Not too much, not too little. Titrating flow rate to minimise inspiratory effort during helmet CPAP: A bench study

BACKGROUND

Non-invasive helmet respiratory support is suitable for several clinical conditions. Continuous-flow helmet CPAP systems equipped with HEPA filters have become popular during the recent Coronavirus pandemic. However, HEPA filters generate an overpressure above the set PEEP.

METHODS

A lung simulator was used to mimic patient respiratory mechanics and effort. Compared to room air spontaneous breathing, the additional inspiratory effort attributable to helmet CPAP (ΔPmusHelmet) was recorded at different continuous-flow rates (30-150 L/min), PEEP levels (5, 10, 12.5 cmH2O) and respiratory rates (15, 20, 25, 30 breaths/minute), both with and without a HEPA filter at the outlet port.

RESULTS

Helmet pressure swings during inspiration largely explained ΔPmusHelmet variations (p<0.001, Spearman's Rho=0.964). The lowest ΔPmusHelmet levels (0.2 [0; 0.4] cmH2O) were frequently recorded (>70%) at a 90 L/min flow rate. Higher ΔPmusHelmet levels were recorded when the continuous-flow was lower than the peak inspiratory flow (3.7 [3.1; 5.6] cmH2O, p<0.001) or when a HEPA filter was used (2.7 [2.2; 3.5], p<0.001). Increasing the flow rate resulted in higher overpressure levels, particularly with a HEPA filter (p<0.001). Overpressure levels correlated with ΔPmusHelmet (p<0.001, Spearman's Rho=0.598).

CONCLUSIONS

Helmet pressure swings below PEEP lead to additional inspiratory efforts. The HEPA filter acts as a flow resistor, generating an overpressure leading to increased respiratory effort. The continuous-flow rate should be titrated high enough to slightly exceed the peak inspiratory flow; however, further flow increase is not recommended as it leads to an increase in overpressure and helmet pressure swings below PEEP.

Prophylactic effects of nutrition, dietary strategies, exercise, lifestyle and environment on nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and its prevalence has risen sharply. However, whether nutrition, dietary strategies, exercise, lifestyle and environment have preventive value for NAFLD remains unclear.

METHODS

Through searching 4 databases (PubMed, Web of Science, Embase and the Cochrane Library) from inception to January 2025, we selected studies about nutrition, dietary strategies, exercise, lifestyle and environment in the prevention of NAFLD and conducted a narrative review on this topic.

RESULTS

Reasonable nutrient intake encompassing macronutrients and micronutrients have an independent protective relationship with NAFLD. Besides, proper dietary strategies including mediterranean diet, intermittent fasting diet, ketogenic diet, and dietary approaches to stop hypertension diet have their inhibitory effects on the developmental process of NAFLD. Moreover, right exercises including walking, jogging, bicycling, and swimming are recommended for the prevention of NAFLD because they could effectively reduce weight, which is an important risk factor for NAFLD, and improve liver function. In addition, embracing a healthy lifestyle including reducing sedentary behavior, not smoking, sleeping well and brushing teeth regularly is integral since it not only could reduce the risk of NAFLD but also significantly contribute to overall prevention and control. Finally, the environment, including the social and natural environments, plays a potential role in NAFLD prevention.

CONCLUSION

Nutrition, dietary strategies, exercise, lifestyle and environment play an important role in the prevention of NAFLD. Moreover, this review offers comprehensive prevention recommendations for people at high risk of NAFLD.

Effect of aspirin dosage on oxidative stress and platelet reactivity in patients undergoing coronary artery bypass grafting (APRICOT): randomized controlled trial

Coronary artery bypass grafting (CABG) triggers oxidative stress and platelet activation. High acetylsalicylic acid (ASA) dose might mitigate the transient proinflammatory state. We compared the effect of three ASA dosages on post-CABG platelet reactivity, oxidative stress, and serum CD39 and CD73 levels. Thirty-six consecutive patients undergoing elective off-pump CABG, pre-treated with ASA 1 × 75 mg for ≥7 days, were randomized to continue the prior treatment regimen, switch to ASA 1 × 150 mg, or ASA 2 × 75 mg. Blood was collected on admission, 7 days, 1 month, and 3 months after CABG. Platelet reactivity was assessed using impedance aggregometry. Platelet oxidative stress was measured as platelet mitochondria extracellular oxygen consumption rate and oxidatively damaged whole-blood DNA cleavage. Serum CD39 and CD73 levels were determined using ELISA. Platelet reactivity and oxidative stress parameters were comparable in all groups. Patients treated with ASA 2 × 75 mg had higher CD39 levels at 7 days and 1 month (p = .049, p = .033), compared to the control group. ASA 2 × 75 mg was associated a beneficial effect on serum CD39 levels after off-pump CABG, without a significant effect on oxidative stress parameters.

Ventricular-arterial coupling: changes with ageing and implications across cardiovascular conditions

PURPOSE

Ventricular-arterial coupling (VAC) is a crucial concept in cardiovascular physiology, representing the dynamic interaction between the left ventricle and the arterial system. This comprehensive literature review explores the changes in VAC with ageing and various cardiovascular diseases (CVDs).

MATERIALS AND METHODS

This literature review covers studies on changes in VAC with age and common CVDs, such as arterial hypertension, atrial fibrillation (AF) and heart failure with preserved and reduced ejection fraction and aortic stenosis (AS). The review discusses traditional measures of VAC, including arterial elastance (Ea) and ventricular elastance (Ees), as well as emerging parameters, such as global longitudinal strain (GLS) and pulse wave velocity (PWV). The review introduces the PWV/GLS ratio as a novel method for assessing VAC.

RESULTS

With ageing, both Ea and Ees increase, while the Ea/Ees ratio remains relatively stable, reflecting balanced arterial and ventricular adaptations. Novel measures, such as PWV/GLS ratio, show greater impairment in older adults and provide a comprehensive evaluation of VAC.

CONCLUSIONS

Ageing disrupts VAC through arterial stiffening and reduced heart function, often exacerbated by CVDs. Novel metrics like PWV/GLS may improve VAC assessment, helping clinicians manage age-related cardiovascular issues by identifying risks earlier and guiding treatment to support efficient heart-artery interaction.

Learning to swim with back pain: a qualitative study of swimmers with chronic low back pain

PURPOSE

Swimming is one form of exercise advised to people with chronic low back pain (CLBP), there is limited research, however, supporting this recommendation and describing the experience and use of swimming in this population. The aim of this study was to explore the experience of people who use swimming to manage CLBP.

