Multi-modal ocular biometrics has recently garnered significant attention due to its potential in enhancing the security and reliability of biometric identification systems in non-constrained scenarios. However, accurately and efficiently segmenting multi-modal ocular traits (periocular, sclera, iris, and pupil) remains challenging due to noise interference or environmental changes, such as specular reflection, gaze deviation, blur, occlusions from eyelid/eyelash/glasses, and illumination/spectrum/sensor variations. To address these challenges, we propose OcularSeg, a densely connected encoder–decoder model incorporating eye shape prior. The model utilizes Efficientnetv2 as a lightweight backbone in the encoder for extracting multi-level visual features while minimizing network parameters. Moreover, we introduce the Expectation–Maximization attention (EMA) unit to progressively refine the model’s attention and roughly aggregate features from each ocular modality. In the decoder, we design a bottom-up dense subtraction module (DSM) to amplify information disparity between encoder layers, facilitating the acquisition of high-level semantic detailed features at varying scales, thereby enhancing the precision of detailed ocular region prediction. Additionally, boundary- and semantic-guided eye shape priors are integrated as auxiliary supervision during training to optimize the position, shape, and internal topological structure of segmentation results. Due to the scarcity of datasets with multi-modal ocular segmentation annotations, we manually annotated three challenging eye datasets captured in near-infrared and visible light scenarios. Experimental results on newly annotated and existing datasets demonstrate that our model achieves state-of-the-art performance in intra- and cross-dataset scenarios while maintaining efficient execution. Full article

The present study aimed to evaluate the in vitro antibacterial and antibiofilm activity of bacterial cellulose hydrogel produced by Zoogloea sp. (HYDROGEL) containing vancomycin (VAN) against bacterial strains that cause wound infections, such as multidrug-resistant (MDR) Staphylococcus aureus and Staphylococcus epidermidis. Initially, HYDROGEL was obtained from sugar cane molasses, and scanning electron microscopy (SEM) was performed to determine morphological characteristics. Then, VAN was incorporated into HYDROGEL (VAN-HYDROGEL). The antibacterial activity of VAN, HYDROGEL, and VAN-HYDROGEL was assessed using the broth microdilution method to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) against methicillin-sensitive S. aureus (MSSA) ATCC 25923, methicillin-resistant S. aureus (MRSA) ATCC 33591, S. epidermidis INCQS 00016 (ATCC 12228), five clinical isolates of MRSA, and nine clinical isolates of methicillin-resistant S. epidermidis, following the Clinical and Laboratory Standards Institute (CLSI) guidelines. Additionally, the antibacterial activity of VAN, HYDROGEL, and VAN-HYDROGEL was studied using the time-kill assay. Subsequently, the antibiofilm activity of VAN, HYDROGEL, and VAN-HYDROGEL was evaluated using crystal violet and Congo red methods, as well as SEM analysis. VAN and VAN-HYDROGEL showed bacteriostatic and bactericidal activity against MRSA and methicillin-resistant S. epidermidis strains. HYDROGEL did not show any antibacterial activity. Analysis of the time-kill assay indicated that HYDROGEL maintained the antibacterial efficacy of VAN, highlighting its efficiency as a promising carrier. Regarding antibiofilm activity, VAN and HYDROGEL inhibited biofilm formation but did not demonstrate biofilm eradication activity against methicillin-resistant S. aureus and S. epidermidis strains. However, it was observed that the biofilm eradication potential of VAN was enhanced after incorporation into HYDROGEL, a result also proven through images obtained by SEM. From the methods carried out in this study, it was possible to observe that HYDROGEL preserved the antibacterial activity of vancomycin, aside from exhibiting antibiofilm activity and enhancing the antibiofilm effect of VAN. In conclusion, this study demonstrated the potential of HYDROGEL as a candidate and/or vehicle for antibiotics against MDR bacteria that cause wound infections. Full article

