Abstract:

Background: Pulse measurement and heart rate are one of the most basic medical skills and yet, is the most important skill that has be learned by all medical professionals. The duration of how long that should be measured is variable depending on the learning of individual medical student. Aim: To assess accuracy of pulse calculation done manually to decide the cutoff on how long pulse should be measured. Methodology: An observational study was conducted after due IRB permission where included patients’ pulse was calculated for different time intervals and extrapolated to calculate the beats per minute. At the same time, patient’s pulse was taken by a calibrated pulse oximeter 6 times during that 1 minute. Average of the Oximeter data was compared against the extrapolated data was compared for their averages and standard deviation across all time fields using T-test and statistical significant difference was found. Result: Presence of statistical difference between the extrapolated data and oximeter data represents that calculating pulse for that long actually yields statistically significant deviation. Calculating pulse for 12 seconds and extrapolating it yields p-value of 0.0002 representing a significant difference but calculating higher than 12, i.e., for 15 seconds and then extrapolating yields p-value of 0.0612 which represents a nonsignificant difference compared to average oximeter pulse reading. Conclusion: This research paper although simple has been a way to answer the age old question on how long pulse should be measured. This concludes that any measurements higher than 15 seconds does yield a nonsignificant difference. Hence, the pulse should at least be measured for 15 seconds or higher.

Abstract: This study reports a previously unrecognized heterozygous MYCN missense variant, c.454G>A (p.Ala152Thr), identified in a child and two affected relatives with clinical findings consistent with Feingold syndrome type 1, an autosomal dominant developmental disorder most commonly caused by loss-of-function variants in MYCN. The proband presented with cleft palate, craniofacial dysmorphism, feeding difficulties, hypotonia, and characteristic digital anomalies. Similar features were observed in the father and sibling. Clinical exome sequencing revealed the novel MYCN variant, which was confirmed by Sanger sequencing and demonstrated co-segregation with the phenotype. Although most pathogenic MYCN variants leading to FS1 truncate the protein, this missense change lies within the N-terminal transactivation domain, a region involved in transcriptional regulation and protein stability. The physicochemical alteration introduced at residue Ala152 may plausibly affect MYCN function, consistent with haploinsufficiency as the established disease mechanism. According to the 2024 ACGS Best Practice Guidelines, the variant is classified as a Variant of Uncertain Significance leaning toward pathogenicity (VUS-warm). This report expands the mutational spectrum of MYCN, supports the potential clinical relevance of N-terminal missense variation in MYCN, and highlights intrafamilial phenotypic variability in FS1.

Abstract: Non-small cell lung cancer (NSCLC) accounts for nearly 85% of lung cancer cases and remains a leading cause of cancer-related mortality worldwide. Advances in molecular diagnostics and targeted therapies have transformed treatment paradigms, yet the in-tegration of molecular testing into routine care for resected NSCLC specimens contin-ues to face significant challenges. This review outlines the technical, clinical, and sys-temic barriers that limit the effectiveness of molecular testing. Key considerations in-clude tissue quality, the limitations of formalin-fixed paraffin-embedded (FFPE) sam-ples, and the comparative roles of conventional methods—such as immunohistochem-istry (IHC), fluorescence in situ hybridization (FISH), and reverse transcription poly-merase chain reaction (RT-PCR)—versus next-generation sequencing (NGS). We also discuss the prevalence and clinical relevance of common genomic alterations, including TP53, KRAS, EGFR, and ALK, as well as their impact on prognosis and treatment se-lection. Real-world obstacles such as accessibility, reimbursement, delays in testing, interdisciplinary coordination, and sample adequacy are critically examined. Emerg-ing innovations—including multi-omics integration, spatial profiling, liquid biopsy, artificial intelligence, and novel targeted therapies—offer opportunities to overcome current limitations and improve patient outcomes. Finally, practical recommendations are proposed to optimize tissue handling, testing algorithms, and access to preci-sion-guided therapies. By addressing these challenges, molecular testing in NSCLC can be more effectively leveraged to personalize treatment strategies and enhance survival outcomes.

