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Lymphedema is a chronic condition characterized by the accumulation of lymphatic fluid in the tissues, causing swelling primarily in the limbs, though other body parts can also be affected. It commonly develops after lymph node removal, or radiation therapy, or due to congenital lymphatic system defects. Effective management is essential due to its significant impact on physical function and quality of life. Complete Decongestive Therapy (CDT) is the primary treatment for lymphedema. This comprehensive approach combines manual lymphatic drainage (MLD), compression bandaging, skincare, and exercise. An early diagnosis and initiation of CDT are critical to preventing irreversible damage to the lymphatic system and worsening symptoms. Successful outcomes depend on timely treatment, patient adherence, and the consistent use of all CDT components, with compression therapy and exercise playing particularly vital roles. Recent research highlights how skin and fat tissue characteristics, such as increased skin thickness and adipose tissue accumulation, complicate lymphedema management, especially in advanced stages. In these cases, where fibrosis and fat deposition are more prominent, traditional CDT may need to be supplemented with advanced treatments like liposuction or enhanced compression techniques. This study explores the factors influencing the success of decongestive therapy, including the stage of lymphedema at the diagnosis, treatment protocols, and individual patient characteristics like skin and fat tissue properties.

Background and Objectives: Metabolic syndrome (MS) represents several diseases encompassing a heterogeneous group of biochemical and physiological abnormalities characterized by structural and functional alterations in the myocardium, including the endothelium of the coronary arteries. MS also affects a substantial portion of the global population. Understanding the risk factors, the development and treatment associated with MS are of paramount importance for early identification, treatment and prevention. This study was designed to evaluate the role of the supplementation of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on endothelial function in patients with MS. Materials and Methods: A total of 80 patients with MS were enrolled in two groups. The study evaluated endothelial function (EF) in subjects before and after a three-month treatment with n-3 PUFAs in a dose of 2.4 g daily (800 mg, three times a day) vs. placebo, using an Endo-PAT2000 device (Itamar Medical Ltd., Caesarea, Israel) measuring the reactive hyperemia index (a parameter of EF) and augmentation index (a parameter of arterial stiffness). Plasmatic levels of glutathione peroxidase, homocysteine, apolipoprotein B and lipoprotein were also evaluated for comparison. Results: The results showed that the average value of reactive hyperemia index before the treatment with n-3 PUFAs was 1.62 ± 0.42, compared to 1.96 ± 0.62 at the end of the study (p < 0.005). The augmentation index changed from 14.66 ± 19.55 to 9.21 ± 15.64 after the treatment (p = 0.003) with n-3 PUFA. The results also revealed a statistically significant decrease in apolipoprotein B (0.94 ± 0.36 vs. 1.13 ± 0.35, p = 0.001) and homocysteine (19.31 ± 5.29 vs. 13.78 ± 3.05, p = 0.001) and an increase in glutathione peroxidase plasma levels (41.65 ± 8.90 vs. 45.20 ± 8.01), p = 0.001. Conclusions: The results of this prospective study showed a significant improvement in EF in subjects with MS treated with n-3 PUFAs in a dose of 2.4 g daily.

Background: There have been 20.5 million deaths due to cardiovascular diseases (CVDs), including atherosclerotic coronary artery disease (CAD) and stroke, so far in 2025. Atherosclerosis, which begins in newborns, may be influenced by preconception factors and continues to develop in adults, requiring a proper assessment of the burden of atherosclerotic plaque, as it is the direct cause of CAD. This review aims to emphasize the role of a staging system proposed by the Lancet Commission for the quantification of atherosclerotic coronary artery disease (ACAD) with an emphasis on preconception risk factors and protective factors, based on coronary computed tomography angiography (CCTA). Methods: It is suggested that the use of CCTA scanning makes it possible to quantify the atherosclerotic plaque burden into four stages. Results: CCTA enables us to see how much plaque has built up, as well as the type of plaque, but not the biochemistry of the plaque, to determine its vulnerability. However, if the plaque is a non-calcified fatty plaque, it is considered to be a strong predictor of the risk of myocardial infarction (MI), whereas a more stable calcified plaque is known to be protective against MI. There are several risk factors and protective factors which may influence the process of the rupture or vulnerability of the plaque. A randomized trial revealed that, after a median follow-up of 10·0 years, deaths due to CAD or non-fatal MI were less frequent in the CCTA group compared with a control group. Conclusions: Despite a few gaps in knowledge about the value of a staging system of ACAD, the available evidence indicates that it is helpful in decreasing morbidity and mortality with available therapies.

