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Recently, the coronavirus pandemic has caused widespread panic around the world. Modern technologies can be used to monitor and control this highly contagious disease. A plausible solution is to equip each patient who is diagnosed with or suspected of having COVID-19 with sensors that can monitor various healthcare and location parameters and report them to the desired facility to control the spread of the disease. However, the simultaneous communication of numerous sensors installed in most of an area's population results in a massive burden on existing Long-Term Evolution (LTE) networks. The existing network becomes oversaturated because it has to manage two more kinds of traffic in addition to regular traffic (text, voice, and video). Healthcare traffic is generated by many sensors deployed over a huge population, and extra traffic is generated by people contacting their family members via video or voice calls. In pandemics, e-healthcare traffic is critical and should not suffer packet loss or latency due to network overload. In this research, we studied the performance of existing networks under various conditions and predicted the severity of network degradation in an emergency scenario. We proposed and evaluated three schemes (doubling bandwidth, combining LTE-A and LTE-M networks, and request queuing) for ensuring the quality of service (QoS) of healthcare sensor (HCS) network traffic without perturbation from routine human-to-human or machine-to-machine communications. We simulated all proposed schemes and compared them with existing network scenarios. Although it is observed from the results that doubling the bandwidth serves the purpose, it is a timeconsuming and expensive solution that seems non-practical in case a sudden peak occurs during an emergency. We can conclude by analyzing the simulations that the proposed queuing scheme is best-suitable under all studied scenarios where QoS for HCS traffic is never compromised, which is the ultimate goal of this research. [ABSTRACT FROM AUTHOR]

Surface-enhanced infrared absorption (SEIRA) spectroscopy is a competent method to detect trace quantity of molecules and even protein conformational flexibility by enhancing their vibrational modes. To improve the spectroscopy features, we propose a surface with honeycomb-like (HC) arrangement of aluminum equilateral triangles within a metal-insulator-metal configuration. With adjustable geometric parameters, the HC nanoantennas allow a tunable and wide spectral coverage in the IR. The reflectance measurements correlate extremely well with the numerical simulations. Being compact and insensitive to the light polarization, the HC are appealing for boosting the signal-to-noise ratio and increasing the number of hotspots as required for sensing applications. These nanoantennas are thus suitable for accurate and broadband SEIRA sensing via a spectral overlap between the large plasmonic resonances and the narrow IR vibrational modes of our analyte (vanillin). In line with our previously studied bowties nanoantennas, we demonstrate, using HC, SEIRA enhancement factors greater than 107 achieved at a tuning ratio below 1 stating the best spectral overlap. Around 104 molecules are sensed per HC tip. The investigation results are matching the best-reported SEIRA studies. These findings pave the way toward sensitive, adaptable, and miniaturized IR spectroscopy devices for vital applications like biosensing and environmental monitoring.

Objective Endovenous techniques are, at present, the recommended choice for truncal vein treatment. However, the thermal techniques require tumescent anaesthesia, which can be uncomfortable during administration. Non-tumescent, non-thermal techniques would, therefore, have potential benefits. This randomised controlled trial is being carried out to compare the degree of pain that patients experience while receiving mechanochemical ablation or radiofrequency ablation. The early results of this randomised controlled trial are reported here. Methods Patients attending for the treatment of primary varicose veins were randomised to receive mechanochemical ablation (ClariVein®) or radiofrequency ablation (Covidien® Venefit™). The most symptomatic limb was randomised. The primary outcome measure was intra-procedural pain using a validated visual analogue scale. The secondary outcome measures were change in quality of life and clinical scores, time to return to normal activities and work as well as the occlusion rate. Results One-hundred and nineteen patients have been randomised (60 in the mechanochemical ablation group). Baseline characteristics were similar. Maximum pain score was significantly lower in the mechanochemical ablation group (19.3 mm, standard deviation ±19 mm) compared to the radiofrequency ablation group (34.5 mm ± 23 mm; p < 0.001). Average pain score was also significantly lower in the mechanochemical ablation group (13.4 mm ± 16 mm) compared to the radiofrequency ablation group (24.4 mm ± 18 mm; p = 0.001). Sixty-six percent attended follow-up at one month, and the complete or proximal occlusion rates were 92% for both groups. At one month, the clinical and quality of life scores for both groups had similar improvements. Conclusion Early results show that the mechanochemical ablation is less painful than the radiofrequency ablation procedure. Clinical and quality of life scores were similarly improved at one month. The long-term data including occlusion rates at six months and quality of life scores are being collected. [ABSTRACT FROM AUTHOR]

