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Acute coronary syndrome (ACS) is a complex clinical syndrome that encompasses acute myocardial infarction (AMI) and unstable angina (UA). Its underlying mechanism refers to coronary plaque disruption, with consequent platelet aggregation and thrombosis. Inflammation plays an important role in the progression of atherosclerosis by mediating the removal of necrotic tissue following myocardial infarction and shaping the repair processes that are essential for the recovery process after ACS. As a chronic inflammatory disorder, atherosclerosis is characterized by dysfunctional immune inflammation involving interactions between immune (macrophages, T lymphocytes, and monocytes) and vascular cells (endothelial cells and smooth muscle cells). New-onset atrial fibrillation (NOAF) is one of the most common arrhythmic complications in the setting of acute coronary syndromes, especially in the early stages, when the myocardial inflammatory reaction is at its maximum. The main changes in the atrial substrate are due to atrial ischemia and acute infarcts that can be attributed to neurohormonal factors. The high incidence of atrial fibrillation (AF) post-myocardial infarction may be secondary to inflammation. Inflammatory response and immune system cells have been involved in the initiation and development of atrial fibrillation. Several inflammatory indexes, such as C-reactive protein and interleukins, have been demonstrated to be predictive of prognosis in patients with ACS. The cell signaling activation patterns associated with fibrosis, apoptosis, and hypertrophy are forms of cardiac remodeling that occur at the atrial level, predisposing to AF. According to a recent study, the presence of fibrosis and lymphomononuclear infiltration in the atrial tissue was associated with a prior history of AF. However, inflammation may contribute to both the occurrence/maintenance of AF and its thromboembolic complications.

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Radial artery spasm (RAS) is a common complication associated with transradial access (TRA) for coronary interventions, particularly affecting elderly patients in whom radial access is preferred due to its benefits in reducing bleeding complications, improving clinical outcomes, and lowering long-term costs. This review examines the incidence, prevention, and treatment of RAS. Methods included an online search of PubMed and other databases in early 2024, analyzing meta-analyses, reviews, studies, and case reports. RAS is characterized by a sudden narrowing of the radial artery due to psychological and mechanical factors with incidence reports varying up to 51.3%. Key risk factors include patient characteristics like female sex, age, and small body size as well as procedural factors such as emergency procedures and the use of multiple catheters. Preventive measures include using distal radial access, hydrophilic sheaths, and appropriate catheter sizes. Treatments involve the intraarterial administration of nitroglycerine and verapamil as well as mechanical methods like balloon-assisted tracking. This review underscores the need for standardizing RAS definitions and emphasizes the importance of operator experience and patient management in reducing RAS incidence and improving procedural success.

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Background: When compared to biventricular pacing, fusion CRT pacing was linked to a decreased incidence of atrial fibrillation (AF). There is a gap in the knowledge regarding exclusive fusion CRT without interference with RV pacing, and all the current data are based on populations of patients with intermittent fusion pacing. Purpose: To assess left atrium remodeling and AF incidence in a real-life population of permanent fusion CRT-P. Methods: Retrospective data were analyzed from a cohort of patients with exclusive fusion CRT-P. Device interrogation, exercise testing, transthoracic echocardiography (TE), and customized medication optimization were all part of the six-monthly individual follow-up. Results: Study population: 73 patients (38 males) with non-ischemic dilated cardiomyopathy aged 63.7 ± 9.3 y.o. Baseline characteristic: QRS 159.8 ± 18.2 ms; EF 27.9 ± 5.1%; mitral regurgitation was severe in 38% of patients, moderate in 47% of patients, and mild in 15% of patients; 43% had type III diastolic dysfunction (DD), 49% had type II DD, 8% had type I DD. Average follow-up was 6.4 years ± 27 months: 93% of patients were responders (including 31% super-responders); EF increased to 40.4 ± 8.5%; mitral regurgitation decreased in 69% of patients; diastolic profile improved in 64% of patients. Paroxysmal and persistent AF incidence was 11%, with only 2% of patients developing permanent AF. Regarding LA volume, statistically significant LA reverse remodeling was observed. Conclusions: Exclusive fusion CRT-P was associated with important LA reverse remodeling and a low incidence of AF.

