To investigate the population-level association between family size and cardiovascular disease (CVD) incidence, focusing on broad patterns rather than causal mechanisms or individual-level effects.

Population level correlations of family size to CVD incidence were analyzed with scatter plots, simple regression, partial correlation and multivariate regression separately. Aging, economic affluence, obesity and urbanization were incorporated in models as potential confounders.

Globally, family size negatively correlated to CVD incidence rate. This relationship remained in partial correlation analyses when controlling for confounders. Stepwise multiple regression revealed that family size may be the most significant predictor of CVD incidence.

Large family size is significantly associated with lower cardiovascular disease (CVD) incidence, potentially due to biological, psychological, and social factors. However, as the data are cross-sectional, this relationship should be interpreted as correlational rather than causal. The association appears more pronounced in developing countries, where contextual factors may amplify its effects.

This study pursued to evaluate the tropisetron effects in attenuating D-galactose induced heart aging in mice. The study aimed to ascertain whether tropisetron affects apoptotic processes, mitochondrial oxidative stress, or inflammatory variables in cardiac tissue, presumably through the modulation of the SIRT1 signaling pathway or sirtuin 1. Aging was induced via administration of D-galactose (200 mg/kg, s.c.). Then, mice were treated with tropisetron (1, 3, and 5 mg/kg/day, i.p.). After 8 weeks, the key indicators of oxidative mitochondrial dysfunction, oxidative stress, pro-inflammatory cytokines, interleukin-6, tumor necrosis factor-α, and nitric oxide concentrations were evaluated. Additionally, the gene expressions of apoptotic regulators Bax and Bcl2, as well as SIRT1, were assessed using real-time PCR. Histological alterations and serum lactate dehydrogenase levels were also assessed. Tropisetron alleviated mitochondrial oxidative stress and inflammatory mediators while decreasing immune cell infiltration into cardiac tissue generated by D-galactose. The simultaneous injection of tropisetron effectively inhibited D-galactose-induced apoptosis by modulating the Bax/Bcl2 ratio and activating the SIRT1 pathway. The administration of tropisetron resulted in reduced serum lactate dehydrogenase levels compared to the group treated just with D-galactose. Moreover, tropisetron successfully reinstated mitochondrial activity and diminished D-galactose-induced aberrant nitric oxide generation. The research concludes that tropisetron may provide protection against cardiac aging by activating multiple mechanisms associated with the SIRT1 pathway.

Social engagement contributes to healthy aging, yet the mechanisms linking social engagement to mortality risk remain poorly understood. This study investigated the biological, behavioral, and psychological pathways mediating this relationship.

We conducted a prospective cohort study using Health and Retirement Study (HRS) data on participants aged 60 and older who completed the Psychosocial and Lifestyle Questionnaires and provided blood samples in 2016. Social engagement was assessed using nine items from the HRS Social Participation questionnaire, with responses categorized as low, moderate, or high. Biological age was calculated using the Klemera-Doubal method and compared to chronological age to identify decelerated aging. We explored mediating pathways between social engagement and 4-year mortality risk using counterfactual mediation analyses.

In total, 2268 participants were included. Higher social engagement was associated with lower all-cause mortality rates over 4 years of follow-up. The high social engagement group participants had a lower median biological age, healthier behaviors, and lower prevalence of depressive symptoms than those in the low and moderate engagement groups. High social engagement was associated with lower mortality risk than low engagement (a-HR: 0.58 [95% CI: 0.39, 0.86; p = 0.009]). This effect was partially mediated by regular physical activity (16%) and decelerated biological age (15%). Other factors such as high depressive symptoms, excess alcohol use, and tobacco use showed no significant mediating effects.

Higher social engagement in older adults is associated with reduced mortality risk possibly due to decreased biological aging and increased physical activity levels.

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder and constitutes a significant threat to global public health. Increasing evidence has shown the therapeutic potential of probiotics in the management of T2DM. This study established a T2DM mouse model through high-fat diet combined with streptozotocin injection (HFD/STZ) and investigated the preventive effects of two probiotic strains: Bifidobacterium animalis subsp. lactis BLa80 and Lactobacillus acidophilus LA85. The results indicated that both probiotic strains significantly improved glucose homeostasis by reducing fasting blood glucose (FBG) levels, enhancing insulin sensitivity, and increasing glucagon-like peptide-1 (GLP-1) levels. Moreover, probiotics decreased blood lipid and pro-inflammatory mediator levels, enhanced the production of anti-inflammatory cytokines, and mitigated pathological alterations in ileal, hepatic, pancreatic, and renal tissues. Subsequent 16S rRNA amplicon sequencing analysis revealed that BLa80 and LA85 interventions effectively modulated gut microbiota composition, particularly by increasing the relative abundance of short-chain fatty acids (SCFAs)-producing bacterial taxa. Notably, the mechanisms of action were strain-specific: BLa80 primarily impacted glycemic control and promoted the proliferation of Bifidobacterium and Limosilactobacillus, whereas LA85 exhibited superior efficacy in regulating lipid metabolism and promoted the growth of Lactobacillus and Alistipes populations. These findings indicate that BLa80 and LA85 can ameliorate symptoms related to T2DM despite their distinct regulatory pathways, suggesting their potential as therapeutic agents in diabetes management.

This study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and community discharge from IRF.

Aim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF-PAI self-care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF-PAI admission functional measures to predict community discharge from IRF after stroke.

Retrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019.

Academic hospital-based IRF.

Five hundred forty-four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hours of IRF admission.

Not applicable.

Admission IRF-PAI self-care and mobility scores and discharge status from IRF.

Of the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF-PAI admission self-care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF-PAI admission mobility score. IRF admission self-care and mobility scores were each statistically significant predictors of community discharge (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.03-1.17; OR = 1.10, CI: 1.03-1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47-1.04) from IRF.

IRF-PAI self-care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF-PAI self-care and mobility measures each predict community discharge.

The aim of the study was to examine whether a healthy lifestyle was associated with reduced utilisation of healthcare professionals and/or prescription medications for stroke survivors.

The study utilised data obtained from the 45 and Up Study, linked to the Medicare claims and Pharmaceutical Benefits Scheme data. The outcome variables were the number of times a person received care from a range of healthcare professions and the number of different prescription medications used by participants. The risk factors were smoking, alcohol consumption, physical activity, and supplement use. Generalised Estimating Equation models were employed to assess the longitudinal association between an outcome variable and risk factors.

Stroke survivors who engaged in moderate-to-high levels of physical activity were significantly less likely to receive care from a general practitioner, a nurse, and an allied health professional, as well as to take blood-thinning medications. Stroke survivors who smoked were more likely to receive care from a specialist doctor. Moreover, stroke survivors who consumed supplements were more likely to receive care from an allied health professional.

The findings carry substantial implications for stroke rehabilitation and secondary prevention, highlighting the positive effects of moderate-to-high physical activity and the associated risks of smoking.

