Heart Failure Issues and Management:A European Perspective

Heart failure poses an increasing problem for global health care systems.The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe.The European experience in heart failure,although similar to that in North America,has recently demonstrated differences in hospitalization which may underlie the differences between health care system confi gurations.Despite the predicted increase in the number of patients affected by heart failure,over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies,device-based therapies,and mechanical therapies,including left ventricular assist devices and cardiac transplantation.Although the treatment of such patients has been clearly delineated in national and international guidelines,the underuse of all available and appropriate therapies remains a signifi cant problem.The purpose of this review is to provide a European perspective on management of heart failure.

A Hybrid Model for Improving Software Cost Estimation in Global Software Development

Accurate software cost estimation in Global Software Development(GSD)remains challenging due to reliance on historical data and expert judgments.Traditional models,such as the Constructive Cost Model(COCOMO II),rely heavily on historical and accurate data.In addition,expert judgment is required to set many input parameters,which can introduce subjectivity and variability in the estimation process.Consequently,there is a need to improve the current GSD models to mitigate reliance on historical data,subjectivity in expert judgment,inadequate consideration of GSD-based cost drivers and limited integration of modern technologies with cost overruns.This study introduces a novel hybrid model that synergizes the COCOMO II with Artificial Neural Networks(ANN)to address these challenges.The proposed hybrid model integrates additional GSD-based cost drivers identified through a systematic literature review and further vetted by industry experts.This article compares the effectiveness of the proposedmodelwith state-of-the-artmachine learning-basedmodels for software cost estimation.Evaluating the NASA 93 dataset by adopting twenty-six GSD-based cost drivers reveals that our hybrid model achieves superior accuracy,outperforming existing state-of-the-artmodels.The findings indicate the potential of combining COCOMO II,ANN,and additional GSD-based cost drivers to transform cost estimation in GSD.

Exercise benefits meet the esophagus

Gastroesophageal reflux disease(GERD)is defined by recurrent and troublesome heartburn and effortless regurgitation or by the specific complications of this condition—that is,esophagitis,esophageal peptic strictures,and Barrett esophagus.1Although GERD is caused by gastric contents'reaching the esophagus,gastric juices can also reach other anatomical locations(pharynx,mouth,larynx,and airways),leading to(or worsening)extra-esophageal conditions(notably asthma)or symptoms(e.g.,wheezing,cough).1 Together with obesity,GERD is the main risk factor for gastroesophageal malignancies.

Advancing pediatric exercise research:A focus on immunomics and cutting-edge technologies

1.The importance of immunomics in pediatric exercise research The profound effect that"acute"or"regular"exercise(i.e.,a single exercise session or repeated sessions over time,respectively)exerts on the immune system has been widely recognized.1 Acute exercise is largely"immuno-enhancing"(e.g.,it may even improve vaccine responses in"at-risk"patients),whereas regular exercise reduces the risk of chronic conditions(not only obesity,diabetes,or cardiovascular diseases,but also several types of cancer)partly due to its anti-inflammatory effects.

Dose-response effect of pre-exercise carbohydrates under muscle glycogen unavailability:Insights from McArdle disease

Background:This study aimed to determine the effect of different carbohydrate(CHO)doses on exercise capacity in patients with McArdle disease—the paradigm of“exercise intolerance”,characterized by complete muscle glycogen unavailability—and to determine whether higher exogenous glucose levels affect metabolic responses at the McArdle muscle cell(in vitro)level.Methods:Patients with McArdle disease(n=8)and healthy controls(n=9)underwent a 12-min submaximal cycling constant-load bout followed by a maximal ramp test 15 min after ingesting a non-caloric placebo.In a randomized,double-blinded,cross-over design,patients repeated the tests after consuming either 75 g or 150 g of CHO(glucose:fructose=2:1).Cardiorespiratory,biochemical,perceptual,and electromyographic(EMG)variables were assessed.Additionally,glucose uptake and lactate appearance were studied in vitro in wild-type and McArdle mouse myotubes cultured with increasing glucose concentrations(0.35,1.00,4.50,and 10.00 g/L).Results:Compared with controls,patients showed the“classical”second-wind phenomenon(after prior disproportionate tachycardia,myalgia,and excess electromyographic activity during submaximal exercise,all p<0.05)and an impaired endurance exercise capacity(-51%ventilatory threshold and55%peak power output,both p<0.001).Regardless of the CHO dose(p<0.05 for both doses compared with the placebo),CHO intake increased blood glucose and lactate levels,decreased fat oxidation rates,and attenuated the second wind in the patients.However,only the higher dose increased ventilatory threshold(+27%,p=0.010)and peak power output(+18%,p=0.007).In vitro analyses revealed no differences in lactate levels across glucose concentrations in wild-type myotubes,whereas a doseresponse effect was observed in McArdle myotubes.Conclusion:CHO intake exerts beneficial effects on exercise capacity in McArdle disease,a condition associated with total muscle glycogen unavailability.Some of these benefits are dose dependent.