Two thermoluminescent dosimeters (SiO2-GeO2 doped fibres and glass beads (GB)) were used to measure small photon field doses and compared against GAFCHROMIC film, a small ionisation chamber (RK-018) and a p-type silicon diode (SCANDITRONIX, F1356), as well as Monte Carlo simulations with FLUKA and BEAMnrc/DOSXYZnrc. Ge-doped SiO2 fibres have been shown by this group to offer a viable system for use as dosimeters. The fibres and GB offer good spatial resolution (∼120 μm and 2 mm respectively), large dynamic dose range (with linearity from tens of mGy up to well in excess of many tens of Gy), are non-hygroscopic and are of low cost. Measurements of beam profiles for field sizes of 10 mm×10 mm, 20 mm×20 mm, 30 mm×30 mm, 40 mm×40 mm, and 100 mm×100 mm were carried out. Through the use of a customised solid water phantom, doped optical fibres and GBs were placed at defined positions along the x -and y -axes to allow accurate beam profile measurement. The maximum difference between FWHM measurements was 1.8 mm. For penumbra measurements (measured between 80% and 20% isodoses), the maximum difference was<1 mm. These measurements indicate good agreement, within measurement uncertainty, with Gafchromic film, data obtained from the use of two commonly used detectors and FLUKA and BEAMnrc/DOSXYZnrc simulations. [ABSTRACT FROM AUTHOR]

Purpose of Review: Hypertension (HTN) is a major risk factor for cardiovascular diseases (CVD). The global prevalence of HTN and related CVD mortality continues to rise. The development of HTN is influenced by genetic predisposition and modifiable risk factors, including diet. One area of ongoing debate is the relationship between red meat consumption and risk of HTN., Recent Findings: Processed red meat has become increasingly implicated in the pathogenesis and morbidity of HTN, though randomized control trials comparing HTN-related outcomes associated with red meat subtypes have yielded heterogenous results. This review summarizes the existing relevant literature and highlights the methodological challenges that complicate definitive conclusions, with a focus on processed versus unprocessed red meat consumption and HTN. It explores pathophysiologic mechanisms contributing to this relationship and reviews practical, evidence-based dietary guidelines that address red meat consumption to mitigate the risk of adverse HTN-related CVD outcomes., Competing Interests: Declarations. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background Chronic limb-threatening ischemia (CLTI) is the most severe manifestation of peripheral arterial disease. Various revascularization techniques are employed to treat peripheral arterial disease. Intravascular shockwave lithotripsy (IVL) is a relatively new procedure for the treatment of calcific lower limb peripheral arterial diseases (PAD). Objectives To assess the effectiveness and safety of shockwave lithotripsy in patients with severe PAD through an evaluation of limb salvage rate and patient survival. Methods A retrospective study of all patients treated with shockwave lithotripsy between November 2019 and June 2024 was performed. The primary outcome was amputation-free survival and secondary outcomes were potential complications of IVL (thrombo-embolization, perforation, and restenosis). Patients were followed up in the clinic and assessed both clinically and with a duplex scan at three months. Results A total of 38 patients were included in the study. The median age was 71 years; 28 were males. Among the patients, 28 (73.68%) were diabetic, 4 patients (10.53%) were current smokers, 10 patients (26.32%) were ex-smokers, and 24 patients (63.16%) were non-smokers. According to the Rutherford classification of PAD, 33 of the 38 patients were in stages 4-6. Only five patients were stage 3. Total number of treated arteries was 47. Treated lesions were 49% in the superficial femoral artery (SFA), 36% in the popliteal artery, 8% in the common femoral artery (CFA), 4% received treatment of the iliac arteries, and 2% of the posterior tibial artery. All treated arteries showed improved angiographic results. Four patients (10.53%) developed distal embolization. No perforation was recorded, and no significant flow-limiting dissection was recorded to require treatment. At the three-month follow-up, imaging revealed improvement in 58% of patients while 5% showed no improvement. Notably, follow-up imaging was not conducted in 37% of patients due to evident clinical improvement such as ulcer healing, palpable pulses, and the presence of Doppler signals. Seven patients required reintervention within three months after the initial IVL operation and 4 patients got revascularized after this period resulting in 11 patients requiring revascularisation after the initial operation. Amputation-free survival was 79% (30 patients). Conclusion Shockwave lithotripsy is associated with a high limb salvage rate and low complication rate. Further research is needed into long-term effectiveness and the role of shockwave treatment as an adjuvant to traditional revascularization techniques of patients with CLTI and short-distance claudicants., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Salihi et al.)