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Congenital heart diseases (CHD) are one of the most common birth defects and the main leading cause of death in children. Many patients with CHD are reaching adulthood due to the success of improved contemporary surgical procedures. Understanding the etiology of CHD remains important for patient clinical management. Both genetic and environmental factors are involved in the development and progression of CHD. Variations in many different genes and chromosomal anomalies can be associated with CHD, by expression of different mechanisms. Sporadic cases are the most frequently encountered in these patients. Atrial septal defect is a common congenital heart disease that refers to direct communication between atrial chambers, found isolated or associated with other syndromes. Imaging techniques, especially transthoracic and transesophageal echocardiography (TOE) represent the key for diagnosis and management of ASD. The disease has a major incidence in adulthood, due to late symptomatology, but assessment and treatment are important to avoid time-related complications. Ebstein's anomaly is a rare congenital disease, with a dominant genetic participation, characterized by an abnormal displacement of the tricuspid valve and right ventricular myopathy, often requiring surgical intervention. Alongside echocardiography, cardiac magnetic resonance (CMR) imaging is the gold standard tool for the assessment of ventricular volumes. Early diagnosis and adequate treatment are mandatory to avoid possible complications of CHD, and thus, ECG, as well as imaging techniques, are important diagnostic tools. However, patients with CHD need a special healthcare team for the entire monitorization in various life stages.

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Methotrexate is an immunosuppressive drug with remarkable therapeutic results in the treatment of autoimmune and proliferative skin diseases. Although it has been more than half a century since it was first introduced into the therapeutic arsenal of dermatologists, there are currently no standardized therapeutic protocols regarding the prescription of methotrexate in dermatology, with the exception of psoriasis treatment. This review aims to highlight the indications and benefits of methotrexate beyond psoriasis, with a focus on a wide range of inflammatory, vesiculobullous, and proliferative dermatological pathologies.

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Given the widespread occurrence of insulin resistance, a key factor in metabolic syndrome and a distinct condition altogether, there is a clear need for effective, surrogate markers. The triglyceride-to-high-density lipoprotein (TG/HDL) ratio stands out as a viable option, indicative of changes in lipid metabolism associated with insulin resistance, offering a cost-effective and straightforward alternative to traditional, more complex biomarkers. This review, in line with PRISMA guidelines, assesses the TG/HDL ratio's potential as an indirect indicator of insulin resistance. Analysing 32 studies over 20 years, involving 49,782 participants of diverse ethnic backgrounds, including adults and children, this review primarily uses a cross-sectional analysis with the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) to gauge insulin resistance. It reveals the TG/HDL ratio's varied predictive power across ethnicities and sexes, with specific thresholds providing greater accuracy for Caucasians, Asians, and Hispanics over African Americans and for men over women. Valid across different weights and ages, for adults and children, it suggests average cutoffs of 2.53 for women and 2.8 for men. The analysis supports the TG/HDL ratio as a simple, accessible marker for insulin resistance, though it advises further research on tailored cutoffs reflecting ethnic and gender differences.

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Heart failure (HF) is a complex medical condition characterized by both electrical and mechanical dyssynchrony. Both dyssynchrony mechanisms are intricately linked together, but the current guidelines for cardiac resynchronization therapy (CRT) rely only on the electrical dyssynchrony criteria, such as the QRS complex duration. This possible inconsistency may result in undertreating eligible individuals who could benefit from CRT due to their mechanical dyssynchrony, even if they fail to fulfill the electrical criteria. The main objective of this literature review is to provide a comprehensive analysis of the practical value of echocardiography for the assessment of left ventricular (LV) dyssynchrony using parameters such as septal flash and apical rocking, which have proven their relevance in patient selection for CRT. The secondary objectives aim to offer an overview of the relationship between septal flash and apical rocking, to emphasize the primary drawbacks and benefits of using echocardiography for evaluation of septal flash and apical rocking, and to offer insights into potential clinical applications and future research directions in this area. Conclusion: there is an opportunity to render resynchronization therapy more effective for every individual; septal flash and apical rocking could be a very useful and straightforward echocardiography resource.

