Abstract Digital transformation significantly impacts all aspects of the economic system, particularly the functioning of monetary policy and the financial sector. As a key process in modernization, digital transformation encompasses innovations that enable faster, safer and more efficient financial transactions, contributing to greater transparency and better economic integration. This paper analyzes the impact of digital transformation on the monetary policies of Southeast European (SEE) countries, with a particular focus on the development and implementation of digital payment systems. The aim of the research is to examine the potential of digital technologies to improve the monetary policies of these countries, enabling them to achieve greater financial stability and alignment with European Union (EU) standards. The focus is on identifying the benefits of implementing digital payments, including reducing transaction costs, improving trust in monetary institutions, and increasing the transparency of financial flows. The methodological framework of the research is based on multi-criteria decision-making (MCDM), using the CRITIC and MARCOS methods. The CRITIC method was used to evaluate the importance of individual criteria relevant to digital payments, while the MARCOS method enabled the ranking of countries based on their potential for implementing digital payments. The results of the research show that alignment with EU legislation is the most important factor, while Romania has the best potential for implementing digital payments among the observed countries. The contribution of this paper is reflected in the development of a strategic framework and the encouragement of regional cooperation, through which SEE countries could realize the full potential of digital transformation to accelerate economic growth and integration with the EU.

Background/Objectives: Large language models (LLMs), such as ChatGPT, have emerged as potential clinical support tools to enhance precision in personalized patient care, but their reliability in radiological image interpretation remains uncertain. The primary aim of our study was to evaluate the diagnostic accuracy of ChatGPT-4o in interpreting chest X-rays (CXRs) and abdominal X-rays (AXRs) by comparing its performance to expert radiology findings, whilst secondary aims were diagnostic confidence and patient safety. Methods: A total of 500 X-rays, including 257 CXR (51.4%) and 243 AXR (48.5%), were analyzed. Diagnoses made by ChatGPT-4o were compared to expert interpretations. Confidence scores (1–4) were assigned and responses were evaluated for patient safety. Results: ChatGPT-4o correctly identified 345 of 500 (69%) pathologies (95% CI: 64.81–72.9). For AXRs 175 of 243 (72.02%) pathologies were correctly diagnosed (95% CI: 66.06–77.28), while for CXRs 170 of 257 (66.15%) were accurate (95% CI: 60.16–71.66). The highest detection rates among CXRs were observed for pulmonary edema, tumor, pneumonia, pleural effusion, cardiomegaly, and emphysema, and lower rates were observed for pneumothorax, rib fractures, and enlarged mediastinum. AXR performance was highest for intestinal obstruction and foreign bodies, and weaker for pneumoperitoneum, renal calculi, and diverticulitis. Confidence scores were higher for AXRs (mean 3.45 ± 1.1) than CXRs (mean 2.48 ± 1.45). All responses (100%) were considered to be safe for the patient. Interobserver agreement was high (kappa = 0.920), and reliability (second prompt) was moderate (kappa = 0.750). Conclusions: ChatGPT-4o demonstrated moderate accuracy for the interpretation of X-rays, being higher for AXRs compared to CXRs. Improvements are required for its use as efficient clinical support tool.

The transition from 5G to 6G networks will catalyze the development of advanced 6G Applications (6G Apps) with enhanced network programmability and intelligence, providing vertical industries and Communication Service Providers (CSPs) with new opportunities to optimize their operations. This article explores the future of the 6G Apps tailored to verticals in the 6G era, highlighting their role as middleware that abstracts network complexities and exposes Application Programming Interfaces (APIs) to enable dynamic interaction and real-time adaptation. Key enablers such as network exposure, Artificial Intelligence (AI), and edge computing are studied in the context of optimizing operations across verticals, and improving Quality of Service (QoS) and fostering innovation. A case study on teleoperated vehicles exemplifies the real-world applicability of these technological enablers for 6G Apps. Furthermore, this article offers insights and explores new research opportunities for 6G Apps tailored to verticals to evolve in the 6G era while addressing key challenges in deploying these applications in real-world commercial networks as a service.