Despite increased availability of effective drug therapy for treatment of heart failure (HF), the morbidity and mortality in chronic heart failure (CHF) are unacceptably high. Therefore, there is an urgent need to ascertain new imaging techniques to identify early sub-clinical forms of cardiac dysfunctions, to guide early relevant treatment. It seems that all the behavioral risk factors—such as tobacco, alcoholism, Western-type diet, sedentary behavior and obesity, emotional disorders, and sleep disorder are associated with early cardiac dysfunction, which may be identified by speckle-tracking echocardiography (STE). Cardiac remodeling can also occur chronologically in association with biological risk factors of CHF, such as diabetes mellitus (DM), hypertension, cardiomyopathy, valvular heart disease, and coronary artery disease (CAD). In these conditions, twisting and untwisting of the heart, cardiac fibrosis, and hypertrophy can be identified early and accurately with 2-Dimentional (2D) and 3D echocardiography (2D echo and 3D echo) with tissue Doppler imaging (TDI), strain imaging via STE, and cardiac magnetic resonance imaging (CMR). Both 2D and 3D echo with STE are also useful in the identification of myocardial damage during chemotherapy and in the presence of risk factors. It is possible that global longitudinal systolic strain (GLS) obtained by STE may be an accurate marker for early identification of the severity of CAD in patients with non-ST segment elevation MI. Left ventricular ejection fraction (LVEF) is not the constant indicator of HF and it is normal in early cardiac dysfunction. In conclusion, this review suggests that GLS can be a useful early diagnostic marker of early or pre-cardiac dysfunction which may be treated by suitable drug therapy of HF along with the causes of HF and adhere to prevention strategies for recurrence. In addition, STE may be a superior clinical tool in the identification of cardiac dysfunction in its early stages compared to ejection fraction (EF) based on conventional echocardiography. Therefore, it is suggested that the chances of either stalling or reversing HF are far better for patients who are identified at an early stage of the disease.

Currently, just a few major parameters are used for cardiovascular (CV) risk quantification to identify many of the high-risk subjects; however, they leave a lot of them with an underestimated level of CV risk which does not reflect the reality. The submitted study design of the Kosice Selective Coronarography Multiple Risk (KSC MR) Study will use computer analysis of coronary angiography results of admitted patients along with broad patients’ characteristics based on questionnaires, physical findings, laboratory and many other examinations. Obtained data will undergo machine learning protocols with the aim of developing algorithms which will include all available parameters and accurately calculate the probability of coronary artery disease. The KSC MR study results, if positive, could establish a base for development of proper software for revealing high-risk patients, as well as patients with suggested positive coronary angiography findings, based on the principles of personalised medicine.

Higher levels of lipoprotein(a) {Lp(a)} are genetically regulated, which is a causal risk factor for cardiovascular disease (CVD) [1-3]. The variability in Lp(a) levels between subjects and population groups is difficult to fully explain by genetic factors, which indicates that 1t might be due to other environmental factors such as diet and nutrients and physical activity [1]. Randomized controlled clinical trials have demonstrated that diets lower in saturated fats may influence Lp(a) concentrations, which is usually in higher direction to the concentrations of low density lipoprotein (LDL) cholesterol [1, 4]. Interestingly, physical activity or exercise has not been found to have consistent effects, because it ranged from no to minimal or moderate effects upon Lp(a) levels, modulated by age and the type, duration and intensity of exercise modality [1]. Replacement of hormones in postmenopausal women lowers Lp(a) levels, which depends on the type of hormones, dose of estrogen and addition of progestogen. It seems that the current evidence supports a role for diet, hormones and related conditions, and liver and kidney diseases in modifying Lp(a) levels [1-5], although there are gaps in knowledge about the value of Lp(a) in AMI [6-12].

All the metabolic and physiological functions of the body have a circadian rhythm, regulated by the day and night cycle of the environment. The homeostatic physiology of the circadian rhythm processes the regulation of sleep and the sleep/wake cycle. Circadian rhythm is the 24-hour rhythm of an internal clock existing in the brain, responsible for regulation of cycles of alertness and sleepiness by responding to the alternation of light and darkness in the environment. The Earth's rotation around its axis synchronizes circadian rhythms in physiology and behavior. The circadian system has evolved to help the adaptation of our physiological functions to changes in the environment and anticipate changes in radiation, temperature, and food intake. Homo sapiens would not be able to optimize energy expenditure and the internal physiology of the body without this endogenous circadian clock. This communication aims to highlight the role of circadian function in cardiovascular and metabolic diseases.