Importance: Chronic hypertension and preeclampsia are leading risk enhancers for maternal-neonatal morbidity and mortality. Severe maternal morbidity (SMM) indicators include heart, kidney, and liver disease, but studies have not excluded patients with preexisting diseases that define SMM. Thus, SMM risks for uncomplicated chronic hypertension specific to preeclampsia remain unclear., Objective: To determine SMM rates and estimate relative risks associated with hypertensive disorders of pregnancy among patients with and without chronic hypertension unencumbered by preexisting vascular or end organ diseases., Design, Setting, and Participants: This retrospective cohort study used longitudinal health data from electronic health records from patients within a community-based, integrated health care system in northern California. The study cohort selected 263 518 pregnant patients without pregestational heart, kidney, or liver disease entering prenatal care at 14 weeks' gestation or earlier and delivering a singleton stillbirth or live birth in 2009 to 2019. The data were analyzed between February 2022 and March 2024., Exposures: Five joint subgroups combining chronic hypertension status and the hypertensive disorders developing during pregnancy, defined as follows: (1) chronic hypertension with superimposed preeclampsia, (2) chronic hypertension and no preeclampsia, (3) no chronic hypertension with preeclampsia, (4) gestational hypertension, and (5) no chronic hypertension and no preeclampsia or gestational hypertension (reference group)., Main Outcomes and Measures: The main outcome was SMM rates at delivery hospitalization (cases per 10 000 births) using the Centers for Disease Control and Prevention criteria (≥1 of 21 indicators to define SMM) obtained from electronic health records. Modified Poisson regression models estimated crude and adjusted relative risks (aRRs) and 95% CIs of SMM associated with the chronic hypertension and developing hypertensive disorders of pregnancy groups vs the reference group (no chronic hypertension and no preeclampsia or gestational hypertension) adjusted for clinical, sociodemographic, social, and behavioral covariates., Results: The analysis included a total of 263 518 pregnant patients (mean [SD] age at delivery, 31.0 [5.3] years), including 249 892 patients without chronic hypertension (4.7% developed preeclampsia) and 13 626 patients with chronic hypertension (31.5% developed superimposed preeclampsia). The highest SMM rates occurred in the no chronic hypertension with preeclampsia (934.3 [95% CI, 882.3-988.3] cases per 10 000 births) and the chronic hypertension with superimposed preeclampsia (898.3 [95% CI, 814.5-987.8] cases per 10,000 births) groups. Lower SMM rates occurred in the chronic hypertension and no preeclampsia (195.1 [95% CI, 168.0-225.2] cases per 10,000 births), gestational hypertension (312.7 [95% CI, 281.6-346.1] cases per 10,000 births), and no chronic hypertension and no preeclampsia or gestational hypertension (165.8 [95% CI, 160.6-171.2] cases per 10,000 births) groups (P < .001). Compared with the no chronic hypertension and no preeclampsia or gestational hypertension group, risks of SMM were significantly higher for the chronic hypertension with superimposed preeclampsia group (aRR, 4.97 [95% CI, 4.46-5.54]), no chronic hypertension with preeclampsia group (aRR, 5.12 [95% CI, 4.79-5.48]), chronic hypertension and no preeclampsia group (aRR, 1.17 [95% CI, 1.003-1.36]; P = .046), and the gestational hypertension group (aRR, 1.78 [95% CI 1.60-1.99])., Conclusions and Relevance: This cohort study found that the highest SMM rates at delivery hospitalization occurred for preeclampsia superimposed on chronic hypertension and preeclampsia without chronic hypertension, while gestational hypertension had intermediate rates of SMM. The patients with chronic hypertension who did not develop preeclampsia had SMM rates that were nearly the same as the lowest-risk patients without chronic hypertension who did not develop preeclampsia or gestational hypertension. These findings provide evidence that prevention of preeclampsia among patients with uncomplicated chronic hypertension is paramount to mitigating maternal morbidity.