Background In low- and middle-income countries, particularly during the COVID-19 pandemic, the availability of epidural analgesia for labor has been limited due to a shortage of anesthesiologists. As an alternative, single-shot spinal analgesia can offer effective pain relief during childbirth. Objective The objective of the study is to evaluate patient satisfaction with single-shot spinal analgesia provided during labor. Methods This descriptive cross-sectional study was conducted at the General Hospital Sarajevo over a two-year period. Fifty parturients received single-shot spinal analgesia during the active phase of labor (cervical dilatation ≥ 5 cm). The analgesic mixture included 0.5% levobupivacaine (0.5 mL), fentanyl (25 mcg), and 0.9% NaCl (1 mL). Pain intensity was assessed using a Visual Analog Scale (VAS) before the procedure, 10 minutes afterward, one hour after administration, and during delivery. Data were collected using a structured questionnaire. Results The average duration of labor pain prior to the procedure was four hours. Mean VAS scores were 9 before the procedure, 3 after 10 minutes, 1 after one hour, and 4 during delivery. Spinal analgesia lasted approximately 110 minutes. During this period, 66% of parturients delivered, while in 34%, the effect of analgesia ended before delivery. All patients expressed satisfaction with the analgesia received. Conclusion Single-shot spinal analgesia provided effective pain relief and high patient satisfaction, even among those who did not deliver during the period of analgesic effect. It offered parturients sufficient time to rest and actively participate in the final stage of labor.

Abstract Background Extensive catheter ablation beyond pulmonary vein isolation may acutely increase atrial tissue stiffness, however, this may differ between energy sources used. Objectives This study aimed to compare acute effects of radiofrequency ablation (RFA) and pulsed field ablation (PFA) on atrial tissue stiffness in a porcine model using multifrequency magnetic resonance elastography (MMRE). Methods In 17 pigs (∼50 kg and ∼16 weeks old) an intercaval line was ablated using only focal RFA (25 W, 30 sec, n=9), only focal monopolar biphasic PFA (CENTAURI PFA generator, 25 A, 10 pulse trains, n=5), or half of the ablation line with PFA and the other half with RFA (n=3) (Figure 1,A). Post-ablation, in vitro MMRE data were acquired with a tabletop MRE scanner (ttMRE) (n=8) (Figure 1,B). In vivo, a novel MMRE protocol utilizing electrocardiography-triggered spin-echo, echo-planar-imaging was established (n=11) (Figure 1,C). Shear wave speed (SWS) was reconstructed as a surrogate for tissue stiffness. Results In vitro ttMRE measurements revealed significantly higher SWS for the RFA ablation zone compared to both the PFA ablation zone (p=0.008) and PFA border zone (p=0.003). Consistently, a novel in vivo MMRE protocol showed 1.37-fold higher SWS of the RFA ablation zone than its border zone (p=0.016) and 1.16-fold higher SWS than the PFA ablation zone (p=0.033). Absolute in vivo SWS differences between ablation zones and border zones were significantly higher for RFA compared to PFA (p=0.019). Conclusions RFA produces stiffer acute atrial lesions compared to PFA in pigs. A novel MMRE scanning protocol allows RFA and PFA lesion evaluation in vivo with the potential to support the refinement of future catheter approaches by optimizing mechanical properties of ablation lesions and minimizing atrial stiffness.

Abstract Background Endocardial atrial fibrillation (AF) ablations using thermal energy sources modulate ganglionated plexi (GP). Contrarily, endocardial pulsed field ablation (PFA) has minimal effect on GP located within the epicardial fat-pads. Purpose To determine structural and antiarrhythmic effects of direct epicardial PFA-delivery to atrial GP-sites. Methods Group-1: Epicardial PFA-delivery to GP sites (n=6 pigs). Group-2: Sham-operated (n=2 pigs). Thoracotomy was performed and five epicardial GP-sites were identified and targeted by saline-irrigated bipolar PFA (1,000V, 100μs, 120-pulses, ECG-synchronised). Local atrial electrogram (EGM) amplitude, atrial effective refractory period (aERP) and AF (inducibility and duration) were investigated. Histology was performed on samples from treatment-adjacent structures. Results In Group-1, 120 PFA-pulses were successfully delivered epicardially to each GP-site. Local EGM-amplitudes did not change after PFA-delivery. GPs showed lower intensity of S100-protein expression within the cytoplasm and membrane with preservation of adjacent atrial myocardium. The aERP at the higher and lower lateral right atrium increased from 123±34ms to 173±47ms (p=0.0358) and from 122±32ms to 221±16ms (p=0.0063) after PFA-treatment, respectively. Total AF-inducibility decreased from 100% to 33%, inducible AF-duration decreased from 4.4±0.6min (including 2 cardioversions) at baseline to 1.3±2.1min (including 1 cardioversion) after PFA-delivery (decrease: -3.2±2min, p=0.007). In one pig, the feasibility of thoracoscopic epicardial PFA delivery at all anatomical GP-sites was shown. Conclusion Epicardial PFA-delivery to anatomical GP-sites is feasible in open-chest or thoracoscopic approach, and acutely decreases GP S100-protein intensity, prolongs aERP and reduces AF-inducibility and duration.