METHODS

Semi-structure interviews were conducted with 14 swimmers who were using swimming to manage CLBP. Thematic analysis was used to analyse the interview data, and the themes were mapped onto the capability, opportunity, motivation and behaviour (COM-B) model to understand the behavioural factors.

RESULTS

Five common themes were developed during the analysis: (1) My back pain journey; (2) Learning to swim with back pain; (3) How swimming looks for me; (4) What I gain from swimming; and (5) Keep calm and carry-on swimming. The themes mapped onto all three COM-B domains.

CONCLUSIONS

The participants found that swimming was a valuable self-management tool for CLBP. The findings from the thematic and COM-B analysis indicate that learning to swim with CLBP can be a complex journey, influenced by several interrelated behavioural factors. In the absence of multi-professional support, inclusive swimming communities and accessible swimming venues, swimming participation rates may be affected.

Smoking as a causative factor in chronic kidney disease: a two-sample Mendelian randomization study

Smoking is widely acknowledged for its harmful effects on multiple organs. However, its specific causal relationship with chronic kidney disease (CKD) remains uncertain. This study applied bivariate causal analysis and two-sample Mendelian randomization (MR) methods to examine the association between various smoking behaviors - initiation, cessation, age at initiation, cigarettes smoked per day, and lifetime smoking - and CKD, using genome-wide data. The inverse variance weighted (IVW) method was the primary analytical tool, supported by sensitivity analyses, pleiotropy assessments, and mediation analyses. External validation was conducted using independent datasets. The results revealed positive associations between CKD and smoking initiation (Pivw = 1.8 × 10-2, OR = 1.192), earlier age at initiation (Pivw = 2.3 × 10-3, OR = 1.481), cigarettes smoked per day (Pivw = 8.8 × 10-3, OR = 1.216), and lifetime smoking (Pivw = 2.3 × 10-7, OR = 2.445). In contrast, smoking cessation demonstrated a protective effect against CKD (Pivw = 4.0 × 10-12, OR = 0.791). External validation results aligned with the primary findings, and the absence of significant heterogeneity confirmed the robustness of the MR analysis. Additionally, the effect of smoking on CKD was mediated by factors such as body mass index, cardiovascular disease, hypertension, and type 2 diabetes. These findings identify smoking as a contributing factor to CKD and suggest that reducing smoking prevalence could significantly lower the incidence of CKD in the population.

The correlation between indirect calorimetry data and the metabolic syndrome development in men and women

Objectives

To investigate the indirect calorimetric findings in subjects with Metabolic Syndrome (MetS) compared to those without MetS and explore the potential parameters for predicting MetS in susceptible individuals.

Methods

Data was collected from a cross-sectional study conducted during the second phase of The Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, which involved 1,014 participants. The presence of MetS was determined using the National Cholesterol Education Program Adult Treatment Panel III criteria. The study involved taking anthropometric measurements, blood samples, and indirect calorimetry measurements.

Results

The study showed significant differences in MetS criteria between the groups with and without MetS. According to the results in men, an increase in resting metabolic rate (RMR)/weight decreased the likelihood of developing MetS. However, an increase in protein oxidation raised the probability of developing MetS. Moreover, an increased RMR/weight or RMR/ body surface area (BSA) decreased the likelihood of developing MetS in women. Based on the logistic regression analysis, men with a higher RMR/Weight had a lower risk of developing MetS. Conversely, an increase in protein oxidation can increase the risk of MetS. However, women with higher RMR/Weight and RMR/BSA had a reduced risk of developing MetS.

Conclusions

These findings suggest that variations in RMR and macronutrient oxidations may play a role in the development of MetS. Assessing RMR and macronutrient oxidation through indirect calorimetry could potentially be used as predictive parameters for MetS. Further research is needed to better understand the underlying mechanisms and implications of these findings.

Tropisetron attenuates high-glucose-induced vascular endothelial dysfunction via inhibition of calcineurin/NFAT signalling

Vascular endothelial dysfunction (VED) is considered an important initiating factor in pathogenesis of diabetic vascular disease. In this process, oxidative insult, cellular hypertrophy, and activation of the calcineurin/nuclear factor of activated T-cell (NFAT) pathway play key roles. Herein, we investigated the effects of tropisetron (TRS), a calcineurin inhibitor, on high glucose (HG)-induced hypertrophy and apoptosis in human umbilical vein endothelial cells (HUVECs). To this end, HUVECs and chorioallantoic membranes (CAMs) were exposed to HG with or without TRS or cyclosporine A (CsA), and the effects of the treatments were evaluated on oxidative stress generation, cell number (proliferation and apoptosis), cell size (hypertrophy), and vessel formation. We also explored the possible role of calcineurin-NFAT signalling in the potential protective effects of TRS on hypertrophy and apoptosis associated with HG. The average size and protein content of the cells exposed to HG for 48h were significantly increased compared with normal glucose (NG). HG significantly increased apoptosis, altered the cell cycle, and elevated oxidative and nitrosative stress in HUVECs. Further, exposing cells to HG resulted in elevated calcineurin activity and NFATc1 translocation to the nuclei. HG also caused a significant decrease in the formation of new blood vessels in CAMs. Inhibition of calcineurin/NFAT pathway by TRS or CsA protected against these pathological changes. Our data demonstrated that inhibition of calcineurin/NFAT signalling by TRS, as a safe calcineurin inhibitor, may ameliorate HG-induced VED. Further in vivo and clinical studies are required to fully determine the protective effects of TRS against VED in diabetes.

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

BACKGROUND

Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity.

METHODS

This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions.

RESULTS

Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR.

CONCLUSIONS

Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

Insights from autopsy-initiated pathological studies of the pathogenesis and clinical manifestations of atherosclerosis and ischemic heart disease: Part II. Ischemic heart disease

CONTEXT

Ischemic heart disease (IHD) due to coronary atherosclerosis constitutes the leading cause of morbidity and mortality worldwide. This review was undertaken to retrospectively analyze the lines of research that generated the evidence for our contemporary understanding of atherosclerosis-based coronary artery disease and to provide a rationale for continued support for autopsy-based research in order to make further progress in reduction of the morbidity and mortaility from IHD.