Abstract: Background: Although early laparoscopic cholecystectomy represents the standard treatment for acute cholecystitis [AC], reliable preoperative risk stratification remains challenging. This study compared the discriminative performance of five prognostic scores: two disease-specific tools (Chole-Risk and a locally modified variant, Chole-Risk mod) and three general indices (POSSUM Physiological Score, APACHE II, and Charlson Comorbidity Index [CCI]) for predicting postoperative complications [POC] and prolonged hospital stay. Methods: This single-center retrospective study included 211 consecutive patients undergoing cholecystectomy for AC between 2015 and 2024. Primary endpoint: the occurrence of any POC. Secondary endpoint: prolonged length of stay (LOS), defined as postoperative hospitalization exceeding the 75th percentile (>6 days). Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), with pairwise comparisons performed using the DeLong test. Calibration was evaluated graphically, and clinical utility was explored through decision curve analysis. Results: POC occurred in 60 patients (28.4%), and prolonged LOS in 51 (24.2%). Chole-Risk mod showed the best discrimination (AUC 0.786) and the strongest association per one-standard-deviation increase (OR 4.10; 95% CI 2.47–6.79). Other scores showed lower performance: Chole-Risk (AUC 0.755), CCI (0.736), POSSUM Physiological Score (0.707), and APACHE II (0.696). For prolonged LOS, Chole-Risk demonstrated the highest discrimination (AUC 0.713). Decision curve analysis confirmed a net clinical benefit for Chole-Risk–based models across a broad range of decision thresholds. Conclusions: Disease-specific scores incorporating variables related to biliary pathology outperform general physiological and comorbidity indices in predicting adverse outcomes after cholecystectomy for acute cholecystitis. These findings suggest that the severity of the local inflammatory process may influence postoperative risk more strongly than the patient’s overall physiological burden. Prospective multicenter validation is warranted.

Abstract: Background/Objectives : Our aim was to evaluate the performance of the reticulocyte hemoglobin content (CHr) assay to diagnose iron deficiency anemia in a context of inflammation in an elderly population, by comparison with the gold standard. Methods: Patients over 18 years old, with anemia and biological inflammatory syndrome, were included consecutively. The accuracy of CHr was compared with that of the gold standard, soluble transferrin receptor/log ferritin. Analyses were performed according to age (subjects over and under 75 years of age) and included specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and the area under the ROC curve (AUC). Results: A total of 174 patients were included, with respectively 84 and 89 patients aged under or 75 years and over, the mean age being 72.5 years (SD 16.9). In the older population, the mean age was 84.6 years (SD 5.2), and 40% were female; the mean hemoglobin was 9.6 (SD 1.4) g/dl and mean CRP 89.7 (SD 72.9) mg/L. The optimal threshold value, determined by maximizing the Youden index, was 25.2pg, at which sensitivity and specificity reached 67% and 94%, respectively. The corresponding PPV and NPV were 62% and 95%. The AUC of the ROC curve was 0.81 with 95% CI: [0.65-0.97], suggesting good diagnostic accuracy. Conclusions: In an elderly population with anemia in a context of inflammation, assessing iron deficiency by including CHr is simple, inexpensive, rapid and practical, as it can be measured as a by-product of a routine complete blood count at little incremental cost, and good NPV can exclude a diagnosis of IDA.