Anticancer effects of exercise:Insights from single-cell analysis

A recent special topic in the Journal of Sport and Health Science reported the health benefits conferred by traditional and innovative m-health exercise and multimodal programs with respect to several types of cancer.1 A possible mechanism behind this protective effect could be enhanced cancer immunosurveillance.

Exerkine response to acute exercise:Still much to discover

Strong evidence supports the benefits of regular physical activity/exercise for the prevention and management of numerous non-communicable diseases.^(1,2)However,despite important advances(particularly the implementation of complex“omics”approaches),the underlying molecular mechanisms remain to be clearly elucidated.In the past decade,the role of exerkines—a myriad of signaling moieties(e.g.,mainly cytokines but also other small peptides,peptides,nucleic acids,lipids,or metabolites,among others)released by muscles(myokines)and other tissues in response to exercise that induces endocrine(at the multisystem level),paracrine,or autocrine effects—has gained attention.^(3,4)Indeed it has been proposed that some of the salutary effects of regular exercise(i.e.,repeated sessions of acute exercise)might be due,at least partly,to the progressive accumulation of frequent,acute episodes of exerkine release.^(5)

An Improved Lung Cancer Segmentation Based on Nature-Inspired Optimization Approaches

The distinction and precise identification of tumor nodules are crucial for timely lung cancer diagnosis andplanning intervention. This research work addresses the major issues pertaining to the field of medical imageprocessing while focusing on lung cancer Computed Tomography (CT) images. In this context, the paper proposesan improved lung cancer segmentation technique based on the strengths of nature-inspired approaches. Thebetter resolution of CT is exploited to distinguish healthy subjects from those who have lung cancer. In thisprocess, the visual challenges of the K-means are addressed with the integration of four nature-inspired swarmintelligent techniques. The techniques experimented in this paper are K-means with Artificial Bee Colony (ABC),K-means with Cuckoo Search Algorithm (CSA), K-means with Particle Swarm Optimization (PSO), and Kmeanswith Firefly Algorithm (FFA). The testing and evaluation are performed on Early Lung Cancer ActionProgram (ELCAP) database. The simulation analysis is performed using lung cancer images set against metrics:precision, sensitivity, specificity, f-measure, accuracy,Matthews Correlation Coefficient (MCC), Jaccard, and Dice.The detailed evaluation shows that the K-means with Cuckoo Search Algorithm (CSA) significantly improved thequality of lung cancer segmentation in comparison to the other optimization approaches utilized for lung cancerimages. The results exhibit that the proposed approach (K-means with CSA) achieves precision, sensitivity, and Fmeasureof 0.942, 0.964, and 0.953, respectively, and an average accuracy of 93%. The experimental results prove thatK-meanswithABC,K-meanswith PSO,K-meanswith FFA, andK-meanswithCSAhave achieved an improvementof 10.8%, 13.38%, 13.93%, and 15.7%, respectively, for accuracy measure in comparison to K-means segmentationfor lung cancer images. Further, it is highlighted that the proposed K-means with CSA have achieved a significantimprovement in accuracy, hence can be utilized by researchers for improved segmentation processes of medicalimage datasets for identifying the targeted region of interest.