Introduction Carotid endarterectomy (CEA) is the gold standard intervention for patients experiencing transient ischemic attacks (TIAs) or embolic strokes with >50% internal carotid artery (ICA) stenosis supplying index hemispheric territory. The recommended period for CEA is 14 days post-index event; this period carries a heightened risk for second ischemic events. However, implementation of this stringent timeline often encounters delays stemming from multifaceted factors. The centralization of vascular services, designed to enhance patient care, introduces a paradigm shift. Centralization's efficacy in improving patient outcomes, particularly in the CEA pathway, is a subject of ongoing investigation. Our study aims to discern the impact of centralized services on the timeliness of CEA for symptomatic carotid artery stenosis, shedding light on this complex interplay of factors. Methods This retrospective study analyzed CEA data at the Bedfordshire, Luton, and Milton Keynes Vascular Network between January 2021 and June 2023. Eligible patients exhibited symptomatic carotid artery stenosis, with asymptomatic cases; those unfit for surgery or receiving best medical therapy only were excluded. Patients were categorized by their primary referral location: Hub, Spoke-1, or Spoke-2. Demographic and referral data were collected, and timelines from symptom onset to surgery were recorded. Continuous variables were expressed as means and standard deviations, and categorical variables as counts and percentages. Box plots illustrated the relationship between referral origin and surgery timing, and the Classification and Regression Tree (CART) assessed second events. Statistical significance was determined using Fisher's exact and chi-square tests, with p<0.05 indicating significance. Results A total of 148 patients underwent CEA after implementing exclusion criteria. 35.5% (n=53) of patients were referred from the Hub, while 45.6% (n=67) and 18.8% (n=28) were from Spoke-1 and Spoke-2, respectively. 40% (n=59) received CEA within the recommended timeframe, and 15.4% (n=23) experienced a second ischemic event pre-surgery. Time from TIA clinic review to referral was 5.5±8 days and 16.4±20 days from vascular referral to surgery. Patterns of delays were observed, with Spoke-2 exhibiting the most significant delays. Notably, amaurosis fugax and embolic stroke correlated with recurrent ischemic events, emphasizing the importance of timely care in CEA. Conclusion Our study underscores the significant benefits and challenges of the Hub and Spoke model in vascular surgery. The growing referral delays from Spoke sites are concerning, emphasizing the need for a multi-disciplinary team approach within Spoke sites to ensure efficient and standardized care delivery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hakeem et al.)

Technology-enabled home-based cardiac rehabilitation (HBCR) is an emerging alternative to traditional center-based cardiac rehabilitation (CBCR), but little is known about outcomes in women. We analyzed 753 diverse and medically complex women who participated in HBCR and CBCR within an integrated health system and found both groups had similar clinical outcomes. Results suggest HBCR is a viable alternative to CBCR among women, including women with multiple comorbidities., Competing Interests: No conflicts of interest exist., (© 2023 The Authors.)

