Examining consensus among fish farmers, scientists, and regulatory authorities is critical for the development and implementation of effective animal welfare assessment schemes. Aquaculture researchers provide scientific data on fish needs, and evidence-based welfare indicators that accurately reflect fish physical and affective state. Fish farmers take care and bring empirical insights into what is feasible in day-to-day routine operations, while the competent authorities play a key role in official controls and in aligning welfare schemes with legal standards and policy objectives. To ensure that these diverse perspectives are meaningfully integrated, structured participatory approaches are needed to build shared understanding and agreement. This study employs a modified Delphi method bringing together various relevant stakeholders to identify and evaluate Operational Welfare Indicators (OWIs) for on-growing European sea bass, Dicentrarchus labrax, in net-pen sea cages. Through iterative questionnaires and discussion via an online tool, the SmartDelphi platform (INNEX LABS, Barcelona, Spain), experts prioritised water quality, behaviour, and health metrics as key OWIs. They also highlighted major welfare challenges and proposed improvements for an objective, reliable and effective on-farm welfare monitoring. The findings offer a social approach for prioritising welfare indicators, incorporating them into farm management and welfare assessment schemes for European sea bass and suggest directions for further research across species and rearing systems.

AIMS:Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), but its long-term comparative efficacy remains uncertain. This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) comparing LAAC with OAC in AF. METHODS AND RESULTS:MEDLINE, Embase, Scopus, and the Cochrane Database of Systematic Reviews were searched through 8 April 2026. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models. Certainty of evidence (CoE) was assessed using GRADE. Six RCTs involving 7004 participants were included (3681 assigned to LAAC and 3323 to OAC). Compared with OAC, LAAC resulted in a significantly higher risk of ischaemic stroke or systemic embolism (134 vs. 80 events; RR 1.41, 95% CI 1.07-1.86; moderate CoE). No significant differences were observed for any stroke or systemic embolism (RR 1.10, 95% CI 0.87-1.39; moderate CoE), all-cause mortality (RR 0.92, 95% CI 0.77-1.10; high CoE), cardiovascular mortality (RR 0.90, 95% CI 0.67-1.21; moderate CoE), non-cardiovascular mortality (RR 0.92, 95% CI 0.75-1.12; moderate CoE), major bleeding (RR 0.91, 95% CI 0.77-1.08; high CoE), or haemorrhagic stroke (RR 0.58, 95% CI 0.28-1.17; moderate CoE). LAAC reduced the risk of nonprocedural clinically relevant bleeding compared with OAC (RR 0.50, 95% CI 0.43-0.59; high CoE). CONCLUSION:In patients with AF, LAAC results in a higher risk of ischaemic stroke or systemic embolism than an OAC-based strategy. Compared with OAC, LAAC has no effect on major bleeding or mortality and does not reduce haemorrhagic stroke.

Red seabream (Pagrus major) reared under intensive rearing conditions faces hypermelanosis and dyspigmentation, resulting in darker and less pink/red skin color, losing the natural appearance of the species. This has a great negative impact on consumers' acceptance and market appeal. Two experiments were performed to test the effect of the source, level, and feeding duration of astaxanthin supplementation in the feed on red seabream skin color reversing the depigmentation problem. Firstly, three different sources of astaxanthin (artificially synthesized, algal-extracted, and yeast-extracted astaxanthin) at the same inclusion level (100 mg kg-1 feed) were tested. Then, the best performing source was tested using five inclusion levels (0, 20, 60, 80, and 100 mg kg-1) in the feed for 60 days. At the same time, growth performance, blood biochemical parameters, antioxidant capacity and cortisol levels were also assessed. The results showed that red seabream appearance can be significantly improved with the inclusion of astaxanthin from the algae Haematococcus pluvialis in the feed even at lower levels compared to the artificially synthesized astaxanthin for a 60-day period. Fish growth performance and blood parameters were not affected by any of the experimental treatments.