Aims The aim of this pilot study was to compare selected three‐dimensional speckle tracking echocardiography (3D STE) parameters in patients with ischaemic and non‐ischaemic aetiology of heart failure (HF) and to identify indices that can differentiate the two pathologies. Methods and results Forty patients with left ventricular ejection fraction (LVEF) ≤ 40% were included to the study: 20 patients (age 63 ± 9.0 years, LVEF 29.0 ± 11.3%) with ischaemic cardiomyopathy and 20 patients (age 64.0 ± 11.0 years, LVEF 27.3 ± 7.5%) with non‐ischaemic cardiomyopathy. All patients underwent two‐dimensional (2D) and three‐dimensional (3D) transthoracic echocardiography. Standard echocardiographic parameters, global longitudinal strain, and rotational parameters of left ventricle (LV) were assessed using 3D speckle tracking (3D STE). There were no differences in standard and STE parameters between the two groups. Among rotational parameters, the LV apical rotation (4.9 ± 3.5° vs. 2.3 ± 2.4°, P = 0.0022) was significantly higher in patients with ischaemic HF. Among all echocardiographic parameters, a cut‐off value of 3.28° (area under the curve 0.78; 95% confidence interval, 0.62 to 0.93) was able to distinguish the ischaemic and non‐ischaemic aetiology of HF with a sensitivity of 80% and specificity of 75%. Conclusions This is the first study that compares 3D STE parameters between patients with ischaemic and non‐ischaemic cardiomyopathy. It was proved that the apical rotation was significantly higher in patients with ischaemic cardiomyopathy. Our findings suggest that 3D STE might be useful in non‐invasive differentiation between ischaemic and non‐ischaemic aetiology of HF.

Background: Diabetes mellitus is associated with hyperglycemia, oxidative stress and an increased risk of cardiovascular disease (CVDs). Administration of empagliflozin (EMPA) reduces blood glucose and blood pressure. Evidence is scarce regarding its role in chronotherapy. This observational study examines the effect of EMPA as chronotherapy in patients with type 2 diabetes mellitus (T2DM). Subjects and Methods: This study included 63 subjects with T2DM, scheduled to receive EMPA. Of these, 57 received EMPA (25mg/day) for 24 weeks, of which 25 received the dose in the evening and 23 in the morning. Clinical data, dietary intake and physical activity were assessed using validated questionnaires. Blood pressures were measured by sphygmomanometer. Single blind therapy with EMPA was associated with a significant reduction in fasting and 2-hour postprandial blood glucose levels and HbAlc. These changes were greater when EMPA was administered in the evening compared to morning. The reductions in pro-inflammatory cytokines, C-reactive proteins, TNF-alpha and interleukin-6, also showed greater and reductions when EMPA was administered in the evening, compared to morning and baseline levels. Chronotherapy with EMPA also caused a non-significant reduction in serum uric acid, systolic and diastolic blood pressures and angiotensin converting enzyme (ACE) levels when given in the evening compared to those patients who received EMPA in the morning, Conclusion: Chronotherapy with EMPA causes a greater reduction in blood glucose, blood pressures, serum uric acid, HbAlc, cytokines and ACE when administered in the evening compared to values obtained when the same dose was administered in the morning. Randomized, controlled intervention trials should be carried out to confirm these observations.

We present a case of a 31-year-old patient, smoker, with no previous medical history, presenting with acute limb ischemia and infarction of the spleen due to peripheral embolism. The source of embolism was thrombi formations in the left ventricular cavity, located in the area of the regional wall motions abnormalities. CT and coronary angiography confirmed the total occlusion of the left anterior descending artery with collateralization. The patient underwent acute bilateral embolectomy of the iliac, femoral, and popliteal arteries. Subsequently, cardiothoracic surgery was indicated with coronary bypass surgery and extirpation of left ventricular masses, later confirmed as thrombus by pathology characteristics. Hematological examinations proved homozygous thrombophilia, and the patient was indicated for lifelong anticoagulation therapy.