Explore the vast range of titles available.

Purpose of Review The following overview article summarizes the most important aspects of diagnosis and screening and provides an overview on the current evidence of glucose-lowering and heart failure treatment in patients with diabetes. Recent Findings Patients with diabetes exhibit an increased risk to develop heart failure and the presence of both comorbidities has a major impact on the prognosis of these patients. Thus, it is of utmost importance to detect heart failure in patients with diabetes and to screen all patients with heart failure for the presence of diabetes. Moreover, the diagnosis of heart failure in diabetes often requires an adjustment of medical therapy. Summary The presence of the 2 comorbidities, heart failure and diabetes, in a given patient which has a major impact on the prognosis and implementation of guideline-directed therapies to reduce cardiovascular risk in this high-risk population is of critical importance.

The aetiology of heart failure with preserved ejection fraction (HFpEF) is heterogenous and overlaps with that of several comorbidities like atrial fibrillation, diabetes mellitus, chronic kidney disease, valvular heart disease, iron deficiency, or sarcopenia. The diagnosis of HFpEF involves evaluating cardiac dysfunction through imaging techniques and assessing increased left ventricular filling pressure, which can be measured directly or estimated through various proxies including natriuretic peptides. To better narrow down the differential diagnosis of HFpEF, European and American heart failure guidelines advocate the use of different algorithms including comorbidities that require diagnosis and rigorous treatment during the evaluation process. Therapeutic recommendations differ between guidelines. Whilst sodium glucose transporter 2 inhibitors have a solid evidence base, the recommendations differ with regard to the use of inhibitors of the renin–angiotensin–aldosterone axis. Unless indicated for specific comorbidities, the use of beta-blockers should be discouraged in HFpEF. The aim of this article is to provide an overview of the current state of the art in HFpEF diagnosis, clinical evaluation, and treatment.

Diagnosis of heart failure is complex but crucial for patient outcomes and often hindered by the untapped potential of unstructured clinical notes. We introduce a novel end-to-end pipeline for heart failure diagnosis, leveraging electronic health records (EHR) and German clinical notes from 846 patients. Our pipeline synthesizes abbreviation disambiguation, translation of German clinical notes to English, medical entity linking to SNOMED-CT, and subsequent classification. The classification was performed using a Support Vector Machine (SVM) and compared against a fine-tuned medBERT.de neural baseline. We reduced the reliance on training data with zero-shot learning to address limitations with abbreviation disambiguation and entity linking approaches. Validation against benchmark datasets and cardiologists demonstrates high accuracy for real clinical use. Abbreviation disambiguation achieved an accuracy of up to 96.1%. Entity linking achieved competitive performance compared to state-of-the-art approaches on selected evaluation datasets. The SVM classification approach utilizing SNOMED-CT concepts and EHR data achieved an F1-score of 65.3%, on par with the medBERT.de neural baseline using clinical notes and EHR data. Despite challenges regarding limited language-specific resources and reference dataset availability for SNOMED-CT annotations in German, our pipeline demonstrates high potential for real-world clinical use and clinical decision support grounded in the standardized SNOMED-CT ontology.

Atrial fibrillation (AF) correlates with an increased risk of all-cause mortality or stroke, mainly due to undiagnosed patients and undertreatment. Its screening is thus a key challenge, for which machine learning methods hold the promise of cheaper and faster campaigns. The robustness of such methods to varying artifacts, noise, and conditions is then crucial. We introduce the first distributional support vector machine (SVM) for robust detection of AF from short, noisy electrocardiograms. It achieves state-of-the-art performance and unprecedented robustness on the screening problem while only leveraging one interpretable feature and little training data. We illustrate these advantages by evaluating on other data sources ( cross-data-set ) and through sensitivity studies. These strengths result from two main components: (i) preliminary peak detection enabling robust computation of medically relevant features; and (ii) a mathematically principled way of aggregating those features to compare their full distributions . This establishes our algorithm as a relevant candidate for screening campaigns.

