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Background: Spaceflight-Associated Neuro-Ocular Syndrome (SANS) is a complex pathology threatening the health of astronauts, with incompletely understood causes and no current specific functional diagnostic or screening test. We investigated the use of the differential performance of the visual system (central vs. perimacular visual function) as a candidate marker of SANS-related pathology in a ground-based microgravity analogue. Methods: We used a simple reaction time (SRT) task to visual stimuli, presented in the central and perimacular field of view, as a measure of the overall performance of the visual function, during acute settings (first 10 min) of vertical, bed rest (BR), −6°, and −15° head-down tilt (HDT) presentations in healthy participants (n = 8). We built dose–response models linking the gravitational component to SRT distribution parameters in the central vs. perimacular areas. Results: Acute exposure to microgravity induces detectable changes between SRT distributions in the perimacular vs. central retina (increased mean, standard deviation, and tau component of the ex-Gaussian function) in HDT compared with vertical presentation. Conclusions: Functional testing of the perimacular retina might be beneficial for the earlier detection of SANS-related ailments in addition to regular testing of the central vision. Future diagnostic tests should consider the investigation of the extra-macular areas, particularly towards the optic disc.

Atrial septal defects (ASDs) present a significant healthcare challenge, demanding accurate and timely diagnosis and precise management to ensure optimal patient outcomes. Artificial intelligence (AI) applications in healthcare are rapidly evolving, offering promise for enhanced medical decision-making and patient care. In the context of cardiology, the integration of AI promises to provide more efficient and accurate diagnosis and personalized treatment strategies for ASD patients. In interventional cardiology, sometimes the lack of precise measurement of the cardiac rims evaluated by transthoracic echocardiography combined with the floppy aspect of the rims can mislead and result in complications. AI software can be created to generate responses for difficult tasks, like which device is the most suitable for different shapes and dimensions to prevent embolization or erosion. This paper reviews the current state of AI in healthcare and its applications in cardiology, emphasizing the specific opportunities and challenges in applying AI to ASD diagnosis and management. By exploring the capabilities and limitations of AI in ASD diagnosis and management. This paper highlights the evolution of medical practice towards a more AI-augmented future, demonstrating the capacity of AI to unlock new possibilities for healthcare professionals and patients alike.

Psoriasis is a chronic, systemic inflammatory disease that has gained popularity among scientific research from many promising perspectives on diagnosis and treatment. Individuals with psoriasis associate numerous comorbidities and have many predisposing factors in common especially with heart disease. Based on this, researchers tried to identify the common pathogenic mechanisms, the impact of risk factors on both pathologies, the influence of one disease on the another as well as the impact of novel therapies used in psoriasis on cardiovascular system, in order to improve the prognosis and quality of life of these patients. Areas of uncertainty. Pathogenic mechanisms involved both in psoriasis and atherosclerotic disease are not fully understood, especially in relationship with actual treatment strategies and their impact on prognosis. The purpose of this descriptive review is to summarize the latest available data, to see whether current treatment strategies of psoriatic disease should take into consideration the risk of cardiovascular disease (CVD) when one drug should be chosen at the expense of another. Data sources. Literature research was performed using electronic database (PubMed, Cochrane Library and Web of Science) between January 2010 and June 2022. We used different keywords and MeSH terms to generate the most relevant results regarding psoriasis and cardiovascular disease. First, we evaluated the titles and abstracts of the articles and we excluded papers that didn’t met selection criteria.