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The rising prevalence of cardiovascular disease underscores the growing significance of heart failure (HF). Pathophysiological insights into HF highlight the dysregulation of the autonomic nervous system (ANS), characterized by sympathetic overactivity and diminished vagal tone, impacting cardiovascular function. Heart rate recovery (HRR), a metric measuring the heart's ability to return to its baseline rate post-exertion, plays a crucial role in assessing cardiovascular health. Widely applied across various cardiovascular conditions including HF, coronary artery disease (CAD), and arterial hypertension (HTN), HRR quantifies the difference between peak and recovery heart rates. Given its association with elevated sympathetic tone and exercise, HRR provides valuable insights into the perspective of HF, beyond effort tolerance, reaching toward prognostic and mortality indicators. Incorporating HRR into cardiovascular evaluations enhances our understanding of autonomic regulation in HF, offering potential implications for prognostication and patient management. This review addresses the significance of HRR in HF assessment, analyzing recently conducted studies, and providing a foundation for further research and clinical application.

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We present the case of a 51-year-old male with known congestive heart failure and acute myocarditis who presented to the emergency department (ED) with swollen testicles and urinary symptoms two weeks after the initiation of sodium glucose cotransporter 2 (SGLT2) inhibitor treatment. Abdominal and pelvic computed tomography (CT) scan was consistent with the diagnosis of Fournier's gangrene (FG). Intravenous antibiotics were administered and surgical exploratory intervention and excision of necrotic tissue were performed, stopping the evolution of necrotizing fasciitis. FG, a reported adverse event, may rarely occur when SGLT2 inhibitors are administered in patients with diabetes. To our knowledge, there have been no reported cases of FG in Romania since SLGT2 inhibitors were approved. The distinguishing feature of this case is that the patient was not diabetic, which emphasizes that patients without diabetes who are treated for heart failure with SGLT2 inhibitors may also be at risk of developing genitourinary infections. The association of predisposing factors may have contributed to the development of FG in this case and even though the benefits of SGLT2 inhibitors outweigh the risks, serious adverse events need to be voluntarily reported in order to intervene promptly, verify the relationship, and minimize the risk of bias.

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Phenolic root exudates (PREs) secreted by wetland plants facilitate the accumulation of iron in the rhizosphere, potentially providing the essential active iron required for the generation of enzymes that degrade polycyclic aromatic hydrocarbon, thereby enhancing their biodegradation. However, the underlying mechanisms involved are yet to be elucidated. This study focuses on phenanthrene (PHE), a typical polycyclic aromatic hydrocarbon pollutant, utilizing representative PREs from wetland plants, including p-hydroxybenzoic, p-coumaric, caffeic, and ferulic acids. Using hydroponic experiments, 16S rRNA sequencing, and multiple characterization techniques, we aimed to elucidate the interaction mechanism between the accelerated degradation of PHE and the formation of rhizosphere biofilm/iron plaque influenced by PREs. Although all four types of PREs altered the biofilm composition and promoted the formation of iron plaque on the root surface, only caffeic acid, possessing a similar structure to the intermediate metabolite of PHE (catechol), could accelerate the PHE degradation rate. Caffeic acid, notable for its catechol structure, plays a significant role in enhancing PHE degradation through two main mechanisms: (a) it directly boosts PHE co-metabolism by fostering the growth of PHE-degrading bacteria, specifically Burkholderiaceae, and by facilitating the production of the key metabolic enzyme catechol 1,2-dioxygenase (C12O) and (b) it indirectly supports PHE biodegradation by promoting iron plaque formation on root surfaces, thereby enriching free iron for efficient microbial synthesis of C12O, a crucial factor in PHE decomposition.

