Sequential Protocol Research Articles

Asymmetric carbohydroxylation of alkenes via sequential photocatalytic oxo-alkylation and enzymatic reduction

Asymmetric carbohydroxylation of alkenes offers an efficient approach to access chiral alcohols, a class of versatile building blocks in pharmaceutical and agrochemical industries, from abundant simple alkenes. Herein we reported a sequential photo-biocatalysis protocol for the asymmetric carbohydroxylation of alkenes, involving a stepwise photocatalytic decarboxylative radical addition/Kornblum oxidation and enzymatic reduction. A series of chiral alcohols with bulky structures were synthesized in up to 75 % isolated yields and 99 % ee from N-hydroxyphthalimide esters and aryl alkenes.

Restoration of coherent reach-grasp-pull movement via sequential intraneural peripheral nerve stimulation in rats

Objective. Peripheral nerve stimulation (PNS) has been demonstrated as an effective way to selectively activate muscles and to produce fine hand movements. However, sequential multi-joint upper limb movements, which are critical for paralysis rehabilitation, has not been tested with PNS. Here, we aimed to restore multiple upper limb joint movements through an intraneural interface with a single electrode, achieving coherent reach-grasp-pull movement tasks through sequential stimulation. Approach. A transverse intrafascicular multichannel electrode was implanted under the axilla of the rat’s upper limb, traversing the musculocutaneous, radial, median, and ulnar nerves. Intramuscular electrodes were implanted into the biceps brachii (BB), triceps brachii (TB), flexor carpi radialis (FCR), and extensor carpi radialis (ECR) muscles to record electromyographic (EMG) activity and video recordings were used to capture the kinematics of elbow, wrist, and digit joints. Charge-balanced biphasic pulses were applied to different channels to recruit distinct upper limb muscles, with concurrent recording of EMG signals and joint kinematics to assess the efficacy of the stimulation. Finally, a sequential stimulation protocol was employed by generating coordinated pulses in different channels. Main results. BB, TB, FCR and ECR muscles were selectively activated and various upper limb movements, including elbow flexion, elbow extension, wrist flexion, wrist extension, digit flexion, and digit extension, were reliably generated. The modulation effects of stimulation parameters, including pulse width, amplitude, and frequency, on induced joint movements were investigated and reach-grasp-pull movement was elicited by sequential stimulation. Significance. Our results demonstrated the feasibility of sequential intraneural stimulation for functional multi-joint movement restoration, providing a new approach for clinical rehabilitation in paralyzed patients.

Palladium-Catalyzed Synthesis of 6-aryl Dopamine Derivatives

Dopamine is a key neurotransmitter involved in a series of biologically relevant processes and its derivatives have sparked significant interest as intriguing synthetic targets. This class of compounds is indeed not only considerable for the potential biological activities but is also promising for diverse applications in material science. In light of this, our research was focused on the synthesis of 6-aryldopamine derivatives starting from 4-(2-aminoethyl)phenol through a sequential protocol, whose main steps are hydroxylation, halogenation, and Suzuki cross-coupling. Our method demonstrated versatility, efficiency, and compatibility with various functional groups, including aldehydes, ketones, esters, ethers, and fluorine.

Investigating the elemental composition of Egyptian glauconite sediments by applying BCR sequential extraction procedure and some single extractants