IntroductionTelerehabilitation in neurological and cardiological diseases is an alternative rehabilitation that improves the quality of life and health conditions of patients and enhances the accessibility to health care. However, despite the reported benefits of telerehabilitation, it is necessary to study its impact on the healthcare system.MethodsThe systematic review aims to investigate the costs and results of telerehabilitation in neurological and cardiological diseases. MEDLINE and EMBASE databases were searched from 2005 to 2021, for studies that assess the costs and results of telerehabilitation compared to traditional rehabilitation (center-based programs) in neurological and cardiological diseases. A narrative synthesis of results was carried out.ResultsA total of 8 studies (865 participants) of 430 records were included. Three studies were related to the costs and results of telerehabilitation in neurological diseases (specifically in stroke). In total, five studies assessed telerehabilitation in cardiological diseases (chronic heart failure, coronary heart disease, acute coronary syndrome, and cardiovascular diseases). The duration of the telerehabilitation ranged from 6 to 48 weeks. The studies included cost-analysis, cost-benefit, cost-effectiveness, or cost-utility. In total, four studies found significant cost/savings per person between $565.66 and $2,352.00 (p < 0.05). In contrast, most studies found differences in costs and clinical effects between the telerehabilitation performed and the rehabilitation performed at the clinic. Just one study found quality-adjusted life years (QALY) significant differences between groups [Incremental cost-effectiveness ratio (ICER) per QALY ($−21,666.41/QALY).DiscussionTelerehabilitation is an excellent alternative to traditional center rehabilitation, which increases the accessibility to rehabilitation to more people, either due to the geographical situation of the patients or the limitations of the health systems. Telerehabilitation seems to be as clinical and cost-effective as traditional rehabilitation, even if, generally, telerehabilitation is less costly. More research is needed to evaluate health-related quality of life and cost-effectiveness in other neurological diseases.Systematic review registration[https://figshare.com/articles/journal_ contribution/Review_Protocol_Costs_and_effects_of_Telerehabilitation_in_ Neurological_and_Cardiological_Diseases_A_Systematic_Review/19619838], identifier [19619838].

The objective of the study is to assess the efect of thrombolitic therapy on clinical prognostic markers in patients with intermediate-high risk pulmonary embolism compared to clasic therapy, and also the assessment of the bleeding risk associated with thrombolitic therapy. Material and methods. We included 82 consecutive patients with intermediate-high risk pulmonary embolism, which were divided in two groups: study group (thrombolysed) and control group (treated with unfractioned heparine alone). Patients with lower bleeding risk were included in control group. Patients were assessed regarding the right ventricle dysfunction markers (both imagistic and biochemical) on admision and on 48 h. The early (7th day) mortality rate and hemodinamic instability rate were evaluated in the two groups, also the major bleeding rate. Outcomes. We proved a statistical significant lower mortality rate in the study group, with no difference regarding the major bleedings. Meanwhile, the hemodinamic instability was lower in the study group compared to control group. Conclusions. The proper patient selection with intermediate-high pulmonary embolism for thrombolitic therapy can bring important benefits in terms of mortality and bleeding complications

Home-based rehabilitation after an acute episode or following an exacerbation of a chronic disease is often problematic with a clear lack of continuity of care between hospital and home care. Secondary prevention is an essential element of long-term rehabilitation where strategies oriented toward risk reduction, treatment adherence, and optimization of quality of life need to be applied. Frail and sometimes isolated, the patient fails to adhere to the proposed post-discharge clinical pathway due to lack of appropriate clinical, emotional, and informational support. Providing a suitable rehabilitation after an acute episode or a chronic disease is a major issue, as it helps people to live independently and enhance their quality of life. However, as the rehabilitation period usually lasts some months, the continuity of care is often interrupted in the transition from hospital to home. Virtual coaches could help these patients to engage in a personalized rehabilitation program that complies with age-related conditions. These coaches could be a key technology for empowering patients toward increasing their adherence to the care plan and to improve their secondary prevention measures. In this paper, we are presenting a novel virtual coaching system that will address these challenges by combining recent technological advances with clinical pathways, based on joint research and validation activities from researchers from the medical and information and communication technology (ICT) domains.