Abstract: Background/Objectives: Frailty is a well-established predictor of adverse outcomes in older adults and patients with chronic disease. The Hospital Frailty Risk Score (HFRS), derived from administrative ICD-10 data, was previously developed and validated in Western populations to identify frailty risk. This study aimed to validate the HFRS in an Asian cirrhotic population and evaluate its ability to predict mortality and hospital readmissions. Methods: Patients with liver cirrhosis and at least one hospital admission in 2018 from two tertiary public hospitals in Singapore were identified using ICD-10 codes. HFRS was calculated using a two-year lookback period according to Gilbert’s methodology. Patients were categorized as no risk (score = 0), low risk (score < 5), intermediate risk (5–15), or high risk (>15). Outcomes assessed included 30-day mortality, 30-day hospital readmission, and 2-year mortality, with follow-up until 31 December 2020. Multivariate logistic regression analysis was performed. Results: A total of 814 patients were included, of whom 629 (77.3%) had frailty-related ICD-10 codes. Increasing HFRS category was independently associated with worse outcomes. Compared with the reference group, 30-day mortality increased stepwise with frailty: low risk odds ratio (OR) 25.74 (95% CI 1.54–431.33, p = 0.02), intermediate risk OR 40.42 (95% CI 2.42–676.14, p = 0.01), and high risk OR 50.92 (95% CI 2.92–887.08, p < 0.01). Higher HFRS was also associated with increased 30-day readmission and 2-year mortality across all risk categories. Conclusions: Frailty-related diagnoses are significant independent predictors of mortality and hospital readmission in patients with liver cirrhosis. HFRS is a cost-effective and scalable tool using administrative data to identify high-risk patients and support clinical risk stratification.

Abstract: Background: Coronal Plane Alignment of the Knee (CPAK) classification enables individualized alignment assessment in total knee arthroplasty (TKA), yet manual evaluation is time-consuming and lacks preoperative-to-postoperative transition analysis. Methods: This study aims to develop and validate a fully automated deep learning-based CPAK classification system and to investigate individual-level transition patterns and their association with short-term clinical outcomes using paired radiographic data from a large Chinese cohort. A retrospective analysis was conducted on 919 patients with knee osteoarthritis who underwent TKA. A keypoint detection model (HRNet-W32) was developed to automatically calculate medial proximal tibial angle, lateral distal femoral angle, arithmetic hip-knee-ankle angle, and joint line obliquity, from which CPAK types were derived. Results: On the validation set (92 cases), the model achieved a mean radius error of 1.22±0.43 mm for keypoint detection; mean absolute errors were ≤0.74° for angular measurements, with intraclass correlation coefficients ≥0.96 compared to manual annotations. Automatic CPAK classification accuracy was 80.98% (kappa = 0.767). Transition matrix analysis showed that only 8.30% of preoperative type I patients maintained their original type postoperatively, with most shifting to types IV, V, or VII. After propensity score matching, no significant differences in clinical outcomes were observed among transition groups (all p > 0.05). Conclusions: These results demonstrate that the proposed automated system enables efficient CPAK assessment, revealing substantial postoperative alignment transitions that were not associated with differential short-term outcomes, thereby supporting AI-assisted individualized alignment planning in TKA.

Abstract: Background: The COVID-19 pandemic profoundly disrupted healthcare systems worldwide, raising concerns regarding delays in cancer diagnosis and treatment. How these disruptions affected breast cancer care during and after the pandemic remains incompletely understood, particularly in Eastern European oncology centers. Methods: We conducted a retrospective cohort study of breast cancer patients treated at the Oncological Institute of Bucharest, comparing a pandemic cohort (n = 73) with a post-pandemic cohort (n = 99) regarding age at diagnose, tumor laterality, tumor location, tumor stage, and time intervals across the diagnostic and treatment pathways. We measured the intervals between: GP referral and the patien’s first presentation to the surgery unit; imaging diagnosis; the date of biopsy or surgery, biopsy result, and initiation of neoadjuvant treatement; the end of neoadjuvant treatement and surgery; surgery and adjuvant treatment; and the interval of time between chemotherapy sessions. Results: Between the two cohorts, the median age was similar (56 [47–67] vs. 59 [50–68] years). Similarities were also found in tumor laterality and quadrant location. In the post-pandemic cohort, 31.3% of patients were diagnosed with advanced stages, compared with 20.5% in the pandemic cohort, although this difference did not reach statistical significance. Our study showed that chemotherapy delivery was more efficient post-pandemic, with shorter intervals between treatment sessions (18 [17–19] vs. 21 [21–22] days). Referral-to-presentation times were also shorter post-pandemic (3 [1–8] vs. 6 [2–10] days). In contrast, during the post-pandemic year, the interval between the end of neoadjuvant therapy and surgery, remained prolonged. Conclusions: During the COVID-19 pandemic, breast cancer care at a major oncology Romanian center was preserved through adapted clinical pathways. We also established that delays in surgical treatment happened in the post-pandemic period and a higher percentage of advanced-stage disease cases were diagnosed. Our findings may suggest that pre-hospital delays and residual system constraints contributed to stage migration in the post-pandemic group rather than deficiencies in oncology care.