We investigated whether empirically derived childhood obesity phenotypes were differentially associated with risk of hypertension in young adulthood, and whether these associations differed by sex.

Data came from 11,404 participants in the Growing Up Today Study, a prospective cohort study in the US established in 1996. We used a childhood obesity phenotype variable that was previously empirically derived using latent class analysis. The childhood obesity phenotypes included an early puberty phenotype (females only), a mothers with obesity phenotype, a high weight concerns phenotype, and a mixed phenotype. Participants without overweight or obesity in childhood or adolescence were the reference group. We then used logistic regression models with generalized estimating equations to examine associations of childhood obesity phenotypes with incident hypertension between ages 20-35 years. All analyses were stratified by sex.

Among females, participants in all of the empirically derived childhood obesity phenotypes were more likely than their peers without childhood overweight/obesity to develop hypertension in young adulthood (early puberty subtype odds ratio (OR) = 2.52; 95% confidence interval (CI) = 1.75, 3.62; mothers with obesity (MO) subtype OR = 2.98; 95% CI = 1.93, 4.59; high weight concerns (WC) subtype OR = 2.33; 95% CI = 1.65, 3.28; mixed subtype OR = 1.66; 95% CI = 1.25, 2.20). Among males, the childhood obesity phenotypes were associated with a higher risk of developing hypertension, although males in the MO (OR = 2.65; 95% CI = 1.82, 3.87) and WC phenotypes (OR = 3.52; 95% CI = 2.38, 5.20) had a greater risk of developing hypertension than the mixed subtype (OR = 1.51; 95% CI = 1.23, 1.86) (p = 0.004).

Risk for incident hypertension in young adulthood varied by childhood obesity phenotypes, as well as by biological sex. If replicated, these results may suggest that increased surveillance of specific childhood obesity phenotypes might help in targeting those at highest risk for hypertension.

Introduction Atrial fibrillation (AF) is a common type of heart rhythm disorder that considerably elevates the risk of stroke. Identifying risk factors and their association with stroke in AF patients is essential for effective prevention strategies. Methodology This cross-sectional study was conducted at the Cardiology Department of Khyber Teaching Hospital, Peshawar, Pakistan, from October 2024 to March 2025. A total of 345 patients with diagnosed AF were enrolled using a non-probability purposive sampling technique. The CHA₂DS₂-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, Prior Stroke or transient ischemic attack (TIA) or thromboembolism, Vasculardisease, Age 65-74 years, Sex category) score was used to assess stroke risk, and associations with various risk factors were analyzed using the Chi-square test. Results Stroke or transient ischemic attack (TIA) was reported in 13% of patients. Significant associations were found between stroke risk and smoking, obesity, chronic kidney disease, thyroid disease, and physical inactivity. No significant correlation was found with alcohol consumption, likely due to cultural and religious practices. Conclusion This study highlights a notable stroke prevalence among AF patients and underscores the importance of managing modifiable risk factors to reduce stroke risk.

Recent trends in in-hospital acute decompensated heart failure (ADHF) have been reported in several registry studies demonstrating no improvement in terms of mortality rate and readmission rate due to heart failure (HF) exacerbation. Trends in management of ADHF may be different in areas where the aging rate is faster.

We retrospectively enrolled 1121 ADHF patients hospitalized between 2008 and 2019. The study patients were classified into three groups based on 4-year periods. Our primary study interests were trends over time in age, length of hospital stay, and clinical outcomes, with endpoints, including 1-year mortality and readmission for HF (reHF).

During the 12-year period, the length of hospital stay was not reduced, but rather prolonged in Period 3 (p < 0.001). Temporal trends in 1-year clinical outcomes showed both 1-year all-cause and cardiovascular mortality tended to increase. No improvement in 1-year reHF rates was observed over time. All-cause mortality was associated with Period 2 (95%CI 1.02-4.97), Period 3 (95%CI 1.30-6.05), older age (≥79 years, 95%CI 1.01-3.20), decreased left ventricular ejection fraction (95%CI 1.08-3.62), higher loop diuretics dose (95%CI 1.07-1.25), higher B-type natriuretic peptide (BNP) levels (95%CI 1.00, 1.01), and decreased hemoglobin levels (95%CI 0.74-0.97). Factors associated with cardiovascular mortality included Period 3 (95%CI 1.02-7.31), higher loop diuretics dose (HR 1.17, 95%CI 1.07-1.27), higher BNP levels (95%CI1.00-1.01), and lower estimated glomerular filtration rate (eGFR) levels on admission (95%CI 0.70-0.95). Predictors of reHF were number of previous HF hospitalizations (95%CI 1.13-1.94), lower eGFR levels (95%CI 0.79-0.94) on admission and suboptimal guideline-directed medical therapy (95%CI 0.50-0.79).

Despite the recent advances in medical therapy, readmission rate in patients with ADHF did not improve during the 12-year observation period. The mortality rate worsened over time. These findings warrant prompt establishment of more effective approaches to prevent and treat ADHF.

Myocardial infarction (MI) with resulting congestive heart failure is one of the leading causes of death worldwide. Current therapies for treating MI, such as devices, traditional medicine, and surgeries, come with many limitations as patients in their final stages of heart failure have little chances of experiencing any reversible changes. In recent decades, Mesenchymal stem cell (MSC) based therapy has become one of the most popular and rapidly developing fields in treating MI. Their supremacy for clinical applications is partially due to their unique properties and encouraging pre-clinical outcomes in various animal disease models. However, the majority of clinical trials registered for MSC therapy for diverse human diseases, including MI, have fallen short of expectations. This review intends to discuss the recent advances in the clinical application of using MSCs for cardiac repair and discuss challenges facing the clinical translation of MSCs for cardiac regeneration such as restoration of endothelial-cardiomyocyte crosstalk, immunomodulation and immune rejection, poor homing and migration, as well as low retention and survival. Furthermore, we will discuss recent strategies being investigated to help overcome some of these challenges.

We examined the relationships between neighborhood characteristics, cumulative genetic risk for Alzheimer's disease (polygenic scores for Alzheimer's disease), and cognitive function using data from the Health and Retirement Study (2008-2020, age>50). Baseline perceived neighborhood characteristics were combined into a subjective neighborhood disadvantage index. Cognitive function was assessed at baseline and measured biennially over a 10-year follow-up period. Analyses were stratified by genetic ancestry. Cox proportional hazard models analyzed associations between neighborhood characteristics, Alzheimer's disease polygenic scores, and their interactions on cognitive impairment. In the European ancestries sample, a one standard deviation higher score on the subjective neighborhood disadvantage index was associated with a higher hazard of any cognitive impairment (HR:1.09; CI:1.03-1.15). Similarly, a one standard deviation increase in Alzheimer's disease polygenic score was associated with a higher risk of cognitive impairment (HR:1.10; CI:1.05-1.16). Similar effect sizes were observed when examining cognitive impairment without dementia and dementia separately. No significant interactions were found. Comparable but nonsignificant trends were noted in the African ancestries sample. Subjective neighborhood disadvantage index and Alzheimer's disease polygenic score were independently associated with incident cognitive impairment. Preventing dementia by addressing modifiable risk factors is essential.