Background/Objectives: HMG-CoA reductase is an enzyme that regulates the initial stage of cholesterol synthesis, and its inhibitors are widely used in the treatment of cardiovascular diseases. Methods: We have created a set of quantitative structure-activity relationship (QSAR) models for human HMG-CoA reductase inhibitors using nested cross-validation as the primary validation method. To develop the QSAR models, we employed various machine learning regression algorithms, feature selection methods, and fingerprints or descriptor datasets. Results: We built and evaluated a total of 300 models, selecting 21 that demonstrated good performance (coefficient of determination, R2 ≥ 0.70 or concordance correlation coefficient, CCC ≥ 0.85). Six of these top-performing models met both performance criteria and were used to construct five ensemble models. We identified the descriptors most important in explaining HMG-CoA inhibition for each of the six best-performing models. We used the top models to search through over 220,000 chemical compounds from a large database (ZINC 15) for potential new inhibitors. Only a small fraction (237 out of approximately 220,000 compounds) had reliable predictions with mean pIC50 values ≥ 8 (IC50 values ≤ 10 nM). Our svm-based ensemble model predicted IC50 values < 10 nM for roughly 0.08% of the screened compounds. We have also illustrated the potential applications of these QSAR models in understanding the cholesterol-lowering activities of herbal extracts, such as those reported for an extract prepared from the Iris × germanica rhizome. Conclusions: Our QSAR models can accurately predict human HMG-CoA reductase inhibitors, having the potential to accelerate the discovery of novel cholesterol-lowering agents and may also be applied to understand the mechanisms underlying the reported cholesterol-lowering activities of herbal extracts.

Purpose: In 2024, Romania is still facing a critical challenge with high cardiovascular disease mortality rates despite extensive research and policy initiatives. Our study sought to examine the actual state of cardiac rehabilitation in Romania by identifying the healthcare facilities that provide and deliver cardiac rehabilitation services. Methods: The research began with a comprehensive investigation into cardiac rehabilitation centers across Romania. This involved leveraging search engines to identify these facilities. Keywords like “cardiac rehabilitation”, “cardiovascular rehabilitation”, and “cardiac rehabilitation centers” were instrumental in pinpointing relevant information, which included names, geographical locations, and contact details of the centers. Upon identification of potential centers, our research team initiated direct engagement with these facilities via telephonic interviews. Results: The data collected in 2024 was compared to previous findings from a 2017 research report to evaluate the progress and impact of prevention efforts over time. While the number of cardiac rehabilitation centers has grown (69.2% increase in the nationwide count of cardiac rehabilitation centers/facilities), an uneven geographic distribution persists, exacerbated by disruptions during the COVID-19 pandemic. Among the cardiac rehabilitation centers identified, 23% are located in balneoclimatic resorts, but the majority of cardiac rehabilitation centers are located in Bucharest. Overall, 65.3% of all identified centers in Romania belong to the private healthcare sector. Among these private centers, 41.1% offer cardiac rehabilitation programs as continuous inpatient care, with durations ranging from 5 to 16 days. All cardiac rehabilitation centers are equipped with the necessary equipment to perform basic cardiological investigations as well as physio-kinesiological rehabilitative procedures, in addition to aerobic physical training (53.8%). In 33.3% of the identified centers, diabetologists and psychologists/psychotherapists are integral members of the multidisciplinary cardiac rehabilitation team, while only 19.2% of the centers include a dietitian/nutritionist. Regarding costs, there is significant variation depending on the geographical area. In Bucharest, a single rehabilitation session costs between 100 to 400 lei (20 to 80 €), and a rehabilitation program spanning 4-6 weeks can cost up to 3350 lei. Comparing costs identified in 2017, we have observed an increase ranging from 47% to 188% in 2024. Conclusions: Despite an increase in the number of cardiac rehabilitation centers, their prevalence remains inadequate to fulfill the demands of the population. Telerehabilitation emerges as a promising solution, with limited adoption in only one center. Cost variations across regions pose a barrier to patient participation. Our article proposes strategies including decision algorithms for personalized recommendations, expanding cardiac rehabilitation centers, and advocating for comprehensive cost reimbursement. The urgent need for collaborative efforts is emphasized, envisioning innovative solutions like mobile applications to foster a sense of community and optimize cardiac rehabilitation, ultimately improving cardiovascular health outcomes in Romania.