Over the past thirteen years, the large-scale biomedical semantic indexing and question-answering challenge (BioASQ) has consistently driven the advancement of methods and tools that enhance access to the rapidly growing body of scientific resources in the biomedical domain. BioASQ offers a unique common testbed where research teams worldwide can evaluate and compare innovative approaches for accessing biomedical knowledge by organizing shared tasks on an annual basis and providing respective benchmark datasets that represent the real information needs of biomedical experts . The fourteenth version of BioASQ (BioASQ14) will be held as an evaluation Lab in the context of CLEF2026, providing six tasks: (i) Task b on biomedical semantic question answering. (ii) Task Synergy on question answering for developing biomedical topics. (iii) Task MultiClinSum-2 on multilingual clinical summarization. (iv) Task BioNNE-R on nested relation extraction in Russian and English. (v) Task ELCardioCC on clinical coding in cardiology. (vi) Task GutBrainIE on gut-brain interplay information extraction. Through its six shared tasks, BioASQ14 challenges the research community to develop methods that go beyond the current state of the art, fostering innovative approaches that enable efficient and precise access to biomedical knowledge while pushing the research frontier forward.

AIMS:The optimal short-term antithrombotic strategy following left atrial appendage occlusion (LAAO) remains uncertain, with the need to balance thromboembolic prevention and bleeding risk presenting a critical challenge. Recent evidence suggests that direct oral anticoagulants (DOACs) may provide a favourable safety-efficacy profile, with low-dose regimens showing potential benefits during the device endothelialization period. This network meta-analysis (NMA) aimed to compare the efficacy and safety of various antithrombotic strategies, including DOAC dosing, following LAAO. METHODS AND RESULTS:A systematic review and NMA were conducted following Cochrane and PRISMA guidelines. Eligible studies included randomized controlled trials (RCT) and observational studies comparing at least two antithrombotic regimens in patients with non-valvular atrial fibrillation undergoing percutaneous LAAO. Primary outcomes were major bleeding and thromboembolism. Secondary outcomes included device-related thrombosis (DRT) and all-cause mortality. Pairwise and network meta-analyses were performed using a random-effects model. A total of 52 studies (49 observational and 3 RCTs) involving 69 751 patients were included. DOACs were consistently associated with significantly lower rates of major bleeding and all-cause mortality than other antithrombotic regimens. Low-dose DOACs showed a potential advantage over standard-dose DOACs in reducing major bleeding risk (odds ratio 0.45, 95% confidence interval: 0.22-0.92). For thromboembolism and DRT, standard-dose DOAC significantly reduced risk compared with single antiplatelet therapy (SAPT) but not with dual antiplatelet therapy (DAPT), whereas low-dose DOAC significantly reduced both outcomes compared with SAPT, DAPT, and vitamin K antagonists plus SAPT. In ranking analysis, DOACs emerged as the most effective and safest antithrombotic strategy, with low-dose DOACs demonstrating further safety benefits in bleeding outcomes. CONCLUSION:DOACs provide a superior safety-efficacy profile compared with other antithrombotic strategies following LAAO, significantly reducing the risks of major bleeding, thromboembolic events, and mortality. While low-dose DOACs may offer additional bleeding risk reduction without compromising efficacy, further research is warranted to confirm their role in clinical practice.

Atrial fibrillation (AF) is a highly prevalent arrhythmia associated with stroke, heart failure and excess mortality. Yet, “silent” AF episodes remain undetected, leading to underestimation of disease burden. Additionally, paroxysms occur in an “unpredictable” way, and available clinical scores only stratify long-term AF risk with moderate discrimination, lacking the ability to evaluate near-term events. Artificial intelligence (AI) applied to sinus rhythm from short or continuous electrocardiogram (ECG) recordings shows that such predictive information is hidden in “plain sight.” This complementary approach seeks to uncover latent AF substrate and forecast imminent AF episodes. Deep-learning models trained on 10-s, 12-lead ECGs can identify individuals with prevalent or long- or near-term AF with areas under the curve (AUCs) up to 0.90, outperforming established clinical scores. Image-based AI-ECG models extend these capabilities to paper or scanned ECGs. Furthermore, AI algorithms applied to 24-h Holter and multi-day patch recordings achieve AUCs ≥0.80 for detecting occult AF or predicting it within 14 days, consistently surpassing risk scores like C2HEST and HATCH. Short-term models utilizing heart-rate variability features further demonstrate that AF can be anticipated minutes to hours before onset, with accuracies around 90% in curated datasets. However, most AI-AF studies remain retrospective, single-system and focused on diagnostic yield rather than clinical outcomes like stroke or mortality. Moreover, few pragmatic trials have evaluated AI-guided AF screening and its translation into clinical benefit. Robust prospective trials and standardized evaluation frameworks are needed before AI-guided AF prediction can be routinely integrated into clinical decision-making.