Abstract: Pediatric seasonal influenza is often considered an acute febrile respiratory infection. However, as influenza viruses continue to evolve, new symptoms may appear and require careful evaluation, monitoring, and follow-up. This communication describes how, during the current winter season, increasing numbers of children had flu-like symptoms, as well as conjunctivitis and sleep-disordered breathing, such as new-onset snoring and short apnea-like episodes that were sometimes accompanied by hypoxemia. As conjunctivitis and sleep-disordered breathing are not typical signs of seasonal influenza, these characteristics should be regarded as related findings rather than defining traits. Possible contributory processes include upper-airway inflammation, post-nasal discharge, and simultaneous lower-respiratory involvement that may lead to hypoxemia. The updated Egyptian/African outpatient management using Kelleni's protocol is discussed, along with a call for continuous monitoring of the described associated symptoms by the pediatric and ENT/sleep clinicians to determine whether an evolving pattern is emerging across settings.

Abstract: Introduction: With age and injury, the infiltration of fat in the paraspinal muscles can cause degeneration, disorganizing the structural integrity of the connective tissue, causing lower back pain (LBP). Human umbilical cord tissue allografts (UCTa) have a collagen-rich matrix with various ECM components that can replace damaged connective tissue. The objective of this study is to evaluate preliminary findings on the safety and efficacy of UCTa for the supplementation of degenerated tissue in thoracic and lumbar paraspinal muscles refractory to standard conservative methods. Materials and Methods: A total of 141 patients from an observational repository were identified with paraspinal muscle degeneration. Patients received one to three applications of UCTa, outcomes were tracked using the Numeric Pain Rating Scale, the Western Ontario and McMaster University Arthritis Index, and the Quality-of-Life Scale. Results: All groups showed positive improvement in the NPRS and WOMAC scales. Multi-application groups revealed statistically significant differences in the analyses. No adverse events or complications were reported. Discussion: Limitations included a lack of a control group and the increase of recall and response bias due to using patient-reported measures. Conclusion: This pilot investigation highlights the need for continued research through randomized controlled trials to validate efficacy, establish optimal dosage protocols, and compare UCTa to other conservative interventions.

Abstract: Background: Post-surgical cardiovascular monitoring places a heavy information burden on clinical teams, requiring rapid synthesis of patient history, intraoperative data, monitoring streams, and surgical outcomes evidence. Existing clinical decision support systems handle this integration poorly, and most offer little visibility into their reasoning. We present a Retrieval-Augmented Generation (RAG) architecture designed specifically for this domain, with a focus on evidence traceability and practical workflow integration. Methods: We developed a three-layer RAG architecture comprising: a retrieval layer to create 768-dimensional representations of clinical scenarios; an augmentation layer employing context-aware filtering and machine learning algorithms to integrate patient-specific data with retrieved evidence; and a generative layer using fine-tuned language models to synthesise actionable clinical recommendations. Results: An evaluation framework is proposed to assess the technical performance and clinical applicability of RAG architecture. The evaluation methodology encompasses technical validation of system components, assessment of clinical workflow integration potential, and analysis of interpretability features essential for healthcare deployment. Conclusions: We describe a RAG architecture for post-surgical cardiovascular monitoring in which every recommendation is linked to retrievable source documents, making the reasoning visible and challengeable. A structured evaluation framework is proposed to guide the system towards clinical validation.