OBJECTIVES

To analyze the contributions of the autopsy to complement and validate other lines of investigation in determining the complex interactions between coronary artery alterations linked to the major manifestations of coronary atherosclerosis, namely, coronary thrombosis, acute myocardial infarction, and sudden cardiac death.

DATA SOURCES

Systematic search on PubMed to gather relevant studies concerning autopsy studies and reviews of the pathology and pathogenesis of atherosclerosis, ischemic heart disease, coronary atherosclerosis, coronary thrombosis, myocardial infarction and sudden cardiac death.

CONCLUSIONS

An extensive search of the published literature has confirmed the continuing importance of the autopsy as a powerful tool to understand the pathogenesis, clinical features, and therapeutic options for the treatment of atherosclerosis and its major manifestation, ischemic heart disease. This has been described in the Part I companion of the present review. Autopsy-initiated studies have documented the prevalence and clinicopathological significance of atherosclerosis in different human populations and its relationship to risk factors. It has been shown that the clinically silent phase of ischemic heart disease (IHD) begins in the first decades of life. Pathological studies have clarified the complex relationship between coronary atherosclerosis, coronary thrombosis, and myocardial ischemic events. These studies also have elucidated the pathological basis of sudden cardiac death. Insights from these studies also have been important in developing and evaluating strategies for continued progress in reducing the morbidity and mortality attributed to atherosclerosis and IHD.

Regulation of Cardiac Function by the Autonomic Nervous System

The autonomic nervous system is critical for regulating cardiovascular physiology. The neurocardiac axis encompasses multiple levels of control, including the motor circuits of the sympathetic and parasympathetic nervous systems, sensory neurons that contribute to cardiac reflexes, and the intrinsic cardiac nervous system that provides localized sensing and regulation of the heart. Disruption of these systems can lead to significant clinical conditions. Recent advances have enhanced our understanding of the autonomic control of the heart, detailing the specific neuronal populations involved and their physiologic roles. In this review, we discuss this research at each level of the neurocardiac axis. We conclude by discussing the clinical field of neurocardiology and attempts to translate this new understanding of neurocardiac physiology to the clinic. We highlight the contributions of autonomic dysfunction in prevalent cardiovascular diseases and assess the current status of novel neuroscience-based treatment approaches.

Patent foramen ovale: A variant of normal or a true congenital heart disease?

Foramen ovale plays a key role in foetal circulation, however it may remain patent after birth throughout the life. Its patency is so frequent in healthy people (27-35 %), such as to be considered a variant of normal. It is at risk of complications, like paradoxical embolism by right to left shunt with stroke, migraine, temporary blindness, as well as aneurysm, thrombosis and endocarditis of the fossa ovalis. There is no doubt that it should be considered a congenital heart disease at all effects. Invasive cardiology closure with umbrella and even with stiches is nowadays feasible and indicated in specific clinical scenarios. Further research is needed to determine whether cardiac echo-doppler screening for identifing affected patients as a primary prevention measure is advisable.

A rare case of myocardial bridging as a cause of complete heart block: A diagnostic challenge

Complete heart block (CHB) is a disruption in electrical impulses to travel from atria to ventricles and can rarely be caused by myocardial bridging (MB), where cardiac tissue compresses a coronary artery during systole. The incidence of MB ranges from 0.5 % to 16 % in coronary angiography patients. This case report presents a 30-year-old female presented with dizziness, shortness of breath, and chest pain, diagnosed with third-degree AV block. Echocardiography revealed interventricular septal thickening and mild mitral regurgitation. Coronary angiography identified myocardial bridging in the mid LAD artery causing significant systolic stenosis. After ruling out reversible causes, a dual-chamber permanent pacemaker was implanted due to persistent heart block. The patient remained stable postprocedure, with decreasing cardiac biomarkers, and was discharged symptom-free with a follow-up appointment scheduled. MB can lead to serious cardiovascular events, including myocardial infarction and CHB. Clinicians must recognize the risks associated with MB and maintain a high suspicion for CHB to ensure timely management. Further studies are needed to clarify the CHB-MB relationship and improve patient outcomes.

An Integrated Network Pharmacology and RNA-seq Approach for Exploring the Protective Effect of Isoquercitrin in Doxorubicin-Induced Cardiotoxicity: Identification of Novel Genes

Cardiotoxicity, a severe side effect of cytotoxic drugs like doxorubicin (DOX), can lead to cardiomyopathy and heart failure, significantly impacting patient prognosis. This study investigates the molecular mechanisms of DOX-induced cardiotoxicity and explores isoquercitrin (IQC) as a potential therapeutic agent. RNA-sequencing analysis revealed 7855 dysregulated genes in DOX vs. Control and 3853 in DOX + IQC vs. DOX groups. Functional enrichment analysis of upregulated genes in the DOX vs. Control group highlighted cytokine-cytokine receptor interaction and calcium signaling pathways as significant immune-related KEGG pathways. Immune genes were shortlisted based on inflammatory functions, followed by protein-protein interaction analysis and hub gene identification. This process revealed IL6, IL1B, IL10, CCL19, CD27, CSF1R, ADRB2, GDF15, TNFRSF10B, and PADI4 as the top 10 interacting immune hub genes. Validation in the DOX + IQC vs. DOX group showed that IQC downregulated CCL19, IL10, PADI4, and CSF1R genes. Computational drug design techniques, including virtual screening and molecular dynamic simulations, identified promising targets for IQC. These targets were experimentally validated using RT-qPCR in AC16 cell lines under four conditions: control, DOX, low dose DOX + IQC, and high dose DOX + IQC. The study demonstrates that IQC significantly reduces inflammation and oxidative stress in human AC16 cardiomyocyte cell line by downregulating inflammatory and stress pathways induced by DOX. It concludes that CCL19 and PADI4 are crucial immune biomarkers for treating DOX-induced cardiotoxicity using IQC, providing insights into potential therapeutic strategies using plant-based compounds to mitigate the cardiotoxic effects of DOX in cancer treatment.

Trends in Proton Pump Inhibitor Use in Sweden by Sex and Age: A Drug Utilisation Study

BACKGROUND

Proton pump inhibitors (PPIs) are among the most popular drugs worldwide. Yet, there are concerns on long-term safety and poor adherence to prescription guidelines. Off-label use in children and increasing maintenance use in older adults may be particularly worrisome.