Objective. Demonstrating cardiovascular injury amoung a group of female patients suffering from anorexia, compared to a similarly-aged group of women with body mass within the normal range. Materials and methods. Clinical, biological and paraclinical parameters were determined in the two patient groups: Group A, consisting of 39 patients suffering from anorexia, and Group B, consisting of 40 patients of similar ages, but having a normal body-mass index (BMI). Results. Compared to the normal-BMI cohort, the female patients diagnosed with anorexia are more bradycardic, have lower blood pressure, biologically were found to suffer from various degrees of anemia (hypochromic, microcytic, caused by iron deficiency), leucocytosis, thrombocytosis, hypoglicemia, slight nitrogen compounds retention, hyponatremia, hypokalemia, hypochloremia, hypomagnesemia, hypocalcemia, hypophosphatemia, low levels of triglycerides and of all cholesterol fractions, hypoproteinemia with hypoalbuminemia, mild hepatic cytolysis, increased levels of creatine kinase and cortisol. In terms of echocardiographic findings, the patients with anorexia have decreased dimensions of all cardiac chambers and of the inferior vena cava, lower cardiac output and index, diminished A-wave velocity, with an increase in E/A ratio, lower E', A' and S' velocities for the lateral ventricular wall, along with lower E' and A' velocities for the interventricular septum, and a decrease in both tricuspid annular and mitral annular systolic excursions. Discussions. There is an obvious link between the magnitude of clinical, biological and paraclinical abnormalities and low BMI. Further studies are needed in order to establish the degree of reversibility of said abnormalities following the total or partial correction of the patients' nutritional deficit. Conclusions. The patients suffering from anorexia present with multiple abnormal findings, both biological = and clinical in nature, alongside a subclinical negative impact on the cardiovascular system. Early detection of these negative changes could impose the adoption of a realimentation plan, possibly accompanied by the use of specific pharmacological agents, that would bring about improvements in these patients' overall status.

Cerebrovascular attacks are one of the leading causes of mortality and morbidity in the world. The most severe are considered to be pontine strokes, because of the high risk of vital functions impairment. The clinical presentation of a pontine stroke can vary from the classical crossed syndrome (ipsilateral cranial nerve palsy and contralateral motor and/or sensory impairment) to pure motor hemiplegia or pure sensory stroke, which are less common.1 Materials and methods. This presentation describes the case of a 39-year-old patient with a re-cent history of untreated SARS-COV 2 infection that was followed in the next month by a sudden onset of facial paralysis, dysarthria and a progressive left hemiplegia. The patient’s functional status was assessed in our Neuromuscular Clinical Division and he underwent a rehabilitation program consisting of physical, occupational and speech therapies. Multidisciplinary efforts were made in order to find the underlying cause of the pontine ischemic stroke. Results. The patient had a personal history of cardiovascular disease risk factors (essential hy-pertension and hyperlipidaemia), without other pathological brain imagining outcomes and normal bleeding tests. The suspicion of an interatrial communication was raised. The patient managed to rapidly maintain the standing posture and to practice walking with unilateral sup-port. At discharge, the facial paralysis and dysarthria were almost completely remitted. The left brachial extremity also showed signs of improvement, as the patient was able to perform flexion and extension movements of the fingers, wrist and forearm. Conclusion. To conclude, the patient’s evolution was favourable, although the certain cause of the underlying stroke has not been clarified. The neurological complications of COVID-19 in-clude ischemic strokes, and cases were reported in young adults too2,3. If this were the case, pre-vention of further cerebrovascular attacks and their complications is necessary1. Caution in terms of medium/long-term prophylactic anticoagulant therapy and careful control of associated cardiovascular disease risk factors has been proposed and discussed in the multidisciplinary team: rehabilitation physician, neurologist, cardiologist.