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This study presents an IoT-based gait analysis system employing insole pressure sensors to assess gait kinetics. The system integrates piezoresistive sensors within a left foot insole, with data acquisition managed using an ESP32 board that communicates via Wi-Fi through an MQTT IoT framework. In this initial protocol study, we conducted a comparative analysis using the Zeno system, supported by PKMAS as the gold standard, to explore the correlation and agreement of data obtained from the insole system. Four volunteers (two males and two females, aged 24–28, without gait disorders) participated by walking along a 10 m Zeno system path, equipped with pressure sensors, while wearing the insole system. Vertical ground reaction force (vGRF) data were collected over four gait cycles. The preliminary results indicated a strong positive correlation (r = 0.87) between the insole and the reference system measurements. A Bland–Altman analysis further demonstrated a mean difference of approximately (0.011) between the two systems, suggesting a minimal yet significant bias. These findings suggest that piezoresistive sensors may offer a promising and cost-effective solution for gait disorder assessment and monitoring. However, operational factors such as high temperatures and sensor placement within the footwear can introduce noise or unwanted signal activation. The communication framework proved functional and reliable during this protocol, with plans for future expansion to multi-device applications. It is important to note that additional validation studies with larger sample sizes are required to confirm the system’s reliability and robustness for clinical and research applications.

The planthopper Pentastiridius leporinus (Hempiptera: Cixiidae) is the main vector of two bacterial pathogens: the γ-proteobacterium ‘Candidatus Arsenophonus phytopathogenicus’ and the stolbur phytoplasma ‘Candidatus Phytoplasma solani’. These pathogens cause the disease syndrome basses richesses (SBR) in sugar beet (Beta vulgaris), which reduces the yields and sugar content. In 2022, potato (Solanum tuberosum) fields were found to be colonized by P. leporinus, and the transmission of Arsenophonus was confirmed, resulting in symptoms like wilting, yellow leaves, and rubbery tubers. We monitored both pathogens in Southwest Germany in 2022 and 2023. This revealed their widespread presence in potato tubers, although there were differences in regional prevalence. The broad prevalence of Arsenophonus was maintained in 2023, whereas the prevalence of stolbur increased in most locations. We confirmed that P. leporinus adults can transmit both pathogens to potatoes, but neither pathogen reduced the germination rate of tubers, and no plants showed abnormal growth after germination. Arsenophonus was not detected in germinated shoots, but 5.4% contained stolbur, emphasizing the need for plant material testing to maintain phytosanitary conditions.

(1) Background: Mitral regurgitation (MR) is associated with increased mortality and frequent hospital admissions. Although mitral valve intervention offers improved clinical outcomes for MR, it is not feasible in many cases. Moreover, conservative therapeutic opportunities remain limited. The aim of this study was to evaluate the impact of ACE inhibitors and angiotensin receptor blockers (ACE-I/ARB) on elderly patients with moderate-to-severe MR and mildly reduced to preserved ejection fraction. (2) Methods: In total, 176 patients were included in our hypothesis-generating, single-center observational study. Hospitalization for heart failure and all-cause death have been defined as the combined 1-year primary endpoint. (3) Results: Patients treated with ACE-I/ARB showed a lower risk for the combined endpoint of death and heart failure-related readmission (HR 0.52 95%CI 0.27–0.99; p = 0.046), even after adjustment for EUROScoreII and frailty (HR 0.52 95%CI 0.27–0.99; p = 0.049) (4) Conclusions: The use of an ACE-I/ARB in patients with moderate-to-severe MR and preserved to mildly reduced left-ventricular ejection fraction (LVEF) significantly associates with improved clinical outcome and might be indicated as a valuable therapeutic option in conservatively treated patients.

Pentastiridius leporinus is a planthopper (Hemiptera: Cixiidae) that vectors two phloem-restricted bacterial pathogens to sugar beet (Beta vulgaris (L.)): the γ-proteobacterium Candidatus Arsenophonus phytopathogenicus and the stolbur phytoplasma Candidatus Phytoplasma solani. These bacteria cause an economically important disease known as syndrome basses richesses (SBR), characterized by yellowing, deformed leaves and low beet yields. Having observed potato fields in Germany infested with cixiid planthoppers and showing signs of leaf yellowing, we used morphological criteria and COI and COII as molecular markers, to identify the planthoppers (adults and nymphs) primarily as P. leporinus. We analyzed planthoppers, potato tubers, and sugar beet roots and detected both pathogens in all sample types, confirming that P. leporinus adults and nymphs can transmit the bacteria. This is the first time that P. leporinus has been shown to transmit Arsenophonus to potato plants. We also found that two generations of P. leporinus were produced in the warm summer of 2022, which will probably increase the pest population size (and thus the prevalence of SBR) in 2023. We conclude that P. leporinus has expanded its host range to potato, and can now utilize both host plants during its developmental cycle, a finding that will facilitate the development of more efficient control strategies.

