVIVO, and Embase) were utilized for this search. Eligible studies included human tissue-based investigations and complementary in vitro experiments evaluating YAP/TAZ or EMT markers in OPMDs and OSCC. Risk of bias was assessed using QUIN, SYRCLE, and JBI tools. From 2,208 records, 12 studies (26 datasets) were included. Across study designs, Hippo-YAP dysregulation and EMT activation were consistently observed across the normal to OPMD to OSCC progression. YAP nuclear localization correlated with reduced E-cadherin and increased vimentin, N-cadherin, Snail, and Slug expression. Crosstalk between YAP and MAPK/ERK, PI3K/Akt/mTOR, and Wnt/β-catenin pathways further amplified EMT signaling. High YAP, hTERT, circEPSTI1, and SNAI2 expression, together with low KLK6, were associated with poor prognosis and increased malignant transformation risk. Pharmacologic inhibition of PI3 K/mTOR, MEK/ERK, or LSD1 reversed EMT phenotypes in experimental models. Conclusion: Integrated activation of Hippo-YAP and EMT pathways is a pivotal event in OPMD-OSCC progression. YAP-centered EMT regulation shows promise as both a biomarker of malignant potential and a therapeutic target for chemoprevention and early intervention.
Opioid-induced "nodding" is commonly misinterpreted as benign sleep but represents a high-risk state of fluctuating consciousness caused by drug-induced respiratory depression. This condition may lead to progressive hypoxia and hypercapnia without normal protective arousal. In the fentanyl era, nodding may reflect a subclinical overdose, with a dangerously narrow transition between sedation and fatal respiratory failure, particularly when opioids are combined with alcohol, benzodiazepines, or other sedative agents. We utilized PUBMED to adopt various works linked to this important topic. Accumulating clinical and neuroimaging evidence suggests that repeated non-fatal overdose events and nodding episodes may contribute to cumulative hypoxic-ischemic brain injury, hippocampal volume loss, and persistent cognitive impairment. Current surveillance systems largely emphasize mortality, thereby underestimating the neurological burden among survivors. Public health and clinical frameworks should redefine nodding as a sentinel respiratory-compromise state and prioritize early intervention, expanded reporting, and improved harm-reduction strategies.
Berberis turcomanica, commonly known as the Turcoman Barberry, is a lesser-studied deciduous shrub of the Berberidaceae family, primarily distributed in Central Asia with its heartland in Turkmenistan. The extracts of the berries of Berberis turcomanica (BTB) were subjected to in vitro assays to assess antioxidant capacity (DPPH, ABTS, FRAP, CUPRAC), enzyme inhibitory activities (acetylcholinesterase, butyrylcholinesterase, tyrosinase, α-amylase, and α-glucosidase), antimicrobial potential (against selected bacterial and fungal strains), and cytotoxic effects on human HaCaT cell lines. Among the 28 chemical constituents analyzed using UHPLC-DAD-QqQ-MS/MS. The extracts exhibited strong antioxidant activity, supported by high total phenolic and flavonoid contents. Significant enzyme inhibition, particularly against tyrosinase and α-glucosidase, suggests potential applications in managing hyperpigmentation and diabetes. Both fruit extracts also exhibited promising antibacterial effects against several bacterial strains and moderate antifungal activity; however, the extracts demonstrated low cytotoxicity toward non-cancerous human keratinocyte HaCaT cells, with IC50 values exceeding 400 µg mL-1, indicating a favorable safety profile and good biocompatibility under the tested conditions. Molecular docking, MD simulation-based analyses, and DFT calculations provided supportive insights into the potential activities of selected individual compounds identified in the extracts, partially complementing the experimentally obtained findings. These results present the first detailed pharmacological and chemical investigation of B. turcmanica berries in two extraction methods and support their potential use as a multifunctional natural agent in pharmaceutical and nutraceutical applications.