OBJECTIVES

To assess differences in PPI use by age, sex calendar year and PPI type, and to explore potential underlying indications (ulcerogenic drugs, and indications) in Sweden.

METHODS

Proton pump inhibitor drug utilisation study based on the Swedish nationwide prescribed drug (2006-2023) and patient registries (2006-2022).

RESULTS

Proton pump inhibitors were used by 14.4% (women) and 10.5% (men) of adults; and 1.0-1.5% of children and adolescents (aged < 20 years). Proton pump inhibitor use was higher in women in all age-groups except small children (aged < 5 years). Proton pump inhibitor use has increased in all age groups, especially in young children (aged < 10 years) and the oldest groups (aged > 65 years). Proton pump inhibitor users aged > 85 years filled most prescriptions with an annual average of 9.5 (men), 11.6 (women) prescriptions. Most prescriptions were for omeprazole and esomeprazole: 63.7% and 23.5% in adults; 23.5% and 44.7% in children (2023). Prescriptions for other drugs for peptic ulcers/reflux became rare, with 99% of prescriptions in this category being PPIs by 2023. Gastro-intestinal diagnoses were predominantly recorded in men, became less prevalent and only explained part of PPI use, while ulcerogenic drugs were common (particularly in women), suggesting PPIs are regularly used for gastroprotection.

CONCLUSION

Proton pump inhibitor use has doubled in children and increased 50% in adults over the study period, in both sexes, while recorded gastrointestinal indications decreased. Alternative therapies were rarely prescribed in Sweden.

Molecular mechanisms of angiotensin type 2 receptor-mediated nitric oxide pathway in angiotensin II-induced vasorelaxation: Roles of potassium channels

A variety of biological functions is attributed to the renin-angiotensin system (RAS). One of them is regulating vascular tone through its final effector Angiotensin II (Ang II). Ang II action is mediated by the Angiotensin type 1 receptor (AT1-R) which plays a role in vasoconstriction, and Angiotensin type 2 receptor (AT2-R) which may result in vascular relaxation through the releasing of endothelium mediates relaxation factors such as Nitric Oxide (NO). Therefore, this study investigated the role of AT2-R in vasodilation after blocking the effect of AT1-R in the rat aorta. Furthermore, it is to determine whether or not Ang II through NO has a role in rat aorta dilation via using valsartan. For control isolated aortic rings were preincubated with Valsartan (AT1- R inhibitor) and then stimulated with angiotensin II dose-dependent. For treating aortic rings different blockers and inhibitors were used. Pd123177 (AT2- R inhibitor) (20 µM), an inhibitor of PKA H-89 (10 µM), eNOS inhibitor L-NAME (0.3 mM), with group of K channel blockers such as TEA (1 mM), 4-AP (1 mM), BaCl2 (1 mM), clotrimazole (0.03 mM) and GLIB (0.01 mM). Our analysis demonstrates vasodilation in aortic rings induced by Ang II after blocking ATI-R and this response was highly reliant on PKA/eNOS and cyclic guanosine monophosphate (cGMP). The data from this investigation provided evidence that Ca2 + activated K+ channels (KCa) and Voltage-dependent K channel (KV) mediated Ang II vasorelaxation. Finally, these results indicate that angiotensin II primarily induces dilatation AT2-R after inhibiting the angiotensin AT1 receptor through a cascade of signaling pathways involving many enzymes and plasma membrane protein channels.

Comparison and Agreement between Cardiovascular Computed Tomography-Derived Mid-Diastolic and End-Diastolic Ventricular Volume in Patients with Congenital Heart Disease

Prospective electrocardiogram (ECG)-triggered cardiovascular computed tomography (CCT) is primarily utilized for anatomical information in congenital heart disease (CHD) and has not been utilized for calculation of the end-diastolic volume (EDV); however, the mid-diastolic volume (MDV) may be measured. The objective of this study was to evaluate the feasibility and agreement between ventricular EDV and MDV. 31 retrospectively ECG-gated CCT were analyzed for the study of the 450 consecutive CCT. CCT images were processed using syngo.via with automatic contouring followed by manual adjustment of the endocardial borders of the left ventricles (LV) and right ventricles (RV) at end-diastolic and mid-diastolic phase (measured at 70% of cardiac cycle). The correlation and agreements between EDV and MDV were demonstrated using Spearman rank coefficient and intraclass correlation coefficient (ICC), respectively. Mean age ± SD was 28.8 ± 12.5 years, 19 were male (61.3%) and tetralogy of Fallot (TOF) was the most common diagnosis (58.1%), 35% (11/31) patients with a pacemaker, ICD or other such contraindication for a CMRI, 23% (7/31) with claustrophobia, and 6.5% (2/31) with developmental delay with refusal for sedation did not have a previous CMRI. The mean ± SD indexed LV EDV and LV MDV were 91.1 ± 24.5 and 84.8 ± 22.3 ml/m2, respectively. The mean ± SD indexed RV EDV and RV MDV were 136.8 ± 41 and 130.2 ± 41.5 ml/m2, respectively. EDV and MDV had a strong positive correlation and good agreement (ICC 0.92 for LV and 0.95 for RV). This agreement was preserved in a subset of patients (21) with dilated RV (indexed RV EDV z-score > 2). Intra-observer reliability (0.97 and 0.98 for LV and RV MDV, respectively) and inter-observer reliability (0.96 and 0.90 for LV and RV MDV, respectively) were excellent. In a select group of patients with CHD, measuring MDV by CCT is feasible and these values have good agreements with EDV. This may be used to derive functional data from prospectively ECG-triggered CCT studies. Further large-scale analysis is needed to determine accuracy and clinical correlation.

Transradial versus transfemoral access in middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis

BACKGROUND

Chronic subdural hematoma (cSDH) is increasingly prevalent in the elderly and traditionally treated with surgical interventions. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive therapy to reduce recurrence rates. Transfemoral access (TFA) is the conventional route for neuroendovascular procedures, but transradial access (TRA) offers potential advantages, including reduced access-site complications, earlier ambulation, and shorter hospital stays.

OBJECTIVE

The aim of this systematic review and meta-analysis was to compare the safety and efficacy of TRA versus TFA for MMAE in cSDH patients.

METHODS

This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and involved a comprehensive search of four databases to identify studies comparing TRA and TFA in MMAE. Outcomes included hematoma recurrence, hospital length of stay, procedural duration, access-site complications, and overall complications.