This study assesses the elemental composition of Egyptian glauconite sediments, focusing on potentially toxic elements (PTEs) and macronutrients. The primary aim is to evaluate the feasibility of utilizing these sediments as a natural source of potassium for agricultural purposes, besides conventional chemical fertilizers like potassium sulfate. To quantify elemental content, chemical analysis was employed across five distinct grain size fractions after grinding glauconite rock. The assessment included potassium, calcium, sodium, and PTE concentrations, utilizing potassium chloride (KCl) and ammonium acetate lactate (AL Solution) as single extractants, and the BCR extraction protocol, in addition to measuring the pseudo-total content of these elements. Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) facilitated a comparative analysis of elemental concentrations. Results indicate PTE concentrations within European Union regulations, with an absence of cadmium. Glauconite samples contain approximately 3–3.3% potassium by weight, alongside significant amounts of essential macronutrients (calcium, magnesium) and micronutrients (copper, nickel, zinc) crucial for agriculture. BCR sequential extraction protocol results closely align with or slightly surpass pseudo-total content results. Notably, the AL Solution demonstrates high efficiency compared to KCl or acetic acid in the first step of the BCR method. BCR sequential protocol provides valuable insights into various elemental forms and potential mobility. Overall, this study reveals that glauconite has the potential to serve as a promising alternative potassium fertilizer without causing adverse environmental impacts.

Predictability of expansion movements performed by clear aligners in mixed dentition in both arches: a retrospective study on digital casts

Backgroundto evaluate the predictability of expansion achieved in patients in early mixed dentition treated with Clear Aligners (CA), analyzing the efficiency of the expansion at the end of the first set of aligners and at the end of the therapy in the upper and lower arch.Methods36 patients (20 F, 16 M; mean age 8.3 ± 1.5 years) were selected retrospectively from the Department of Orthodontics of the Hospital of Rome “Tor Vergata”. All subjects were treated with CA with no other auxiliaries than attachments. For each patient a standardized sequential expansion protocol was planned for both arches. Digital dental casts were created at three observation periods from an intraoral scanner: prior to treatment (T0), at the end of the first set of aligners (T1), at the end of treatment (T2). The 3D models in planned position determined by the first Clincheck (CC) were obtained for comparison with T1 and T2. Six linear transversal measurements were used to evaluate the dimensional changes and the predictability of expansion movements, comparing T1-CC and T2-CC.Resultsa statistically significant increase within the pre-treatment and the final outcomes for all the variables examined was found. In the upper arch, the greatest level of predictability was detected at the level of the first (46.44%) and second deciduous molar width (44.95%) at T1. The analysis of T2-CC changes showed a significant increase in the percentage of predictability of expansion at the level of the first permanent molars, at mesial (54.86%) and distal (58.92%) width. In the lower arch, a higher percentage of predictability than the upper arch was reported at T1-CC and T2-CC, with the greatest values at the level of second (T1-CC: 48.70%; T2-CC: 75.32%) and first deciduous molar width (T1-CC: 45.71%; T2-CC: 72.75%).ConclusionsCA can induce significant transversal increments. The predictability of expansion is variable, but it did not exceed the 50% during the first set of aligners. It was necessary to apply refinement set to achieve a good predictability for expansion of about 70%. The expansion in the lower arch was observed to be more predictable than in the upper arch.

Power of Sequential Protocols in Hidden Quantum Channel Discrimination

Power of Sequential Protocols in Hidden Quantum Channel Discrimination

Behavioral and genetic correlates of heterogeneity in learning performance in individual honeybees, Apis mellifera.

Learning an olfactory discrimination task leads to heterogeneous results in honeybees with some bees performing very well and others at low rates. Here we investigated this behavioral heterogeneity and asked whether it was associated with particular gene expression patterns in the bee's brain. Bees were individually conditioned using a sequential conditioning protocol involving several phases of olfactory learning and retention tests. A cumulative score was used to differentiate the tested bees into high and low performers. The rate of CS+ odor learning was found to correlate most strongly with a cumulative performance score extracted from all learning and retention tests. Microarray analysis of gene expression in the mushroom body area of the brains of these bees identified a number of differentially expressed genes between high and low performers. These genes are associated with diverse biological functions, such as neurotransmission, memory formation, cargo trafficking and development.