Introduction: Antimicrobial resistance (AMR) is currently a growing concern among healthcare providers, underscoring the importance of describing the regional susceptibility profile for common microorganisms that are associated with urinary tract infections (UTIs). This knowledge serves as the foundation for proper empirical therapeutic recommendations tailored to local susceptibility patterns. Results: We found a high prevalence of ESBL-producing strains (36.9%), with Escherichia coli and Klebsiella spp. being the most prevalent isolated bacteria. Among the catheterized patients, Klebsiella spp. emerged as the primary etiology, with a significant correlation between catheterization and Proteus spp. (p = 0.02) and Providencia stuartii (p < 0.0001). We observed significant correlations between urinary catheterization and older age (68.9 ± 13.7 years vs. 64.2 ± 18.1 years in non-catheterized patients, p = 0.026) and with the presence of an isolate with extensive drug resistance (p < 0.0001) or even pandrug resistance (p < 0.0001). Susceptibility rates significantly decreased for almost all the tested antibiotics during the study period. Notably, susceptibility was markedly lower among catheterized patients, with the most pronounced differences observed for carbapenems (59.6% versus 83.4%, p < 0.0001) and aminoglycosides (37.1% versus 46.9%, p = 0.0001). Materials and Methods: We conducted a retrospective study analyzing the susceptibility profiles of 724 extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales isolated from urine cultures. Our focus was on highlighting susceptibility profiles among isolates associated with urinary catheterization and assessing the shifts in the susceptibility rates over time. Conclusions: The constant rise in AMR rates among Enterobacterales presents significant challenges in treating severe infections, particularly among urinary catheterized patients. This trend leaves clinicians with limited or no effective treatment options. Consequently, the development and implementation of personalized treatment protocols are imperative to ensure efficient empirical therapies. Full article

There is a notable correlation between mitochondrial homeostasis and metabolic disruption. In this review, we report that obesity-induced disruption of mitochondrial homeostasis adversely affects lipid metabolism, adipocyte differentiation, oxidative capacity, inflammation, insulin sensitivity, and thermogenesis in thermogenic fat. Elevating mitochondrial homeostasis in thermogenic fat emerges as a promising avenue for developing treatments for metabolic diseases, including enhanced mitochondrial function, mitophagy, mitochondrial uncoupling, and mitochondrial biogenesis. The exerkines (e.g., myokines, adipokines, batokines) released during exercise have the potential to ameliorate mitochondrial homeostasis, improve glucose and lipid metabolism, and stimulate fat browning and thermogenesis as a defense against obesity-associated metabolic diseases. This comprehensive review focuses on the manifold benefits of exercise-induced exerkines, particularly emphasizing their influence on mitochondrial homeostasis and fat thermogenesis in the context of metabolic disorders associated with obesity. Full article

Cataract disease is strongly associated with progressively accumulating oxidative damage to the extremely long-lived crystallin proteins of the lens. Cysteine oxidation affects crystallin folding, interactions, and light-scattering aggregation especially strongly due to the formation of disulfide bridges. Minimizing crystallin aggregation is crucial for lifelong lens transparency, so one might expect the ubiquitous lens crystallin superfamilies (α and βγ) to contain little cysteine. Yet, the Cys content of γ-crystallins is well above the average for human proteins. We review literature relevant to this longstanding puzzle and take advantage of expanding genomic databases and improved machine learning tools for protein structure prediction to investigate it further. We observe remarkably low Cys conservation in the βγ-crystallin superfamily; however, in γ-crystallin, the spatial positioning of Cys residues is clearly fine-tuned by evolution. We propose that the requirements of long-term lens transparency and high lens optical power impose competing evolutionary pressures on lens βγ-crystallins, leading to distinct adaptations: high Cys content in γ-crystallins but low in βB-crystallins. Aquatic species need more powerful lenses than terrestrial ones, which explains the high methionine content of many fish γ- (and even β-) crystallins. Finally, we discuss synergies between sulfur-containing and aromatic residues in crystallins and suggest future experimental directions. Full article

During the first and second stages of postnatal development, neocortical neurons exhibit a wide range of spontaneous synchronous activity (SSA). Towards the end of the second postnatal week, the SSA is replaced by a more sparse and desynchronized firing pattern. The developmental desynchronization of neocortical spontaneous neuronal activity is thought to be intrinsically generated, since sensory deprivation from the periphery does not affect the time course of this transition. The extracellular protein reelin controls various aspects of neuronal development through multimodular signaling. However, so far it is unclear whether reelin contributes to the developmental desynchronization transition of neocortical neurons. The present study aims to investigate the role of reelin in postnatal cortical developmental desynchronization using a conditional reelin knockout (Reln^cKO) mouse model. Conditional reelin deficiency was induced during early postnatal development, and Ca²⁺ recordings were conducted from organotypic cultures (OTCs) of the somatosensory cortex. Our results show that both wild type (wt) and Reln^cKO exhibited an SSA pattern during the early postnatal week. However, at the end of the second postnatal week, wt OTCs underwent a transition to a desynchronized network activity pattern, while Reln^cKO activity remained synchronous. This changing activity pattern suggests that reelin is involved in regulating the developmental desynchronization of cortical neuronal network activity. Moreover, the developmental desynchronization impairment observed in Reln^cKO was rescued when Reln^cKO OTCs were co-cultured with wt OTCs. Finally, we show that the developmental transition to a desynchronized state at the end of the second postnatal week is not dependent on glutamatergic signaling. Instead, the transition is dependent on GABA_AR and GABA_BR signaling. The results suggest that reelin controls developmental desynchronization through GABA_AR and GABA_BR signaling. Full article