The rapid spread of the bacterial yellowing disease Syndrome des Basses Richesses (SBR) has a major impact on sugar beet (Beta vulgaris) cultivation in Germany, resulting in significant yield losses. SBR-causing bacteria are transmitted by insects, mainly the Cixiid planthopper Pentastiridius leporinus. However, little is known about the biology of this emerging vector, including its life cycle, oviposition, developmental stages, diapauses, and feeding behavior. Continuous mass rearing is required for the comprehensive analysis of this insect. Here we describe the development of mass rearing techniques for P. leporinus, allowing us to investigate life cycle and ecological traits, such as host plant choice, in order to design agronomic measures that can interrupt the life cycle of nymphs in the soil. We also conducted field studies in recently-infected regions of Rhineland-Palatinate and south Hesse, Germany, to study insect mobility patterns and abundance at four locations during two consecutive years. The soil-depth monitoring of nymphs revealed the movement of the instars through different soil layers. Finally, we determined the prevalence of SBR-causing bacteria by designing TaqMan probes specific for two bona fide SBR pathogens: Candidatus Arsenophonus phytopathogenicus (Gammaproteobacteria) and Candidatus Phytoplasma solani (stolbur phytoplasma). Our data suggest that P. leporinus is spreading northward and eastward in Germany, additionally, the abundance of SBR-carrying planthoppers is increasing. Interestingly, P. leporinus does not appear to hibernate during winter, and is polyphagous as a nymph. Stolbur phytoplasma has a significant impact on SBR pathology in sugar beet.

The addition of glycerol to protein solutions is often used to hinder the aggregation and denaturation of proteins. However, it is not a generalised practice against chemical degradation reactions. The chemical degradation of proteins, such as deamidation and isomerisation, is an important deteriorative mechanism that leads to a loss of functionality of pharmaceutical proteins. Here, the influence of glycerol on the chemical degradation of a protein and its correlation to glycerol-induced conformational changes is presented. The time-dependent chemical degradation of a pharmaceutical protein, GA-Z, in the absence and presence of glycerol was investigated in a stability study. The effect of glycerol on protein conformation and oligomerisation was characterised using asymmetric field-flow fractionation and small-angle neutron scattering in a wide glycerol concentration range of 0–90% v/v. The results from the stability study were connected to the observed glycerol-induced conformational changes in the protein. A correlation between protein conformation and the protective effect of glycerol against the degradation reactions deamidation, isomerisation, and hydrolysis was found. The study reveals that glycerol induces conformational changes of the protein, which favour a more compact and chemically stable state. It is also shown that the conformation can be changed by other system properties, e.g., protein concentration, leading to increased chemical stability.

Background: The aim of this study was to assess the incidence, outcomes, and risk factors associated with thrombocytopenia following TAVI according to a corrected platelet count (CPC), to avoid the bias of hemodilution/concentration. Methods: We analyzed patients who underwent TAVI in our center between 2009 and 2018. The study population were divided into three groups: none (NT), mild (MT), and severe (ST) postoperative thrombocytopenia. Primary outcomes were bleedings, length of hospital stay, and mortality. A multivariate logistic regression was performed to assess risk factors for ST. Results: A total of 907 patients were included in the analysis. MT was observed in 28.1% and ST in 2.6% of all patients. The following clinical outcomes were recorded: incidence of life-threatening and major bleeding (NT = 14.2%, MT = 20.8%, ST = 58.3%), the median length of hospital stay (NT = 8, MT = 10, ST = 14 days), in-hospital mortality (NT = 3.9%, MT = 6.3%, ST = 16.7%), and the overall significance in comparison with NT (p < 0.05). The logistic regression showed ST was associated with preoperative CPC, transapical access, diabetes mellitus, and the critical preoperative state. Conclusions: Worse clinical outcomes are associated with both MT and ST after TAVI. In particular, ST is associated with higher in-hospital and 30-day mortality. Management of modifiable baseline and procedural variables may improve this outcome.

