Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly, with an uncertain prevalence and often diagnosed incidentally. This case report presents a 62-year-old male with ARCAPA diagnosed during an evaluation for chest surgery. The patient had a history of colon cancer and active tuberculosis, complicating the clinical management. He reported chest pain, shortness of breath, and palpitations, with atrial fibrillation observed on a 24 h Holter ECG. Coronary angiography revealed robust collateral circulation and a suspected anomalous origin of the right coronary artery, confirmed by CT imaging. The patient’s stress MRI showed mildly reduced left and right ventricular ejection fractions and perfusion deficits in the apical segments (2/17) of the septal and inferior walls. Given the patient’s comorbidities, including active tuberculosis, the Heart team decided on a non-operative management approach, focusing on careful monitoring and pharmacological management rather than immediate surgery. This case emphasizes the complexity of managing ARCAPA in the context of significant comorbidities, highlighting the importance of individualized, multidisciplinary treatment strategies. Early diagnosis using advanced imaging techniques is crucial, and a non-operative approach can be considered in patients with preserved left ventricular function and no significant ischemia, as demonstrated in this case.

Cardiotocography (CTG) is essential for monitoring high-risk pregnancies, yet perinatal asphyxia prediction accuracy remains limited to 50–55%. Regions of artifacts (missing valid signals)-including signal processing aberrations-possibly contribute to this limitation, highlighted by 40% of FDA reports on intrapartum stillbirths. This cohort study applied causal inference to two digitized CTG databases, analyzing 36,792 labor episodes (>36 weeks) at a tertiary Australian hospital (2010–2021) and externally validating on a Czech dataset (n = 552).High rates of missing valid signals (>30% fetal heart rate signal dropout or >1% maternal-fetal heart rate coincidence) was independently associated with asphyxia (aOR 1.47, 95% CI 1.19–1.81); dropout >30% showing stronger link (aOR 1.58, 95% CI 1.13–2.20 Australian dataset; aOR 2.30, 95% CI 1.08–4.91 Czech dataset). Risk of asphyxia increased with higher dropout (>37.45%, aOR 2.21 Australian dataset; >34.01%, aOR 4.08 Czech dataset). Integrating measures of missing valid signals into fetal monitoring algorithms may improve decision-making and neonatal outcomes.

Background Many low-income and middle-income countries have introduced public health insurance systems, whereby, thanks to government subsidies, selected groups are entitled to receive insurance coverage even if not paying direct contributions into the system. These efforts towards achieving universal health coverage were often undermined by difficulties in enrolment and registration, barriers to health service utilisation or complicated rules around service packages. Governmental and non-governmental accountability initiatives have been established to overcome these barriers in order to make health insurance programmes responsive and to empower citizens. This paper examines evidence and synthesizes lessons from 20 accountability initiatives in six selected countries to understand how these achieved (or not) these goals. Methods We systematically analysed six final reports and five published papers which were part of a multicountry research programme from 2019 to end of 2022 studying accountability initiatives. Between June 2023 and September 2024, we systematically extracted data and synthesised findings from the reports and papers based on a conceptual framework, adapted from a framework developed by Molyneux, which had been adopted by the country teams to guide their studies. We coded the extracted data and identified the content, context and process factors that enabled or hindered the accountability initiatives in achieving their intended goals. We present and discuss factors that were present in at least two initiatives. Results Governmental initiatives were in most instances established in conjunction with the health reforms that introduced the health insurance programmes they address. Whereas some of these initiatives were effective, many were undermined by poor outreach to citizens, inadequacy of resources, conflicts of interest and power imbalances and lack of fidelity to original design. Non-governmental initiatives often emerged to fill existing gaps in government services and programmes. Many of the non-governmental initiatives had several features which helped them in contributing to citizen empowerment, and these included embeddedness in and being trusted by the local communities, flexibility in operating and reaching out to people and the underlying motivation of people working in them. Conclusions The effective implementation of accountability initiatives requires transparency, trust-building measures, active outreach and community engagement and adequate resources. These elements can ensure that initiatives achieve their intended goal of enhancing citizens’ access to their health insurance entitlements. Further research is needed to understand how best collaboration between governmental and non-governmental initiatives can be fostered to build synergies between the two toward the achievement of common goals.

Restless legs syndrome is a neurological disease from the spectrum of movement disorders, with psychiatric comorbid symptoms and manifestations. Women are affected twice as often as men, and the frequency in the population is 4-10%, while during pregnancy the prevalence triples. This research was conducted as a result of a search and selection of studies on the prevalence of RLS in pregnancy, which include works published in domestic and foreign journals and searches of PubMed, PubMed Central, Web of Science, Scopus and Embase. A primary search of medical databases found 316 publications. In this secondary process, due to the lack of access to the abstract or full text, and due to the poor quality of the articles, 11 relevant publications were finally found and included in this systematic review. The total number of respondents included in this research is 7033, aged 19-45. The lowest prevalence was 4.9% in Japan, and the highest prevalence was 54.7% in Saudi Arabia. In this review, the overall mean frequency of restless legs syndrome during pregnancy was 24.69%. Furthermore, in our ongoing research conducted in 2022 on restless legs syndrome, we recorded a frequency of 26.5% in a population of 266 pregnant women in the third trimester of pregnancy. The frequency of restless legs syndrome is high among the population of pregnant women, and according to its etiology, clinical manifestations and comorbid manifestation, this disorder represents a close link between psychiatry, neurology and gynecology. For this reason, pregnant women should pay extra attention to the early detection of this disorder, which can significantly affect a pregnant woman's daily energy level, poor sleep and daytime sleepiness, and more frequent symptoms of anxiety and depression.

