Two different European Reference Networks cover connective tissue diseases with pediatric onset (ERN ReCONNET and ERN RITA). The transition of care is a significant focus, with ReCONNET centers actively addressing this through updated programs. Despite these efforts, challenges persist. We aimed to inventory transitional care programs for rCTDs across Europe. In April 2023, the ERN ReCONNET Transition of Care Task Force, consisting of expert clinicians, patient advocates, and coordination team members, created a survey to assess transitional care practices. The survey was distributed to ERN ReCONNET and ERN RITA centers, and responses received by March 15, 2024, were analyzed. Sixty-seven responses from 59 centers across 20 European countries were collected. Pediatric rheumatologists typically initiated the transition process (49% of centers). Twenty centers had joint clinics. Despite positive self-assessments of transitional programs, significant limitations were noted. Transition policies varied, with only 40% of centers having a formal standardized policy and less than half of the centers adhering to available transition of care guidelines. Transfer readiness was evaluated using validated questionnaires in 13% of centers, while 29% transitioned patients based solely on age without any readiness assessments. Main challenges included finding adult-oriented centers and the lack of guidelines or engagement from adult centers. Adult healthcare providers also noted a lack of training in adolescent medicine. The survey highlighted diverse transition practices and resources across centers, with challenges in readiness evaluation and the use of guidelines. Despite these obstacles, respondents rated ongoing transition processes positively. Enhancing patient perspectives in the transition process is crucial to meet their needs during this critical phase.
Atherosclerosis of the coronary arteries is a chronic, progressive condition characterized by the buildup of plaque within the arterial walls. Coronary artery disease (CAD), more specifically coronary atherosclerosis (CATS), is one of the leading causes of death worldwide. Computational modeling frameworks have been used for simulation of atherosclerotic plaque progression and with the advancement of agent-based modeling (ABM) the simulation results became more accurate. However, there is a need for optimization of resources for predictive modeling, hence surrogate models are being built to substitute lengthy computational models without compromising the results. This study explores the development of a surrogate model for atherosclerotic plaque progression using ABM simulation data. The dataset used for this study contains samples from latin-hypercube sampling based generated simulation parameters used in conjunction with 15 patient-specific geometries and corresponding plaque progression data. The developed surrogate model is based on deep learning using artificial neural networks (ANN). The surrogate model achieved an accuracy of 95.4% in benchmarking with the ABM model it was built upon which indicates the robustness of the framework. Adoption of surrogate models with high accuracy in practice opens an avenue for utilization of high-fidelity decision support systems for predicting atherosclerotic plaque progression in real-time.
Although the influence of infill masonry on horizontal load structure behavior is well-documented, current standards and regulations have yet to fully incorporate or explicitly define the load-bearing capacity of this complex system. Canadian and American standards present more comprehensive and specific methodologies for calculating the load-bearing capacity of infill masonry and frame systems. In contrast, European standards tend to focus on offering general guidelines for the design of these systems without delving into the detailed calculation procedures. However, extensive data and experimental studies on this topic are available in the literature. The primary aim of this paper was to compile a database of experiments involving frames with different types of infill masonry. Subsequently, the empirical results obtained through the application of analytical expressions from various standards are compared to the experimental data included in the compiled database. The obtained load-bearing values were compared to different standards and work conducted by various researchers found in the literature in order to assess their reliability. Based on the obtained results, important conclusions were drawn, specifically to the most accurate equivalent diagonal model used and the analytical expressions to be used in the assessment of the masonry-infilled steel frame behavior. The equivalent diagonal model, utilized in all analytical expressions, can provide highly accurate estimations of load-bearing capacities that closely align with the experimental results. Regardless of the type of infill element, the analytical expressions consistently overestimated the load-bearing capacity. In the presence of longitudinal force, analytical expressions tend to be conservative, providing significantly lower load-bearing values compared with experimental results, which ensures a safety margin. The database can be utilized to develop numerical models, which can subsequently serve as the foundation for probabilistic methods used in conducting reliability assessments.
