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Background: This systematic review will address the influence of Information and Communication Technologies (ICTs) on democratic processes and citizens’ participation, which is enabled by such tools as social media, e-voting systems, e-government initiatives, and e-participation platforms. Methods: Based on an in-depth analysis of 46 peer-reviewed articles published between 1999 and 2024, this review emphasizes how ICTs have improved democratic engagement quality, efficiency, and transparency, but highlights key challenges and research gaps. Results: From this angle, ICT tools have great potential to nurture civic engagement and good governance through transparency. Challenges persist with the ethical and social implications of surveillance technologies, security concerns about digital voting systems, and the widening digital divide disproportionately affecting marginalized populations. The current regulatory framework dealing with privacy and misinformation issues is relatively weak, and there is also a lack of understanding about ICTs’ long-term effects on democratic governance. Conclusions: This review underlines the duality of the roles played by ICT as both an enabler and a challenge to democratic processes. It calls for regulatory measures to protect privacy, fight disinformation, and reduce the digital divide. Future research in this area should focus on the long-term effects of ICTs and how they can be equitably and efficiently integrated into democratic systems, with strategies aimed at maximizing benefits while minimizing risks.

Type A aortic dissection (TAAD) involves the ascending aorta or the arch. Acute TAAD usually requires urgent replacement of the ascending aorta. However, a subset of these patients develops aortic rupture due to further dilatation of the residual dissected aorta. There is currently no reliable means to predict the risk of dilatation following TAAD repair. In this study, we performed a comprehensive morphological and hemodynamic analysis for patients with and without progressive aortic dilatation following surgical replacement of the ascending aorta. Patient-specific models of repaired TAAD were reconstructed from post-surgery computed tomography images for detailed computational fluid dynamic analysis. Geometric and hemodynamic parameters were evaluated and compared between patients with stable aortic diameters (N = 9) and those with aortic dilatation (N = 8). Our results showed that the number of re-entry tears and true/false lumen pressure difference were significantly different between the two groups. Patients with progressive aortic dilatation had higher luminal pressure difference (6.7 [4.6, 10.9] vs. 0.9 [0.5, 2.3] mmHg; P = 0.001) and fewer re-entry tears (1.5 [1, 2.8] vs. 5 [3.3, 7.5]; P = 0.02) compared to patients with stable aortic diameters, suggesting that these factors may serve as potential predictors of aneurysmal dilatation following surgical repair of TAAD.

Objective This retrospective study aimed to compare the outcomes of sutureless aortic valve replacement (su-AVR) and conventional bioprosthetic sutured AVR (cAVR) in high-risk patients undergoing redo surgery. Methods A total of 79 patients who underwent redo AVR between 2014 and 2021 were included in the study. Of these, 27 patients underwent su-AVR and 52 underwent cAVR. Patient characteristics and clinical outcomes were analysed using multivariate regression and Kaplan Meier survival test. Results The groups were similar in terms of age, gender, left ventricular function, and number of previous sternotomies. In cases of isolated AVR, su-AVR had significantly lower cross clamp times than cAVR (71 vs. 86 min, p  = 0.03). Postoperatively, 4 cAVR patients required pacemaker compared to zero patients in the su-AVR group. There were no significant differences between the two groups in terms of postoperative complications, intrahospital stay (median 9 days, IQR 7–20), or in-hospital mortality (1 su-AVR; 2 cAVR). The long-term survival rate was similar between the su-AVR (90%) and cAVR (92%) groups (log rank p  = 0.8). The transvalvular gradients at follow-up were not affected by the type of valve used, regardless of the valve size (coef 2.68, 95%CI -3.14–8.50, p  = 0.36). Conclusion The study suggests that su-AVR is a feasible and safe alternative to cAVR in high-risk patients undergoing redo surgery. The use of su-AVR offers comparable outcomes to cAVR, with reduced cross clamp times and a lower incidence of postoperative pacemaker requirement in isolated AVR cases. The results of this study contribute to the growing body of evidence supporting the use of su-AVR in high-risk patients, highlighting its feasibility and safety in redo surgeries.

Background Rapid-deployment aortic valve replacement (RDAVR) is an alternative to conventional AVR (cAVR) for aortic stenosis. Benefits include a reduction in operative times, facilitation of minimal access surgery and superior haemodynamics compared to conventional valves. However, further evidence is required to inform guidelines, preferably in the form of propensity-matched studies that include mid-term follow-up data. Methods This was a single-centre, retrospective, propensity-matched cohort study comparing the Perceval and conventional Perimount Magna Ease valve for short- and mid-term clinical parameters and size-matched mid-term echocardiographic parameters ( n  = 102 in both groups) from 2014 to 2020. Data were extracted from a nationally managed dataset. Results There were no demographic differences between the matched groups. The Perceval group had shorter cross-clamp time (Perceval 62 [49–81] minutes; Perimount 79 [63–102] minutes, P  < 0.001), shorter bypass time (Perceval 89 [74–114] minutes; Perimount 104 [84–137] minutes, P  < 0.001), and more frequent minimally-invasive approaches (Perceval 28%; Perimount 5%, P  < 0.001). Size-matched haemodynamics showed initially higher gradients in the Perceval group, but haemodynamics equalised at 12 + months. The Perceval group had a more favourable % change in the left ventricular posterior wall dimension at 2 + years (Perceval − 4.8 ± 18; Perimount 17 ± 2). Conclusions The Perceval facilitated shorter operations, which may benefit intermediate-high-risk, elderly patients with comorbidities requiring concomitant procedures. It also facilitated minimally invasive surgery. Size-matched haemodynamic performance was similar at mid-term follow-up, with the Perceval possibly better facilitating regression of left ventricular hypertrophy.