Introduction The Perclose ProGlide and, more recently, MANTA Large-Bore Closure Device are commonly used vascular closure devices (VCDs) for managing large-bore vascular access haemostasis. The extent of calcification in the common femoral artery (CFA) plays a crucial role in choosing between these devices. ProGlide may face challenges with anterior calcification, while MANTA may have issues with posterior calcification. Our study compared their effectiveness, adjunct usage, calcification impact and early/late complications. Methods A retrospective analysis of procedures involving large-bore CFA access from 2017 to 2022 was conducted. Closure was grouped according to VCD as Group A (ProGlide) and Group B (MANTA). Calcification was designated as anterior and posterior and combined on pre-operative computed tomography angiography along 10 mm segments with 0.625 mm slice thickness. The success of haemostasis was graded as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts) and Grade 3 (failed haemostasis needing rescue); Grades 1 and 2 were pooled as successful haemostasis. Statistical analysis was undertaken in Minitab 21 for Windows, particularly analysing calcification and its impact on the success of haemostasis. Results We evaluated 370 large-bore CFA accesses, distributed across two groups: Group A(64.9%, n=243) and Group B (35.1%, n=127), for a total of 205 endovascular procedures (93.1% (191) EVAR and 5.3% (11) TEVAR). The mean age was 74.9±8 years, predominantly males (88.2%, n=181). The average body mass index (BMI) was 28±5.8, with 20.9% (43) individuals having diabetes and 18.5% (37) current smokers. The mean sheath size OD was 16±2.5, with 4.5% (11) re-do groins in Group A and 6.2% (8) in Group B. Successful haemostasis was achieved in 91.8% (n=223) in Group A (44.8%, n=109 Grade 2) and 90.5% (n=115) in Group B (21%, n=27 Grade 2). Rescue operations were needed in 8.2% (20) in Group A and 9.1% (12) in Group B. Pseudoaneurysms developed more commonly in Grade 2 haemostasis with 9.9% (11) in Group A and 1.6% (2) in Group B (p=0.3). Anterior calcification was observed in 14.8% (36) in Group A and 18.8% (24) in Group B. In comparison, posterior calcification was present in 62.5% (152) in Group A and 66.9% (85) in Group B. Notably, calcification did not significantly impact haemostasis (p=0.79). Additional VCD deployment was necessary due to device failure in 4.5% (11) cases in Group A and 1.5% (2) cases in Group B. Conclusion The overall success rate was comparable between the two groups. However, Group A required more adjuncts to achieve successful haemostasis. The site of calcification did not impact the efficacy of closure devices. Pseudoaneurysm formation was more frequent when adjuncts were needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hakeem et al.)

Terahertz time-domain spectroscopy (THz-TDS) at room temperature and standard atmosphere pressure remains so far the backbone of THz photonics in numerous applications for civil and defense levels. Plasmonic microstructures and metasurfaces are particularly promising for improving THz spectroscopy techniques and developing biomedical and environmental sensors. Highly doped semiconductors are suitable for replacing the traditional plasmonic noble metals in the THz range. We present a perfect absorber structure based on semiconductor III-Sb epitaxial layers. The insulator layer is GaSb while the metal-like layers are Si doped InAsSb (∼ 5·10 19  cm -3 ). The doping is optically measured in the IR with polaritonic effects at the Brewster angle mode. Theoretically, the surface can be engineered in frequency selective absorption array areas of an extensive THz region from 1.0 to 6.0 THz. The technological process is based on a single resist layer used as hard mask in dry etching defined by electron beam lithography. A wide 1350 GHz cumulative bandwidth experimental absorption is measured in THz-TDS between 1.0 and 2.5 THz, only limited by the air-exposed reflectance configuration. These results pave the way to implement finely tuned selective surfaces based on semiconductors to enhance light-matter interaction in the THz region.