Atomic force microscopy (AFM) is a technique that relies on detecting forces at the nanonewton scale. It involves using a cantilever with a tiny tip at one end. This tip interacts with the short- and long-range forces of material surfaces. These cantilevers are typically manufactured with Si or Si₃N₄ and synthesized using a lithography technique, which implies a high cost. On the other hand, through simple chemical methods, it is possible to synthesize a magneto-dielectric composite made up of artificial SiO₂ opals infiltrated with superparamagnetic nanoparticles of Fe₃O₄. From these materials, it is possible to obtain tipless cantilevers that can be used in AFM analysis. Tipless cantilevers are an alternative tool in nanoscale exploration, offering a versatile approach to surface analysis. Unlike traditional AFM probes, tipless versions eliminate the challenges associated with tip wear, ensuring prolonged stability during measurements. This makes tipless AFM particularly valuable for imaging delicate or soft samples, as it prevents sample damage and provides precise measurements of topography and mechanical and electromechanical properties. This study presents the results of the characterization of known surfaces using magneto-dielectric cantilevers and commercial cantilevers based on Si. The characterization will be carried out through contact and non-contact topography measurements. Full article

In our pursuit of high-power terahertz (THz) wave generation, we propose innovative edge-terminated single-drift region (SDR) multi-quantum well (MQW) impact avalanche transit time (IMPATT) structures based on the Al_xGa_1−xN/GaN/Al_xGa_1−xN material system, with a fixed aluminum mole fraction of x = 0.3. Two distinct MQW diode configurations, namely p⁺-n junction-based and Schottky barrier diode structures, were investigated for their THz potential. To enhance reverse breakdown characteristics, we propose employing mesa etching and nitrogen ion implantation for edge termination, mitigating issues related to premature and soft breakdown. The THz performance is comprehensively evaluated through steady-state and high-frequency characterizations using a self-consistent quantum drift-diffusion (SCQDD) model. Our proposed Al_0.3Ga_0.7N/GaN/Al_0.3Ga_0.7N MQW diodes, as well as GaN-based single-drift region (SDR) and 3C-SiC/Si/3C-SiC MQW-based double-drift region (DDR) IMPATT diodes, are simulated. The Schottky barrier in the proposed diodes significantly reduces device series resistance, enhancing peak continuous wave power output to approximately 300 mW and DC to THz conversion efficiency to nearly 13% at 1.0 THz. Noise performance analysis reveals that MQW structures within the avalanche zone mitigate noise and improve overall performance. Benchmarking against state-of-the-art THz sources establishes the superiority of our proposed THz sources, highlighting their potential for advancing THz technology and its applications. Full article

Seeing the atomic configuration of single organic nanoparticles at a sub-Å spatial resolution by transmission electron microscopy has been so far prevented by the high sensitivity of soft matter to radiation damage. This difficulty is related to the need to irradiate the particle with a total dose of a few electrons/Ų, not compatible with the electron beam density necessary to search the low-contrast nanoparticle, to control its drift, finely adjust the electron-optical conditions and particle orientation, and finally acquire an effective atomic-resolution image. On the other hand, the capability to study individual pristine nanoparticles, such as proteins, active pharmaceutical ingredients, and polymers, with peculiar sensitivity to the variation in the local structure, defects, and strain, would provide advancements in many fields, including materials science, medicine, biology, and pharmacology. Here, we report the direct sub-ångström-resolution imaging at room temperature of pristine unstained crystalline polymer-based nanoparticles. This result is obtained by combining low-dose in-line electron holography and phase-contrast imaging on state-of-the-art equipment, providing an effective tool for the quantitative sub-ångström imaging of soft matter. Full article