In recent years, the number of elderly heart failure patients with multiorgan failure has been increasing. Furthermore, the combination of heart failure and decreased hepatic reserve can cause severe skeletal muscle impairment and decreased survival rates. This study investigated whether the degree of improvement in the five repetitions of sit-to-stand (5STS) and walking speed (WS) differs depending on hepatic reserve in elderly heart failure patients.

The patients were divided into the following two groups: good hepatic reserve (albumin-bilirubin score [ALBI score] ≤-2.25) and poor hepatic reserve (ALBI score >-2.25). Propensity score matching was performed using the brain natriuretic peptide level. A two-way analysis of variance (ANOVA) was performed to examine the main effects of the hepatic reserve and time points (admission or discharge).

After propensity score matching, 28 out of the 33 (84.8%) patients in the good hepatic reserve (age, 83.74 ± 9.25 years and ALBI score, -2.55 ± 0.19 points) and 27 out of 40 (67.5%)patients in the poor hepatic reserve (age, 85.85 ± 7.53 years and ALBI score, -1.93 ± 0.26 points) were analyzed. Two-way ANOVA showed that the 5STS (p = 0.04) and WS (p = 0.01) in poor hepatic reserve tended to be worse than in good hepatic reserve. Furthermore, the 5STS (p = 0.04) and WS tended to improve at discharge in both groups. However, the improvement in WS was not significant (p = 0.15).

Our study suggests that the hepatic reserve in elderly heart failure patients may be an important factor in the assessment of physical functions.

The objective of this study is to examine the therapeutic efficacy of miR-133a-transfected bone marrow mesenchymal stem cells (BM-MSCs) in restoring damaged myocardium, reducing myocardial fibrosis, and improving cardiac function following myocardial infarction (MI).

Bone marrow mesenchymal stem cells (BM-MSCs) were transfected with miR-133a using lentivirus vectors, and the in vitro transfection efficiency was assessed. A rat MI animal model was established to examine the survival rate of miR-133a-transfected BM-MSCs in ischemic myocardium. The effects of miR-133a transfection on rat primary cardiac fibroblasts were evaluated both in vitro and in vivo.

The experimental group had a significantly higher concentration of double-stranded DNA (dsDNA) compared to the control group. Fluorescent staining revealed an enhanced survival rate of MSCs in the miR-133a transfection group compared to controls. Additionally, the protein and gene expression of apoptosis-related indicators in the infarcted myocardium were lower in the experimental group compared to the control group. Following co-culture with rat primary cardiac fibroblasts, the miR-133a-transfected MSCs exhibited a significantly lower expression of myofibroblast-specific proteins and mRNA compared to controls. The levels of collagen I, connective tissue growth factor (CTGF) protein, and messenger RNA (mRNA) in the infarcted myocardium of rats transplanted with BM-MSCs transfected with miR-133a were significantly lower than those in the control group, and their left ventricular ejection fraction (LVEF) was significantly increased compared with the group that received unmodified BM-MSCs.

Our results demonstrate that miR-133a transfection following MI improves the survival rate of transplanted MSCs in ischemia-hypoxic myocardium, inhibits the transformation of cardiac fibroblasts into myofibroblasts, reduces myocardial fibrosis, and improves cardiac function following MI. This approach holds promise as a novel therapeutic strategy for myocardial repair.

Many researchers nowadays choose multi-omics techniques for myocardial infarction studies. However, there's yet to be a review article integrating myocardial infarction multi-omics. Hence, this study adopts the popular bibliometrics. Based on its principles, we use software like R Studio, Vosviewer, Citespace, and SciMAT to analyze literature data of myocardial infarction omics research (1991-2022) from Web of Science. By extracting key information and calculating weights, we conduct analyses from 4 aspects: Collaboration Network Analysis, Co-word Analysis, Citing and Cited Journal Analysis, and Co-citation and Clustering Analysis, aiming to understand the field's cooperation, research topic evolution, and knowledge flow. The results show that myocardial infarction omics research is still in its early stage with limited international cooperation. In terms of knowledge flow, there's no significant difference within the discipline, but non-biomedical disciplines have joined, indicating an interdisciplinary integration trend. In the overall research field, genomics remains the main topic with many breakthroughs identifying susceptibility sites. Meanwhile, other omics fields like lipidomics and proteomics are also progressing, clarifying the pathogenesis. The cooperation details in this article enable researchers to connect with others, facilitating their research. The evolution trend of subject terms helps them set goals and directions, quickly grasp the development context, and read relevant literature. Journal analysis offers submission suggestions, and the analysis of research base and frontier provides references for the research's future development.

This study aims to explore the regulatory role of cuproptosis in carotid intimal hyperplasia (IH), providing new insights into its pathophysiological mechanisms and potential diagnostic and therapeutic strategies.

We downloaded single-cell sequencing and bulk transcriptome data from the GEO database to screen for copper-growth-associated genes (CAGs) using machine-learning algorithms, including Random Forest and Support Vector Machine. After identifying relevant genes, we verified CAGs expression in IH and control groups using a rat model of carotid balloon strain. We analyzed the immune infiltration characteristics of carotid intimal hyperplasia and used electron microscopy to observe mitochondrial structural changes in cuproptosis. Additionally, we performed subgroup analyses of carotid balloon strains. The cuproptosis activity of VSMCs was explored in a single-cell dataset. Immunohistochemistry was applied to validate the expression of CAGs.

By means of machine learning algorithms, we identified several genes, including Pdhx and Fdx1, as novel therapeutic targets for carotid intimal hyperplasia. Meanwhile, immunohistochemistry results observed decreased expression of Pdhx and Fdx1 in the Neointimal hyperplasia(Neo) group. Immunohistochemical results showed a difference in cellular infiltration between Dendritic cells resting and Mast cells resting. By calculating cuproptosis activity in vascular smooth muscle cells (VSMCs), we found increased cuproptosis activity in normal vascular smooth muscle cells which was also observed in the electron microscopy. Microscopy revealed less mitochondrial swelling characteristic of cuproptosis in Neo group.

The CAGs identified may regulate intimal hyperplasia in rat carotid arteries by modulating cuproptosis and represent potential targets for treatment.

Uncontrolled hypertension is a significant US health problem, despite existing effective treatments. This study assessed the impact of variations in patterns of blood pressure data on physician perceptions of hypertension control using different forms of data visualization.

Physicians (N = 57) reviewed eight brief vignettes describing a fictitious patient; each vignette included a graph of the patient's blood pressure data. We examined how variations in mean systolic blood pressure (SBP), blood pressure standard deviation (SD), and form of visualization (e.g., line graph with raw values or smoothed values only) affected judgments about hypertension control and need for medication change.