Background/Objectives: Colorectal cancer (CRC) remains a significant health burden, and its delayed diagnosis at advanced stages leads to poor survival outcome. Detection of known and novel prognostic markers is essential. In this study, the status of likely prognostic markers—the apoptotic inducing factor (AIFM3), vestigial-like family member 4 (VGLL4), and WNT4—was evaluated. Methods: AIFM3, VGLL4, and WNT4 expression in CRC tissues across different stages (Dukes A–D) were analyzed using histological immunofluorescence staining and RNA sequencing analyses. Results: In advanced CRC stages, progressive loss of normal crypt architecture, reduction of goblet cells, and necrotic debris were detected along with differential expression patterns of AIFM3, VGLL4, and WNT4. AIFM3 exhibited high reactivity in the lamina propria of healthy tissue and Dukes A, but this was diminished in advanced CRC stages. VGLL4 expression, initially confined to the lamina propria, increased significantly in the epithelium of Dukes B and C, with a cytoplasmic localization pattern. WNT4 expression was elevated in the CRC epithelium across all stages, contrasting with a significant reduction in lamina propria reactivity. RNA sequencing corroborated these findings, showing significant downregulation of AIFM3 and WNT4 and upregulation of VGLL4 in CRC tissues compared to controls. Expression of AIFM3 and WNT4 showed no correlation with survival outcome, while low VGLL4 expression was correlated with better survival outcome. Conclusions: The results suggest distinct roles for AIFM3, VGLL4, and WNT4 in CRC progression, highlighting only VGLL4 as a potential prognostic marker. Further evaluation of VGLL4 and its specific role in CRC progression remains to be elucidated.
Embedded systems, particularly when integrated into the Internet of Things (IoT) landscape, are critical for projects requiring robust, energy-efficient interfaces to collect real-time data from the environment. As these systems become complex, the need for dynamic reconfiguration, improved availability, and stability becomes increasingly important. This paper presents the design of a framework architecture that supports dynamic reconfiguration and “on-the-fly” code execution in IoT-enabled embedded systems, including a virtual machine capable of hot reloads, ensuring system availability even during configuration updates. A “hardware-in-the-loop” workflow manages communication between the embedded components, while low-level coding constraints are accessible through an additional abstraction layer, with examples such as MicroPython or Lua. The study results demonstrate the VM’s ability to handle serialization and deserialization with minimal impact on system performance, even under high workloads, with serialization having a median time of 160 microseconds and deserialization having a median of 964 microseconds. Both processes were fast and resource-efficient under normal conditions, supporting real-time updates with occasional outliers, suggesting room for optimization and also highlighting the advantages of VM-based firmware update methods, which outperform traditional approaches like Serial and OTA (Over-the-Air, the ability to update or configure firmware, software, or devices via wireless connection) updates by achieving lower latency and greater consistency. With these promising results, however, challenges like occasional deserialization time outliers and the need for optimization in memory management and network protocols remain for future work. This study also provides a comparative analysis of currently available commercial solutions, highlighting their strengths and weaknesses.
In the Croatian apple germplasm, there are, presumably, unique genotypes that have not yet been documented in reference molecular databases. Due to similarities between accessions, incorrect names are often used, which creates a problem in the identification of accessions. Overall, 169 apple accessions and 11 reference cultivars from the largest ex situ apple collection in the Republic of Croatia were investigated within this study. The examined accessions have been genotyped using SSR markers. In order to assess the advantage of a high-resolution marker system, such as SNPs, compared to low-resolution markers, such as SSRs, a subset of 23 unique apple accessions and eight reference cultivars were genotyped using the 480K Affymetrix Axiom SNP array. Results obtained through the use of two marker systems revealed 26 synonyms, 40 duplicates, 13 mislabeling accessions, 45 accessions with confirmed identity (known cultivars), and 45 unique accessions, as well as the true identity of a large number of accessions, currently maintained at the Croatian National Apple Germplasm Bank. In order to investigate the pomological variability of unique apples, a three-year study was carried out on eleven pomological traits. The researched germplasm shows an exceptional diversity of pomological properties. Many of the accessions can be considered unique, and the results of the pomological characterization indicated that this germplasm contains valuable traits of interest for future breeding programs.
In this study, the effect of ammunition on soil quality (physical and chemical indicators) at shooting ranges was investigated at four sites in Croatia. The sites differ in soil type (fluvisols, leptosols and terra rossa) and climatic conditions (Mediterranean and continental). The intensity of shooting range use (calculated from the age of the lane and the average number of targets used per year) and the distance from the shooting range (−40 m to +240 m) were examined in relation to soil chemical composition and soil quality. High contents of Pb and Sb at 100 m from the shooting position were observed in fluvisol and terra rossa soils, and the contamination factors (CFs) ranged from 6 up to 97. The study found high natural soil Cr and Ni content in leptosols and terra rossa due to paedogenic reasons (CFs < 1.3) and soil acidification (a decrease in soil pHKCl) due to ammunition/target use. Long-term measures for sustainable soil management and environment protection must be taken at shooting ranges to minimise the potential risks to ecosystems, wildlife and human health (an EU strategy).