To evaluate the clinical and functional outcomes of patients who underwent fixation of traumatic osteochondral knee fractures using autologous bone pegs. We conducted a retrospective cross-sectional study including 11 patients who underwent surgery between 2021 and 2024. Clinical, radiographic, and functional outcomes were evaluated during a mean follow-up of 33.9 ± 10.6 months, including functional assessment using the International Knee Documentation Committee (IKDC) Subjective Knee Form. The mean patient age was of 20.3 ± 5.4 years, with a predominance of patellar lesions (81,8%). The radiographic evaluation demonstrated consolidation of the osteochondral fragment in all cases, without signs of displacement or fixation failure. The mean IKDC score was of 75.0 ± 17.1 points. There were no major complications or reoperations. Fixation of traumatic osteochondral knee fractures with autologous bone pegs resulted in adequate consolidation and satisfactory functional outcomes in this case series, representing a safe, effective, and low-cost biological alternative to manage these lesions. Avaliar os desfechos clínico-funcionais de pacientes submetidos à fixação de fraturas osteocondrais traumáticas do joelho com palitos ósseos autólogos. Realizamos um estudo retrospectivo transversal, que incluiu 11 pacientes operados entre 2021 e 2024. Foram analisados dados clínicos, radiográficos e funcionais, com aplicação do Formulário de Avaliação Subjetiva do Joelho do International Knee Documentation Committee (IKDC) durante o acompanhamento ambulatorial médio de 33,9 ± 10,6 meses. A amostra apresentou média etária de 20,3 ± 5,4 anos, com predomínio de lesões patelares (81,8%). A avaliação radiográfica demonstrou consolidação do fragmento osteocondral em todos os casos, sem sinais de deslocamento ou falha da fixação. A pontuação média no IKDC foi de 75,0 ± 17,1. Não foram observadas complicações graves ou necessidade de reintervenções cirúrgicas. A fixação de fraturas osteocondrais traumáticas do joelho com palitos ósseos autólogos resultou em consolidação adequada e desfechos funcionais satisfatórios nesta série de casos, e configura-se como alternativa biológica segura, eficaz e de baixo custo para o manejo dessas lesões.
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition marked by persistent and impairing patterns of inattention, hyperactivity, and impulsivity. Evidence from neurochemical, pharmacological, and genetic research supports the hypothesis that ADHD involves alterations in neurotransmission, primarily within dopaminergic and noradrenergic systems, with contributions from other neurotransmitter pathways and their interactions. Neuroimaging studies identify structural and functional differences in regions such as the frontal cortex and subcortical structures, although findings remain heterogeneous. Genomic research indicates a polygenic basis, with common and rare variants influencing synaptic transmission, neuronal development, regulatory pathways, and related biological processes. These studies also point to shared genetic influences between ADHD and psychological, social, and somatic traits. Additional omics approaches have further expanded these insights, although larger and more integrative studies across multiple layers remain needed. Environmental factors not only influence the onset of ADHD but also shape its course and prognosis, with emerging evidence highlighting complex gene-environment correlations and interactions. Together, the heterogeneity of findings across neuroimaging, genomic, and multi-omics studies underscores the importance of integrative approaches that embrace diversity across populations, methodologies, and biological systems. The present review provides a comprehensive overview of ADHD's biological foundations, highlighting central nervous system mechanisms, their interplay with genetic and environmental factors, and recent advances from multi-omics research with translational potential. We also discuss key methodological considerations, emphasizing that the biological architecture of ADHD is complex, highly polygenic, and spans multiple levels of analysis.
Electronic health records (EHRs) are increasingly used for clinical research and machine learning, yet they are plagued by missing values, outliers, inconsistent coding, and heterogeneous data types. Traditional rule-based cleaning pipelines demand extensive domain expertise and manual effort. Large language models (LLMs) exhibit strong code-generation and clinical reasoning abilities, but their utility for automating structured data preprocessing in clinical datasets remains underexplored. We evaluated three LLMs, GPT-4 (OpenAI, Inc., San Francisco, United States), Claude 3.5 Sonnet (Anthropic, San Francisco, United States), and Gemini 1.5 Pro (Google DeepMind, Mountain View, United States), on five data cleaning tasks and two feature engineering tasks across three publicly available clinical datasets: Medical Information Mart for Intensive Care (MIMIC-IV) (PhysioNet), the eICU Collaborative Research Database (PhysioNet), and National Health and Nutrition Examination Survey (NHANES) 2017-2020 (CDC). LLM-generated preprocessing scripts were benchmarked against a conventional rule-based pipeline. Downstream predictive performance was assessed using XGBoost and logistic regression for in-hospital mortality prediction, evaluated by area under the receiver operating characteristic curve (AUROC) and F1 score. Claude 3.5 Sonnet achieved the highest mean data cleaning F1 score (0.90), followed by GPT-4 (0.89) and Gemini 1.5 Pro (0.85), all exceeding the rule-based baseline (0.77). For mortality prediction on MIMIC-IV, data preprocessed by Claude 3.5 Sonnet yielded the best XGBoost AUROC (0.851; 95% CI: 0.839-0.863), compared with GPT-4 (0.842), Gemini 1.5 Pro (0.829), rule-based cleaning (0.803), and no cleaning (0.761). LLM-engineered features contributed incremental AUROC gains of 0.015-0.025 over manually constructed feature sets. LLMs can substantially automate clinical data cleaning and feature engineering, achieving performance comparable to or exceeding hand-crafted pipelines. However, domain expert oversight remains essential to validate clinical plausibility and prevent silent data corruption.