RESULTS

Four studies met the inclusion criteria. There were no significant differences between TRA and TFA in hematoma recurrence (Relative Risk (RR) 0.65, 95 % Confidence Interval [CI] 0.09-4.85), hospital length of stay (Mean Difference [MD] 0.10 days, 95 % CI -0.11-0.31), procedural duration (MD 0.04 h, 95 % CI -0.49-0.56), access-site complications (RR 0.24, 95 % CI 0.04-1.40), or overall complications (RR 0.76, 95 % CI 0.33-1.75).

CONCLUSION

TRA demonstrates comparable safety and efficacy to TFA for MMAE in cSDH patients. Although current evidence is limited to observational studies, these findings support the feasibility of TRA as an access route. Future large-scale studies are necessary to validate these results and optimize procedural strategies.

Blunted Blood Pressure Dipping During Night Shift Work: Does It Matter? Can We Intervene?

Cardiovascular disease (CVD) is the leading cause of adult death in the United States. Numerous studies show that night shift workers face a disproportionately higher risk of CVD compared to non-shift workers. Despite these data, the scientific and medical communities have not identified the physiological mechanisms that contribute to increased CVD risks for night shift workers. We propose that repetitive exposure to blunted blood pressure (BP) dipping associated with sleep loss during night shift work is an important, clinically meaningful, understudied, and modifiable contributor to increased risk of CVD. Blunted BP dipping occurs when BP fails to decrease or "dip" 10%-20% during nighttime hours (typically while sleeping) relative to daytime hours (typically while awake). Blunted BP dipping is widely considered a clinically meaningful indicator of poor cardiovascular health. Previous research suggests it is a common consequence of night shift work and occurs during sleep before and immediately after night shifts. Relatively few studies of shift work and CVD have focused on blunted BP dipping as a mechanism of CVD risk. Recent experimental research shows that restoration of normal BP patterns-during night shift work-is achievable with strategic napping and may reduce the risk of CVD. We present a series of important mechanistic-related questions and next steps for future research focused on blunted BP dipping and night shift work.

The endothelial surface layer-glycocalyx - Universal nano-infrastructure is fundamental to physiology, cell traffic and a complementary neural network

The glycocalyx and its associated endothelial surface layer which lines all cell membranes and most tissues, dwarfs the phospholipid membrane of cells in extent. Its major components are sulphated polymers like heparan and chondroitin sulphates and hyaluronic acid. These form a fuzzy layer of unknown structure and function. It has become increasingly clear that the ESL-GC complex must play many roles. We postulate it has a self-organised infrastructure that directs cell traffic, acts in defence against pathogens and other cells, and in diseases like diabetes, and heart disease, besides being a playground for a host of biochemical activity. Based on an analogous sulphated polymeric system Nafion, the fuel cell polymer, we suggest a model for the structure of the ESL-GC complex and how it functions. Taken together with parallel developments in physical chemistry, in nanobubbles, their stability in physiological media, and reactivity, we believe the model may throw light on a variety of phenomena, diabetes and some other diseases.

Bioelectronics hydrogels for implantable cardiac and brain disease medical treatment application

Hydrogel-based bioelectronic systems offer significant benefits for point-of-care diagnosis, treatment of cardiac and cerebral disease, surgical procedures, and other medical applications, ushering in a new era of advancements in medical technology. Progress in hydrogel-based bioelectronics has advanced from basic instrument and sensing capabilities to sophisticated multimodal perceptions and feedback systems. Addressing challenges related to immune responses and inflammation regulation after implantation, physiological dynamic mechanism, biological toxicology as well as device size, power consumption, stability, and signal conversion is crucial for the practical implementation of hydrogel-based bioelectronics in medical implants. Therefore, further exploration of hydrogel-based bioelectronics is imperative, and a comprehensive review is necessary to steer the development of these technologies for use in implantable therapies for cardiac and brain/neural conditions. In this review, a concise overview is provided on the fundamental principles underlying ionic electronic and ionic bioelectronic mechanisms. Additionally, a comprehensive examination is conducted on various bioelectronic materials integrated within hydrogels for applications in implantable medical treatments. The analysis encompasses a detailed discussion on the representative structures and physical attributes of hydrogels. This includes an exploration of their intrinsic properties such as mechanical strength, dynamic capabilities, shape-memory features, stability, stretchability, and water retention characteristics. Moreover, the discussion extends to properties related to interactions with tissues or the environment, such as adhesiveness, responsiveness, and degradability. The intricate relationships between the structure and properties of hydrogels are thoroughly examined, along with an elucidation of how these properties influence their applications in implantable medical treatments. The review also delves into the processing techniques and characterization methods employed for hydrogels. Furthermore, recent breakthroughs in the applications of hydrogels are logically explored, covering aspects such as materials, structure, properties, functions, fabrication procedures, and hybridization with other materials. Finally, the review concludes by outlining the future prospects and challenges associated with hydrogels-based bioelectronics systems.

Exploring the Potential for Graphic Warning Labels to Reduce Intentions to Consume Energy Drinks

ISSUE ADDRESSED

Effective interventions to reduce energy drink (ED) consumption are needed. This study explored the effect of warning labels on intentions to reduce ED consumption, perceived label effectiveness and protection motivation theory (PMT) constructs.

METHODS

Australian ED consumers aged 18 to 39 years (N = 343) participated in an experimental online survey, randomly assigned to view one of three ED warning label conditions (weight gain, cardiac effects, no label-control). Intentions to reduce ED consumption, perceived effectiveness of labels and selected PMT constructs were assessed.

RESULTS

Participants reported moderate-high awareness of the health effects of consumption (62.68%) and advisory statements on EDs (69.39%), including daily consumption limits (48.40%). EDs were consumed frequently, with 56.26% regular (at least weekly) consumers and most commonly for functional benefits (e.g., alertness). ED warning labels did not have a statistically significant effect on intentions to reduce consumption. The cardiac label performed better than the weight gain label in 'grabbed attention' (72.97% vs. 55.66%, p = 0.008), with non-significant trends (p > 0.05, absolute differences ≥ 10%) suggesting it was stronger on some other perceived effectiveness measures. Supplementary analyses indicated females in the cardiac condition reported greater intentions to reduce ED consumption than females in the control condition (p = 0.042).

CONCLUSIONS

Graphic warning labels and labels warning of cardiac effects are worthy of further exploration as a potential intervention to reduce ED consumption. SO WHAT?: Future research should explore the motivations underlying ED consumption and further explore messages that will resonate with consumers.