Biodegradable vascular stents (BVS) are deemed as great potential alternatives for overcoming the inherent limitations of permanent metallic stents in the treatment of coronary artery diseases. The current study aimed to comprehensively compare the mechanical behaviors of four poly(lactic acid) (PLA) BVS designs with varying geometries via numerical methods and to clarify the optimal BVS selection. Four PLA BVS (i.e., Absorb, DESolve, Igaki-Tamai, and Fantom) were first constructed. A degradation model was refined by simply including the fatigue effect induced by pulsatile blood pressures, and an explicit solver was employed to simulate the crimping and degradation behaviors of the four PLA BVS. The degradation dynamics here were characterized by four indices. The results indicated that the stent designs affected crimping and degradation behaviors. Compared to the other three stents, the DESolve stent had the greatest radial stiffness in the crimping simulation and the best diameter maintenance ability despite its faster degradation; moreover, the stent was considered to perform better according to a pilot scoring system. The current work provides a theoretical method for studying and understanding the degradation dynamics of the PLA BVS, and it could be helpful for the design of next-generation BVS. Full article

Since its inception in 2010, Challenges has had a strong interdisciplinary focus on sustainability and global challenges, including many important contributions to advances in renewable energies, biodiversity, food security, climate change, urban and rural development, green design, and the interrelated implications for human and environmental health [...] Full article

In 1926, a New York Times article described the cultural and ethnic flows in south Brazil as a “Melting Pot”. The report predicted that German Brazilians, tied to their ethnoracial origin, would soon be Brazilianized. The study of congregational song practices offers insight into the relationship between migration, race, culture, and ethnicity. Moreover, investigating Brazilian Lutheran singing practices helps us understand how the New York Times’ prediction unfolded on the ground. This paper examines the Brazilian Lutheran hymnal Livro de Canto, published in 2017, and displays how Brazil’s ethnoracial diversity is manifested and negotiated in the Lutheran context, both musically and theologically. By interviewing members of the hymnal committee and investigating how they dealt with Brazil’s ethnoraciality in the context of the hymnal compilation, this paper demonstrates ways denominations and churchgoers negotiate theological, cultural, musical, and ethnoracial identities through congregational singing. More importantly, it showcases how Brazilian Lutheran church music practices inform broader social conversations around racism, nationalism, Blackness, and Brazilianness. Full article

Sorting out the requirements for intelligent functions is the prerequisite and foundation of the top-level design for the development of intelligent ships. In light of the development of inland intelligent ships for 2030, 2035, and 2050, based on the analysis of the division of intelligent ship functional modules by international representative classification societies and relevant research institutions, eight necessary functional modules have been proposed: intelligent navigation, intelligent hull, intelligent engine room, intelligent energy efficiency management, intelligent cargo management, intelligent integration platform, remote control, and autonomous operation. Taking the technical realization of each functional module as the goal, this paper analyzes the status quo and development trend of related intelligent technologies and their feasibility and applicability when applied to each functional module. At the same time, it clarifies the composition of specific functional elements of each functional module, puts forward the stage goals of China’s inland intelligent ship development and the specific functional requirements of different modules under each stage, and provides reference for the Chinese government to subsequently formulate the top-level design development planning and implementation path of inland waterway intelligent ships. Full article

Unmanned sailboats, harnessing wind for propulsion, offer great potential for extended marine research due to their virtually unlimited endurance. The sails typically operate at high attack angles, which contrasts with aircraft that maintain small angles to prevent stalling. Despite the reduction in lift during stalling, the resultant increase in drag contributes significantly to the sail’s thrust. However, the sail often experiences vortex shedding due to high attack angles, leading to low-frequency oscillations and erratic navigation. This study employs large-eddy simulations (LESs) on a 3D NACA0012 sail at a Reynolds number of 3.6 × 10⁵, which is validated by experimental data. It observes the lift and drag coefficients across attack angles from 5 to 90 degrees and compares these with a Dynarig sail. The findings reveal that higher attack angles amplify fluctuations in lift and drag coefficients. Vortex shedding, resulting from flow separation, creates pressure changes and oscillations in aerodynamic forces. Fast Fourier transformation (FFT) analysis identifies dominant frequencies between 0.5 and 10 Hz, indicating low-frequency oscillations. The study’s insights into the impact of attack angle and sail type on the oscillation frequency are favorable for the design of unmanned sailboats, aiding in the prediction of wind-induced frequencies and optimal attack angle determination. Full article