Background: Obstructive sleep apnea syndrome (OSAS) is a widespread respiratory disease that is associated with recurrent breathing intermissions at night. The corresponding oxidative stress triggers a low-grade systemic inflammation which leads to alterations of different immune cells in the peripheral blood. The current standard treatment for OSAS is continuous positive airway pressure (CPAP), whereas hypoglossal nerve stimulation (HNS) has been established as a second-line treatment option for CPAP failure. The aim of the study was to investigate the influence of HNS for OSAS patients on the distribution and differentiation of circulating monocyte subsets in connection with the clinical parameters. Materials and Methods: Therefore, a detailed analysis of the distribution of CD14/CD16 characterized monocyte subsets in the peripheral blood of OSAS patients before and after HNS therapy was performed by flow cytometry. Furthermore, values of BMI (body mass index), ODI (oxygen desaturation index), and ESS (Epworth Sleepiness Scale) were measured. Results: These OSAS patients significantly improved AHI and ESS scores under HNS. In addition, HNS revealed the potential to ensure normal distributions of blood monocyte subsets and even improved the monocyte dynamics in selected OSAS patients, but there were no significant correlations with AHI, ODI, HNS usage, and daytime sleepiness. Conclusions: We conclude that HNS-related positive effects on the oxygenation of the peripheral blood as well as affect the distribution of circulating monocyte subsets, but clinical OSAS correlations are missing. Far more individual clinical, cellular and molecular factors are involved in this sensitive and complex regulatory network and have to be elucidated in further studies.

Railway networks systems are by design open and accessible to people, but this presents challenges in the prevention of events such as terrorism, trespass, and suicide fatalities. With the rapid advancement of machine learning, numerous computer vision methods have been developed in closed-circuit television (CCTV) surveillance systems for the purposes of managing public spaces. These methods are built based on multiple types of sensors and are designed to automatically detect static objects and unexpected events, monitor people, and prevent potential dangers. This survey focuses on recently developed CCTV surveillance methods for rail networks, discusses the challenges they face, their advantages and disadvantages and a vision for future railway surveillance systems. State-of-the-art methods for object detection and behaviour recognition applied to rail network surveillance systems are introduced, and the ethics of handling personal data and the use of automated systems are also considered.

(1) Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a standard therapy for portal hypertension. We aimed to explore the association of established baseline scores with TIPS outcomes. (2) Methods: In total, 136 liver cirrhosis patients underwent TIPS insertion, mainly to treat refractory ascites (86%), between January 2016 and December 2019. An external validation cohort of 187 patients was chosen. (3) Results: The majority of the patients were male (62%); the median follow-up was 715 days. The baseline Child—Turcotte–Pugh stage was A in 14%, B in 75% and C in 11%. The patients’ liver-transplant-free (LTF) survival rates after 3, 12 and 24 months were 87%, 72% and 61%, respectively. In the univariate analysis, neither bilirubin, nor the international normalized ratio (INR), nor liver enzymes were associated with survival. However, both the APRI (AST-to-platelet ratio index) and the FIB-4 (fibrosis-4 score) were associated with LTF survival. For patients with FIB-4 > 3.25, the hazard ratio for mortality after 2 years was 3.952 (p < 0.0001). Liver-related clinical events were monitored for 24 months. High FIB-4 scores were predictive of liver-related events (HR = 2.404, p = 0.001). Similarly, in our validation cohort, LTF survival was correlated with the APRI and FIB-4 scores. (4) Conclusions: Well-established scores that reflect portal hypertension and biochemical disease activity predict long-term outcomes after TIPS and support clinical decisions over TIPS insertion.

(1) Background: Whether coronary computed tomography angiography (CTA) or the coronary artery calcium score (CACS) should be used for diagnosis of coronary heart disease, is an open debate. The aim of our study was to compare the atherosclerotic profile by coronary CTA in a young symptomatic high-risk population (age, 19–49 years) in comparison with the coronary artery calcium score (CACS). (2) Methods: 1137 symptomatic high-risk patients between 19–49 years (mean age, 42.4 y) who underwent coronary CTA and CACS were stratified into six age groups. CTA-analysis included stenosis severity and high-risk-plaque criteria (3) Results: Atherosclerosis was more often detected based on CTA than based on CACS (45 vs. 27%; p < 0.001), 50% stenosis in 13.6% and high-risk plaque in 17.7%. Prevalence of atherosclerosis was low and not different between CACS and CTA in the youngest age groups (19–30 y: 5.2 and 6.4% and 30–35 y: 10.6 and 16%). In patients older than >35 years, the rate of atherosclerosis based on CTA increased (p = 0.004, OR: 2.8, 95%CI:1.45–5.89); and was higher by CTA as compared to CACS (34.9 vs. 16.7%; p < 0.001), with a superior performance of CTA. In patients older than 35 years, stenosis severity (p = 0.002) and >50% stenosis increased from 2.6 to 12.5% (p < 0.001). High-risk plaque prevalence increased from 6.4 to 26.5%. The distribution of high-risk plaque between CACS 0 and >0.1 AU was similar among all age groups, with an increasing proportion in CACS > 0.1 AU with age. A total of 24.9% of CACS 0 patients had coronary artery disease based on CTA, 4.4% > 50% stenosis and 11.5% had high-risk plaque. (4) Conclusions: In a symptomatic young high-risk population older than 35 years, CTA performed superior than CACS. In patients aged 19–35 years, the rate of atherosclerosis was similar and low based on both modalities. CACS 0 did not rule out coronary artery disease in a young high-risk population.

