Continuous positive airway pressure as an alternative to deep-inspiration breath holding for mediastinal lymphoma radiotherapy.

Advanced Fetal Cardiac Disease Detection Using Optimized Gegenbauer Graph Neural Networks on Ultrasound Images to Facilitate Early Diagnosis and Clinical Assessment.

Myocardial infarction (MI) is a life-threatening condition caused by reduced oxygen supply to the heart muscle due to blockage of the coronary arteries. Delayed or missed diagnosis increases the risk of mortality and heart failure, making early detection critical. Echocardiography is a non-invasive imaging technique that uses real-time ultrasound to examine the heart's structure and function, including the evaluation of coronary artery disease and detection of regional wall motion abnormalities linked to MI. However, current approaches encounter limitations such as susceptibility to noise, restricted motion analysis capabilities, and significant computational demands. Hence, this work proposes EfficientNet_SpinalNet (Efficient_SpinalNet) for MI detection using echocardiography video. The proposed model utilizes the Hamad Medical Corporation Heart Hospital & Qatar University (HMC-QC) dataset and the Cardiac Acquisitions for Multi-structure Ultrasound Segmentation (CAMUS) dataset. The process begins by retrieving a video sample from the dataset, which is then decomposed into individual image frames. A hybrid filtering approach, integrating both median and Gaussian techniques, is first applied to the frames to suppress noise and enhance image quality. Following this preprocessing step, the Left Ventricle (LV) wall is fully extracted using the Fuzzy Local Information C-Means Clustering (FLICM) method, which further enables precise identification of the endocardial border. Following segmentation, displacement metrics and area variation curves are computed and passed into the feature extraction module. The extracted features, along with the displacement and area data, are then utilized for MI detection using the Efficient_SpinalNet architecture, which synergistically merges EfficientNet-B3-attn-2 with SpinalNet for enhanced diagnostic accuracy. Moreover, the experimental result reveals that the Efficient_SpinalNet functioned efficiently, attaining accuracy, sensitivity, and specificity values of 91.19%, 92.01%, and 92.435%. These results indicate that Efficient_SpinalNet is a reliable and efficient approach for real-time MI detection, offering potential improvements in clinical decision-making and patient outcomes.

It is becoming increasingly recognized that high-level spinal cord injury (SCI) is associated with altered heart structure and function, as well as a significantly elevated risk for heart disease. Despite this knowledge, we know remarkably little about the temporal molecular changes that occur in the heart following SCI and how these relate to functional decline. In the present study, we addressed this shortcoming by combining bulk RNA sequencing (RNA-seq) of left ventricle (LV) tissue with matching invivo cardiac function assessments (i.e., pressure-volume loops obtained via LV catheterization) from the same animals. We studied rats at either the acute (1 and 3d post-SCI) or chronic (12wk post-SCI) stage of SCI to establish temporal patterns and compared findings to sham-injured rats. We found that SCI induces marked, time-dependent changes in cardiac gene expression and function. Acute (1-3d) and chronic (12w) SCI display distinct, often opposing transcriptomic signatures, with thousands of genes differentially expressed versus SHAM. Acute SCI is characterized by suppressed immune, inflammatory, cell cycle, and stress-response pathways with altered metabolism. Chronic SCI shows upregulated immune signaling, impaired oxidative phosphorylation, extracellular matrix remodeling, and stress responses. Functionally, cardiac systolic dysfunction occurs early post-SCI and persists to the chronic phase. Reduced systolic function is strongly correlated with changes in immune, hypoxia, and cholesterol-related genes at the acute timepoints and with immune and hormone-signaling pathways at the chronic timepoint. Collectively, our data provide novel insight into the cardiac transcriptome post-SCI and identify the molecular pathways that most strongly correlate with functional decline.