Objectives Thrombocytopenia following Perceval aortic valve replacement has been described previously with variable outcome. Studies have lacked a robust analysis of platelet fluctuation and factors affecting it. We aimed to statistically describe the trend in thrombocyte variability as compared with conventional aortic valve replacement, and to assess predictors as well as impact on associated outcomes. Methods One hundred consecutive patients with first-time Perceval were retrospectively compared to 219 patients after Perimount Magna Ease valve replacement. The primary outcome was the serial thrombocyte count on day 0–6. Generalized estimating equations were used to analyse the data using fixed-effect models: for the effect of the post-operative day on platelet count, and random-effect models estimating both time-variant (platelets) and time in-variant variables (valve type, age, LV function, pre-op platelet level). Results Perceval patients were older (72 ± 1 vs 68 ± 1 years, p  < 0.01) with higher NYHA status (3(2–3) vs 2(1–2), p  < 0.001). Mean platelet count in the sutureless group was lowest on day 2 (91.9 ± 31.6 vs 121.7 ± 53.8 × 10 3  µl −1 ), and lower on day 4 (97.9 ± 44) and 6 (110.6 ± 61) compared to the conventional group (157.2 ± 60 and 181.7 ± 79) but did not result in a higher number of transfusions, bleeding or longer hospital stay ( p  > 0.05). Reduced platelet count was a strong predictor of red cell transfusion in the conventional ( p  = 0.016), but not in the sutureless group ( p  = 0.457). Age (Coef -1.025, 95%CI-1.649—-0.401, p  < 0.001) and CPB-time (Coef 0.186, 95%CI-0.371—-0.001, p  = 0.048) were predictors for lower platelet levels. Conclusion Considering the older patient profile treated with Perceval, postoperative thrombocytopenia does not impact on outcome in terms of transfusions, complications or hospital stay.

Background Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset or first recognition during pregnancy, which is characterized by an increased insulin resistance. Gestational diabetes mellitus is associated with pregnancy-related maternal and fetal morbidity (both antenatal and perinatal). Myo-inositol has been suggested to improve insulin resistance in women with polycystic ovary syndrome. The aim of this study is to examine the impact of myo-inositol supplementation during pregnancy on the incidence of gestational diabetes mellitus. Methods We will conduct a single-center, open-label, randomized controlled trial. A total of 160 healthy pregnant women with singleton pregnancy at 11–13 +6 weeks of gestation will be randomly allocated in two groups: intervention group ( N  = 80) and control group ( N  = 80). The intervention group will receive myo-inositol and folic acid (4000 mg myo-inositol and 400 mcg folic acid daily) from 11 to 13 +6 weeks of gestation until 26–28 weeks of gestation, while the control group will receive folic acid alone (400 mcg folic acid daily) for the same period of time as intervention group. The primary outcome will be gestational diabetes incidence rate at 26–28 weeks of gestation, according to the results of a 75 g oral glucose tolerance test held at 26–28 weeks of gestation. The secondary outcomes will include fasting blood glucose levels, glycated hemoglobin levels, insulin resistance level (evaluated by homeostasis model assessment of insulin resistance and Matsuda Index), and incidence rate of diet-treated gestational diabetes and diabetes requiring insulin therapy at 26–28 weeks of gestation. Discussion This trial will provide evidence for the effectiveness of myo-inositol supplementation during pregnancy in reducing the incidence of gestational diabetes mellitus. Trial registration ISRCTN registry: ISRCTN16142533 . Registered on 9 March 2017.

The COVID-19 pandemic accelerated virtual collaboration, reshaping digital communication, remote work, education, and e-democracy. This study examines the impact of these tools on digital citizen participation through a quantitative cross-sectional survey of n = 1122 participants across diverse demographics. Using stratified purposive sampling, descriptive statistics, correlation analyses, and segmentation by demographic and psychological factors, we analyzed how infrastructure quality, personality traits, and social dynamics influenced virtual engagement. While digital platforms have improved accessibility, findings reveal that they often fail to foster interpersonal trust and democratic deliberation. Statistical analyses demonstrated significant correlations between communication effectiveness and relationship quality (ρ = 0.387, p < 0.001), with distinct patterns emerging across age groups, community sizes, and personality types. Infrastructure disparities significantly impacted participation, particularly in rural areas (χ2 = 70.72, df = 12, p < 0.001, V = 0.145). Recommendations include enhancing digital infrastructure, developing adaptive e-governance platforms, and implementing trust-building mechanisms. Despite the limitations of self-reported data and the cross-sectional design, these insights contribute to building more inclusive digital governance frameworks. Future research should employ longitudinal approaches to explore evolving trends in e-democratic participation.