A stratigraphic complex composed of mass transport deposits (MTDs), where the gas occurrence allows for the formation of a gas chimney and pipe structure, is identified based on seismic interpretation in the QiongDongNan area of the northern South China Sea. During the Fifth Gas Hydrate Drilling Expedition of the Guangzhou Marine Geological Survey, this type of complex morphology that has close interaction with local gas hydrate (GH) distribution was eventually confirmed. A flow-reaction model is built to explore the spatial–temporal matching evolution process of massive GH reservoirs since 30 kyr before the present (BP). Five time snapshots, including 30, 20, 10, and 5 kyr BP, as well as the present, have been selected to exhibit key strata-evolving information. The results of in situ tensile estimation imply fracturing emergence occurs mostly at 5 kyr BP. Six other environmental scenarios and three cases of paleo-hydrate existence have been compared. The results almost coincide with field GH distribution below the bottom MTD from drilling reports, and state layer fracturing behaviors always feed and probably propagate in shallow sediments. It can be concluded that this complex system with 10% pre-existing hydrates results in the exact distribution and occurrence in local fine-grained silty clay layers adjacent to upper MTDs. Full article

Mechanized harvesting is the key technology to solving the high cost and low efficiency of manual harvesting, and the key to realizing mechanized harvesting lies in the accurate and fast identification and localization of targets. In this paper, a lightweight YOLOv5s model is improved for efficiently identifying grape fruits and stems. On the one hand, it improves the CSP module in YOLOv5s using the Ghost module, reducing model parameters through ghost feature maps and cost-effective linear operations. On the other hand, it replaces traditional convolutions with deep convolutions to further reduce the model’s computational load. The model is trained on datasets under different environments (normal light, low light, strong light, noise) to enhance the model’s generalization and robustness. The model is applied to the recognition of grape fruits and stems, and the experimental results show that the overall accuracy, recall rate, mAP, and F1 score of the model are 96.8%, 97.7%, 98.6%, and 97.2% respectively. The average detection time on a GPU is 4.5 ms, with a frame rate of 221 FPS, and the weight size generated during training is 5.8 MB. Compared to the original YOLOv5s, YOLOv5m, YOLOv5l, and YOLOv5x models under the specific orchard environment of a grape greenhouse, the proposed model improves accuracy by 1%, decreases the recall rate by 0.2%, increases the F1 score by 0.4%, and maintains the same mAP. In terms of weight size, it is reduced by 61.1% compared to the original model, and is only 1.8% and 5.5% of the Faster-RCNN and SSD models, respectively. The FPS is increased by 43.5% compared to the original model, and is 11.05 times and 8.84 times that of the Faster-RCNN and SSD models, respectively. On a CPU, the average detection time is 23.9 ms, with a frame rate of 41.9 FPS, representing a 31% improvement over the original model. The test results demonstrate that the lightweight-improved YOLOv5s model proposed in the study, while maintaining accuracy, significantly reduces the model size, enhances recognition speed, and can provide fast and accurate identification and localization for robotic harvesting. Full article

Accurate estimation of soil water content (SWC) is crucial for effective irrigation management and maximizing crop yields. Although dielectric property-based SWC measurements are widely used, their accuracy is still affected by soil variability, soil–sensor contact, and other factors, making the development of convenient and accurate soil-specific calibration methods a major challenge. This study aims to propose a plate compression filling technique for soil-specific calibrations and to monitor the extent of soil biomass degradation using dielectric properties. Before and after biodegradation, dielectric measurements of quartz sand and silt loam were made at seven different water contents with three different filling techniques. A third-order polynomial fitting equation explaining the dependence of the dielectric constant on the volumetric water content was obtained using the least-squares method. The suggested plate compression filling method has a maximum mean bias error (MBE) of less than 0.5%, according to experimental results. Depending on the water content, silt loam’s dielectric characteristics change significantly before and after biodegradation. The best water content, measured in gravimetric units, to encourage the decomposition of biomass was discovered to be 24%. It has been demonstrated that the plate compression filling method serves as a simple, convenient, and accurate alternative to the uniform compaction method, while the dielectric method is a reliable indicator for evaluating biomass degradation. This exploration provides valuable insights into the complex relationship between SWC, biomass degradation, and soil dielectric properties. Full article

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro–Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness. Full article

Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome. Full article

Background/Objectives: Population aging is rapidly increasing, and the importance of preventive medicine has been stressed. Health checkups, diet, and exercise are of paramount importance. This study aimed to evaluate the effectiveness of a personalized dual-task intervention that combined exercise with cognitive tasks in improving physical and cognitive functions among independently living older individuals. Methods: Participants aged >65 years who were mostly independent in their activities of daily living were divided into two groups. The group receiving the 20 min robot-assisted session was compared with the group receiving traditional functional restoration training. This randomized trial assessed the impact of this intervention on the 30 s chair stand test score and Montreal Cognitive Assessment—Japanese version score of the participants. Results: Both scores significantly improved in the intervention group, indicating enhanced lower-limb function and cognitive capabilities. Conclusions: These findings suggest that integrating cognitive tasks with physical exercise can stand as an effective strategy to improve overall well-being in older people, offering valuable insights for designing comprehensive preventive health programs tailored to this demographic. Full article

Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep, and it is closely linked to several cardiovascular issues due to intermittent hypoxia, nocturnal hypoxemia, and disrupted sleep patterns. Pulmonary hypertension (PH), identified by elevated pulmonary arterial pressure, shares a complex interplay with OSA, contributing to cardiovascular complications and morbidity. The prevalence of OSA is alarmingly high, with studies indicating rates of 20–30% in males and 10–15% in females, escalating significantly with age and obesity. OSA’s impact on cardiovascular health is profound, particularly in exacerbating conditions like systemic hypertension and heart failure. The pivotal role of hypoxemia increases intrathoracic pressure, inflammation, and autonomic nervous system dysregulation in this interplay, which all contribute to PH’s pathogenesis. The prevalence of PH among OSA patients varies widely, with studies reporting rates from 15% to 80%, highlighting the variability in diagnostic criteria and methodologies. Conversely, OSA prevalence among PH patients also remains high, often exceeding 25%, stressing the need for careful screening and diagnosis. Treatment strategies like continuous positive airway pressure (CPAP) therapy show promise in mitigating PH progression in OSA patients. However, this review underscores the need for further research into long-term outcomes and the efficacy of these treatments. This review provides comprehensive insights into the epidemiology, pathophysiology, and treatment of the intricate interplay between OSA and PH, calling for integrated, personalized approaches in diagnosis and management. The future landscape of OSA and PH management hinges on continued research, technological advancements, and a holistic approach to improving patient outcomes. Full article

Objectives: Fontan circulation presents significant challenges for patients with congenital heart disease, often necessitating heart transplantation (HTX) due to deteriorating functionality across multiple organ systems. However, the impact of prior Fontan palliation on HTX outcomes remains poorly understood, with early mortality rates suggesting a heightened risk. The aim of our study is to evaluate the long-term results after heart transplantation in patients with univentricular congenital heart disease previously palliated with Fontan circulation. Methods: A retrospective analysis was conducted on patients who underwent HTX for congenital heart disease. Patients were categorized into two groups based on the pre-HTX circulation pathway: the Failing Fontan Group (FFG) and the Biventricular Congenital Group (BCG). Data were collected from patients between 1987 and 2018. Early and late outcomes, including survival rates, were assessed and critically analyzed. Results: Of the 66 patients, 29 (43%) had a failing Fontan palliation (FFG), and 37 had biventricular congenital diseases (BCG) before heart transplantation. Early mortality (30-day) was not statistically different between the two group. The overall survival rate was 82.6 ± 13.9% at 1 year, 79.0 ± 14.9% at 5 years, 67.2 ± 17.6% at 10 years and 63.2 ± 18.2 ± at 15 years for the FFG, and 86.1 ±11.4% at 1 year, 79.5 ± 13.7% at 5 years, 75.7 ± 14.9% at 10 years, 75.7 ± 14.9% at 15 years for the BCG, with no statistically significant difference (Mantel Cox p value: 0.69, 0.89, 0.52 and 0.39, respectively). Regarding Cox-regression analysis, the long-term survival rate was not affected either by previous Fontan surgery or by the era of heart transplantation (before vs. after the year 2000). Conclusions: Although heart transplantation after Fontan palliation showed a higher risk in the early post-operative period, the medium- and long-term survival rates are comparable with biventricular circulation patients. Despite the failing Fontan patients being a challenging set of candidates for transplantation, it is a reasonable option in their treatment. Full article