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Antibiotic residues in aquaculture environment pose persistent threats to ecology and human health, exacerbated by salt-alkali mariculture wastewater. Yet, little is known about antibiotic removal in tidal flow constructed wetlands (TFCWs) under salinity stress, especially considering TFCW constitution, configuration, and influent water characteristics. Here, the removal performance and mechanism of different TFCWs for sulfonamide antibiotics (SAs: sulfadiazine, sulfamethazine, sulfamonomethoxine, and sulfamethoxazole) and trimethoprim (TMP) from mariculture wastewater (with low, medium, and high salinity) were evaluated alongside comparisons of environmental factors and microbial responses. Results showed substantial reduction in alkalinity (from 8.25-8.26 to 7.65-8.18), salinity (from 3.67-11.30 ppt to 3.20-10.79 ppt), and SAs concentrations (from 7.79-15.46 mg/L to 0.25-10.00 mg/L) for mariculture wastewater using TFCWs. Zeolite and yellow flag configurations exhibited superior performance in SAs removal from mariculture wastewater. Furthermore, the salt-alkali neutralization and oxygen transport capabilities of zeolite, along with the salt-alkali tolerance and biofilm formation characteristics of yellow flag, promoted the development of a biofilm in the rhizosphere dominated by oxidative stress tolerance and facultative anaerobic traits, thereby improving the TFCW microenvironment. Consequently, aerobic (Sulfuritalea and Enterobacter) and salt-tolerant (Pseudomonas) functional bacteria involved in antibiotic degradation were selectively enriched in the zeolite- and yellow flag-TFCWs, contributing to the effective biodegradation of SAs (achieving removal efficiency of 92-97 %). Besides, the high salt-alkali levels of mariculture wastewater and the strong oxygen-enriched capacity of the TFCWs not only enhanced the aerobic oxidation reaction of SAs, but also bidirectionally inhibited the substrate adsorption and anaerobic reduction process of TMP. These findings address a critical gap by investigating the efficacy of TFCWs in removing antibiotics from mariculture wastewater under various salinity conditions, providing essential insights for optimizing wetland design and improving wastewater management in mariculture environments.

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Infectious and inflammatory dermatoses featuring skin lesions with loss of tissue expose skin layers to microbial invasions, disrupt the normal skin microbiome, and potentially lead to sepsis. However, literature data on the incidence of cutaneous-onset sepsis are scarce. This retrospective observational study assessed hospital admissions for primary skin lesions without bacterial infections and sepsis during 2020-2022 in the largest emergency hospital in NE Romania. Of 509 patients, 441 had infected lesions, 78 had sepsis caused by venous ulcers from microbial eczema cellulitis, superinfected bullous dermatoses, erysipelas, and erythroderma. Cultured samples revealed S. aureus, P. aeruginosa, and E. coli; and K. pneumoniae and S. ß-hemolytic associated with sepsis, even if this was rarer. Clinical manifestations included ulcerations, erosions, fissures, excoriations, bullae, vesicles, pruritus, tumefaction, edema, fever, chills, pain, adenopathy, and mildly altered mental status. Underlying chronic heart failure, atrial fibrillation, anemia, and type-1 diabetes mellitus were comorbidities associated with infection and sepsis. Significant associations and risk factors, including their combined effects, are discussed to draw attention to the need for further research and adequate management to prevent sepsis in adult patients of any age presenting with infected skin lesions (especially cellulitis) and comorbidities (especially type 1 diabetes mellitus and anemia).