Background:Inflammation has recently been identified as a critical regulator of the pathophysiology and prognosis of acute coronary syndrome (ACS). The systemic immune-inflammation index (SII), derived from platelet, neutrophil, and lymphocyte counts, has gained attention as a potential marker for predicting adverse outcomes in cardiovascular diseases. However, the prognostic value of the SII, particularly in relation to gender differences, has not been extensively studied. Methods:Thus, we conducted a retrospective cohort study of 835 patients hospitalized for ACS at Hippokration Hospital, Thessaloniki, Greece, between 2017 and 2023. The SII was calculated using blood samples taken at admission. Logistic and Cox regression models were used to evaluate the relationship between the SII and all-cause mortality, with stratified analyses conducted according to gender. Receiver operating characteristic (ROC) analysis, Kaplan-Meier survival curves, and restricted cubic spline (RCS) modeling were also performed to assess the discriminative ability and non-linear associations of the SII with mortality. Results:A total of 835 patients were included, with a median follow-up of 25 months. An elevated SII was independently associated with increased long-term mortality, with patients in the highest SII quartile exhibiting a 2.3-fold higher risk of death compared to those in the lowest quartile (adjusted hazard ratio (aHR) = 2.31, 95% confidence interval (CI): 1.60-3.32; p < 0.001). The optimal cut-off value for the SII was identified as 1864.19. Gender-stratified analyses revealed a stronger prognostic value in women compared to men (area under the curve (AUC) = 0.70 vs 0.58; p = 0.018). The Kaplan-Meier and Cox regression analyses confirmed significantly worse survival for patients with SII levels above this threshold (p < 0.05). The RCS modeling demonstrated a non-linear relationship between the SII and mortality, with a marked increase in risk at higher levels of the SII, especially in women. Conclusions:The SII is a simple, easily accessible biomarker that independently predicts mortality in ACS patients, with notable gender-specific differences in the prognostic value of the SII. Nonetheless, incorporating SII into routine risk assessment could enhance risk stratification and improve personalized treatment strategies, particularly in settings with limited resources.

Background Pulsed field ablation (PFA) is an emerging modality for atrial fibrillation management, offering rapid pulmonary vein isolation and the possibility of the left atrial posterior wall ablation. Combining PFA with left atrial appendage occlusion (LAAO) represents a holistic strategy for managing heart rhythm abnormalities and minimizing stroke risk, particularly in patients with high thromboembolic and bleeding risks.Case summary We present a case of a 52-year-old woman with persistent atrial fibrillation, recent percutaneous coronary intervention, and a history of adenomyosis-related menorrhagia, exacerbated by the use of dual antithrombotic therapy. She underwent a single-session PFA and LAAO. The procedure was uncomplicated. At three-month follow-up, imaging confirmed appropriate device placement and complete closure. Anticoagulation was discontinued at three months, and the patient remained asymptomatic at 1-year follow-up while on single antiplatelet therapy.Discussion This case highlights the feasibility and safety of combining PFA and LAAO in a high-risk patient and underscores the potential for broader adoption in selected populations. Larger studies are needed to evaluate long-term outcomes.