BackgroundNon‐invasive imaging‐based assessment of blood flow plays a critical role in evaluating heart function and structure. Computed Tomography (CT) is a widely‐used imaging modality that can robustly evaluate cardiovascular anatomy and function, but direct methods to estimate blood flow velocity from movies of contrast dynamics have not been developed.PurposeThis study evaluates the impact of CT imaging parameters on Physics‐Informed Neural Networks (PINN)‐based flow estimation and proposes an improved PINN‐based approach, SinoFlow, which uses sinogram data directly to estimate blood flow.MethodsWe generated pulsatile flow fields in an idealized 2D vessel bifurcation using computational fluid dynamics and simulated CT scans with varying gantry rotation speeds, photon flux, and pulse mode imaging settings. We compared the performance of PINN‐based flow estimation using reconstructed images (ImageFlow) to SinoFlow.ResultsSinoFlow significantly improved flow estimation performance by avoiding temporal inconsistency errors introduced by filtered backprojection. SinoFlow was robust across all tested gantry rotation speeds and consistently produced lower mean squared error and velocity errors than ImageFlow. Additionally, SinoFlow was less susceptible to noise in the sinogram and was compatible with pulsed‐mode imaging and maintained higher accuracy with shorter pulse widths.ConclusionsThis study demonstrates the potential of SinoFlow for CT‐based flow estimation, providing a more promising approach for non‐invasive blood flow assessment. The findings inform future applications of PINNs to CT images and provide an alternative which avoids limitations associated with image‐based estimation.

PurposeTo compare dosimetric trade-offs among two full-VMAT and two hybrid 3D-CRT/VMAT strategies for left-sided whole-breast irradiation (WBI), and to evaluate the influence of planning strategy, introducing a novel tangential hybrid approach (H-tVMAT).Patients and MethodsTwenty patients with left-sided breast cancer treated with WBI (40.05 Gy in 15 fractions) were retrospectively analyzed. For each patient, four plans were generated within a single treatment planning system under free-breathing conditions: large-angle VMAT, tangential VMAT (tVMAT), Hybrid VMAT (H-VMAT), and the novel tangential Hybrid tVMAT (H-tVMAT). Primary dosimetric endpoints included heart and pulmonary structures and the contralateral breast, with dedicated evaluation of low-dose exposure. Target conformity, homogeneity index (HI), and monitor units (MUs) were also assessed.ResultsAll strategies achieved clinically acceptable target coverage and homogeneity. Hybrid configurations consistently reduced cardiac, pulmonary, and contralateral low-dose exposure compared with full-VMAT solutions. Among the evaluated strategies, H-tVMAT provided the most favorable balance between heart/LAD sparing, low-dose containment, and target coverage. Appropriately configured tangential VMAT achieved dosimetric results close to hybrid solutions, underscoring the importance of arc geometry. No statistically significant differences in delivery complexity were observed across strategies.ConclusionDosimetric performance in left-sided WBI is strongly influenced by planning implementation rather than nominal technique category alone. Hybrid tangential VMAT achieved the most balanced dosimetric profile, while optimized tangential VMAT provided comparable results. These findings support a strategy-specific approach to technique selection, emphasizing the central role of implementation choices in breast radiotherapy planning.

Cardiovascular diseases remain a leading cause of mortality worldwide, highlighting the urgent need for advanced therapeutic strategies in cardiac regenerative medicine. Among emerging technologies, 3D bioprinting has revolutionized the fabrication of biomimetic tissues by enabling precise spatial control over cells and biomaterials. At the same time, microfluidic systems, also referred to as "organ-on-a-chip" platforms, have provided dynamic environments that closely mimic natural cardiac physiology. In this review, we first summarize the structure and function of the human heart to establish the biological context for cardiac tissue modeling. We then discuss the main 3D bioprinting techniques (droplet-based, extrusion-based, and laser-assisted bioprinting) and highlight their advantages, limitations, and suitability for the fabrication of microfluidic architectures. Key properties of ideal biomaterials for both 3D bioprinting and organ-on-a-chip systems are discussed, with an emphasis on materials commonly used in microfluidic systems. Finally, we provide an in-depth overview of microfluidic systems and explore how 3D bioprinting is being used to create integrated heart-on-a-chip platforms for disease modeling and regenerative therapy. The integration of these technologies holds promise for the development of next-generation platforms in personalized cardiovascular therapy.