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Plants play a crucial role as a removal pathway in constructed wetlands, demonstrating the ability to absorb and tolerate antibiotics from wastewater. However, the specific contribution of plants in this regard has not yet to be sufficiently established. To gain a more comprehensive insight into the associated processes, we selected three common wetland plant species, Canna indica L. (C. indica), Cyperus alternifolius L. (C. alternifolius), and Thalia dealbata Fraser (T. dealbata), to evaluate their capacity for uptake, accumulation, and physiological response in the removal of sulfamethoxazole (SMX) at varying initial concentrations (10, 30, 100, and 300 µg/L) under hydroponic conditions. The results showed that SMX removal was more efficient at lower concentrations (10 and 30 µg/L) than at higher concentrations (100 and 300 µg/L). Moreover, plant systems were found to consistently outperform unplanted systems in SMX removal. Among the assessed species, C. indica was identified as being relatively effective in the removal of SMX, whereas the performance of C. alternifolius was notably less pronounced. A positive correlation was observed between the concentration of SMX in the plant tissues and that in the external aqueous medium. However, plant tissue residues contributed only a minor fraction to the overall removal of SMX. Wetland plants absorb SMX through their roots, and we accordingly detected significantly higher concentrations in submerged plant tissues. Furthermore, we also detected reductions in net photosynthetic rates indicative of potential phytotoxicity, which is associated with the accumulation of antibiotic in the shoot tissues. Accumulation of SMX in the roots and rhizomes was also found to be associated with the development of shorter roots, with this effect becoming more pronounced with an increase in the concentration of exogenous SMX. However, despite these adverse effects, plants can detoxify antibiotics via the glutathione pathway. Of the assessed plant species, C. indica was identified as the most SMX tolerant, as indicated by Km and Vmax values, with C. alternifolius being the least tolerant. Our findings in this study reveal the potential value of wetland plants in the sequestration of antibiotics and provide evidence for the underlying mechanisms of action. These findings could make an important contribution to the implementation of phytoremediation in antibiotic-contaminated water.

Three wetland plants with fibrous root systems, namely Canna indica, Cyperus alterniflius, and Thalia dealbata, were selected to investigate the removal efficiencies of sulfamethoxazole in the hydroponic system by different emergent plants, quantify the contribution of uptake and accumulation for sulfamethoxazole in plant tissues, and assess the physiological responses of plants and their effect on the removal of sulfamethoxazole. The knowledge obtained from this study shows the potential use of wetland plants for removing antibiotics and the inherent mechanisms, which will be useful for the application of phytoremediation in antibiotic contaminated water.

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A whole-year investigation of full-scale integrated subsurface-constructed wetlands (ISCWs) was carried out to purify the tail water from a wastewater treatment plant (WWTP) for wastewater reclamation under four plant species, four hydraulic loading rates (HLRs), and four seasons. The results showed that ISCWs were effective for the purification of WWTP discharge, with the average removal efficiencies of COD, NH4+-N, TN, and TP being 48%, 49%, 9%, and 30%, respectively. Typical pollutant concentrations in the treated effluent of ISCWs were 8.19 mg/L COD, 1.76 mg/L NH4+-N, 11.57 mg/L TN, and 0.36 mg/L TP, which met most of the water quality standards for reusing recycling water. Emergent plants with well-developed root systems may be capable of promoting the decontamination of ISCWs. Seasonal change played an important role in the treatment process: the removal of phosphorus by plant uptake and microbial utilization was more active in the warm season and the co-occurrence of organic degradation and nitrification, whereas the cold season is conducive to exothermic adsorption process of pollutants to substrates. Properly increasing the HLRs may improve the availability of ISCWs according to the requirement of effluent quality. Furthermore, the C/N ratio might be the key factor for the purification effect of ISCWs, because the COD level of WWTP discharge may change the process of NH4+-N biotransformation.