This study evaluates the effects of harvest, slaughter, and temperature on the physiological stress response and post−mortem muscle quality of European seabass (Dicentrarchus labrax). These effects were assessed thorough various stress indicators, including endocrine (cortisol), metabolic (glucose, lactate), osmoregulatory (osmolality), and behavioural indicators (loss of behavioural response; LBR) alongside muscle quality (muscle pH decline and rigor mortis). Results indicate that pre-slaughter crowding causes a stress response by elevating basal cortisol and osmolality to levels that undermine the specific impacts of slaughter methods. Under low−stress handling (rapid netting or hook−and−line), brain pithing (ikigun) consistently minimized cortisol elevation and achieved the fastest LBR time, whereas asphyxia induced the most severe disturbances across all indicators. Temperature acted as a modulator, accelerating LBR and post-mortem muscle pH decline under rapid netting, but having a limited impact under stressful conditions (e.g., following crowding + brailing). These findings emphasize that while slaughter methods like pithing are superior for welfare and muscle quality preservation, benefits are, however, significantly diminished by poor pre-slaughter handling. Consequently, optimizing fish welfare and product quality requires a holistic management approach that prioritizes the mitigation of cumulative stress before slaughter.

Background: Early identification of patients at risk for adverse outcomes after cardiac surgery remains a major clinical challenge. While preoperative risk scores are widely used, the prognostic value of early postoperative ICU severity scores and functional performance measures has not been fully clarified. Methods: This prospective observational study included 195 patients undergoing cardiac surgery between 2018 and 2024. Predictive performance of EuroSCORE II, the SOFA score, the APACHE II score, Karnofsky performance status, handgrip strength, and phase angle was assessed for postoperative complications and mortality. Receiver operating characteristic (ROC) curves with 95% confidence intervals were calculated, and pairwise comparisons between ROC curves were performed. Major postoperative complications were analyzed using a composite endpoint including stroke, prolonged intubation, sepsis, and reoperation, excluding systemic inflammatory response syndrome (SIRS). Results: Major postoperative complications occurred in 46 patients (23.6%). For prediction of major postoperative complications, SOFA demonstrated the highest discrimination (AUC = 0.881, 95% CI 0.819-0.928), followed by APACHE II (AUC = 0.826, 95% CI 0.753-0.888) and EuroSCORE II (AUC = 0.695, 95% CI 0.602-0.785). In-hospital mortality occurred in 19 patients (9.7%). SOFA showed the strongest predictive performance (AUC = 0.915, 95% CI 0.851-0.968), followed by APACHE II (AUC = 0.869, 95% CI 0.781-0.939) and EuroSCORE II (AUC = 0.742, 95% CI 0.595-0.870). During follow-up, 54 patients (27.7%) died. Predictive performance was comparable between SOFA (AUC = 0.710, 95% CI 0.618-0.793), APACHE II (AUC = 0.695, 95% CI 0.606-0.782), and EuroSCORE II (AUC = 0.680, 95% CI 0.599-0.757). Conclusions: Early postoperative ICU severity scores, particularly SOFA and APACHE II, demonstrated strong predictive ability for major postoperative complications and in-hospital mortality following cardiac surgery and outperformed preoperative risk scores.

Glucocorticoids (GCs), such as cortisol, bind to receptors in most tissues, triggering a stress response that enables individuals to adapt to stressors physiologically and behaviorally. GC signaling has been associated with plastic, stress-induced epigenetic modifications. However, the epigenetic profiles of individuals with divergent cortisol reactivity before and after a common challenge test have rarely been considered. Cortisol levels were measured in the blood plasma of 400 European seabass (Dicentrarchus labrax) to select 80 individuals exhibiting low- and high-responsiveness phenotypes. Weight, lysozyme activity, and plasma glucose and lactate levels were also measured. The methylome of blood samples from these individuals was investigated at 41,132 CpG positions before and after a 3-mo stress challenge test. We identified 273 differentially methylated cytosines, which mapped to 159 annotated differentially methylated genes (DMGs). We categorized differential methylation as "constitutive" or "induced," distinguishing between the two phenotypes in pre- and post-stress situations, respectively. Methylation observed at DMGs may also remain hypo- or hypermethylated in both contexts; however, seven of these showed a rewiring from hypo- to hypermethylation. Many DMGs are relevant to GC signaling, connecting to the non-genomic and genomic actions of cortisol. They can be considered as stress biomarkers monitored in the blood of this highly-prized species. Although our current study has limitations, we demonstrate the potential of a genome-wide epigenetic approach to studying endocrine divergence between stress-responsive fish phenotypes.NEW & NOTEWORTHY The association of DNA methylation with glucocorticoid signaling has attracted considerable interest. However, studies investigating genome-wide methylation differences in individuals with different cortisol responses before and after exposure to stress have been overlooked. Here, we demonstrate that the blood methylomes of fish with distinct cortisol responsiveness exhibit distinct pre-and post-stress methylation profiles, indicative of the cellular and organismal actions of cortisol possibly triggering the adaptive stress response of each phenotype in the face of stress.