Background and Objectives: Left ventricular aneurysm (LVA) causes geometric changes, including reduced systolic function and a more spherical shape, which is quantified by the sphericity index (SI), the ratio of the short to long axis in the apical four-chamber view. This study aimed to assess SI’s value in A-LVA and B-LVA, identify influencing factors, and evaluate its clinical relevance. Materials and Methods: This clinical study included 54 patients with post-infarction LVA and used echocardiography to determine LVA locations (A-LVA near the apex and B-LVA in the basal segments), with SI and other echocardiographic measures assessed in both systole and diastole for the entire cohort and stratified by A-LVA and B-LVA groups. Results: Among the 54 patients, 41 had A-LVA and 13 had B-LVA. The mean SI was 0.55 in diastole and 0.47 in systole for the cohort. Patients with A-LVA had a mean SI of 0.51 in diastole and 0.44 in systole, while B-LVA patients exhibited significantly higher SI values, with 0.65 in diastole and 0.57 in systole, due to lower long-axis (L) values in both phases. The mean left ventricular ejection fraction (EF) was 23.95% in A-LVA and 30.85% in B-LVA, with no significant difference. However, apical aneurysms were larger (greater LVAV and LVAA) and more significantly reduced functional myocardium. LVEDV, LVESV, LVEDA, and LVESA did not differ significantly between A-LVA and B-LVA. In cases of severe mitral regurgitation (MR), SI was notably higher (0.75 in diastole) due to a marked reduction in the L axis. Conclusions: SI is key in differentiating A-LVA and B-LVA on echocardiography. B-LVA has lower volume and area values, but similar aneurysm and left ventricular volumes and EF. Higher SI in B-LVA is due to a reduced L-axis, and is worsened by severe mitral regurgitation (MR). Surgical ventricular reconstruction (SVR) compensates for L-axis reduction, with preservation of the L axis critical for achieving a more physiological shape. SI thus serves as a marker for left ventricular geometry and surgical outcomes.
<p><strong>Aim</strong> The position of science and scientific research in Bosnia and Herzegovina (B&H) is unfavourable. University education lacks research programs, hindering students from developing critical evaluation skills. <br /><strong>Methods</strong> This cross-sectional study examined knowledge, attitudes, experience and perceived barriers towards scientific research among biomedical students and recent graduates at the University of Sarajevo in B&H. A self-reporting questionnaire was distributed via social networks and among students from all years of the Medical, Dentistry, Pharmaceutical faculties, the Faculty of Health Sciences, and the Faculty of Science, as well as recent graduates.<br /><strong>Results</strong> The survey was completed by 243 participants. The mean knowledge score of 4.3/11 was noticed; 216 (96%) believed research was necessary for healthcare improvement. Although 147 participants (65.3%) attended courses on research methodology, only 63 (28%) engaged in scientific research at their faculties. Only 5 (8.5%) employed graduates participated in research at their jobs. Almost half, 99 (44%) participants consulted scientific papers only upon recommendation. The majority of participants, 199 (82.2%), reported they experienced barriers to conducting research in B&H. <br /><strong>Conclusion</strong> Biomedical students and graduates demonstrated limited research knowledge, but had positive attitudes and acknowledged significant barriers. Improved faculty curricula in research areas and more opportunities are needed.</p>
Coronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05–0.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel. Clinical manifestations can include heart failure, myocardial ischemia due to coronary steal, arrhythmias, or infective endocarditis. We report a case of a 39-year-old man initially evaluated in 2016 for peripheral edema and suspected right ventricular (RV) abnormality. Earlier assessments indicated a left anterior descending (LAD) coronary artery–RV fistula, but initial catheterization was nondiagnostic. Transthoracic echocardiography (TTE) revealed a dilated left coronary artery (LCA) and an RV apex aneurysm, confirmed by CT and coronary angiography, showing a 14 mm LAD fistula with large aneurysmal sacs (45.6 × 37.3 mm). Cardiac MRI demonstrated a tortuous LAD fistula draining into RV aneurysmal sacs with preserved biventricular function. Surgical intervention was recommended, but the patient declined and was lost to follow-up until 2022, being asymptomatic. Re-evaluation showed progression in aneurysm size (47 × 45 mm and 16 × 18 mm) without ventricular functional change. Follow-up TTE in 2023 indicated stable findings. This case emphasizes the necessity of multimodal imaging (TTE, CT, MRI, angiography) for CAF diagnosis and management planning. Given the variability in CAF presentation and outcomes, individualized management—including surgical, percutaneous, or conservative strategies—is crucial. Persistent follow-up is essential for monitoring potential complications and guiding treatment, even in asymptomatic patients refusing intervention.
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