The exact cause of autism spectrum disorder (ASD) is yet unknown, although possible causes include early childhood, foetal development, gestation, delivery mode, genetics, and environmental variables. Approximately 1% of children worldwide have ASD, and this percentage is rising. The immunological, endocrine, gut microbiota and brain-gut axis quality influence the intensity of ASD symptoms. Deficits in the composition and diversity of gut microbiota are common in children with ASD, accounting for 9-90% of these illnesses, including elevated inflammatory cytokines, inflammation, leaky gut syndrome, and pathological microflora growth. Dysbiosis can be made worse by eating issues that are prevalent in ASD. B vitamins, such as cobalamin and folate, which are essential methyl donors for DNA epigenetic changes, are usually produced by a healthy gut microbiota. 50% of people with ASD have a vitamin B deficit. This work summarises research on the impact of gut microbiota on DNA methylation and B vitamin synthesis in ASD, as well as etiological variables connected to dysbiosis. Probiotics, postbiotics, and vitamin B therapies in kids with ASD should be investigated in future studies.

Iron deficiency (ID) is a major problem in heart failure (HF) patients. Iron deficiency is often pressent in patients with rheumatoid arthritis (RA), can be a cause of fatigue and linked with reduced functional capacity. The relationship between ID and right ventricular (RV) systolic function in patients with RA is still not well understood. The aim of this study was to analyze the relationship between ID and RV systolic function. A forty six female patients with seropositive RA were included in our study. Primary goal was to determine association between iron deficiency and echocardiography parameters such as Tricuspid annular plane systolic excursion TAPSE, RV fractional area change (RV FAC), TDI-Derived tricuspid lateral annular systolic velocity (RV TDI S’), Pulmonary artery systolic pressure (PASP); RV free wall global longitudinal strain (RVfwGLS), RV global longitudinal strain (RV GLS) and Right ventriculoarterial coupling (RVAC). The RVAC was determined with the RVfwGLS/PASP ratio. RA was diagnosed according to the ACR/EULAR 2010 classification criteria, without other significant comorbidity. ID was defined as ferritin levels lower than 100 ng/mL and iron levels lower than 10 µmol/L. The mean age of stady population was 57±8 years. Iron deficiency was found in 48% of analysed RA patients. On transthoracic echocardiography the median TAPSE was 18.3 mm, the mean FAC % 38.4±.6.3, the mean RV GLS %-17.2±7.5, the mean RVfwGLS % -20.6±3.8, the mean RV TDI S’ was 10.6±3.9 cm/s, the mean PASP was 29,2±8.7mmHg, the mean RVAC was 0.76. There was no notable difference in demographics or in TAPSE, RV FAC, RV TDI S’, and PASP between patients with iron deficiency and those without. The RVfwGLS (-16.7% vs -21.2%, p = 0.005) was lower in patients with ID. RV GLS (-14.3% vs -18.6%, p=0.005) was lower in patients with ID. Additionally, RVAC (0.65 vs 0.91, p=0.005) was lower in patients with ID. A significant correlation exists between iron deficiency and subclinical RV dysfunction, defined as reduced RV GLS, RVfwGLS and RVAC prior to the decline of parameters commonly used on echocardiography to measure right ventricle systolic function (TAPSE, RV FAC, PASP and RV TDI S'). Screening for iron deficiency in RA patients facilitates early detection and treatment of iron deficiency which may prevent RV dysfunction.

Background Belzutifan, a selective hypoxia-inducible factor-2α inhibitor, is approved for von Hippel–Lindau (VHL) disease-associated tumours and is Food and Drug Administration-approved for the management of advanced sporadic clear-cell renal-cell carcinoma. While belzutifan has demonstrated efficacy across VHL-related lesions, real-world safety data remain limited. Patients and methods We report a fatal intracranial haemorrhage occurring within 72 h of belzutifan initiation in a patient with VHL-associated central nervous system haemangioblastomas (CNS-HBs). Results This represents the third post-marketing case of early haemorrhage involving CNS or spinal haemangioblastomas, following previously reported spinal and cerebellar bleeds. Although CNS-HBs are highly vascular, spontaneous haemorrhage is exceedingly rare. The clustering of haemorrhagic events in these cases, within days of treatment initiation, suggests a rare but potentially serious adverse event not currently listed on regulatory labels. Conclusions This case highlights the importance of pharmacovigilance as belzutifan use expands into broader real-world populations, particularly in rare disease settings where trial cohorts are small and long-term safety data are limited.