Background: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in this demographic. Methods: This post hoc analysis of the MISOAC-AF trial focused on hospitalized AF patients aged ≥ 75 years prescribed OAC at discharge. Predictors of VKA and reduced DOAC dosing were identified using adjusted odds ratios (aORs). Cox regression models calculated adjusted hazard ratios (aHRs) for primary (all-cause mortality) and secondary outcomes (stroke, bleeding, AF or heart failure hospitalization, cardiovascular death). Results: Among 450 elderly patients, 63.6% received DOACs and 36.4% received VKAs. Higher CHA2DS2-VASc and HAS-BLED scores and antiplatelet use predicted VKA prescription. Hypertension, prior stroke, and bleeding history favored DOAC use. Advanced age and chronic kidney disease correlated with reduced DOAC dosing. Over a 3.7-year follow-up period, there was no significant difference in all-cause mortality between the DOAC and VKA groups (aHR 0.79, 95% CI 0.58–1.06) or between the full-dose and reduced-dose DOAC groups (aHR 0.96, 95% CI 0.60–1.53). Secondary analyses also did not yield statistically significant results in either comparison. Conclusions: Clinical profile parameters in elderly AF patients predict VKA or DOAC use. Clinical outcomes were similar between different OAC therapies.

Heart failure is a prevalent and clinically significant condition, with ejection fraction (EF) serving as a key parameter for its classification. Given its critical role in diagnosis and patient evaluation, management, precise EF estimation is a priority in cardiovascular imaging for guiding therapeutic decisions. This study introduces an automated framework for EF quantification using a pair of four-chamber view (4CH) echocardiographic images—captured at end-diastolic and end-systolic phases, integrating deep learning and geometric modeling. An attention-based U-Net segments the left ventricle (LV), while an ellipsoidal model enables three-dimensional LV reconstruction for EF calculation. Performance evaluation against ground truth data demonstrates minimal estimation errors, with Bland-Altman analysis confirming strong agreement. The classification of EF groups, conducted to assess the clinical impact of deviations in measurements, yielded an accuracy of 82.0%. Despite these promising results, further refinement of three-dimensional ventricular volume reconstruction is necessary to enhance precision.Clinical relevance— An affordable and accurate EF calculation can support timely heart failure classification and management.

Consistent behavioural patterns defined as personality, are exhibited within individuals over time and across situations. Personality has been associated with the health, welfare and robustness of farm animals. This study aimed to identify the personality profiles of ewes reared under intensive farming and explore links with specific productive and physiological characteristics. To achieve this, 40 adult female sheep (Ovis aries) were studied. The experiment lasted for six months divided into three equal periods (A, B, and C). During period A, the animals were reared in two groups based on their breed. In period B the animals were equally mixed in two groups while in period C the animals returned to their initial state, as in period A. Ewes’ behaviour was recorded during the total experimental period. Based on the social behaviours that remained stable during the examined periods, three personality profiles were recognized (Dynamic, Receptive and Social). Ewes with high scores on the Dynamic profile received affiliative behaviours by more members of the group (p = 0.044) and ewes with low scores spent more time foraging (p = 0.021) and had lower body weight (p = 0.014). In addition, within the receptive profile, ewes with medium scores had the lowest blood cortisol as a response to handling (p = 0.020). Ewes with high scores in the Social profile exchanged affiliative behaviours with more individuals (p < 0.001) and performed less frequent vocalizations (p = 0.047). Finally, ewes with low scores in the social profile produced more milk (p = 0.046). Farm animal personality could be very useful in animal husbandry. Personality dimensions could be directly linked to productive and physiological characteristics as well as social dynamics and thus they can form useful indices for welfare status in animal husbandry. Therefore, understanding personality traits, can assist in improving farming practices or focusing on animals with lower welfare status for better management.