Diagnosis and treatment of lung cancer: A molecular perspective

This editorial comments on the review by Da Silva et al, published in the World Journal of Clinical Oncology which focuses on the molecular perspectives of lung cancer. With the rapid development of molecular technology, new diagnostic methods are constantly emerging, including liquid biopsy, the identification of gene mutations, and the monitoring biomarkers, thus providing precise information with which to identify the occurrence and development of lung cancer. Biomarkers, such as circulating tumor cells, circulating tumor DNA, and circulating RNA can provide helpful information for clinical application. Common types of genetic mutations and immune checkpoints include epidermal growth factor receptor, anaplastic lymphoma kinase, c-ROS proto-oncogene 1, programmed death-1 and cytotoxic T-lymphocyte-associated protein. According to specific biomarkers, targeted therapy and immunotherapy can improve survival outcomes based on the types of gene mutation and immune checkpoints. The application of molecular approaches can facilitate our ability to control the progression of disease and select appropriate therapeutic strategies for patients with lung cancer.

Risk of Lower Gastrointestinal Bleeding in Nonsteroidal Anti-inflammatory Drug (NSAID) and Proton Pump Inhibitor Users Compared with NSAID-Only Users: A Common Data Model Analysis

Background/Aims

Recent studies have shown an increased risk of lower gastrointestinal bleeding in patients who use both nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs). We analyzed the risk of lower gastrointestinal bleeding and compared this risk between NSAID+PPI users and NSAID-only users.

Methods

In this retrospective, observational study, data from five hospitals were analyzed using a common data model to determine the risk of lower gastrointestinal bleeding and compare this risk between NSAID+PPI users (target cohort) and NSAID-only users (comparative cohort). Cox proportional hazard models and the Kaplan-Meier estimations were employed after extensive propensity score matching.

Results

Among 24,530 individuals in the target cohort and 57,264 in the comparative cohort, 8,728 propensity score-matched pairs were analyzed. The risk of lower gastrointestinal bleeding was significantly higher in NSAID+PPI users than in NSAID-only users (hazard ratio [HR], 2.843; 95% confidence interval [CI], 1.998 to 4.044; p<0.001). Similar findings were also noted in elderly patients >65 years (HR, 2.737), males (HR, 2.963), and females (HR, 3.221). However, the risk of lower gastrointestinal bleeding was comparable between NSAID+mucoprotective agent users and NSAID-only users (HR, 2.057; 95% CI, 0.714 to 5.924; p=0.172).

Conclusions

The risk of lower gastrointestinal bleeding was higher in NSAID+PPI users than in NSAID-only users. However, the risk of lower gastrointestinal bleeding was comparable between NSAID+mucoprotective agent users and NSAID-only users.

Protocol for mouse carotid artery perfusion for in situ brain tissue fixation and parallel unfixed tissue collection

As the study of central control of multiple organ function becomes more prominent, there is an increasing need for the collection of fixed brain and unfixed organs and tissues from the same experimental animal. Here, we present a protocol for performing carotid artery cannulation, organ and tissue collection, in situ brain perfusion and fixation, and brain dissection in mice. We describe steps for cannulating the carotid artery, harvesting the heart and other organs, and perfusing, fixing, and dissecting the brain.

Influence of Primary Neurologic Disease on Cardiovascular Health in Females

Neurocardiology is an interdisciplinary field that examines the complex interactions between the nervous and the cardiovascular systems, exploring how neurological processes, such as autonomic nervous system regulation and brain-heart communication impact heart function and contribute to cardiovascular health and disease. Although much of the focus on cardiovascular health has centered on traditional risk factors, the influence of the nervous system, especially in females, is increasingly recognized as a key determinant of cardiovascular outcomes. This article reviews existing literature on the neurological mechanisms that impact cardiovascular function in females. Specifically, we analyze how primary neurological disorders including cerebrovascular disease, headache disorders, and multiple sclerosis have specific downstream effects on cardiac function. By understanding the complex relationship between neurological and cardiovascular health, this review highlights the need for sex-specific approaches to prevention, diagnosis, and treatment of cardiovascular disease in females, ultimately encouraging the discovery of more effective care strategies and improving health outcomes.

Association of atrial cardiopathy and residual shunt after patent foramen ovale closure in patients experiencing migraine

AIMS

Migraine is a prevalent and incapacitating condition. The association between patent foramen ovale (PFO) and migraine-type headaches has been extensively documented. In clinical practice, patients may observe residual shunting after PFO closure. Nevertheless, the underlying mechanisms affecting residual shunting after PFO closure remain unclear. Recent studies have identified left atrial abnormalities, specifically atrial cardiopathy, as an independent risk factor for the development of atrial fibrillation (AF), left atrial thrombosis, and subsequent stroke. To that end, the present study aims to investigate the relationship between residual shunt occurrence after PFO closure and atrial cardiopathy.

METHODS

A retrospective analysis comparing postoperative residual shunts in patients with and without atrial cardiopathy was conducted. The study cohort consisted of 174 patients with severe migraine and confirmed right-to-left shunt (RLS) (grades II-IV) who voluntarily opted for PFO closure between April 1, 2021, and December 31, 2022. Enrolled patients were categorized into two groups: PFO with or without atrial cardiopathy.

RESULTS

A total of 174 migraineurs who underwent PFO closure (PFO with atrial cardiopathy group, n = 20; PFO without atrial cardiopathy group, n = 154) were included. Compared to patients without atrial cardiopathy, those with atrial cardiopathy were older (54.85 ± 11.86 vs. 43.03 ± 13.78 years, p = 0.0003), had a higher prevalence of hypertension (30.00% vs. 11.69%, p = 0.0255), and a higher prevalence of diabetes mellitus (10.00% vs. 1.30%, p = 0.0146). Following fully adjusted multivariate logistic analysis, atrial cardiopathy (OR = 0.119; P = 0.046), BMI (OR = 0.875; P = 0.025) and atrial septal aneurysm (OR = 5.465; P = 0.028) were identified as independent predictors for residual right-to-left shunt.

CONCLUSIONS

The presence of atrial cardiopathy in patients with severe migraine and PFO was inversely associated with residual shunting following PFO closure.