Congenital Heart Disease (CHD) represents the predominant form of congenital anomaly and occurs in approximately 0.8% of live births. Surgical correction is the definitive method used to treat CHD; however, postoperative complications can increase the risk of mortality and morbidity. Transcatheter closure has emerged as an alternative therapy for some CHD with left-to-right shunts, providing outcomes comparable with those of surgical correction. This narrative review was conducted to synthesize existing literature on the effect of thiamine supplementation in pediatric patients undergoing transcatheter closure for left-to-right shunt CHD. Thiamine deficiency in pediatric heart disease can weaken the heart by reducing its energy supply. Conversely, harmful changes to the heart's structure are linked to a specific enzyme balance. Since evidence suggests thiamine can correct this imbalance, thiamine supplementation may represent a therapeutic strategy to improve heart structure and function after treatment. In individuals with systolic heart failure, supplementation with thiamine has been associated with an enhancement in Left Ventricular Ejection Fraction (LVEF). Thiamine acts directly on cardiomyocytes, enhancing energy production and improving cardiac function. Therefore, thiamine administration during transcatheter closure is expected to stabilize the Matrix Metalloproteinase- 9 (MMP-9) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) levels, which may enhance or improve left ventricular function and dimensions.

Loss of Phospholamban Phosphorylation Blunts Ca2+ Handling During the Cellular Adrenergic Response

Maternal hyperglycemia disrupts cardiomyocyte maturation via aberrant nucleotide metabolism and suppression of AMPK signaling.

Automatic segmentation of cardiac magnetic resonance (CMR) images improves the evaluation of heart structure and function, helping clinical diagnosis and the generation of in silico models. Recent advances have introduced synthetic augmentation (SA) using generative adversarial networks (GANs) and topological correction (TC) via persistent homology to enhance segmentation with convolutional neural networks (CNNs). However, their combined effectiveness remains unexplored. Here, we extend and systematically evaluate these techniques, individually and in combination, for the first time in the context of three-dimensional (3D) CMR segmentation across challenging multi-vendor, multi-center, multi-class, and multi-contrast data sets. Data involved anisotropic, topologically inconsistent cine and late gadolinium-enhanced (LGE) CMRs, and isotropic, topologically consistent ex vivo CMRs. Topological priors were defined in each data set from ground truth label (GTL) assessments, and TC was applied by retraining the baseline 3D CNN with a loss function accounting for topological discrepancies. For SA, deformed GTLs were used to generate synthetic images using trained 3D GANs. Consistent segmentation improvements were observed for the ex vivo data in both overlap with GTLs and topological precision when applying TC and SA individually and in combination. Notably, an enhanced identification of the infarction was obtained when SA and TC were used in the LGE data. Overall, SA increased the predictions overlap with GTLs, while TC reduced the topological discrepancies across all data sets. TC and SA demonstrate strong potential for improving 3D CMR segmentation on complex, real-world data sets, especially when topologically consistent data are available for training.

Electrocardiogram (ECG) is a widely available, non-invasive diagnostic tool used for cardiovascular screening and provides essential insights into heart rhythm, structure, and function. However, the high dimensionality of ECGs and their entanglement with demographic information pose challenges for building fair and privacy-preserving machine learning models. ECG signals inherently encode soft biometric attributes such as sex, age, and race, which may introduce bias and raise privacy concerns in data-sharing environments. To address these challenges, we propose a deep learning framework that learns clinically relevant ECG representations while suppressing sensitive demographic information. We leverage a variational autoencoder (VAE) with a dual-discriminator architecture. One adversarial branch reduces soft biometric encoding, while the other preserves clinically important discrimination of reduced left ventricular ejection fraction (LVEF). The privacy-preserving reconstructed ECGs reduced identifiability of soft biometrics by independent CNN models with AUROC for sex 0.59 (from original 0.79), age 0.63 (from 0.78), and race 0.57 (from 0.69), while retaining clinically-useful predictions like reduced LVEF 0.82 (from 0.86), left ventricular hypertrophy (LVH) 0.72 (from 0.75), and 5-year mortality 0.67 (from 0.66). These findings demonstrate the effectiveness of our approach for retaining ECG data yet protecting patient privacy.