Intimate partner violence after childbirth: an explanatory sequential mixed-methods study protocol

BackgroundIntimate partner violence (IPV) is the most common form of violence against women. Postpartum IPV refers to any type of IPV that occurs up to one year after childbirth and has many adverse impacts on mothers and their children. Considering the lack of sufficient information on the prevalence and factors related to IPV after childbirth in Iran, this study aimed to evaluate the frequency and severity of IPV, its different forms, and psychosocial factors related to IPV, as well as to explore how IPV is perceived among mothers one year after childbirth.MethodsAn explanatory sequential mixed-methods design was used to conduct this study in two phases. The first phase is a cross-sectional study that will be performed on postpartum mothers who have a one-year-old child referred to health care centers in the southern region of Tehran, Iran, with the aim of determining the prevalence of IPV and its related factors. The second phase is a qualitative conventional content analysis study with the purpose of exploring women’s experiences and perceptions of IPV and its preventive or protective factors. Purposive sampling will be used. Based on the results of the quantitative phase, mothers who are at the two ends of the IPV spectrum (based on their total Conflict Tactics Scale (CTS-2) scores) will be selected, and in-depth and semistructured interviews will be conducted with them. Finally, the researchers will provide an interpretation of the quantitative results using qualitative data.DiscussionThis is the first study that uses a mixed methods approach to explain different dimensions of IPV, its related factors, and mothers' perceptions of it. By providing a better understanding of this phenomenon, it is hoped that the results of this research will be used by policymakers and officials of educational and cultural systems to plan and provide effective interventions, enact laws, and present educational and cultural programs to prevent IPV after childbirth.Ethical codeIR.TUMS.FNM.REC1400.200.

Exploring contrast-enhancing staining agents for studying adipose tissue through contrast-enhanced computed tomography

Contrast-enhanced computed tomography offers a nondestructive approach to studying adipose tissue in 3D. Several contrast-enhancing staining agents (CESAs) have been explored, whereof osmium tetroxide (OsO4) is the most popular nowadays. However, due to the toxicity and volatility of the conventional OsO4, alternative CESAs with similar staining properties were desired. Hf-WD 1:2 POM and Hexabrix have proven effective for structural analysis of adipocytes using contrast-enhanced computed tomography but fail to provide chemical information. This study introduces isotonic Lugol’s iodine (IL) as an alternative CESA for adipose tissue analysis, comparing its staining potential with Hf-WD 1:2 POM and Hexabrix in murine caudal vertebrae and bovine muscle tissue strips. Single and sequential staining protocols were compared to assess the maximization of information extraction from each sample. The study investigated interactions, distribution, and reactivity of iodine species towards biomolecules using simplified model systems and assesses the potential of the CESA to provide chemical information. (Bio)chemical analyses on whole tissues revealed that differences in adipocyte gray values post-IL staining were associated with chemical distinctions between bovine muscle tissue and murine caudal vertebrae. More specific, a difference in the degree of unsaturation of fatty acids was identified as a likely contributor, though not the sole determinant of gray value differences. This research sheds light on the potential of IL as a CESA, offering both structural and chemical insights into adipose tissue composition.

Molar Distalization by Clear Aligners with Sequential Distalization Protocol: A Systematic Review and Meta-Analysis.