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BACKGROUND: Breast cancer is arguably one of the leading causes of death among women around the world. The automation of the early detection process and classification of breast masses has been a prominent focus for researchers in the past decade. The utilization of ultrasound imaging is prevalent in the diagnostic evaluation of breast cancer, with its predictive accuracy being dependent on the expertise of the specialist. Therefore, there is an urgent need to create fast and reliable ultrasound image detection algorithms to address this issue. METHODS: This paper aims to compare the efficiency of six state-of-the-art, fine-tuned deep learning models that can classify breast tissue from ultrasound images into three classes: benign, malignant, and normal, using transfer learning. Additionally, the architecture of a custom model is introduced and trained from the ground up on a public dataset containing 780 images, which was further augmented to 3900 and 7800 images, respectively. What is more, the custom model is further validated on another private dataset containing 163 ultrasound images divided into two classes: benign and malignant. The pre-trained architectures used in this work are ResNet-50, Inception-V3, Inception-ResNet-V2, MobileNet-V2, VGG-16, and DenseNet-121. The performance evaluation metrics that are used in this study are as follows: Precision, Recall, F1-Score and Specificity. RESULTS: The experimental results show that the models trained on the augmented dataset with 7800 images obtained the best performance on the test set, having 94.95 ± 0.64%, 97.69 ± 0.52%, 97.69 ± 0.13%, 97.77 ± 0.29%, 95.07 ± 0.41%, 98.11 ± 0.10%, and 96.75 ± 0.26% accuracy for the ResNet-50, MobileNet-V2, InceptionResNet-V2, VGG-16, Inception-V3, DenseNet-121, and our model, respectively. CONCLUSION: Our proposed model obtains competitive results, outperforming some state-of-the-art models in terms of accuracy and training time.

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To maintain the health of aquaculture fish, it is critical to understand the composition of microorganisms in aquaculture water and sediment and the factors affecting them. This study examined the water and sediment microbiota compositions of four different types of ponds in South China that were used to culture grass carp (Ctenopharyngodon idella) of different sizes through high-throughput sequencing of the 16S rRNA gene, and analyzed their correlations with environmental factors. The results showed that ponds with cultured grass carp of different sizes exhibited significant differences in terms of water physicochemical properties and composition of water and sediment microbiota. Furthermore, the exchange of microorganisms between water and sediment microbiota was lowest in ponds with the smallest grass carp and highest in ponds with the largest grass carp. All detected environmental factors except water temperature were significantly correlated with the water microbiota, and all detected environmental factors in the sediment were correlated with sediment microbiota. Moreover, Aeromonas hydrophila and Vibrio were significantly increased in the water microbiota, especially in ponds with small juvenile grass carp, implying an increased risk of A. hydrophila and Vibrio infections in these environments. Our results provide useful information for the management of grass carp aquaculture ponds.

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BACKGROUND: The left ventricular (LV) remodelling process represents the main cause of heart failure after a ST-segment elevation myocardial infarction (STEMI). Speckle-tracking echocardiography (STE) can detect early deformation impairment, while also predicting LV remodelling during follow-up. The aim of this study was to investigate the STE parameters in predicting cardiac remodelling following a percutaneous coronary intervention (PCI) in STEMI patients. METHODS: The study population consisted of 60 patients with acute STEMI and no history of prior myocardial infarction treated with PCI. The patients were assessed both by conventional transthoracic and ST echocardiography in the first 12 h after admission and 6 months after the acute phase. Adverse remodelling was defined as an increase in LVEDV and/or LVESV by 15%. RESULTS: Adverse remodelling occurred in 26 patients (43.33%). By multivariate regression equation, the risk of adverse remodelling increases with age (by 1.1-fold), triglyceride level (by 1.009-fold), and midmyocardial radial strain (mid-RS) (1.06-fold). Increased initial twist decreases the chances of adverse remodelling (0.847-fold). The LV twist presented the largest area under the receiver operating characteristic (ROC) curve to predict adverse remodelling (AUROC = 0.648; 95% CI [0.506;0.789], p = 0.04). A twist value higher than 11° has a 76.9% specificity and a 72.7% positive predictive value for reverse remodelling at 6 months.