This study conducted a systematic literature review to answer the question: "What is the frequency of post-discharge complications in patients who had bacterial meningitis during childhood and adolescence?" Observational studies assessing post-discharge complications in patients aged 29 days to 18 years with bacterial meningitis were included. Studies on Mycobacterium tuberculosis meningitis or lacking clear diagnostic criteria were excluded. Searches were performed in July 2025 across seven databases (PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, LILACS, and BVS). Evidence certainty was assessed using GRADE. Data on events and total participants were synthesized quantitatively. Thirteen studies were included (sample size range: 51-3623 participants). Age at meningitis diagnosis ranged from 29 days to 18 years, with follow-up periods from 6 months to 35 years. The overall complication rate was 37.3% (95% CI 28.7-46.9). The most frequent sequelae were cognitive impairment (21.6%; 95% CI 13.2-32.8), emotional/behavioural problems (15.3%; 95% CI 8.1-26.8), and hearing loss (14.3%; 95% CI 7.7-25.1). Bacterial meningitis in childhood is associated with a significant and persistent impact on health and development. Despite heterogeneity across studies, a consistently high burden of auditory, motor, cognitive, and behavioural sequelae is observed, underscoring the need for long-term follow-up of affected individuals.
Federated medical AI revolutionizes multi-center collaboration, while communication cost, data scarcity, and heterogeneity still limit its practical deployment. Foundation models (FMs) offer a promising avenue for addressing these challenges, owing to their generalization capabilities and efficient adaptability to medical tasks. Here, we present Federated Generative Prompt Learning (Fed-GPL), a universal and efficient framework for multi-center medical image analysis. It collaboratively trains a prompt generator that produces customized prompts for each patient, capturing patient-specific variations and enabling precise medical diagnosis. Fed-GPL is compatible with various vision FMs and medical tasks, such as Vision Transformer (ViT) for diabetic retinopathy and melanoma classification, and Segment Anything (SAM) for polyp and prostate segmentation. Fed-GPL outperforms traditional models and full fine-tuning methods, with only 8.26% and 6.55% of the total FM parameters being trained across classification and segmentation tasks, while converging within just 15 communication rounds. For low-resource settings, Fed-GPL maintains its performance with 5% of the original training data.
Identifying communities disproportionately affected by hepatitis C infection is essential for targeted prevention and resource allocation. This study aimed to identify zip code tabulation areas at elevated risk of hepatitis C infection in Los Angeles County and to identify area-level variables of importance in estimating hepatitis C infection rates. This was an ecological cross-sectional study integrating Elastic Net and Random Forest machine learning approaches. The outcome was reported first-time RNA-positive hepatitis C infection among persons aged 18-39 years residing in Los Angeles County from January 2020 to December 2023. 31 area-level variables representing socioeconomic conditions, healthcare access, and opioid-related morbidity were included as model features. Model-predicted hepatitis C infection rates were used as proxies for underlying community-level risk. Zip code tabulation areas with model-predicted hepatitis C rates above the 80th percentile were classified as very high risk. Area-level variables of importance were identified through Elastic Net feature selection, and importance scores and rankings were derived from the Random Forest model. Forty-nine of 245 zip code tabulation areas were classified as very high risk and were distributed across the county. Nine area-level variables of importance were identified. In descending order of importance, these included: proportions of families living below the federal poverty level, residents aged 18-39 years, and households without a vehicle; annual rates of opioid-related emergency department visits, newly diagnosed HIV infections, and opioid-related hospitalizations; distance to substance use treatment facilities; and proportions of Asian and male residents. Integrating machine learning methods with public health surveillance data enabled the identification of communities at elevated risk of hepatitis C infection and area-level variables of importance in estimating hepatitis C infection rates. The findings could help identify priority areas that warrant further assessment for targeted hepatitis C elimination interventions, including harm-reduction programs, testing, and linkage-to-care efforts.