With the popularity of clear aligners, the sequential distalization protocol has been more commonly used for molar distalization. However, the amount of molar distalization that can be achieved, as well as the accompanying side effects on the sagittal dimension, are unclear. Registered with PROSPERO (CRD42023447211), relevant original studies were screened from seven databases (MEDLINE [PubMed], EBSCOhost, Web of Science, Elsevier [SCOPUS], Cochrane, LILACS [Latin American and Caribbean Health Sciences Literature], and Google Scholar) supplemented by a manual search of the references of the full-reading manuscripts by two investigators independently. A risk of bias assessment was conducted, relevant data were extracted, and meta-analysis was performed using RStudio. After the screening, 13 articles (11 involving maxillary distalization, two involving mandibular distalization) met the inclusion criteria. All studies had a high or medium risk of bias. The meta-analysis revealed that the maxillary first molar (U6) mesiobuccal cusp was distalized 2.07 mm [1.38 mm, 2.77 mm] based on the post-distalization dental model superimposition, and the U6 crown was distalized 2.00 mm [0.77 mm, 3.24 mm] based on the post-treatment lateral cephalometric evaluation. However, the U6 mesiobuccal root showed less distalization of 1.13 mm [-1.34 mm, 3.60 mm], indicating crown distal tipping, which was validated by meta-analysis (U6-PP angle: 2.19° [1.06°, 3.33°]). In addition, intra-arch anchorage loss was observed at the post-distalization time point (U1 protrusion: 0.39 mm [0.27 mm, 0.51 mm]), which was corrected at the post-treatment time point (incisal edge-PTV distance: -1.50 mm [-2.61 mm, -0.39 mm]). About 2 mm maxillary molar distalization can be achieved with the sequential distalization protocol, accompanied by slight molar crown distal tipping. Additional studies on this topic are needed due to the high risk of bias in currently available studies.

The Utility of Magnetic Resonance Enterography and Double Balloon Enteroscopy-Assisted Endoscopic Balloon Dilatation for Small Bowel Strictures in Crohn’s Disease: A Retrospective Observational Study

Introduction: Crohn’s disease (CD) of the small bowel is associated with a severe course and increased risk of complications. Strictures at this location are challenging to diagnose and out-of-reach of colonoscopy. We aimed to evaluate the detection rate of small bowel strictures with magnetic resonance enterography (MRE) and assess the efficacy of double balloon enteroscopy-assisted endoscopic balloon dilatation (DBE-assisted EBD) in managing these strictures. Methods: A retrospective study included all patients with DBE-assisted EBD of small bowel strictures in CD in our facility. All patients had MRE to detect strictures prior to the dilatation. Sequential dilatation protocol was performed using through-the-scope (TTS) working channel balloons. The outcomes included technical success defined by the passage of the enteroscope post-dilatation, resolution of symptoms, and the requirement of repeated procedures or surgery during 12 months of follow-up. Results: Twenty DBE-assisted EBDs of small bowel strictures were attempted during 13 DBE procedures in 10 patients (6 males, median age 42). MRE identified 75% of the strictures with 100% accuracy in localisation. Retrograde DBE was the approach in 16/20 (80%) strictures. Anaesthetic intubation was used in 8/20 (40%). DBE reached 19/20 strictures. All the reached strictures were dilated successfully; the technical success following dilatation was 72.2%. The median DBE insertion time with TTS balloon dilatation was 66 min. Three patients required follow-up dilatations within 2–3 months. Surgery was not needed during the follow-up period. Conclusions: MRE is essential in diagnosing and localising small bowel strictures in CD. DBE reached 95% of strictures with successful dilatation. Immediate technical success was high, and safety was demonstrated. Planned repeat procedures for sequential dilatation were performed in a few patients. Surgical resection was avoided in all patients.

Factors influencing smartwatch use and comfort with health data sharing: a sequential mixed-method study protocol

IntroductionSmartwatches have become ubiquitous for tracking health metrics. These data sets hold substantial potential for enhancing healthcare and public health initiatives; it may be used to track chronic health conditions,...

Adapted Sequential Extraction Protocol to Study Mercury Speciation in Gold Mining Tailings: Implications for Environmental Contamination in the Amazon.