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Left ventricle remodeling (LVR) after acute myocardial infarction (aMI) leads to impairment of both systolic and diastolic function, a major contributor to heart failure (HF). Despite extensive research, predicting post-aMI LVR and HF is still a challenge. Several circulant microRNAs have been proposed as LVR predictors; however, their clinical value is controversial. Here, we used real-time quantitative polymerase chain reaction (qRT-PCR) to quantify hsa-miR-22-3p (miR-22) plasma levels on the first day of hospital admission of ST-elevation aMI (STEMI) patients. We analyzed miR-22 correlation to the patients' clinical and paraclinical variables and evaluated its ability to discriminate between post-aMI LVR and non-LVR. We show that miR-22 is an excellent aMI discriminator and can distinguish between LVR and non-LVR patients. The discriminative performance of miR-22 significantly improves the predictive power of a multiple logistic regression model based on four continuous variables (baseline ejection fraction and end-diastolic volume, CK-MB, and troponin). Furthermore, we found that diabetes mellitus, hematocrit level, and the number of erythrocytes significantly influence its levels. These data suggest that miR-22 might be used as a predictor of ventricular function recovery in STEMI patients.

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Diabetes mellitus (DM) is one of the world's most important health problems, affecting more than half a billion of the world's population today, with an ever-increasing prevalence. Among the most common manifestations of diabetes are skin manifestations, with 30-70% of patients experiencing skin complications during the course of the disease. Conditions such as acanthosis nigricans, diabetic dermopathy, necrobiosis lipoidica, bacterial infections, fungal infections, skin xerosis, and metabolic prurigo are often associated with diabetes and often precede its diagnosis. We conducted a retrospective study on a group of 103 patients hospitalized between January 2018 and December 2022, in a clinic of a county hospital, using as criteria the diagnosis of diabetes mellitus complicated by cutaneous manifestations frequently associated with diabetes. The aim was to observe which are the most common manifestations and whether they correlate with data in the research literature. In the present study, manifestations such as diabetic foot (20% of patients), bacterial (35%) and fungal infections, and cutaneous xerosis (45%) were predominant. Often, the integumentary involvement may precede the diagnosis of the underlying disease. It is therefore very important to recognize, investigate and treat these manifestations as soon as possible.

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Lindera melissifolia is an endangered shrub indigenous to the broadleaf forest of the Mississippi Alluvial Valley (MAV). In this region, extant colonies of the species are found in periodically ponded habitats where a diversity of broadleaf trees can form well-developed overstory and sub-canopies-these habitat characteristics suggest that soil flooding and light availability are primary drivers of L. melissifolia ecophysiology. To understand how these two factors affect its photosynthetic capacity, we quantified leaf characteristics and photosynthetic response of plants grown in a large-scaled, field setting of three distinct soil flooding levels (no flood, 0 day; short-term flood, 45 days; and extended flood, 90 days) each containing three distinct light availability levels (high light, 30% shade cloth; intermediate light, 63% shade cloth; and low light, 95% shade cloth). Lindera melissifolia leaves showed marked plasticity to interacting effects of flooding and light with lamina mass per unit area (Lm/a) varying 78% and total nitrogen content per unit area (Na) varying 63% from the maximum. Photosynthetic capacity (A1800-a) ranged 123% increasing linearly with Na from low to high light. Extended flooding decreased the slope of this relationship 99% through a reduction in N availability and metabolic depression of A1800-a relative to Na. However, neither soil flooding nor light imposed an additive limitation on photosynthetic capacity when the other factor was at its most stressful level, and the A1800-a-Na relationship for plants that experienced short-term flooding suggested post-flood acclimation in photosynthetic capacity was approaching the maximal level under respective light environments. Our findings provide evidence for wide plasticity and acclimation potential of L. melissifolia photosynthetic capacity, which supports active habitat management, such as manipulation of stand structure for improved understory light environments, to benefit long-term conservation of the species in the MAV.