Objective: To evaluate the levels of periostin in patients with systemic sclerosis (SSc) and their association with features of systemic sclerosis., Methods: The levels of periostin were assessed in the serum of 106 SSc patients and 22 healthy controls and by immunofluorescence staining in cardiac tissue from 4 SSc patients and 4 controls. Serum periostin was measured via enzyme-linked immunosorbent assay. The results were analyzed using Mann-Whitney test or Kruskal-Wallis test followed by Dunn's multiple comparisons tests and Spearman's test for correlations. Cardiac tissue from SSc patients and controls was stained for periostin and co-stained for periostin and collagen type I using immunofluorescence., Results: Periostin levels were higher in patients with SSc compared to controls and directly correlated to modified Rodnan skin score and echocardiography parameters of left ventricular measurements. Immunofluorescence staining in SSc cardiac tissue showed patchy periostin expression in all SSc patients, but not in controls. Furthermore, there was extensive periostin expression even in areas without collagen deposition, while all established fibrotic areas showed colocalization of collagen and periostin. There was no association between periostin levels and interstitial lung disease, pulmonary hypertension or other vascular complications., Conclusion: Periostin is elevated in SSc cardiac tissue in vivo and circulating levels of periostin are increased in SSc, correlating with the extent of disease duration, degree of skin fibrosis, and left ventricular structural assessments. Periostin may be a potential biomarker that can provide further pathogenic insight into cardiac fibrosis in SSc., (© 2022. The Author(s).)

Importance: Prior studies have suggested that participation in home-based cardiac rehabilitation (HBCR) vs center-based cardiac rehabilitation (CBCR) results in similar clinical outcomes in patients with low to moderate risk; however, outcome data from demographically diverse populations and patients who are medically complex are lacking., Objective: To compare hospitalizations, medication adherence, and cardiovascular risk factor control between participants in HBCR vs CBCR., Design, Setting, and Participants: This retrospective cohort study was conducted among patients in Kaiser Permanente Southern California (KPSC), an integrated health care system serving approximately 4.7 million patients, who participated in CR between April 1, 2018, and April 30, 2019, and with follow-up through April 30, 2020. Data were analyzed from January 2021 to January 2022., Exposures: Participation in 1 or more HBCR or CBCR sessions., Main Outcomes and Measures: The primary outcome was 12-month all-cause hospitalization. Secondary outcomes included all-cause hospitalizations at 30 and 90 days; 30-day, 90-day, and 12-month cardiovascular hospitalizations; and medication adherence and cardiovascular risk factor control at 12 months. Logistic regression was used to compare hospitalization, medication adherence, and cardiovascular risk factor control, with inverse probability treatment weighting (IPTW) to adjust for demographic and clinical characteristics., Results: Of 2556 patients who participated in CR (mean [SD] age, 66.7 [11.2] years; 754 [29.5%] women; 1196 participants [46.8%] with Charlson Comorbidity Index ≥4), there were 289 Asian or Pacific Islander patients (11.3%), 193 Black patients (7.6%), 611 Hispanic patients (23.9%), and 1419 White patients (55.5%). A total of 1241 participants (48.5%) received HBCR and 1315 participants (51.5%) received CBCR. After IPTW, patients who received HBCR had lower odds of hospitalization at 12 months (odds ratio [OR], 0.79; 95% CI, 0.64-0.97) but similar odds of adherence to β-blockers (OR, 1.18; 95% CI, 0.98-1.42) and statins (OR, 1.02; 95% CI, 0.84-1.25) and of control of blood pressure (OR, 0.98; 95% CI, 0.81-1.17), low-density lipoprotein cholesterol (OR, 0.98; 95% CI, 0.81-1.20), and hemoglobin A1c (OR, 0.98; 95% CI, 0.82-1.18) at 12 months compared with patients who received CBCR., Conclusions and Relevance: These findings suggest that HBCR in a demographically diverse population, including patients with high risk who are medically complex, was associated with fewer hospitalizations at 12 months compared with patients who participated in CBCR. This study strengthens the evidence supporting HBCR in previously understudied patient populations.