Smoothing successfully reduced visual noise for the physicians. For controlled hypertension, physician judgments were more consistent with clinical guidelines when using the smoothed graph compared with the raw data graph. Judgments about hypertension control with the smoothed graph were similar to judgments made using the raw data graph for cases of uncontrolled hypertension.

Data visualization can direct physicians to attend to more clinically meaningful information, thereby improving their judgments of hypertension control.

Hypoxic-ischemic brain injury is a common cause of mortality after cardiac arrest (CA) and cardiopulmonary resuscitation; however, the specific underlying mechanisms are unclear. This study aimed to explore postresuscitation changes based on multi-omics profiling.

A CA swine model was established, and the neurological function was assessed at 24 h after resuscitation, followed by euthanizing animals. Their fecal, blood, and hippocampus samples were collected to analyze gut microbiota, metabolomics, and transcriptomics.

The 16S ribosomal DNA sequencing showed that the microbiota composition and diversity changed after resuscitation, in which the abundance of Akkermansia and Muribaculaceae_unclassified increased while the abundance of Bifidobacterium and Romboutsia decreased. A relationship was observed between CA-related microbes and metabolites via integrated analysis of gut microbiota and metabolomics, in which Escherichia-Shigella was positively correlated with glycine. Combined metabolomics and transcriptomics analysis showed that glycine was positively correlated with genes involved in apoptosis, interleukin-17, mitogen-activated protein kinases, nuclear factor kappa B, and Toll-like receptor signal pathways.

Our results provided novel insight into the mechanism of hypoxic-ischemic brain injury after resuscitation, which is envisaged to help identify potential diagnostic and therapeutic markers.

Compared with normal hearts, failing hearts are more vulnerable to develop atrial fibrillation under sympathetic stimulation. It has been shown that dobutamine and caffeine challenge can induce spontaneous ventricular tachyarrhythmias in normal hearts.

This study was designed to investigate whether failing hearts have increased vulnerability to dobutamine- and caffeine-induced ventricular arrhythmias, and whether dantrolene treatment provides therapeutic benefits in this condition.

A myocardial infarction (MI)-heart failure (HF) rat model was used 2 months after surgery. Sham-surgery animals served as the control animals. MI-HF rats were randomized into MI-HF untreated and MI-HF dantrolene-treated groups. Dobutamine (25 μg/kg, intraperitoneal [IP]) and caffeine (50 mg/kg, IP) were administered acutely to induce ventricular arrhythmias. MI-HF-dantrolene group received dantrolene (10 mg/kg, IP) 30 minutes before the arrhythmia test. Spontaneous Ca2+ sparks in isolated ventricular myocytes from control and MI-HF rats were also examined.

Dobutamine induced less inotropic response in MI-HF rats than in control rats. Dobutamine + caffeine induced ventricular tachyarrhythmias in 9 of 10 MI-HF rats, while no ventricular arrhythmia was induced in the control rats (P < .01). Dantrolene treatment significantly decreased ventricular arrhythmia inducibility (n = 2 of 10, P < .05) in MI-HF rats. In isolated ventricular myocytes, Ca2+ sparks were significantly increased in MI-HF rats, and dantrolene treatment decreased Ca2+ sparks in these animals.

Although dobutamine evoked less inotropic effects, failing hearts were more vulnerable to dobutamine and caffeine-induced ventricular tachyarrhythmias. Dantrolene treatment decreased Ca2+ sparks in isolated ventricular myocytes from failing hearts and ameliorated ventricular tachyarrhythmias induced by dobutamine and caffeine in MI-HF rats in vivo.

Research on predictive models for hospital mortality in patients who have survived 24 h following cardiopulmonary resuscitation (CPR) is limited. We aim to explore the factors associated with hospital mortality in these patients and develop a predictive model to aid clinical decision-making and enhance the survival rates of patients post-resuscitation.

We sourced the data from a retrospective study within the Dryad dataset, dividing patients who suffered cardiac arrest following CPR into a training set and a validation set at a 7:3 ratio. We identified variables linked to hospital mortality in the training set using Least Absolute Shrinkage and Selection Operator (LASSO) regression, as well as univariate and multivariate logistic analyses. Utilizing these variables, we developed a prognostic nomogram for predicting mortality post-CPR. Calibration curves, the area under receiver operating curves (ROC), decision curve analysis (DCA), and clinical impact curve were used to assess the discriminability, accuracy, and clinical utility of the nomogram.

The study population comprised 374 patients, with 262 allocated to the training group and 112 to the validation group. Of these, 213 patients were dead in the hospital. Multivariate logistic analysis revealed age (OR 1.05, 95% CI: 1.03-1.08), witnessed arrest (OR 0.28, 95% CI: 0.11-0.73), time to return of spontaneous circulation (ROSC) (OR 1.05, 95% CI: 1.02-1.08), non-shockable rhythm (OR 3.41, 95% CI: 1.61-7.18), alkaline phosphatase (OR 1.01, 95% CI: 1-1.01), and sequential organ failure assessment (SOFA) (OR 1.27, 95% CI: 1.15-1.4) were independent risk factors for hospital mortality for patients who survived 24 h after CPR. ROC of the nomogram showed the AUC in the training and validation group was 0.827 and 0.817, respectively. Calibration curves, DCA, and clinical impact curve demonstrated the nomogram with good accuracy and clinical utility.

Our prediction model had accurate predictive value for hospital mortality in patients who survived 24 h after CPR, which will be beneficial for assisting in identifying high-risk patients and intervention. Further confirmation of the model's accuracy required external validation data.

Revascularization therapies, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), alleviate symptoms and treat myocardial ischemia. Patients with multivessel disease, particularly those undergoing 3-vessel PCI, are more susceptible to procedural complications, which can increase healthcare costs. Developing efficient strategies for resource allocation has become a paramount concern due to tightening healthcare budgets and the escalating costs of treating heart conditions. Therefore, it is essential to develop an evaluation model to estimate the costs of PCI surgeries and identify the key factors influencing these costs to enhance healthcare quality. This study utilized the National Health Insurance Research Database (NHIRD), encompassing data from multiple hospitals across Taiwan and covering up to 99% of the population. The study examined data from triple-vessel PCI patients treated between January 2015 and December 2017. Additionally, six machine-learning algorithms and five cross-validation techniques were employed to identify key features and construct the evaluation model. The machine learning algorithms used included linear regression (LR), random forest (RF), support vector regression (SVR), generalized linear model boost (GLMBoost), Bayesian generalized linear model (BayesGLM), and extreme gradient boosting (eXGB). Among these, the eXGB model exhibited outstanding performance, with the following metrics: MSE (0.02419), RMSE (0.15552), and MAPE (0.00755). We found that the patient's medication use in the previous year is also crucial in determining subsequent surgical costs. Additionally, 25 significant features influencing surgical expenses were identified. The top variables included 1-year medical expenditure before PCI surgery (hospitalization and outpatient costs), average blood transfusion volume, ventilator use duration, Charlson Comorbidity Index scores, emergency department visits, and patient age. This research is crucial for estimating potential expenses linked to complications from the procedure, directing the allocation of resources in the future, and acting as an important resource for crafting medical management policies.