Cardiac myxoma: a comprehensive review

Heart tumours are a diverse group of tumours that may present with symptoms or be discovered incidentally when a patient is being evaluated for a physical or seemingly unrelated ailment. Cardiac myxoma, although rare, is the second most common benign primary cardiac tumours after papillary fibroelastoma. It occurs in sporadic form and familial form, as seen in Carney complex disorder. Cardiac myxoma can affect all age groups, but the majority manifests in their third to sixth decade of life, with a mean age of 50 years at diagnosis. There is a slight preponderance in females in a ratio of 2:1. Conversely, they are incredibly uncommon in fetuses and newborns but commonly diagnosed in children around a mean age of 9-10 years. About 90% originate in the atrium as a solitary or pedunculated mass. Within the atrial chamber, 75% occur on the left atrium close to the fossa ovalis, while others occur in the right atrium, ventricles, and valves. Serious complications often arise even in the absence of symptoms, and such complications include intracardiac obstruction, systemic and pulmonary emboli, as well as constitutional symptoms that mimic connective tissue and inflammatory diseases. There is no pathognomonic clinical presentation. Complete surgical excision of the tumour, including the use of robotic surgery, is the key component of a successful course of treatment. To monitor for tumour recurrence, long-term follow-up is frequently carried out with interval echocardiography. This review will focus on providing information on the various forms of cardiac myxoma, aetiology, molecular genetics, clinical presentation, histopathologic findings, differential diagnosis, treatment, and complications.

Impact of telehealth care on clinical outcomes in heart failure patients

IntroductionHeart failure (HF) is associated with high incidence and mortality rates, limited physical activity, decreased quality of life, and increased healthcare expenses. Implementing a Telehealth Care (TC) HF program might address these challenges while improving patient outcomes.MethodWe conducted a retrospective observational study using electronic medical record data. The study recruited 916 participants screened with ICD-10 code I50 from 2016 to 2020. After data screening, 210 participants were divided into a remote care group and a control group using propensity score matching. Patients in the remote care group received TC visits for HF management via Bluetooth-enabled equipment, while those in the control group received typical care.ResultsAmong the 587 participants, those who received TC experienced reduced rates of all-cause mortality and readmission within one year, as well as lower rates of cardiovascular disease and HF-related readmission. However, there was no significant difference in cardiovascular disease mortality compared to the control group within one year. Kaplan-Meier time-event curves showed that there were significant differences in survival analysis.DiscussionTC significantly reduced all-cause mortality and rehospitalization rates in HF patients, highlighting its role in enhancing patient outcomes through remote monitoring. Although cardiovascular-specific mortality within one year did not exhibit significant differences, the TC group had fewer HF-related readmissions. This suggests improved disease management and self-care in this group. The findings demonstrate the potential of TC as a valuable tool in standard HF care, particularly for patients with comorbidities, such as diabetes and coronary heart disease.

Acute mental stress-induced alpha or beta-adrenergic reactivity patterns linked to unique cardiometabolic risk profiles

Cardiometabolic risk may differ based on a stress-induced alpha(α)-adrenergic response versus a predominant beta(β)-adrenergic response. Whether these responses might serve as significant markers of distinct cardiometabolic risk profiles based on hemodynamic reactivity remain unknown. We (1) characterized predominant α-and β-adrenergic hemodynamic response patterns to acute mental stress; and (2) determined the cardiometabolic risk profile within predominant α-or β-adrenergic responders, irrespective of age, sex, or ethnicity. We included 117 South African teachers (aged 20-65 years) and administered an acute mental stress task (Color-Word-Conflict test) for one-minute. Participants' hemodynamic response profiles were characterized as predominant α-adrenergic (decreases in cardiac output (CO) and Windkessel arterial compliance (Cwk) (lowest quartile)) (n = 48) and β-adrenergic (increases in CO, Cwk (highest quartile)) responses (n = 69) via Finometer beat-to-beat hemodynamic monitoring. Ambulatory-BP was measured and the number of 24 H-ischemic events determined by ECG. Cardiometabolic markers were analyzed using fasting blood samples, and abnormal glucose tolerance (Abnl-GT), combining prediabetes and diabetes, was defined as glycated hemoglobin (HbA1c) ≥ 5.7% and/or fasting glucose > 100 mg/dL and/or diabetes medication usage. Predominant α-adrenergic responders presented with an overall poorer cardiometabolic profile, with higher levels of HbA1c, insulin, greater insulin resistance and higher total cholesterol and lower HDL-cholesterol. Adjusted analyses indicated that a predominant α-adrenergic profile had higher odds of central obesity (P = 0.031), low HDL-cholesterol (P = 0.042), 24-H-hypertension (P < 0.001), cardiac stress (P = 0.025), ischemic events (P = 0.048) and medium-to-high 10-year stroke probability (P < 0.001), compared to β-adrenergic responders. In the β-adrenergic responders, higher odds for ischemic events, stroke probability and Abnl-GT were found (all P ≤ 0.022), compared to α-adrenergic responders. Independent of age, sex or ethnicity, the risk profile identified in predominant α-adrenergic responders mainly involved the effects of a high-pressure system, cardiac stress, and ischemia. Whereas in predominant β-adrenergic responders, the risk profile pointed to a more metabolic and hyperperfusion injury-related cardiometabolic risk.

Investigating Cognitive Load and Autonomic Arousal During Voice Production and Vocal Auditory-Motor Adaptation

PURPOSE

Cognitive load and autonomic arousal are hypothesized to affect voice production, yet the nature of these relationships is unclear. The purpose of this study was to assess how cognitive load and autonomic arousal differentially affect voice production and vocal motor control.

METHOD

Physiological measures of autonomic arousal were recorded from 30 adults under different cognitive loads elicited by a Stroop task. In Experiment 1, voice acoustic measures were measured during speech production. In Experiment 2, fundamental frequency (fo) responses to predictably altered auditory feedback (sensorimotor adaptation) were measured. Mixed linear-effects models assessed relationships between variables. Changes between cognitive loads were compared among the two experiments.

RESULTS

In Experiment 1, increased cognitive load was associated with increases in sound pressure level, whereas increases in autonomic arousal measures (i.e., decreases in skin conductance rise time, pulse amplitude, and period) were related to decreases in cepstral peak prominence. Increased autonomic arousal (i.e., decreased pulse amplitude) was related to increased adaptation in Experiment 2. Participants who responded to increased cognitive load by decreasing fo during Experiment 1 showed more adaptation in Experiment 2.