The heart undergoes substantial structural changes in response to new physiological demands, which occur with the rapid opening of pulmonary circulation immediately after birth. The dependence on pulmonary circulation causes an immediate increase in ventricular workload, resulting in microstructural changes that serve to maintain overall physiological homeostasis. Ageing continues to evolve the heart's structure due to increased myocardial tissue stress and strain, initiating the formation of a new extracellular matrix to facilitate the physiology of an adult. Quantifying the region-specific and age-dependent microstructural changes in tissue due to ageing is pivotal for the development of constitutive models for computational simulations. This study aimed to determine the microstructure of porcine ventricles at four time points from neonatal to adulthood. The three-dimensional microstructure was investigated using diffusion-tensor magnetic resonance imaging, two-photon excited fluorescence and second-harmonic generation microscopy to quantify fibre tractography, fractional anisotropy (FA), spherical measure, rotation and dispersion of cardiomyocytes and collagen fibrils. The results revealed that the left ventricle possessed greater FA than the right. Adult hearts demonstrated smaller FA than the young. The anterior left and right ventricles exhibited greater cardiomyocyte and collagen fibril rotation and dispersion than the posterior. The adult hearts possessed greater cardiomyocyte and collagen fibril rotation and dispersion than young hearts. The right ventricle demonstrated greater cardiomyocyte rotation in the younger hearts, and the Left in the adult. This study provides baseline data that should prove useful to bioengineers, researchers, and mathematicians in developing region-specific and age-dependent constitutive models to enhance the accuracy and bio-fidelity of computational simulations.

Cardiac point-of-care ultrasound (cPOCUS) is used to obtain key information about the heart's structure and function when an echocardiogram is not available. This prospective, cross-sectional study aimed to compare fractional shortening (FS%) and left-atrium-to-aorta ratio (LA:Ao) obtained by cPOCUS in different body positions to echocardiography. Thirty-nine dogs had cPOCUS performed in three different body positions: left lateral recumbency (RT), right lateral recumbency (LT), and standing or sternal recumbency (RST). The cPOCUS values from each body position for FS% and LA:Ao were tested for agreement with the echocardiogram by Bland-Altman plots, correct clinical assessment by generalized estimated equation models, and quality score of the cPOCUS images as a percentage. Bland-Altman analysis showed a positive bias for FS% (0.9% to 9.8%) and both positive and negative bias for LA:Ao (within 0.2) for the cPOCUS values. The correct clinical assessment was made in the majority of cases for FS% in RST (67%) and RT (67%), and for LA:Ao in RST (55%). The clinical assessment was more often correct when the image quality score was higher. Intraclass correlation showed good agreement (≥0.61) between investigators for FS% in all body positions and LA:Ao in RT and RST. This study showed that cPOCUS performed from the right hemithorax can provide estimates and correct clinical assessment of FS% and LA:Ao. Obtaining measurements in the LT position is not recommended.