Although there are certain drug categories associated with heart failure (HF), most of the associated risks are unclear. We investigated the top drugs associated with HF and acute HF (AHF) reported in the FDA Adverse Event Reporting System (FAERS).

We reviewed publicly available FAERS databases from 2004 to 2023. Using the search terms "cardiac failure" or "cardiac failure acute" and classifying cases by drug name, we processed and analyzed drug reports related to HF or AHF.

From 2004 to 2023, 17,379,609 adverse drug events were reported by FAERS, of which 240,050 (1.38%) were reported as HF. Among those with HF, the male-to-female ratio was 0.94% and 52.37% were >65 years old; 46.2% were from the United States. There were 5,971 patients with AHF. We identified 38 drugs and 13 drug classes with a potential high risk of causing HF, and 41 drugs and 19 drug classes were associated with AHF. The median onset times of HF and AHF were 83 days (IQR: 11-416) and 49 days (IQR: 8-259), respectively. The Weibull shape parameter (WSP) test showed early failure-type profile characteristics.

This study highlights key drugs associated with drug-induced HF and AHF, emphasizing the importance of early risk assessment and close monitoring, particularly during the initial stages of treatment. These findings contribute to a better understanding of drug-induced HF and provide a basis for future research on its underlying mechanisms.

Immediate recognition of cardiac arrest, start of cardiopulmonary resuscitation (CPR) and early defibrillation are key factors to improve survival rates. However, there is considerable variation in the quality of bystander CPR. Video assisted CPR (V-CPR) has been shown to possibly improve CPR quality provided by bystanders. Since 2020, Norwegian emergency medical dispatchers have used V-CPR to increase dispatcher situational awareness and improve on-scene response.

We present a case with witnessed out-of-hospital cardiac arrest (OHCA) in a 58-year-old male with known cardiac disease. Two laypersons present were assisted in CPR with the use of V-CPR. This was complicated by no previous CPR training in both laypersons, long ambulance response times and CPR induced consciousness (CPRIC).

The case represents a complex cardiac arrest with prolonged CPR, CPRIC, two bystanders with no previous CPR training, where V-CPR was instrumental in providing on scene guidance and in decision-making. A more tailored approach to a complex OHCA with long lasting resuscitation was enabled, where high quality CPR was performed and no rescue breaths were given prior to EMS arrival.

Acute chest pain is one of the most common reasons for ED visits in the United States. Most patients are eventually admitted to the hospital to "rule out ACS" even when there are no significant EKG abnormalities or elevated cardiac enzymes. In addition to undergoing expensive tests while in the hospital, patients are also exposed to iatrogenic harm thereby worsening the overall healthcare costs. Meanwhile, the use of coronary computed tomography angiography (CTA) as a "gatekeeper" diagnostic test for patients with low to intermediate risk for coronary artery diseases (CADs) has significantly lowered hospital admissions and associated costs. However, coronary CTA may not be helpful for all classes of patients. Therefore, this study seeks to determine if the distribution of patients presenting to the ED with chest pain in an acute care facility will justify an investment in coronary CTA and contribute to lowering healthcare costs. Patients' data between July 2022 and June 2023 were considered in our analysis. Results revealed that a significant number of patients who presented to the ED for chest pain and were subsequently admitted to the hospital for further work-up would have benefited from coronary CTA screening without any need for further inpatient work-up. Also, cost analysis showed that the use of coronary CTA would have helped significantly lower healthcare costs in this facility.

Exercise (EX) or cognitive and social enrichment (ENRICH) are 2 strategies for promoting cognition poststroke. Whether sleep moderates the effects of EX or ENRICH on cognition in adults with chronic stroke is unknown.

A 3-arm parallel randomized clinical trial among community-dwelling adults aged 55+ years with chronic stroke (ie, ≥12 months since stroke). Participants were randomized to 2× per week EX, ENRICH, or balance and tone control (BAT). At baseline, device-measured sleep duration and efficiency were measured using wrist-worn actigraphy; self-reported quality was measured by Pittsburgh Sleep Quality Index (PSQI). Participants were categorized at baseline as having good or poor device-measured duration, device-measured efficiency, or self-reported quality based on PSQI. The primary cognitive outcome was Alzheimer's Disease Assessment Scale Plus (ADAS-Cog-Plus) measured at baseline, 6 months (end of intervention), and 12 months (6-month follow-up). We examined if baseline sleep categorizations (ie, good vs poor) moderated the effects of EX or ENRICH on ADAS-Cog-Plus.

We enrolled 120 participants in the trial (EX = 34; ENRICH = 34; BAT = 52). Sleep quality (ie, device-measured sleep efficiency or self-reported sleep quality) categorization moderated effects of EX (but not ENRICH) on ADAS-Cog-Plus. Compared with BAT participants with poor sleep quality, EX participants with poor sleep quality had better ADAS-Cog-Plus performance at 6 months (estimated mean difference for those with poor device-measured sleep efficiency: -0.48; 95% CI [-0.85, -0.10]; p = .010); estimated mean difference for those with poor self-reported sleep quality: -0.38; 95% CI [-0.70, -0.07]; p = .014). There was no effect of EX on ADAS-Cog-Plus for participants with good sleep quality. Device-measured sleep duration did not moderate intervention effects.

Exercise is particularly beneficial in improving cognitive function in adults with chronic stroke and poor sleep quality.

Severe left ventricular dysfunction and ventricular wall motion abnormalities predispose individuals to thrombosis and thromboembolism. Thromboembolism is one of the main causes of increased mortality in patients with heart failure and reduced ejection fraction (HFrEF). However, regarding thromboembolism due to HFrEF in sinus rhythm, most cases to date have reported ischemic strokes, and repeated embolization of peripheral arteries has been reported not uncommon. Herein, we report the case of a 48-year-old man with a definite diagnosis of sinus rhythm HFrEF and recurrent peripheral arterial embolization within a short period. The condition is caused by severe left ventricular systolic dysfunction and abnormal left ventricular wall motion, resulting in blood stasis and abnormal blood composition, with or without left ventricular thrombosis, and can lead to thromboembolism. Current guidelines state that patients with heart failure and clear indication(s) for anticoagulation (e.g., atrial fibrillation, heart valve replacement) should be administered appropriate anticoagulation therapy. However, controversy persists regarding whether patients with HFrEF in sinus rhythm can benefit from anticoagulation therapy. This case highlights the utility and necessity of anticoagulation for the prevention of intracardiac thrombosis and the treatment of peripheral arterial embolism in patients with HFrEF in sinus rhythm.