Artisanal small-scale gold mining (ASGM), an increasingly prevalent activity in South America, generates mercury-contaminated tailings that are often disposed of in the environment, leading to the introduction of mercury into ecosystems and the food web, where it bioaccumulates. Therefore, studying the geochemical processes involved in the desorption and dissolution of mercury in these tailings is essential for critical risk evaluations in the short and long term. For this purpose, sequential extraction procedures (SEPs) can be useful because they help to identify the phases to which Hg is associated, although they also have limitations such as a lack of selectivity and specificity. In this work, we propose a modified four-step SEP: exchangeable mercury (F1), oxidizable mercury (F2), mercury bound to Fe oxides (F3), and strongly bound mercury (F4). To test this adapted sequential extraction method, we evaluated the Hg contamination in mercury-contaminated tailings of the Amazon basin. The results revealed a total mercury concentration of 103 ± 16 mg·kg-1 in the tailings, with a significant portion in F1 (28% of the total), where Hg was bioavailable. The large Hg concentration in F3 (36%) suggested that Fe oxides likely contribute to mercury retention. Together, the SEP results emphasize the urgent need for improved surveillance of gold mining activities and responsible tailings management practices to mitigate environmental contamination and safeguard the health of the Amazon ecosystem.

Sediment-redox dynamics in an oligotrophic deep-water lake in Tierra del Fuego: insights from Fe isotopes

For long time in the history of Earth, ferruginous conditions governed the oceans. With the rise of oxygen during the Proterozoic era and the subsequent evolution of living organisms, worldwide deposition of iron formations occurred. These sedimentary units reveal the transition into oxic oceans, passing by local and transitory euxinic conditions, especially in coastal shelves. Constraining the iron cycle and the biogeochemical processes occurring in present and past ferruginous basins helps answering some of the question regarding global oxygenation, the evolution of life and past climate changes. Therefore, Fe speciation and Fe isotopes in both Proterozoic and recent sedimentary records have been widely used to reconstruct past basin dynamics and redox conditions in the sediment–water interface. However, sedimentation and early diagenesis can alter paleoredox proxies and their primary climate signals. In this work, we disentangled alteration processes occurring at the redox front below the sediment–water interface of a ventilated deep-water lake (Lago Fagnano, Argentina/Chile). A sequential extraction protocol was applied to characterize two reactive Fe pools: Fe oxyhydroxides and reduced iron. Subsequently, Fe isotopes were constrained to determine the main processes mobilizing Fe. At the redox front, ferric minerals reach a δ56Fe value of − 1.3‰ resulting from oxidation of dissolved Fe likely following a Rayleigh distillation effect. Dissolved Fe is produced right below via Fe reduction, as shown by the low ferric Fe content. Our observations delineate a redox cycle and a redox horizon undergoing constant upward migration, initiated by regular sedimentation. However, during events of increased rapid sedimentation (e.g., seismites) this dynamic cycle is interrupted inducing full or partial preservation of the Fe-rich redox front. In such case, oxidation of dissolved Fe is interrupted and can be recycled in ferrous minerals, such as Fe monosulfides and amorphous phases with δ56Fe values down to − 1.7 ‰. These findings have significant implications for the recording of biogeochemical cycles in the geological past, the use of Fe isotopes in freshwater-lake sediments for paleoclimate studies, and the progress of our knowledge regarding the geochemistry of past oceans.

The link between organizational choice and global input sourcing under sequential production

AbstractThis article analyzes the ways heterogenous firms procure their inputs in the presence of relationship‐specific investments and incomplete contracts. We first consider a closed economy in which firms decide how to structure their organization. Production is sequential and inputs (upstream and downstream) are sourced in the same order as production. While our closed‐economy setup is analogous to Antràs and Chor (Econometrica, 2013), there are two distinct features: (1) The reward to each supplier is determined through bargaining over the full revenue of the firm (as opposed to marginal contribution of the supplier), and (2) The reward structure combined with our sequential bargaining protocol gives rise to linkages across suppliers. The analysis in Antràs and Chor (Econometrica, 2013) identifies a mechanism in which upstream organizational decisions have spillover effects on downstream suppliers' investment incentives. Thanks to our novel features, we identify another mechanism: the spillover effects of downstream organizational decisions on the investment incentive of upstream suppliers. Next, we consider an open economy in which firms not only make organizational decisions but also determine where to source their inputs. We show that these decisions are connected between sequential production stages such that the sourcing location of the upstream input may affect the organizational choice in the downstream stage. We then examine how within sectoral heterogeneity and variations in industry characteristics influence the relative prevalence of firms that choose to form different organizational structures.