Bridging the gap: Predicting brain metastasis in breast cancer

Chen et al explored clinicopathological features and prognostic factors,revealing advanced tumor stage,lung metastases,HER-2 overexpression,and triple-negative status as key contributors.Recent research connects astrocytes'role in brain metastasis with signaling pathways and the impact of Trastuzumab on HER-2 tumor survival.Factors such as positive HER2 status,lack of estrogen receptor expression,and liver metastasis are identified as additional risk factors.The routine use of magnetic resonance imaging,insights into gene mutations associated with metastasis,and the role of radiotherapy,including prophylaxis possibilities,is controversial in clinical practice.Understanding these risk factors in a multidisciplinary collaboration is precise for local treatments and targeted therapies,particularly for HER2+tumors,impacting directly on longer survival.

Federated Learning on Internet of Things:Extensive and Systematic Review

The proliferation of IoT devices requires innovative approaches to gaining insights while preserving privacy and resources amid unprecedented data generation.However,FL development for IoT is still in its infancy and needs to be explored in various areas to understand the key challenges for deployment in real-world scenarios.The paper systematically reviewed the available literature using the PRISMA guiding principle.The study aims to provide a detailed overview of the increasing use of FL in IoT networks,including the architecture and challenges.A systematic review approach is used to collect,categorize and analyze FL-IoT-based articles.Asearch was performed in the IEEE,Elsevier,Arxiv,ACM,and WOS databases and 92 articles were finally examined.Inclusion measures were published in English and with the keywords“FL”and“IoT”.The methodology begins with an overview of recent advances in FL and the IoT,followed by a discussion of how these two technologies can be integrated.To be more specific,we examine and evaluate the capabilities of FL by talking about communication protocols,frameworks and architecture.We then present a comprehensive analysis of the use of FL in a number of key IoT applications,including smart healthcare,smart transportation,smart cities,smart industry,smart finance,and smart agriculture.The key findings from this analysis of FL IoT services and applications are also presented.Finally,we performed a comparative analysis with FL IID(independent and identical data)and non-ID,traditional centralized deep learning(DL)approaches.We concluded that FL has better performance,especially in terms of privacy protection and resource utilization.FL is excellent for preserving privacy becausemodel training takes place on individual devices or edge nodes,eliminating the need for centralized data aggregation,which poses significant privacy risks.To facilitate development in this rapidly evolving field,the insights presented are intended to help practitioners and researchers navigate the complex terrain of FL and IoT.

Depression Intensity Classification from Tweets Using Fast Text Based Weighted Soft Voting Ensemble

Predicting depression intensity from microblogs and social media posts has numerous benefits and applications,including predicting early psychological disorders and stress in individuals or the general public.A major challenge in predicting depression using social media posts is that the existing studies do not focus on predicting the intensity of depression in social media texts but rather only perform the binary classification of depression and moreover noisy data makes it difficult to predict the true depression in the social media text.This study intends to begin by collecting relevant Tweets and generating a corpus of 210000 public tweets using Twitter public application programming interfaces(APIs).A strategy is devised to filter out only depression-related tweets by creating a list of relevant hashtags to reduce noise in the corpus.Furthermore,an algorithm is developed to annotate the data into three depression classes:‘Mild,’‘Moderate,’and‘Severe,’based on International Classification of Diseases-10(ICD-10)depression diagnostic criteria.Different baseline classifiers are applied to the annotated dataset to get a preliminary idea of classification performance on the corpus.Further FastText-based model is applied and fine-tuned with different preprocessing techniques and hyperparameter tuning to produce the tuned model,which significantly increases the depression classification performance to an 84%F1 score and 90%accuracy compared to baselines.Finally,a FastText-based weighted soft voting ensemble(WSVE)is proposed to boost the model’s performance by combining several other classifiers and assigning weights to individual models according to their individual performances.The proposed WSVE outperformed all baselines as well as FastText alone,with an F1 of 89%,5%higher than FastText alone,and an accuracy of 93%,3%higher than FastText alone.The proposed model better captures the contextual features of the relatively small sample class and aids in the detection of early depression intensity prediction from tweets with impactful performances.

Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction

Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Methods The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)≥4,with NSTEMI to an invasive or conservative strategy.The primary endpoint was the number of days alive and out of hospital(DAOH)one year after discharge.For this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS>4,n=124)patients.Results Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56%).Among vulnerable patients,DAOH were similar regardless of strategy(invasive vs.conservative:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS>4,invasively managed lived 29 days less than their conservative counterparts.In contrast,the-re were no differences in the subgroup with CFS=4.Conclusions Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.

Frailty and acute coronary syndrome: does gender matter?

There are important sex-related differences in elderly patients with acute coronary syndrome(ACS).Women are older,more frequently frail,and present more comorbidities than men.Atypical symptoms at presentation are also more common in female patients,they are leaded to a delayed diagnosis and treatment.Coronary angiography and subsequent revascularization are frequently underused in elderly women and they tend to receive less guidelines-recommended therapies.The prognosis in elderly frail women with ACS is poor,and it is with high mortality and readmissions rates.Bleeding is recurrent ischemic events in which it is more frequent in women than in men.Recovery time might be long,and a multidisciplinary approach is desirable to improve prognosis and quality of life.Further studies are needed in order to clarify the benefit of the different therapies in the group of frail women,and this is particularly true for revascularization,as scientific evidence in this group is very scarce.

Diagnosis of interatrial block

In the 70＇s, we classified for the first time the blocks at the atrial level into interatrial blocks （IAB）, partial and advanced, and other types of atrial blocks including the concept of atrial aberrancy, and atrial dissociation.

Efficacy of bevacizumab-containing chemotherapy in metastatic colorectal cancer and CXCL5 expression: Six case reports

BACKGROUND In metastatic colorectal cancer(mCRC),the anti-vascular endothelial growth factor drug bevacizumab(BVZ)plus chemotherapy significantly improves progression-free survival compared to chemotherapy(CT)alone.This benefit is not,however,observed in all patients.While increased chemokine CXCL5 gene expression promoting angiogenesis has been proposed as a prognostic mCRC biomarker,few studies have examined its relationship with drug efficacy.This study sought to analyze tumor CXCL5 gene expression in six patients with different efficacy of BVZ-containing CT in terms of the tumor response to treatment.CASE SUMMARY We report six cases of stage IV KRAS-mutated mCRC.Patients were given first line treatment with BVZ-containing chemotherapy in University Hospital of Fuenlabrada.The six patients differed in terms of primary tumor location(right/left side),tumor burden(mostly hepatic and peritoneal disease)and clinical disease course.Before treatment onset,total RNA was isolated from paraffinated tumor biopsy specimens and CXCL5 gene expression quantified through conventional RT-qPCR procedures.Our main finding was that CXCL5 expression levels were several times higher in three patients with lower progression free survival(under 6 mo)from the start of treatment.CONCLUSION A higher expression of CXCL5 was observed in the three patients showing worse tumor response to treatment.

Prediction of sudden death in elderly patients with heart failure

Most heart failure （HF） related mortality is due to sudden cardiac death （SCD） and worsening HF, particularly in the case of reduced ejection fraction. Predicting and preventing SCD is an important goal but most works include no or few patients with advanced age, and the prevention of SCD in elderly patients with HF is still controversial. A recent reduction in the annual rate of SCD has been recently described but it is not clear if this is also true in advanced age patients. Age is associated with SCD, although physicians frequently have the perception that elderly patients with HF die mainly of pump failure, underestimating the importance of SCD. Other clinical variables that have been associated to SCD are symptoms, New York Heart Association functional class, ischemic cause, and comorbidities （chronic obstructive pulmonary disease, renal dysfunction and diabetes）. Some test results that should also be considered are left ventricular ejection fraction and diameters, natriuretic peptides, non-sustained ventricular tachycardias and autonomic abnormalities. The combination of all these markers is probably the best option to predict SCD. Different risk scores have been described and, although there are no specific ones for elderly populations, most include age as a risk predictor and some were developed in populations with mean age 〉 65 years. Finally, it is important to stress that these scores should be able to predict any type of SCD as, although most are due to tachyarrhythmias, bradyarrhythmias also play a role, particularly in the case of the elderly.