Congenital Heart Disease (CHD) is an abnormality in the heart's structure or function present from birth. Indonesia reports over 40,000 new cases annually. Despite the heavy burden, data on CHD characteristics in East Nusa Tenggara remain limited. To investigate the clinical and demographic characteristics of CHD patients in Kupang, East Nusa Tenggara, and to describe their presenting symptoms and complications. We conducted a retrospective study of 148 CHD patients enrolled between August 1, 2023, and December 31, 2024, at Prof. W.Z. Johannes Regional Hospital, Kupang. Clinical profiles and demographic data were collected from the cardiology department's registers. Statistical analysis was performed using IBM SPSS® version 30. Acyanotic CHD (ACHD) was more prominent, accounting for 83.7% of cases, with atrial septal defect (ASD) being the most common (30.4%). Tetralogy of Fallot (TOF) was the most common type of cyanotic CHD (4.1%). The largest age group was neonates (37.2%). Almost half (45.3%) of the patients were underweight. Respiratory infections (25%) were the most common complication. The results of this study demonstrate the dominance of acyanotic lesions and reveal a high prevalence of malnutrition among CHD patients in Kupang. These findings provide baseline data to enhance early detection, nutritional optimization, and the strengthening of CHD care services in areas of eastern Indonesia.

Pre-eclampsia (PE) and fetal growth restriction (FGR) have been shown to impact fetal cardiac remodeling in the third trimester and postnatally, with evidence to suggest that this leads to increased long-term cardiovascular risk. This study aimed to examine fetal cardiac remodeling in pregnancies with PE and/or FGR during the second trimester. This was a retrospective nationwide cohort study of ultrasound images from routine screening at 18-22 weeks of gestation in Denmark. We included 139 430 singleton pregnancies that were conceived spontaneously for which at least one relevant standardized cardiac plane (four-chamber view and/or three-vessel view) was available from the second-trimester scan. An artificial intelligence model performed automated segmentation and extraction of fetal cardiac biometric measurements. Data were collected for four groups: the reference group, defined as appropriate-for-gestational-age (AGA) fetuses from a normotensive pregnancy (n = 131 150); AGA fetuses from a PE pregnancy (AGA + PE group; n = 3095); FGR fetuses from a normotensive pregnancy (normotensive + FGR group; n = 4572); and FGR fetuses from a PE pregnancy (PE + FGR group; n = 613). Differences between groups in cardiac biometric measurements were presented as Z-scores adjusted for abdominal circumference at the second-trimester scan. Compared with the reference group, fetuses in the PE + AGA group had significantly larger right-sided heart structures, and the main pulmonary artery (MPA) and ventricular septum were wider. Fetuses in the normotensive + FGR group displayed significantly smaller cardiac structures, including smaller MPA and ascending aorta diameters, and increased left ventricular sphericity compared with the reference group. Fetuses in the PE + FGR group differed significantly from the reference group only in terms of smaller left atrial area, narrower ascending aorta and increased left ventricular sphericity. However, PE + FGR fetuses had significantly wider MPA andventricular septumand larger right-sided structures compared with normotensive + FGR fetuses, mimicking the features of the PE + AGA group, suggesting a distinct effect of PE on fetal cardiac remodeling. Cardiac remodeling is evident as early as the second trimester, with distinct patterns of modulation in fetuses from pregnancies affected by PE vs FGR. In particular, PE is associated with an enlarged right heart and greater MPA diameter. Understanding these early differences in fetal cardiac morphology may improve risk prediction models and guide early intervention to improve long-term cardiovascular outcome. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Tricuspid Regurgitation Peak-to-Mean Velocity Ratio: Linking Doppler Morphology to Right Heart Hemodynamics in Pulmonary Hypertension.