Exploratory analysis of spontaneous versus paced breathing on heart rate variability in veterans with combat-related traumatic injury.

Respiration is a crucial determinant of autonomic balance and heart rate variability (HRV). The comparative effect of spontaneous versus paced breathing on HRV has been almost exclusively explored in healthy adults and never been investigated in an injured military cohort. To examine the effect of spontaneous versus paced breathing on HRV in veterans with combat-related traumatic injury (CRTI). Observational cohort study. ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study, Stanford Hall, UK. The sample consisted of 100 randomly selected participants who sustained CRTI (eg, amputation) during their deployment (Afghanistan 2003-2014) and were recruited into the ongoing ADVANCE prospective cohort study. Not applicable. HRV was recorded using a single-lead ECG. HRV data were acquired during a sequential protocol of 5-minute spontaneous breathing followed immediately by 5 minutesof paced breathing (six cycles/minute) among fully rested and supine participants. HRV was reported using time domain (root mean square of successive differences), frequency domain (low frequency and high frequency) and nonlinear (sample entropy) measures. The agreement between HRV during spontaneous versus paced breathing was examined using the Bland-Altman analysis. The mean age of participants was 36.5 ± 4.6 years. Resting respiratory rate was significantly higher with spontaneous versus paced breathing (13.4 ± 3.4 vs. 7.6 ± 2.0 breaths/minute; p < .001), respectively. Resting mean heart rate and root mean square of successive differences were significantly higher with paced breathing than spontaneous breathing (p < .001). Paced breathing significantly increased median low frequency power than spontaneous breathing (p < .001). No significant difference was found in the absolute power of high frequency between the two breathing protocols. The Bland-Altman analysis revealed poor agreement between HRV values during spontaneous and paced breathing conditions with wide limits of agreement. Slow-paced breathing leads to higher HRV than spontaneous breathing and could overestimate resting "natural-state" HRV.

Low-dose, high-pitch, spiral (FLASH) mode versus conventional sequential method for coronary artery calcium scoring: A derivation-validation study.

The present study sought to compare the diagnostic accuracy and radiation dose of ECG-gated, ultra-fast, low-dose, high-pitch, spiral (FLASH) mode versus conventional, ECG-gated, sequential coronary artery calcium (CAC) scoring in patients with suspected coronary artery disease (CAD). The study included 120 patients who underwent both conventional scanning and FLASH mode scanning and were subdivided into derivation and validation cohorts. In the conventional sequential (step-and-shoot) protocol, prospective ECG-gated, non-contrast acquisition was performed at 70% of R-R interval. The spiral (FLASH) mode utilized a high-pitch and high-speed gantry rotation scanning mode where acquisition of the entire heart was done within a single cardiac cycle with prospective ECG-gating at 70% of R-R interval. Correlation between CAC scores derived from conventional (cCAC) and FLASH mode (fCAC) in derivation cohort was excellent (r=0.99; P<0.001). A linear regression model was used to develop a formula for deriving the estimated CAC score (eCAC) from fCAC (eCAC=0.978 x fCAC). In validation cohort, eCAC showed excellent agreement with cCAC (ICC=0.9983; 95%CI: 0.9972 - 0.9990). Excellent agreement for risk classification (weighted kappa=0.93898; 95%CI: 0.86833 - 1.0000) was observed with 95% (57/60) scores falling within the same risk category. Effective dose was significantly lower in FLASH mode (conventional, 0.58±0.21 mSv vs. FLASH, 0.34±0.12 mSv; P<0.0001). CAC scoring using FLASH mode is feasible with high accuracy and shows excellent agreement with conventional CAC scores at significantly reduced radiation doses.