Mitral transcatheter edge-to-edge repair (M-TEER) has become a cornerstone for treating patients with mitral regurgitation (MR). However, the prognostic impact of baseline tricuspid regurgitation (TR) on outcomes after M-TEER remains uncertain. This systematic review and meta-analysis evaluates the influence of baseline TR in patients undergoing M-TEER. We searched PubMed, Embase, SCOPUS, Cochrane Library, and Web of Science through January 2026. Studies comparing outcomes in patients with none/mild TR versus moderate/severe TR after M-TEER were included. Data were synthesized using random-effects models. Eight observational studies involving 24,129 patients were included. Compared to patients with none/mild TR, those with baseline moderate/severe TR had a 2.05-fold higher risk of all-cause mortality (RR 2.05; 95% CI: 1.41-2.98) and an 82% higher risk of heart failure rehospitalization (RR 1.82; 95% CI: 1.22-2.73). Moderate/severe TR was also associated with a 5% lower likelihood of procedural success (RR 0.95; 95% CI: 0.94-0.97). Regarding echocardiographic outcomes, patients with baseline moderate/severe TR had a 12% lower probability of achieving none/mild residual MR (RR 0.88; 95% CI: 0.80-0.97) and a 20% higher risk of moderate residual MR (RR 1.20; 95% CI: 1.05-1.38), though the risk of severe residual MR did not differ significantly between groups. Baseline moderate/severe TR was associated with a 48% higher risk of NYHA class ≥ III at follow-up (RR 1.48; 95% CI: 1.27-1.73). Although statistically significant, the pooled differences in follow-up sPAP (MD: 0.25 mmHg) and LVEF (MD: -0.08%) were clinically negligible, while no significant differences were observed in TAPSE. Baseline moderate/severe TR is strongly associated with a worse prognosis and limited functional recovery following M-TEER. Further studies are warranted to determine whether simultaneous or staged TR interventions improve outcomes in patients undergoing M-TEER.
Climate change increasingly affects population health and healthcare systems. While normative frameworks emphasize physicians' societal role in climate protection, empirical evidence on how general practitioners perceive and address climate- and environment-related issues in daily clinical practice remains somewhat limited and not yet fully consistent across studies. We conducted a nationwide cross-sectional online survey among general practitioners (N = 500; 38.2% female) in Germany. The questionnaire assessed attitudes toward climate protection, attribution of responsibility for climate- and environment-related practice in healthcare, and the frequency of addressing climate- and environment-related issues in practice by patients and practitioners. Data were analyzed using descriptive statistics, group comparisons, and correlation analyses. A majority of respondents (65.8%) considered climate- and environment-related issues relevant to their professional role and endorsed physicians' function as societal role models. Agreement regarding individual responsibility within clinical practice was comparatively moderate (22.6%), with responsibility more frequently attributed to institutional (29.1%) and policy levels (49.2%). Attitudes toward environmental responsibility were largely consistent across subgroups defined by federal state, community size, practice type, and professional experience, while female general practitioners reported higher levels of environmental concern (M = 3.94 vs. M = 3.43; p < .001), indicating a small to moderate effect. Climate- and environment-related issues were reported to arise regularly in general practice, initiated by both physicians and patients (monthly or more often in physicians 68.4% versus patients 59.2%; never in physicians 12.4% versus patients 12.6%). The findings suggest that German general practitioners broadly acknowledge the relevance of climate- and environment-related issues to their professional role and are open to integrating such considerations into clinical context. At the same time, ambivalence regarding individual responsibility highlights the need for clearer normative orientation. Integrating climate- and environment-related considerations into professional standards, clinical guidelines, and medical education may help provide such orientation and support physicians in navigating ethical tensions.
The aging process is accompanied by physiological, biomechanical, and cognitive impairments. In this scenario, functional capacity tests and vertical jumps are used to assess muscle strength and power, which are performed in expensive equipment. Thus, this study analyzed the kinetic behavior of the 30-s chair test, the SJ and CMJ kinetic behavior, and the association between the 30-s with the SJ and CMJ. Twelve older adults (5 females and 7 males) performed the 30-s chair test, the squat jump (SJ), and the countermovement jump (CMJ) on two force platforms. The kinetic behavior of these actions was evaluated. For the 30-s chair test, it was calculated the vertical ground reaction force and linear impulse during the preparatory and lifting phases. The initial vertical forces and the maximal vertical forces, the rate of force development, and the jump height during the SJ and CMJ were calculated. The kinetics of the 30-s chair test is correlated with the kinetics of both SJ and CMJ. The kinetic analysis showed that the ninth repetition of the 30-s test was the cutoff point predictor of the muscle strength and power when compared to the SJ and CMJ tests.