This research investigates the conflicting concepts of fantasy and surveillance in the representation of forbidden love within Lahore's visual culture. It explores how intimacy, desire and the pursuit of relationships are constructed, controlled and, in many cases, hidden behind a socio-cultural environment shaped by moral codes, familial expectations and public scrutiny. It further focuses on the connections of love-related taboos like lesbian love, queer love, and extramarital intimacy in contemporary Pakistani Art. By concentrating on themes of queer desire, unconventional love and emotional concealment, the study examines how intimacy becomes both a place of desire and a forced control. Moreover, by adopting an interdisciplinary approach, the research analyzes Pakistan in contemporary art, literature, and media to explore the manner in which cultural norms and power structures affect emotional demonstrations rather than authentic intimacy. In this process, the works of Bano Qudsia and Sadaat Manto, and the visual practices of Shehzil Malik and Salman Toor are key case studies to be studied on the matter, as to how fictional stories of love involve a play between fantasy, repressions and social observations. These works expose mediating techniques of the romantic ideals through the mechanism of cultural surveillance, for the boundaries between private emotion and public morality are continually negotiated. The studio aspect of this research is the materialization of these ideas through an immersive installation of suspended globes of glass connected with threads, each functioning as a fragile container depicting different narratives of forbidden love, existing outside of socially accepted norms. It will serve as a metaphor for fragmented visual narratives of forbidden intimacy and love, showing its transparency and fragility with the help of layered, fractured, and fragmented heart structures combined with symbolic objects to evoke emotional tension and illusions, drawing inspiration from the visual language of Chiharu Shiota’s work.

The anthracycline antibiotic doxorubicin (DOX) is a potent chemotherapy drug, but its use is limited by dose-dependent cardiotoxicity. We previously reported that genetic deletion of p38δ protects female mice from DOX-induced cardiotoxicity (DIC), suggesting that inhibiting this kinase could be an effective treatment. Here, we developed a fully chemically stabilized small interfering RNA (siRNA) that effectively silences p38δ. In an acute DIC model, silencing p38δ reduced mortality and morbidity, preserved heart structure and function, and decreased fibrosis in female mice. It also alleviated DOX-induced electrophysiological remodeling and decreased cardiac inflammation and senescence-associated secretory phenotype (SASP). Transcriptomic analysis of DOX-treated p38δ-deficient hearts revealed the downregulation of genes associated with inflammation, ion transport, and impulse generation, and the upregulation of genes involved in oxidative stress management, autophagy, and immune signaling. These findings support silencing p38δ as a promising approach to protect against DIC, highlighting the potential of siRNA-based therapies to mitigate anthracycline cardiotoxicity.NEW & NOTEWORTHY This study presents the first isoform-specific inhibition of p38δ using a docosanoic (DCA)-conjugated, fully chemically stabilized siRNA. Our lead compound, si644, achieves potent, durable, and well-tolerated p38δ silencing in vivo in mouse hearts and ex vivo in human cardiac organotypic slices. si644-mediated p38δ silencing protects female mice from DIC by mitigating DOX-induced structural, electrophysiological, fibrotic, and inflammatory remodeling. These findings establish p38δ inhibition as a promising therapeutic strategy for preventing anthracycline cardiotoxicity.

Cardiac rehabilitation (CR) is a clinically proven cost-effective intervention and reduces the risk of hospital readmissions and recurrent cardiac events and improves exercise capacity and health-related quality of life in people. However, access to CR in low and middle-income countries remains scarce and a high unmet need. The purpose of this study was to adapt a home-based CR programme (‘the Heart Manual’) originally developed and evaluated in the United Kingdom (UK) for the people with coronary heart disease (CHD) in Bangladesh. Guided by the 2021 ADAPT methodological framework, a multiphase approach to intervention adaptation was undertaken that included mapping of the Bangladeshi healthcare context and in-depth consultation meetings and workshops with key stakeholders (patients and their families, healthcare professionals, and health service providers). In addition to language translation (English to Bangla) and cultural adaptation, the UK Heart Manual content and structure were modified whilst retaining its core interventional components and principles. The resulting Bangla Heart Manual comprises of three main adaptions: (1) combination of the UK Heart Manual post-myocardial infarction and revascularisation manuals into a single document; (2) development of a short version for easy reference for patients; and (3) creation of audiovisual and animated versions of materials to promote patient accessibility. Using an evidence-based approach, the UK Heart Manual programme was contextually and culturally adapted for people with CHD in the Bangladesh healthcare setting. The Bangla Heart Manual provides the opportunity for access to home-based CR in a low resource setting. Research is needed to confirm the feasibility and acceptability of the delivery of the adapted Bangla Heart Manual for healthcare practitioners, patients, and their families.