While resuscitation guidelines emphasize early vasopressor administration and advanced airway management, their optimal sequence remains unclear. We sought to determine the associations between vasopressor-airway resuscitation sequence and out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART).

We analyzed data from the PART trial. For each patient we determined times of first vasopressor administration (epinephrine or vasopressin), and successful advanced airway insertion (laryngeal tube or endotracheal tube). We classified each case as vasopressor-first or advanced airway-first. We used Generalized Estimating Equations to determine associations between vasopressor-airway sequence and outcomes (72-hour survival, return of spontaneous circulation (ROSC) on emergency department arrival, survival to hospital discharge, hospital survival with favorable neurologic status) and CPR outside of recommended parameters (chest compression fraction <0.8, chest compression rate <100 or >120 per min, or ventilation rate <8 or >12 breaths/min), adjusting for confounders.

Of 3,004 patients in the parent trial, we analyzed 2,404, including 1,821 vasopressor-first and 583 advanced airway-first. Median intervention times: ALS arrival-to-vasopressor 8 min (IQR 6-11) and ALS arrival-to-airway 11 min (8-15). Compared with airway-first, vasopressor-first sequence was not associated with 72-hour survival (adjusted OR 0.96; 95% CI: 0.71-1.31), ROSC (0.83; 0.66-1.06), hospital survival (1.09; 0.68-1.73), or hospital survival with favorable neurologic status (0.97; 0.53-1.78). Vasopressor-first sequence was not associated with non-compliance with recommended CPR performance parameters.

Vasopressor-airway resuscitation sequence was not associated with OHCA outcomes or CPR quality.

Historically, the management of carotid artery disease has primarily focused on the degree of stenosis as the main indicator for assessing stroke etiology, risk, and need for intervention. However, accumulating evidence suggests that structural and biological features within the arterial wall, such as intraplaque hemorrhage, may have superior diagnostic, prognostic, and therapeutic values. Under current guidelines, unless an atheroma results in ≥50% stenosis, it is not considered the cause of a cerebrovascular event. This results in extensive and often unproductive diagnostic workup, prescription of ineffective medical therapy, and preclusion of patients from receiving revascularization procedures that have been shown to prevent recurrent cerebrovascular events in cases of ≥50% stenosis. A subset of embolic strokes of undetermined source, which account for up to 25% of all ischemic cerebrovascular events, are thought to be due to thromboembolic phenomena from undiagnosed plaque disruptions in nonstenotic arteries (<50% stenosis). Recently, it has been proposed to reclassify this subgroup of patients as symptomatic nonstenotic carotid if the carotid plaque ipsilateral to the cerebrovascular event presents with high-risk features including intraplaque hemorrhage, lipid-rich necrotic core, thinning/rupture of the fibrous cap, and ulceration. In this review, we first provide a historical overview of the chain of events and circumstances that resulted in the present management of carotid artery disease. Second, we embed the contemporary biomarkers of plaque vulnerability in a modern mechanistic paradigm of carotid plaque disruption and thromboembolization. Third, we review the clinically available imaging tools to detect these biomarkers, and how their use has started to shed light on the prevalence and natural history of this underdiagnosed condition. Fourth, we review recent clinical studies employing a contemporary definition of symptomatic nonstenotic carotid and discuss targeted treatments for this condition. Finally, we make a case to generate the much-needed high-level evidence to align the clinical management of patients with symptomatic nonstenotic carotid with a contemporary understanding of plaque disruption and thromboembolization.

The cost-effectiveness of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) has previously been reported across the spectrum of surgical mortality risk. We present an updated analysis specific to the UK based on 4-year data from the Evolut Low Risk Trial, which showed a maintained numerical survival benefit with TAVI.

A decision-analytic Markov model was used to project outcomes and costs over a lifetime horizon. Adverse events and utilities were modeled based on 4-year trial data. Beyond 4 years, no difference in long-term survival between TAVR and SAVR was assumed. Costs were informed by NHS England reference costs and reflect resource utilization in the UK TAVI Trial, with costs and effects discounted at 3.5% p.a. The lifetime incremental cost-effectiveness ratio (ICER) was evaluated against the established £20,000-£ 30,000 per QALY cost-effectiveness threshold. Extensive sensitivity and scenario analyses were performed, including comparison to prior results based on 12-month data.

TAVI improved survival by 0.41 life years and added 0.28 QALYs at incremental cost of £5,021, resulting in a lifetime ICER of £17,883 per QALY gained. 57.5% and 85.3% of probabilistic sensitivity analysis simulations were cost-effective at the £20,000 and £30,000 per QALY thresholds. Use of 4- vs. 1-year trial data markedly improved lifetime cost-effectiveness.

Recent 4-year follow-up data from the Evolut Low Risk trial suggest TAVI adds meaningful patient benefit over lifetime and can be expected to be a cost-effective intervention compared to SAVR for low surgical risk patients in a UK setting.

We examined the presentation to hospital, subtypes of ischaemic stroke for patients admitted to stroke services in Qatar and their 90-day prognosis based on the modified Rankin Scale (mRS) for those with diagnosed and undiagnosed diabetes, hypertension and dyslipidaemia.

We conducted a retrospective analysis of patients admitted with acute ischaemic stroke from January 2014 to April 2024. The mRS was dichotomised with favourable outcome (0-2) and unfavourable outcome (3-6).

A total of 9479 patients were included in the study. Patients with a prior history of hypertension and dyslipidaemia and untreated/undiagnosed for these risk factors on admission were more likely to present with a lower National Institute of Health Stroke Scale (NIHSS) score at admission (p<0.001). These patients were also more likely to present with small vessel disease (SVD) or subcortical stroke (p<0.001). Multivariate analysis revealed that age (adjusted OR 1.05, 95% CI 1.04 to 1.06) and hypertension (adjusted OR 1.44, 95% CI 1.07 to 1.96) were more likely to have an mRS score of 3-6 at 90 days while males (adjusted OR 0.56, 95% CI 0.46 to 0.69), prior antidiabetic therapy (adjusted OR 0.52, 95% CI 0.34 to 0.79) and undiagnosed diabetes (adjusted OR 0.46, 95% CI 0.22 to 0.99) were protective against an mRS score of 3-6 at 90 days after adjusting for covariates.

Patients with a prior history of hypertension and dyslipidaemia and undiagnosed on admission are more likely to present with a lower NIHSS score but have a worse outcome at 90 days. The lower NIHSS may be explained by a higher frequency of SVD.