Prevalence and incidence of interatrial block in global population and in different clinical situations

The high prevalence of interatrial block （IAB） is widely neglected due to its frequent underdiaguosis. Its prevalence depends mainly on age and also on the presence of associ- ated heart disease. In patients without structural heart dis- ease, it is mainly an elderly condition. This is particularly true for advanced IAB, rarely found in global population before 65 years but with prevalence of 8% in the 70＇s and 25% in centenarians,tll When studying prevalence data of this condition, three factors should be taken into account in order to interpret differences that are frequently related with the methodology used （Table 1, Figure 1）.

Modulation of faecal metagenome in Crohn's disease:Role of microRNAs as biomarkers

BACKGROUND The gut microbiota plays a key role in the maintenance of intestinal homeostasis and the development and activation of the host immune system. It has been shown that commensal bacterial species can regulate the expression of host genes. 16 S rRNA gene sequencing has shown that the microbiota in inflammatory bowel disease(IBD) is abnormal and characterized by reduced diversity. Micro RNAs(miRNAs) have been explored as biomarkers and therapeutic targets, since they are able to regulate specific genes associated with Crohn's disease(CD). In this work, we aim to investigate the composition of gut microbiota of active treatment-na?ve adult CD patients, with miRNA profile from gut microbiota.AIM To investigate the composition of gut microbiota of active treatment-na?ve adult CD patients, with miRNA profile from gut microbiota.METHODS Patients attending the outpatient clinics at Valme University Hospital without relevant co-morbidities were matched according to age and gender. Faecal samples of newonset CD patients, free of treatment, and healthy controls were collected. Faecal samples were homogenized, and DNA was amplified by PCR using primers directed to the 16 S bacterial rRNA gene. Pyrosequencing was performed using GS-Junior platform. For sequence analysis, MGRAST server with the database Ribosomal Project was used. MiRNA profile and their relative abundance were analyzed by quantitative PCR.RESULTS Microbial community was characterized using 16 S rRNA gene sequencing in 29 samples(n = 13 CD patients, and n = 16 healthy controls). The mean Shannon diversity was higher in the healthy control population compared to CD group(5.5 vs 3.7). A reduction in Firmicutes and an increase in Bacteroidetes were found. Clostridia class was also significantly reduced in CD. Principal components analysis showed a grouping pattern, identified in most of the subjects in both groups, showing a marked difference between control and CD groups. A functional metabolic study showed that a lower metabolism of carbohydrates(P = 0.000) was found in CD group, while the metabolism of lipids was increased. In CD patients, three miRNAs were induced in affected mucosa: mir-144(6.2 ± 1.3 fold), mir-519(21.8 ± 3.1) and mir-211(2.3 ± 0.4). CONCLUSION Changes in microbial function in active non-treated CD subjects and three miRNAs in affected vs non-affected mucosa have been found. miRNAs profile may serve as a biomarker.

Atrial fibrillation in the elderly

Atrial fibrillation （AF） is the most frequent arrhythmia. Due to population aging, AF is a growing epidemic and its importance will continue to increase in the next decades. Although the prevalence of AF is high in advanced age, the number of subjects with predisposing factors for AF is even higher. Most of these factors increase the risk of atrial fibro- sis, an important component of atrial arrhythmia mecha- nisms. In fact, the new techniques to detect atrial fibrosis are showing the strong association between atrial fibrosis and AF risk. Regarding predisposing factors for AF, interatrial block （LAB） seems to be a key factor.

Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know

External beam radiotherapy(EBRT) is one of the principal curative treatments for patients with prostate cancer(PCa). Risk group classification is based on prostate-specific antigen(PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging(MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI(mp MRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrastenhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpM RI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decisionmaking for EBRT. mpM RI is also being used in salvageradiotherapy(SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence-pelvic(local, nodal, or bone) or distant-in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpM RI in detecting local recurrences-even in patients with low PSA levels(0.3-0.5 ng/m L)-and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpM RI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.