Oral health has been implicated as a contributor to systemic inflammation and cardiovascular disease. However, the reverse relationship-whether systemic inflammation causally affects oral health-remains poorly defined. This study investigates the directional role of systemic inflammation in oral disease using genetic and phenotypic data from the UK Biobank. We analyzed data from 468,460 UK Biobank participants, integrating self-reported oral health measures with plasma levels of high-sensitivity C-reactive protein (hsCRP). To assess causality, we examined the IL6R single nucleotide polymorphism rs2228145 (p.Asp358Ala), a well-characterized variant associated with impaired IL-6 receptor signaling and reduced systemic inflammation. Higher hsCRP tertiles were significantly associated with increased prevalence of poor oral health indicators, including tooth loss, dentures, bleeding gums, and loose teeth (all p < 0.001). Carriers of the IL6R C/C genotype exhibited significantly lower hsCRP levels and a reduced burden of oral pathology, including lower odds for toothache (OR 0.91 [95%CI 0.87-0.94]), bleeding gums (OR 0.97 [95%CI 0.94-0.99]), and loose teeth (OR 0.92 [95%CI 0.88-0.96]). Our findings support systemic inflammation-mediated via IL-6 signaling-as a causal determinant of impaired oral health. This study provides novel evidence for a directional link from systemic inflammation to oral disease, with potential implications for targeted immunomodulatory interventions in oral health.

The integration of clinical research data across various institutions faces hurdles due to differing definitions, inconsistent terminologies, and inadequate support for interoperable metadata. While biomedical ontologies offer valuable tools for structuring clinical data, they have not yet been fully utilized for creating comprehensive metadata descriptors, such as variable semantics, statistical summaries, and governance elements essential for data discovery and alignment. We present the Clinical Metadata Exploration Ontology (CMEO) that builds upon well-established ontologies to provide a cohesive representation of study designs, data elements, exploratory statistics, and data reuse permissions. CMEO facilitates semantic querying for study exploration and comparison of data elements across studies, particularly when individual-level data cannot be shared. We demonstrate its utility using metadata from five studies: four heart-failure studies and one wearable-based type 1 diabetes study. After serializing, we executed SPARQL queries that operationalized study-level discovery, variable alignment across studies, and governance-constrained reuse. This FAIR-compliant, metadata-driven integration across heterogeneous sources enables scalable, privacy-conscious research and underpins federated clinical data exploration.

Background Teledentistry has the potential to enhance access to dental care and interprofessional communication. However, its implementation depends strongly on practitioners’ acceptance and understanding. Therefore, this study aimed to assess dentists’ awareness, knowledge, and acceptance of teledentistry and to examine how professional experience, anticipated frequency of use, and practice size influence their attitudes. Furthermore, the interest in a dedicated teledentistry centre was evaluated. Methods A cross-sectional survey was conducted among 362 dentists. A 16-item questionnaire was distributed via SoSci Survey and in paper form. Statistical analysis included chi-square and Fisher-Freeman-Halton exact tests ( P < .05). Results Of the 362 dentists invited, 187 completed the survey, yielding a response rate of 52%. More than 70% of participants were familiar with the term teledentistry, yet only one quarter demonstrated a comprehensive understanding of its scope. About one third (32%) had previously used teledentistry in clinical practice. A large majority (71%) considered the establishment of a regional teledentistry centre beneficial, for improving communication with specialists and managing referrals, although their expectations regarding acceptable response times varied considerably between one day and one week. Interest in teledentistry showed no significant association with years of professional experience ( P = .76) or the number of dentists in a practice ( P = .598) but correlated significantly with the frequency of relevant clinical cases ( P < .01, Cramér’s V = 0.449). Main concerns included diagnostic limitations without in-person contact and data privacy. Conclusions The study highlights a generally positive attitude toward teledentistry. The findings provide substantial support for the proposed initiative to establish a teledentistry centre, operating on the premise of the store-and-forward method. Familiarity with the concept and clinical demand influence acceptance more than professional experience or the number of practicing dentists in a dental office.