The transition from 5G to 6G networks will catalyze the development of advanced 6G Applications (6G Apps) with enhanced network programmability and intelligence, providing vertical industries and Communication Service Providers (CSPs) with new opportunities to optimize their operations. This article explores the future of the 6G Apps tailored to verticals in the 6G era, highlighting their role as middleware that abstracts network complexities and exposes Application Programming Interfaces (APIs) to enable dynamic interaction and real-time adaptation. Key enablers such as network exposure, Artificial Intelligence (AI), and edge computing are studied in the context of optimizing operations across verticals, and improving Quality of Service (QoS) and fostering innovation. A case study on teleoperated vehicles exemplifies the real-world applicability of these technological enablers for 6G Apps. Furthermore, this article offers insights and explores new research opportunities for 6G Apps tailored to verticals to evolve in the 6G era while addressing key challenges in deploying these applications in real-world commercial networks as a service.

Abstract Background Extensive catheter ablation beyond pulmonary vein isolation may acutely increase atrial tissue stiffness, however, this may differ between energy sources used. Objectives This study aimed to compare acute effects of radiofrequency ablation (RFA) and pulsed field ablation (PFA) on atrial tissue stiffness in a porcine model using multifrequency magnetic resonance elastography (MMRE). Methods In 17 pigs (∼50 kg and ∼16 weeks old) an intercaval line was ablated using only focal RFA (25 W, 30 sec, n=9), only focal monopolar biphasic PFA (CENTAURI PFA generator, 25 A, 10 pulse trains, n=5), or half of the ablation line with PFA and the other half with RFA (n=3) (Figure 1,A). Post-ablation, in vitro MMRE data were acquired with a tabletop MRE scanner (ttMRE) (n=8) (Figure 1,B). In vivo, a novel MMRE protocol utilizing electrocardiography-triggered spin-echo, echo-planar-imaging was established (n=11) (Figure 1,C). Shear wave speed (SWS) was reconstructed as a surrogate for tissue stiffness. Results In vitro ttMRE measurements revealed significantly higher SWS for the RFA ablation zone compared to both the PFA ablation zone (p=0.008) and PFA border zone (p=0.003). Consistently, a novel in vivo MMRE protocol showed 1.37-fold higher SWS of the RFA ablation zone than its border zone (p=0.016) and 1.16-fold higher SWS than the PFA ablation zone (p=0.033). Absolute in vivo SWS differences between ablation zones and border zones were significantly higher for RFA compared to PFA (p=0.019). Conclusions RFA produces stiffer acute atrial lesions compared to PFA in pigs. A novel MMRE scanning protocol allows RFA and PFA lesion evaluation in vivo with the potential to support the refinement of future catheter approaches by optimizing mechanical properties of ablation lesions and minimizing atrial stiffness.

Abstract Background Endocardial atrial fibrillation (AF) ablations using thermal energy sources modulate ganglionated plexi (GP). Contrarily, endocardial pulsed field ablation (PFA) has minimal effect on GP located within the epicardial fat-pads. Purpose To determine structural and antiarrhythmic effects of direct epicardial PFA-delivery to atrial GP-sites. Methods Group-1: Epicardial PFA-delivery to GP sites (n=6 pigs). Group-2: Sham-operated (n=2 pigs). Thoracotomy was performed and five epicardial GP-sites were identified and targeted by saline-irrigated bipolar PFA (1,000V, 100μs, 120-pulses, ECG-synchronised). Local atrial electrogram (EGM) amplitude, atrial effective refractory period (aERP) and AF (inducibility and duration) were investigated. Histology was performed on samples from treatment-adjacent structures. Results In Group-1, 120 PFA-pulses were successfully delivered epicardially to each GP-site. Local EGM-amplitudes did not change after PFA-delivery. GPs showed lower intensity of S100-protein expression within the cytoplasm and membrane with preservation of adjacent atrial myocardium. The aERP at the higher and lower lateral right atrium increased from 123±34ms to 173±47ms (p=0.0358) and from 122±32ms to 221±16ms (p=0.0063) after PFA-treatment, respectively. Total AF-inducibility decreased from 100% to 33%, inducible AF-duration decreased from 4.4±0.6min (including 2 cardioversions) at baseline to 1.3±2.1min (including 1 cardioversion) after PFA-delivery (decrease: -3.2±2min, p=0.007). In one pig, the feasibility of thoracoscopic epicardial PFA delivery at all anatomical GP-sites was shown. Conclusion Epicardial PFA-delivery to anatomical GP-sites is feasible in open-chest or thoracoscopic approach, and acutely decreases GP S100-protein intensity, prolongs aERP and reduces AF-inducibility and duration.

The exact cause of autism spectrum disorder (ASD) is yet unknown, although possible causes include early childhood, foetal development, gestation, delivery mode, genetics, and environmental variables. Approximately 1% of children worldwide have ASD, and this percentage is rising. The immunological, endocrine, gut microbiota and brain-gut axis quality influence the intensity of ASD symptoms. Deficits in the composition and diversity of gut microbiota are common in children with ASD, accounting for 9-90% of these illnesses, including elevated inflammatory cytokines, inflammation, leaky gut syndrome, and pathological microflora growth. Dysbiosis can be made worse by eating issues that are prevalent in ASD. B vitamins, such as cobalamin and folate, which are essential methyl donors for DNA epigenetic changes, are usually produced by a healthy gut microbiota. 50% of people with ASD have a vitamin B deficit. This work summarises research on the impact of gut microbiota on DNA methylation and B vitamin synthesis in ASD, as well as etiological variables connected to dysbiosis. Probiotics, postbiotics, and vitamin B therapies in kids with ASD should be investigated in future studies.