Research has started using Magnetic Resonance Imaging (MRI) to elucidate the action of acupuncture on neuroplasticity following ischemic stroke (IS). Acupuncture is thought to be a potentially beneficial treatment for IS. However, the results remain inconsistent because of MRI processing techniques and study design variations. Therefore, this coordinate-based meta-analysis and systematic review aimed to assess the current state of knowledge about the regional brain fMRI imaging characteristics in acupuncture-treated IS patients. Twenty studies-including 392 IS patients and 256 health controls-met the inclusion criteria after searches via Chinese and English databases. The design techniques utilized in this research were mainly owned before-and-after controlled and randomized controlled trials. Only one study used independent component analysis (ICA), while the majority of MRI analytical techniques focus on functional connectivity (FC) and fractional amplitude of low-frequency fluctuation (fALFF/ALFF). The findings demonstrated a significant rise in the ALFF value of the left supplementary motor region after treatment with acupuncture. The left cerebellum, right inferior frontal gyrus, and hemisphere lobule VIII all showed substantial activation of Reho values. The triangular portion, BA 48, the left inferior network and inferior longitudinal fasciculus, as well as other brain areas decreased in the left inferior frontal gyrus; most research has used FC analysis employing motor areas as seed regions. We found that acupuncture regulated the motor-related network and reorganized the language-related network. Furthermore, acupuncture appears therapeutic for several IS effects, which may be connected to how acupuncture regulates the brain's plasticity.

About 10 million individuals in USA presented annually in the emergency department (ED) with chest pain or with signs and symptoms of acute coronary syndrome (ACS). The advent of point of care (POC) devices, able to measure high sensitivity troponin, are a very interesting tool in the ED setting for its rapid turnaround time (<10 min).

The present study evaluates the diagnostic performance of the Atellica VTLi (Siemens) in real life setting using the clinical data derived from integrated diagnoses of emergency room staff and cardiologist and in comparison with standard laboratory hs-cTnT assay (Cobas 8000, Elecsys, Roche). 966 patients admitted to the emergency department of "G. Mazzini Hospital" in Teramo, Italy, from July 27, 2022, through June 09, 2023, were enrolled.

The diagnostic performance of POC hs-cTnI was evaluated. An appropriate POC hs-cTnI threshold values <4 ng/L supplied a sensitivity and an NPV of 100 % (95 % CI: 99.5-100) in order to achieve rapid rule out for MI through a single measurement at patient presentation in the ED. Furthermore, a derivation POC hs-cTnI concentration >54 ng/L provided a specificity of 97.2 % (95 % CI: 95.9-98.1) and a PPV of 43.5 % (95 % CI: 40.3-46.7) for ruling in MI.

This platform showed comparable diagnostic performance for myocardial infarction to the central laboratory. Our data suggest the possible use of the Atellica VTLi hs-cTnI POC assay either in emergency department of urban medical centre, either in rural hospital for triage and patient management.

Ischemic stroke often leads to cognitive dysfunction, which delays the recovery process of patients. However, its pathogenesis is not yet clear. In this study, the cerebral ischemia-reperfusion model was built as the experimental object, and the hippocampal dentate gyrus (DG) was the target brain area. TTC staining was used to evaluate the degree of cerebral infarction, and nerve cell membrane potentials and local field potentials (LFPs) signals were collected to explore the mechanism of cognitive impairment in ischemia-reperfusion mice. The results showed that the infarcted area on the right side of the brain of the mice in the model group was white. The resting membrane potential, the number of action potential discharges, the post-hyperpolarization potential and the maximum ascending slope of the hippocampal DG nerve cells in the model mice were significantly lower than those in the control group ( P < 0.01); the peak time, half-wave width, threshold and maximum descending slope of the action potential were significantly higher than those in the control group ( P < 0.01). The time-frequency energy values of LFPs signals in the θ and γ bands of mice in the ischemia and reperfusion groups were significantly reduced ( P < 0.01), and the time-frequency energy values in the reperfusion group were increased compared with the ischemia group ( P < 0.01). The signal complexity of LFPs in the ischemia and reperfusion group was significantly reduced ( P < 0.05), and the signal complexity in the reperfusion group was increased compared with the ischemia group ( P < 0.05). In summary, cerebral ischemia-reperfusion reduced the excitability of nerve cells in the DG area of the mouse hippocampus; cerebral ischemia reduced the discharge activity and signal complexity of nerve cells, and the electrophysiological indicators recovered after reperfusion, but it failed to reach the healthy state during the experiment period.

This study aims to assess the  consistency of various CT-FFR software, to determine the reliability of current CT-FFR software, and to measure relevant influence factors. The goal is to build a solid foundation of enhanced workflow and technical principles that will ultimately improve the accuracy of measurements of coronary blood flow reserve fractions. This improvement is critical for assessing the level of ischemia in patients with coronary heart disease.

103 participants were chosen for a prospective research using coronary computed tomography angiography (CCTA) assessment. Heart rate, heart rate variability, subjective picture quality, objective image quality, vascular shifting length, and other factors were assessed. CT-FFR software including K software and S software are used for CT-FFR calculations. The consistency of the two software is assessed using paired-sample t-tests and Bland-Altman plots. The error classification effect is used to construct the receiver operating characteristic curve.

The CT-FFR measurements differed significantly between the K and S software, with a statistical significance of P < 0.05. In the Bland-Altman plot, 6% of the points (14 out of 216) fell outside the 95% consistency level. Single-factor analysis revealed that heart rate variability, vascular dislocation offset distance, subjective image quality, and lumen diameter significantly influenced the discrepancies in CT-FFR measurements between two software programs (P < 0.05). The ROC curve shows the highest AUC for the vessel shifting length, with an optimal cut-off of 0.85 mm.

CT-FFR measurements vary among software from different manufacturers, leading to potential misclassification of qualitative diagnostics. Vessel shifting length, subjective image quality score, HRv, and lumen diameter impacted the measurement stability of various software.

Cardiovascular diseases (CVDs) are a major cause of death globally, and minority communities are at higher risk of chronic health outcomes. A combination of lifestyle, including physical activity (PA), good nutrition, and reduced stress, can improve life expectancy. This study aimed to analyze the association between CVDs and PA among the adult population (N = 3,956) based on the World Health Organization (WHO) STEPwise Approach to Surveillance (STEPS) survey in Afghanistan. Descriptive statistics, logistic regression, and spatial analytical techniques were used to analyze the data. Based on the WHO STEPS data, the computed prevalence of CVDs, obesity, hypertension, diabetes, and high cholesterol were 7.41%, 45.57%, 34.06%, 9.51%, and 12.16%, respectively. Multivariate logistic analysis indicated that moderate work-related PA was associated with higher odds of CVDs and high cholesterol while inversely associated with obesity. Moderate leisure-related PA was positively associated with obesity. Vigorous leisure-related PA was associated with lower risks of CVDs, obesity, and high cholesterol but had a positive association with hypertension. Spatial analysis revealed a CVD hotspot in the southern region and the risk factors clustered in the northern region. These findings offer valuable insights for community and public health practitioners to design targeted interventions for reducing the burden of CVDs and risk factors in communities in developing countries.