Background The treatment of aortic valve disease in small annuli remains a debated topic in terms of prosthetic choice - biological or mechanical - and risk of patient prosthesis mismatch. Methods The clinical data of the 241 patients who received a small size sutureless prosthesis from the Sorin Universal REgistry on Aortic Valve Replacement (SURE-AVR) (NCT02679404) were analysed at 30 days and at follow-up. The mean age was 75.5 ± 7.8 years (89.2% female); the mean Society of Thoracic Surgeons (STS) score was 4.2 ± 3.2%, and the preoperative NYHA class II or III score was 83.8%. A minimally invasive approach was performed in 52.7% of patients; concomitant procedures were performed in 27.8% of patients. Similar aortic clamping and cardiopulmonary bypass times were observed in the overall isolated cohort and the isolated minimally invasive cohort. The mean intensive care unit (ICU) stay was 2.4 ± 2.0 days and the total length of stay was 10.3 ± 6.1 days. Results Three deaths were recorded at 30 days (1.2%), 2 for noncardiac causes. One patient experienced a myocardial infarction (0.4%) and 2 a nondisabling stroke (0.8%). 2 patients showed intraprosthetic leakage ≥ 2 and one patient para-prosthetic leakage ≥ 2; of these, one patient required reoperation with prosthesis removal. 4.1% of patients required a pacemaker implant. At a maximum follow-up of 8.1 years, 10 cardiovascular deaths, 4 valve related reinterventions (3 structural valve deterioration (SVD) requiring TAVI Valve-in-Valve, 1 endocarditis) occurred. Conclusions With their good clinical outcomes, sutureless prostheses represent a good alternative for patients with small annuli, who are at high risk for annular enlargement and anticoagulant therapy. Trial registration Study number 587/2015.

Background: Dysregulation of the immune response in the course of COVID-19 has been implicated in critical outcomes. Lymphopenia is evident in severe cases and has been associated with worse outcomes since the early phases of the pandemic. In addition, cytokine storm has been associated with excessive lung injury and concomitant respiratory failure. However, it has also been hypothesized that specific lymphocyte subpopulations (CD4 and CD8 T cells, B cells, and NK cells) may serve as prognostic markers for disease severity. The aim of this study was to investigate possible associations of lymphocyte subpopulations alterations with markers of disease severity and outcomes in patients hospitalized with COVID-19. Materials/Methods: A total of 42 adult hospitalized patients were included in this study, from June to July 2021. Flow-cytometry was used to calculate specific lymphocyte subpopulations on day 1 (admission) and on day 5 of hospitalization (CD45, CD3, CD3CD8, CD3CD4, CD3CD4CD8, CD19, CD16CD56, CD34RA, CD45RO). Markers of disease severity and outcomes included: burden of disease on CT (% of affected lung parenchyma injury), C-reactive protein and interleukin-6 levels. PO2/FiO2 ratio and differences in lymphocytes subsets between two timepoints were also calculated. Logistic and linear regressions were used for the analyses. All analyses were performed using Stata (version 13.1; Stata Corp, College Station, TX, USA). Results: Higher levels of CD16CD56 cells (Natural Killer cells) were associated with higher risk of lung injury (>50% of lung parenchyma). An increase in CD3CD4 and CD4RO cell count difference between day 5 and day 1 resulted in a decrease of CRP difference between these timepoints. On the other hand, CD45RARO difference was associated with an increase in the difference of CRP levels between the two timepoints. No other significant differences were found in the rest of the lymphocyte subpopulations. Conclusions: Despite a low patient number, this study showed that alterations in lymphocyte subpopulations are associated with COVID-19 severity markers. It was observed that an increase in lymphocytes (CD4 and transiently CD45RARO) resulted in lower CRP levels, perhaps leading to COVID-19 recovery and immune response homeostasis. However, these findings need further evaluation in larger scale trials.

ObjectivesThe management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing the two management strategies.MethodsPubMed, Cochrane and Web of Science databases were systematically searched from inception until 10 January 2022. The search key terms were ‘asymptomatic’, ‘severe aortic stenosis’ and ‘intervention’.ResultsMeta-analysis of two published randomised trials, AVATAR and RECOVERY, included 302 patients and showed that early intervention resulted in 55% reduction in all-cause mortality (HR=0.45, 95% CI 0.24 to 0.86; I2 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I2 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I2 78%). Additionally, meta-analysis of eight observational studies showed improved mortality in patients treated with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I2 77%).ConclusionThis meta-analysis provides evidence that, in patients with severe asymptomatic aortic stenosis, early intervention reduces all-cause mortality and improves outcomes compared with conservative management. While this is very encouraging, further randomised controlled studies are needed to draw firm conclusions and identify the optimal timing of intervention.PROSPERO registration numberCRD42022301037.