Friedreich's ataxia is a multisystem disorder with scoliosis being the most common non‐neurological manifestation. While scoliosis surgery is typically performed in adolescent, ambulatory patients, few data exist on surgical outcomes in patients with advanced disease. We present a 38‐year‐old woman with late‐stage Friedreich's ataxia and pronounced thoracolumbar scoliosis (Cobb angle 48°) causing severe pain and limited sitting tolerance. After posterior corrective spondylodesis (T4‐ilium), she reported marked improvements in pain, sitting tolerance, function, and quality of life in the SF‐36 questionnaire. This case highlights the potential for substantial clinical and functional benefits from scoliosis surgery in patients with advanced Friedreich's ataxia.

Background The TIM-HF2 study demonstrated that remote patient management (RPM) in a well-defined heart failure (HF) population reduced the percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death during 1-year follow-up (hazard ratio 0.80) and all-cause mortality alone (HR 0.70). Higher rates of hospital admissions and mortality have been reported in HF patients with diabetes compared with HF patients without diabetes. Therefore, in a post-hoc analysis of the TIM-HF2 study, we investigated the efficacy of RPM in HF patients with diabetes. Methods TIM-HF2 study was a randomized, controlled, unmasked (concealed randomization), multicentre trial, performed in Germany between August 2013 and May 2018. HF-Patients in NYHA class II/III who had a HF-related hospital admission within the previous 12 months, irrespective of left ventricular ejection fraction, and were randomized to usual care with or without added RPM and followed for 1 year. The primary endpoint was days lost due to unplanned cardiovascular hospitalization or due to death of any cause. This post-hoc analysis included 707 HF patients with diabetes. Results In HF patients with diabetes, RPM reduced the percentage of days lost due to cardiovascular hospitalization or death compared with usual care (HR 0.66, 95% CI 0.48–0.90), and the rate of all-cause mortality alone (HR 0.52, 95% CI 0.32–0.85). RPM was also associated with an improvement in quality of life (mean difference in change in global score of Minnesota Living with Heart Failure Questionnaire score (MLHFQ): − 3.4, 95% CI − 6.2 to − 0.6). Conclusion These results support the use of RPM in HF patients with diabetes. Clinical trial registration ClinicalTrials.gov NCT01878630.

Observational studies suggest an association between impaired oral health and cardiovascular disease; however, the directionality and underlying mechanisms remain unclear. In particular, whether heart failure (HF) itself adversely affects oral and periodontal health has not been systematically investigated in large populations or experimental models.We examined the association between HF and self-reported oral health indicators in 502,387 participants of the UK Biobank, including 17,356 individuals with HF defined by ICD-9/10 codes. Multivariable logistic regression models adjusted for demographic factors, cardiovascular comorbidities, systemic inflammation, lifestyle, and socioeconomic status were applied. To explore causality and mechanisms, periodontal tissue remodeling and inflammation were assessed in a murine model of pressure overload–induced HF using transverse aortic constriction (TAC). Periodontal ligament (PDL) space and alveolar bone microarchitecture were quantified by micro-computed tomography, and gingival inflammatory gene expression was analyzed by RT–PCR.HF patients exhibited a significantly higher prevalence of oral health burden compared with controls (51% vs. 40%, p<0.001). HF was associated with a 1.6-fold increased risk of impaired oral health, which remained significant after full adjustment (adjusted OR 1.18, 95% CI 1.14–1.22; p<0.001). In mice, reduced left ventricular ejection fraction following TAC was strongly associated with expansion of the maxillary PDL space (R 2 = 0.63, p = 0.009) and alterations in alveolar bone microarchitecture (trabecular thickness R 2 = 0.41 p = 0.061, trabecular number R 2 = 0.38 p = 0.07). These structural changes were accompanied by increased gingival expression of pro-inflammatory cytokines, including Il1b (SHAM vs. TAC: 1.44 ± 1.02 vs. 3.39 ± 1.53,  p  = 0.06) and TNF-α (SHAM vs. TAC: 1.37 ± 0.86 vs. 5.71 ± 1.23,  p  = 0.002 predominantly in the maxilla.HF is independently associated with impaired oral health in a large population cohort and induces site-specific periodontal inflammation and remodelling in experimental HF. These findings support HF as an upstream driver of compromised oral-periodontal health, challenging the prevailing concept that oral disease primarily contributes to cardiovascular pathology.