Background: Acute Heart Failure (AHF) is a leading cause of hospitalizations and remains a significant socioeconomic burden. Despite advances in medical care, mortality and rehospitalization rates remain high. Previous AHF audits have revealed regional differences and a poor adherence to guidelines. This study aimed to assess guideline adherence in a public teaching hospital to identify areas for improvement. Methods: This retrospective observational study examined clinical routine data of patients hospitalized for AHF at a Swiss public teaching hospital between 2018 and 2019. AHF management was evaluated against the relevant guidelines of the European Society of Cardiology. Results: The study included 760 AHF cases of 726 patients (median age 84 years, range 45-101, 50% female). NT-pro-BNP levels were measured in 92% of the cases. Electrocardiography was performed in 95% and chest X-rays in 90% of cases. Echocardiography was conducted in 54% of all cases and in 63% of newly diagnosed AHF cases. Intravenous furosemide was initiated in 76%. In the subgroup of cases with reduced ejection fraction (HFrEF), 86% were discharged with beta-blockers and 69% with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Among cases with left ventricular ejection fraction ≤ 35%, mineralocorticoid receptor antagonists were prescribed in 55%. Conclusions: We observed generally good adherence to guideline recommendations. However, several improvements are needed in initial assessment and documentation, diagnostic procedures such as echocardiography, discharge medication, and lifestyle recommendations. Compared to other studies, our diagnostic workup was more aligned with guidelines, the use of intravenous diuretics was similar, and the duration of hospital stay and mortality rates were comparable.

Intravenous thrombolysis (IVT) and/or endovascular therapy (EVT) are currently considered best practices in acute stroke patients. Data regarding the efficacy and safety of reperfusion therapies in patients with atrial fibrillation (AF) are conflicting as regards haemorrhagic transformation, mortality, and functional outcome. This study sought to investigate for any differences, in terms of safety and effectiveness, between AF patients with acute ischaemic stroke (AIS) treated and untreated with reperfusion therapies.

Data from two multicenter cohort studies (RAF and RAF-NOACs) on consecutive patients with AF and AIS were analyzed to compare patients treated and not treated with reperfusion therapies (IVT and/or EVT). Multivariable logistic regression analysis was performed to identify independent predictors for outcome events: 90-day good functional outcome and mortality. A propensity score matching (PSM) analysis compared treated and untreated patients.

Overall, 441 (25.4%) were included in the reperfusion-treated group and 1,295 (74.6%) in the untreated group. The multivariable model suggested that reperfusion therapies were significantly associated with good functional outcome. Rates of mortality and disability were higher in patients not treated, especially in the case of higher NIHSS scores. In the PSM comparison, 173/250 patients (69.2%) who had received reperfusion therapies had good functional outcome at 90 days, compared to 146/250 (58.4%) untreated patients (p = 0.009, OR: 1.60, 95% CI:1.11-2.31).

Patients with AF and AIS treated with reperfusion therapies had a significantly higher rate of good functional outcome and lower rates of mortality compared to those patients with AF and AIS who had undergone conservative treatment.

In patients presenting with ST-segment elevation myocardial infarction (STEMI), the prevalence of having concomitant severe non-culprit lesion(s) is ≥40%. While timely primary PCI (pPCI) for the culprit lesion is the standard practice, management of the non-culprit lesions remains unsettled.

This prospective multi-center observational study recruited 492 acute STEMI patients who underwent successful pPCI for the culprit lesion. Culprit-only versus complementary non-culprit lesion(s) PCI (either immediate or staged during the same hospital stay) was according to the operator's discretion. Clinical, echocardiographic, and angiographic data were collected and tabulated. The residual SYNTAX score (rSS) was completed by the time of discharge considering the residual lesions after all in-hospital revascularization procedures. Through a minimum follow-up of 12 months, older age, presentation with heart failure Killip class ≥ II, lower estimated glomerular filtration rate (eGFR) on admission, lower left ventricular ejection fraction (LVEF), and higher rSS by discharge were significantly associated with recurrent MACE. In multivariate regression analysis, Killip class ≥ II, LVEF, and rSS were found to be independent predictors for recurrent MACE. In the Receiver Operating Characteristics curve, an rSS of >8 had a sensitivity of 70.1%, and specificity of 75.3% to predict 1-year MACE.

Residual syntax score proved to be an independent predictor for recurrent MACE through the subsequent year post STEMI. Patients with rSS >8 seem to be at the highest risk for adverse events and are likely to be the most deserving for completing revascularization to reduce the disease burden.

Pulmonary embolisms (PEs) are obstructions of the pulmonary arteries by thrombi, which are emboli and they most frequently originate from the deep venous system of the inferior limbs. Emboli can also come from the inferior vena cava, abdominal and pelvic veins, or the upper body venous system from the right atrium or ventricle of the heart. Thrombi can form in situ inside pulmonary arteries as well. A cancer patient is at a higher risk for thromboembolic phenomena given both the oncological pathological context and also due to the associated medical or surgical treatment they receive. PE is a high-risk medical emergency that is associated with an increased risk of early mortality, with sudden death occurring in 25% of patients. The long-term presence of this condition can result in thromboembolic pulmonary hypertension. The risk of mortality, both in the acute and long-term, is dependent on the severity of the acute form, the recurrence of the embolism and the associated conditions. The majority of deaths associated with PE can be prevented by early diagnosis. The aim of the present review was to describe the various biological and cellular parameters, together with known paraclinical investigations, to assist in the rapid diagnosis of PE. Mortality in patients with PE and neoplastic conditions may be reduced by initiating anticoagulant treatment as soon as possible. PE may be the first manifestation of an underlying silent malignancy or may represent a complication of an already diagnosed malignancy. Exclusion or confirmation of the diagnosis is of utmost importance to avoid unnecessary anticoagulant treatment associated with a high risk of bleeding or to start immediate anticoagulant treatment if required.

This review explores the role of smartphone applications in providing real-time guidance for cardiopulmonary resuscitation (CPR) practices and highlights their potential to improve CPR quality among laypersons. A narrative literature review was conducted on the effectiveness of mobile CPR applications for smartphones. Studies published between 2014 and 2024 were included to ensure that new technological advances were examined. Our findings revealed that guided CPR applications significantly improve most critical parameters for efficacious resuscitation. Application users demonstrated that they achieved performance comparable to or even better than CPR-certified individuals. However, these tools have limitations, mostly related to familiarity, which may result in a delay in activating the application and, therefore, in initiating CPR. While smartphone applications are promising tools for enhancing bystander CPR, their integration into emergency medical response requires careful consideration. To fully take advantage of these applications, they should be incorporated into public health campaigns and standard CPR training. This would be even more successful if the application's functionality were standardized across different regions. Our research indicates that a combination of education and technology will likely play a major role in CPR training in the future, improving the efficacy and accessibility of life-saving measures. Smartphone applications could greatly improve the chain of survival in out-of-hospital cardiac arrest (OHCA) events. The design and accessibility of these applications as well as the integration of these applications with current emergency response frameworks should be the main areas of future research.