(1) Background: The athlete’s heart may develop permanent vessel enlargement. The purpose of our study was to define normal values for coronary artery dimensions of endurance athletes by coronary computed tomography angiography (CTA). (2) Methods: Ninety-eight individuals (56.2 ± 11 years) were included into this retrospective matched case-controlled-study. Endurance athletes had regular training volumes of ≥1 h per unit, ≥3–7 times per week (either cycling, running or mountain-endurance). Athletes were matched for age and gender with sedentary controls using propensity score. Quantitative CTA analysis included coronary vessel dimensions (two diameters and area) of the LM, LAD, CX and RCA for all AHA-16-segments. (3) Results: Proximal LAD area and diameter (p = 0.019); proximal/mid CX (diameter and area; p = 0.026 and p = 0.018/p = 0.008 and p = 0.009); mid RCA diameter and area; and proximal RCA diameter were significantly larger in endurance athletes (p < 0.05). The left main area (p = 0.708) and diameter (p = 0.809) as well as the mid LAD and distal segments were not different. We present the histograms and data for normal values ±1 and ± 2 SD. (4) Conclusions: Endurance athletes have larger proximal LAD, proximal/mid CX and RCA vessel dimensions, while LM and distal segments are similar. Hence, dilated coronary arteries in endurance athletes (“Athlete’s arteries”) have to be distinguished from diffuse ectatic segments developing during Kawasaki disease or multisystemic inflammation syndrome after COVID-19.

Background: Vitamin D supplementation may be associated with lower cardiovascular (CV) events, but the data are controversial. It remains speculative whether vitamin D supplementation has a direct effect on coronary atherosclerosis. We therefore set out to assess the influence of vitamin D supplementation on the coronary atherosclerosis profile quantified by coronary computed tomography angiography (CTA) in a retrospective case–control cohort study. Methods: 176 patients (age: 62.4 ± 10.4) referred to coronary CTA for clinical indications were included. A total of 88 patients receiving vitamin D supplementation (mean duration 65.3 ± 81 months) were 1:1 propensity score matched with 88 controls for age, gender, smoking, arterial hypertension, positive family history, dyslipidemia, and diabetes. Coronary stenosis severity (CAD-RADSTM), mixed plaque burden (weighted for non-calcified), high-risk-plaque (HRP) features, and plaque density (HU) were quantified by CTA. Serum 25-hydroxyvitamin D (OH)-levels were measured in 138 patients and categorized into four groups (0: 60 ng/mL) and compared with CTA. Results: The prevalence of atherosclerosis by CTA was similar in both groups (75.6% versus 74.3%, p = 0.999), >50% coronary stenosis was slightly higher in controls (p = 0.046), but stenosis severity score (CAD-RADS) was not different (p = 0.106). Mixed plaque burden (weighted for non-calcified) was lower in patients receiving vitamin D supplementation (p = 0.002) and high-risk-plaque prevalence was markedly lower (3.8% versus 32%, p < 0.001). CT plaque density (HU) was higher (p < 0.001) in the vitamin D group. Patients with serum vitamin D (OH) levels >60 ng/mL had higher plaque density (p = 0.04), indicating more calcified and less vulnerable plaque. Conclusions: In this retrospective case–control cohort study, vitamin D supplementation was associated with less high-risk plaque, less non-calcified plaque burden, and a higher calcified plaque independent of CV risk factors.

Retrofitting of industrial heat recovery systems can contribute significantly to meeting energy efficiency targets for industrial plants. One issue to consider when screening retrofit design proposals is that industrial heat recovery systems must be able to handle variations, e.g., in inlet temperatures or heat capacity flow rates, in such a way that operational targets are reached. Consequently, there is a need for systematic retrofitting methodologies that are applicable to multi-period heat exchanger networks (HENs). In this study, a framework was developed to achieve flexible and cost-efficient retrofit measures of (industrial) HENs. The main idea is to split the retrofitting processes into several sub-steps. This splitting allows well-proven (single period) retrofit methodologies to be used to generate different design proposals, which are collected in a superstructure. By means of structural feasibility assessment, structurally infeasible design proposals can be discarded from further analysis, yielding a reduced superstructure. Additionally, critical point analysis is applied to identify those operating points within the uncertainty span that determine necessary overdesign of heat exchangers. In the final step, the most cost-efficient design proposal within the reduced superstructure is identified. The proposed framework was applied to a HEN retrofit case study to illustrate the proposed framework.