Abstract: Background: Post-sternotomy mediastinitis remains a devastating complication of cardiac surgery. Although most cases are bacterial, fungal mediastinitis due to Candida albicans is rare, aggressive, and particularly difficult to treat because of biofilm formation, prosthetic involvement, and limited penetration of systemic antifungal agents into infected tissues. Taurolidine is a taurine-derived antimicrobial compound with broad antibacterial, antifungal, and anti-biofilm properties that has shown promising results in catheter-related infection prevention and cardiac implantable electronic device surgery. Case summary: We report, to our knowledge, the first intramediastinal use of taurolidine for Candida albicans mediastinitis after biological Bentall surgery. Following urgent resternotomy and extensive debridement, 200 mL of taurolidine solution was instilled into the mediastinum for 60 minutes, then aspirated. Postoperatively, taurolidine irrigation via mediastinal drainage was combined with negative-pressure wound therapy and systemic antifungal treatment. Results: Rapid microbiological sterilization was achieved, inflammatory markers normalized, and follow-up computed tomography demonstrated complete resolution of mediastinal infection. Delayed sternal closure was then performed successfully without recurrence at 6-month follow up. Conclusion: Intramediastinal taurolidine irrigation may represent a promising adjunctive strategy for mediastinitis after cardiac surgery in high-risk patients. Further clinical evaluation is warranted.

Abstract: Because of its anatomical complexity, the cervical spine is highly susceptible to injury, especially the blunt acceleration/deceleration trauma of which the most frequent mechanism, is “whiplash”, commonly referred to as Whiplash Associated Disorder (WAD). Despite this knowledge the significance and complexity of whiplash injuries are widely underestimated. This underestimation of the significance of this injury is the widely held belief that it is a benign self-limiting soft tissue injury that frequently has monetary gain attached. Estimates are that 10% of all spine injuries are related to WAD with 40% of these involving the Atlas (C1) and Axis (C2). This negative framing of the injury which has largely been shaped by the insurance industry rather than by clinicians frequently causes medical providers to view the injury with skepticism, despite estimates showing that approximately 50% of whiplash patients suffer chronic neck-related disability. Adding to the problem faced by clinicians are the more recently imposed guidelines for diagnosing and treating acute whiplash, especially in the area of imaging that has placed both the provider and the patient at increased risk.

Abstract: Introduction: Cervical paraspinal enthesopathy is characterized by fatty infiltration and muscle degeneration; current methods only provide symptomatic relief or involve significant postoperative complications. This study provides preliminary results for the clinical potential of umbilical cord tissue allografts (UCTa) in patients with cervical paraspinal enthesopathy and degeneration refractory to standard care. Materials and Methods: The Numeric Pain Rating Scale, Western Ontario and McMaster University Arthritis Index, and Quality of Life Scale were used to measure outcomes of thirty-one patients with cervical paraspinal degeneration from an observational repository who received one to three UCT allograft applications. The Wilcoxon Signed-Rank test, Mann-Whitney U test, and Jonckheere-Terpstra test were performed for the analysis. Results: Substantial percentage improvements were observed from the patient cohort, with the triple application group reporting the highest percentage improvement. Statistically significant differences were presented in all application groups. No adverse events were reported. Discussion: This study provided preliminary findings that UCTas are a safe, minimally invasive application for cervical paraspinal defects. Notable limitations included a lack of a direct comparison group and a small sample size. Conclusion: This study highlights the need for continued research to validate the preliminary results for the safety, feasibility, and efficacy of umbilical cord tissue allografts in patients with cervical paraspinal defects.

Abstract:

Background: The impact of overweight and adipocyte size on the development of type 2 diabetes mellitus (T2DM) even remains unclear. Aim: To study: 1) the relationship between the state of adipocytes and/or overweight/obesity, the development of T2DM and its clinical and laboratory signs; 2) the effect of weight loss on glycemic level, hyperinsulinemia (HI), insulin resistance (IR), and T2DM status. Methods. Design: a systematic review. Settings: Web of Science, EBSCO, Scopus/ Science-Direct, Google Scholar, PubMed, Cochrane, и Wolter Kluwer were searched for articles published for 26 years (2000-2026). The study bases on a systematic review of 3853 articles published worldwide. Results. In total, 142 full-text articles were assessed for eligibility. With an increase in overweight, the size of adipose tissue increases, adipocytes increase, the cell radius increase. All it leads to an overload of intracellular transport and internal organs. Increase in cell size triggers intracellular mechanisms to limit further nutrient supply. When cell size increases excessively, conformational changes in cellular receptors are activated, resulting in the development of IR. The increase in cell size and the maximum accumulation of overweight, as parallel processes, lead to hyperglycemia and HI with gradual development of IR and T2DM. Any type of intentional weight loss leads to a decrease in IR, HI and the disappearance of T2DM. Targeted weight loss in patients with T2DM improves metabolic and cardiovascular health, reduces blood pressure and blood sugar, reduces doctor visits, normalization of HbA1c, HI, IR. Conclusions. IR is a protective reaction of the cells, preventing its oversaturation and overflow. Overweight is an independent risk factor for the development of T2DM and its clinical and laboratory manifestations. Targeted weight loss leads to disappearance of symptoms of HI, IR and T2DM.

Abstract: This review outlines the health risks associated with excessive dietary intake of n 6 polyunsaturated fatty acids (PUFAs), particularly linoleic acid (LA), which is highly prevalent in the Western diet. It proposes a targeted nutritional strategy to reduce n-6 PUFA overconsumption and increase n-3 PUFA intake, aiming to restore a healthier fatty acid balance and counteract imbalance induced pathogenetic consequences. The conceptual framework builds on the foundational insights of William E. M. Lands regarding PUFA driven eicosanoid imbalance. It extends these principles by integrating contemporary models of impaired adipose tissue expandability, functional lipodystrophy, insulin resistance, and ectopic lipid deposition as central mechanisms of lipotoxicity and as unifying drivers of the modern organo metabolic spectrum of non communicable diseases. The proposed nutritional strategy combines dietary modifications—such as avoiding seed oils and processed foods as well as products from industrialized animal farming, while prioritizing fatty fish and/or algae derived supplements—with lifestyle interventions and ongoing laboratory monitoring. This approach is designed to lower chronic disease risk and improve overall metabolic resilience. In addition, Western diet related socioeconomic issues and ecological burdens are addressed. However, further research is required to corroborate the available findings before broader implementation of the proposed strategy can be recommended.

Abstract: Background: The crista terminalis (CT) is a fibromuscular ridge forming the embryonic boundary between the sinus venosus and the primitive right atrium. While a physio-logical structure, rare cases of CT hypertrophy present a diagnostic challenge, often appearing as a right atrial pseudo-mass on imaging. Given its role as a site of conduction block and its association with two-thirds of right atrial arrhythmias, distinguishing hy-pertrophy from pathological masses is clinically vital. We present a case of a 58-year-old female who was referred to our hospital for rapid, irregular palpitations, accompanied by hypertension. Transthoracic and then transesophageal echocardiography (TEE) revealed an isoechoic right atrial mass, attached to the posterolateral wall of the right atrium, with a broad base of implantation and no intrinsic mobility. To exclude high-risk diagnoses, such as thrombi and myxomas, as well as other common right atrial mass mimics like the Chiari network, cardiac computed tomography angiography (CCTA) was performed. CCTA provided high-resolution tissue characterization, confirming the mass as a hy-pertrophied CT by its lack of contrast enhancement and its precise anatomical orientation. Conclusion: This case reinforces the epidemiological profile of CT hypertrophy, which predominantly affects females in their sixth decade. It highlights the necessity of a multi-modal imaging approach, transitioning from TEE to CCTA or cardiac magnetic resonance imagery (CMR), to prevent unnecessary invasive interventions or anticoag-ulation. Furthermore, this report supports the hypothesis that structural hypertrophy may exacerbate the CT's underlying arrhythmogenic potential, possibly through enhanced conduction anisotropy. Further research is needed to establish the correlation between CT thickness and the severity of atrial tachyarrhythmias.