Exchangeable versus residual metals in naturally aged plastic litter.

Metals may be associated with plastics as additives arising from manufacture or through acquisition from the environment, but these associations are often poorly defined or referred to synonymously when considering metal availability. In this study, samples of plastic litter (n = 22) have been collected from various environmental and industrial compartments of Lublin Province, Poland, and fractionated according to polymer type (polyethylene, polyethylene terephthalate, nylon, expanded polystyrene, polypropylene, and "mixed") before being micronised to < 2mm. Composites (n = 89) were subjected to two phases of a standardised and widely employed sequential extraction protocol (Bureau Communautaire de Reference; BCR) in order to define available (acid-soluble and exchangeable) and residual (soluble in boiling aqua regia) concentrations of Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn. For a given metal, total content, calculated by summing available and residual components, was highly variable, both between locations and amongst polymer categories, reflecting the heterogeneous distribution of a multitude of different additives. Overall, however, concentrations were greatest for Fe, with medians of several hundred to several thousand mg kg-1 amongst the different polymers, and lowest for Cd, Co, and Ni, where nearly all concentrations were below 10mgkg-1. Median percentage metal availabilities were greatest for expanded polystyrene and were above 25% for Mn and Zn and below 10% for Cr and Fe in all polymer types. These observations are largely, but not entirely, attributed to the relative contributions of metals acquired from the environment and metals present as additives and residues. Significantly, the approach employed allows direct comparisons of metal availability in plastics with metal availability in environmental solids in order to evaluate the overall impacts of plastics in metal risk assessments.

Fisher information rates in sequentially measured quantum systems

We consider the impact that temporal correlations in the measurement statistics can have on the achievable precision in a sequential metrological protocol. In this setting, and for a single quantum probe, we establish that it is the transitions between the measurement basis states that plays the most significant role in determining the precision, with the resulting conditional Fisher information being interpretable as a rate of information acquisition. Projective measurements are shown to elegantly demonstrate this in two disparate estimation settings. Firstly, in determining the temperature of an environment and, secondly, to ascertain a parameter of the system Hamiltonian. In both settings we show that the sequential estimation approach can provide a useful method to enhance the achievable precision.

The combination of high-frequency QRS and ST-segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease.

High-frequency QRS (HF-QRS) manifests as a novel adjunct electrocardiographic marker with potential utility in coronary artery disease (CAD) detection. We hypothesize that HF-QRS analysis may be superior to conventional ST-segment analysis in detecting CAD, and the combination of these two analyses in the exercise stress test may enhance the diagnostic efficacy for CAD. The study incorporated a sample of 157 patients (mean age 62 9 years) referred for nonemergent angiography. Before angiography, patients underwent exercise stress testing utilizing an upright bicycle. High-resolution electrocardiogram (ECG) data were collected during the exercise test, facilitating both HF-QRS and conventional ST-segment analyses. The diagnostic efficacy of HF-QRS and ST-segment analysis were compared, utilizing angiographic outcomes as the gold standard. The study design integrated HF-QRS analysis and ST-segment analysis via sequential and concurrent testing protocols. In terms of CAD detection, HF-QRS analysis displayed superior sensitivity compared to conventional ST-segment analysis (63% vs. 37%, p = .002). The serial test significantly increased specificity from 79% to 97% (p = .002) compared to ST-deviation analysis alone. It showed a markedly low sensitivity of 26%. The parallel test significantly increased sensitivity from 37% to 77% (p < .001), while retaining a moderate level of specificity of 51%. The quantity of ECG leads exhibiting a positive HF-QRS response demonstrated a correlation with the severity of CAD (p < .001). HF-QRS analysis exhibited superior sensitivity in detecting angiographically confirmed CAD relative to conventional ST-segment analysis. Moreover, the combination of HF-QRS and ST-segment alterations during exercise stress test enhanced the diagnostic efficacy for CAD.