Abstract: Background: Goals of care discussions are essential communication skills in medical training that bridge patient values with clinical decision-making. Integrating palliative care principles into these conversations enables holistic, patient-centered care, yet medical trainees often lack structured preparation for these critical interactions. Objective: This narrative review examines how medical training can effectively integrate palliative care approaches into goals of care discussions through structured communication frameworks, interdisciplinary collaboration, and emerging innovations to promote patient-centered outcomes. Methods: Literature on evidence-based communication frameworks (SPIKES, REMAP, SUPER, Serious Illness Conversation Guide) was reviewed to identify training approaches. Clinical outcomes including patient satisfaction, hospice utilization, ICU transfers, and intervention intensity were examined. Educational barriers and facilitators—including communication training curricula, cultural competency, language considerations, and multidisciplinary team involvement—were evaluated. Emerging technologies supporting clinician education and practice were also assessed. Results: Training in structured communication frameworks improves patient-physician relationships, reduces patient anxiety, and increases family satisfaction. Early palliative care integration through effective discussions leads to increased hospice awareness and utilization while reducing burdensome interventions. Key educational facilitators include dedicated communication skills training, multidisciplinary team participation (including chaplains and palliative care specialists), and AI-assisted documentation tools that support learning while preserving humanistic clinician-patient interactions. Conclusions: Integrating palliative care principles into medical training for goals of care discussions is essential for developing patient-centered clinicians. Combining structured communication frameworks, interprofessional education, targeted skills training, and technological support creates a comprehensive educational approach that prepares trainees to elicit patient goals, create individualized care plans, and deliver holistic care that honors patient values.

Abstract: Wearable sensors enable continuous recording of electrocardiographic, photoplethys-mographic, and inertial signals and have accelerated the development of digital bi-omarkers in cardiovascular medicine. Transthyretin amyloidosis (ATTR) is a progressive multisystem disease characterized by arrhythmia, conduction disturbances, hemody-namic impairment, autonomic dysfunction, and gait abnormalities, making it theoreti-cally suitable for multimodal wearable monitoring. This review summarizes current knowledge on wearable applications in ATTR, evaluates the plausibility of extrapolating signal-based biomarkers from related cardiovascular and neurological cohorts, and out-lines methodological and implementation challenges. ATTR-specific data remain limited to small observational studies, mainly on long-term rhythm monitoring and supervised functional assessment. More comprehensive findings support the extraction of metrics such as atrial fibrillation burden, activity patterns, gait variability, and heart rate var-iability. However, ATTR-related structural remodeling and high arrhythmia burden may distort conventional digital biomarkers, necessitating disease-specific preprocessing and prospective validation. Wearable monitoring in ATTR is technically feasible and biologically plausible but remains investigational. Before routine integration into care pathways can be recommended, standardized, phenotype-stratified studies are needed that link wearable-derived characteristics to assessed clinical outcomes.

Abstract: Background: Obesity is a risk factor for increased blood pressure, in which the relation-ship is mediated by the action of various pro-inflammatory mediators such as myelop-eroxidase (MPO), xanthine oxidase (XO), and oxidized low-density lipoprotein (Ox-LDL). The objective of this research is to evaluate the contribution serum MPO, xanthine oxidase XO, and Ox-LDL as determinants of blood pressure in adults with abdominal obesity. Methods: A cross-sectional study was conducted involving 86 adults with abdominal obesity. Waist circumference (WC), fasting serum glucose (FSG), MPO, XO, and serum Ox-LDL were measured. The contributions of these parameters to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were then assessed. Results: Multivariate analy-sis showed that the determinants of SBP were WC, FSG, MPO, and XO (Beta = 0.418, 0.328, 0.282, 0.248 respectively, all p< 0.05; adjusted R2 = 41.5%), while the determinants of DBP were FSG, WC, and MPO (Beta = 0.310, 0.284, 0.274, respectively, all p< 0.05; adjusted R2 = 24.8%). Conclusions: MPO has a role as a determining factor for SBP and DBP, XO has a role as a determining factor for SBP, while Ox-LDL does not have a significant role in blood pressure.