CONCLUSION

Differential effects of cognitive load and autonomic arousal emphasize the importance of individual physiological variability when assessing how stress affects the voice.

Lactylation: a promising therapeutic target in ischemia-reperfusion injury management

Ischemia-reperfusion injury (IRI) is a critical condition that poses a significant threat to patient safety. The production of lactate increases during the process of IRI, and lactate serves as a crucial indicator for assessing the severity of such injury. Lactylation, a newly discovered post-translational modification in 2019, is induced by lactic acid and predominantly occurs on lysine residues of histone or nonhistone proteins. Extensive studies have demonstrated the pivotal role of lactylation in the pathogenesis and progression of various diseases, including melanoma, myocardial infarction, hepatocellular carcinoma, Alzheimer's disease, and nonalcoholic fatty liver disease. Additionally, a marked correlation between lactylation and inflammation has been observed. This article provides a comprehensive review of the mechanism underlying lactylation in IRI to establish a theoretical foundation for better understanding the interplay between lactylation and IRI.

Step-by-Step Approach to Phrenic Nerve Displacement

Phrenic nerve injury, though rare, can be a serious complication of catheter ablation leading to significant morbidity. The close proximity of the phrenic nerve to the site of origin of arrhythmias may also impact the success of catheter ablation. When the phrenic nerve is near the optimal site of ablation, several techniques have been proposed to create separation between the nerve and the epicardium, including the introduction of fluid, gas, and balloons. In this article, we present a step-by-step approach to phrenic nerve displacement to facilitate ablation, including a review of phrenic nerve anatomy, localization techniques, procedural strategies, and necessary equipment.

Psoriasis and cardiovascular risk: associated and protective factors

BACKGROUND

Psoriasis (Pso) is an inflammatory skin disease associated with Metabolic Syndrome (MetS), Steatotic Liver Disease (SLD) and cardiovascular risk. However, the effect of anti-inflammatory therapy on cardiovascular risk is uncertain.

OBJECTIVES

To determine the relationship between anti-inflammatory therapy and subclinical atherosclerosis in individuals with Pso, using the gold standard carotid-femoral Pulse Wave Velocity (cf-PWV) measurement. Additionally, to evaluate the association between cf-PWV, steatosis and Advanced Fibrosis (AF) using Transient Elastography (TE) by Fibroscan®.

METHODS

Cross-sectional study including Pso patients submitted to cf-PWV and TE. Steatosis was defined as a controlled attenuation parameter ≥ 275 dB/m, AF as liver stiffness measurement ≥ 10 kPa, and increased Aortic Stiffness (AoS) as cf-PWV ≥ 10 m/s. Significant cumulative methotrexate dose was ≥ 1500 mg (MTX1500). Logistic regression analysis evaluated the independent variables associated with increased AoS.

RESULTS

Eighty patients were included (mean age 56.2 ± 11.5-years, 57.5% female, BMI 28.6 ± 5.3 kg/m2). Prevalences of MetS, diabetes mellitus, dyslipidemia, systemic arterial hypertension, steatosis and AF were 57.5%, 40.0%, 67.5%, 70.0%, 50.0% and 16.3%, respectively. MTX1500 was present in 45%, immunobiological treatment in 33.8%, and cf-PWV ≥ 10 m/s in 21.2%. On logistic regression analysis, age was independently related to cf-PWV ≥ 10 m/s (OR = 1.21; 95% CI 1.06‒1.38; p = 0.003) and MTX1500 was a protective cardiovascular factor (OR = 0.18; 95% CI 0.038‒0.87; p = 0.033). No association was observed between steatosis, AF or immunobiological therapy and cf-PWV ≥10 m/s.

STUDY LIMITATIONS

Sample size.

CONCLUSION

In patients with Pso, increased AoS was associated with age, but not with steatosis or AF. A protective cardiovascular effect of MTX was found in a Pso population with a high prevalence of MetS and its components.

Assessment of the prognostic performance of TIMI, PAMI, CADILLAC and GRACE scores for short-term major adverse cardiovascular events in patients undergoing emergent percutaneous revascularisation: a prospective observational study

OBJECTIVES

Accurately predicting short-term MACE (major adverse cardiac events) following primary percutaneous coronary intervention (PCI) remains a clinical challenge. This study aims to assess the effectiveness of four established risk scores in predicting short-term MACE after primary PCI.

DESIGN

Prospective observational study.

SETTING

The National Institute of Cardiovascular Diseases, Karachi, Pakistan.

PARTICIPANTS

We enrolled a cohort of consecutive adult patients diagnosed with ST-elevation myocardial infarction undergoing primary PCI over a 6-month period, from 1 January 2022 to 30 June 2022.

OUTCOME MEASURES

All the patients were followed at intervals of 3 months up to 12 months, and MACE events were recorded. Thrombolysis in Myocardial Infarction (TIMI), Primary Angioplasty in Myocardial Infarction (PAMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) and Global Registry of Acute Coronary Events (GRACE) scores were obtained.

RESULTS

A total of 2839 patients (79.3% male, mean age 55.6±11.2 years) were included. Over a median follow-up of 244 days, the composite MACE rate was 18.4% (521). All-cause mortality was 13.5% (384), reinfarction requiring revascularisation was 4.3% (121), heart failure-related rehospitalisation was 2.7% (76), stent thrombosis occurred in 5.6% (160) and cerebrovascular accident events were documented in 1% (28). The area under the curve for TIMI, PAMI, CADILLAC and GRACE scores was 0.682 (95% CI 0.655 to 0.709), 0.688 (95% CI 0.663 to 0.713), 0.686 (95% CI 0.66 to 0.711) and 0.695 (95% CI 0.669 to 0.72), respectively, for the prediction of MACE. On multivariable Cox regression, high-risk categories based on GRACE score were independent predictors of MACE with adjusted HR of 1.88 (95% CI 1.28 to 2.77; p=0.001).

CONCLUSIONS

A significant proportion of patients experienced short-term MACE after primary PCI. While none of the assessed scores demonstrated significant predictive power, the GRACE score exhibited comparatively better predictive ability than the TIMI, PAMI and CADILLAC scores.

Impaired myocardial deformation and aortic distensibility by cardiac MRI in girls with Turner syndrome

Girls and women with Turner syndrome (TS) suffer from increased risk of cardiovascular diseases. We hypothesized that left ventricular (LV) myocardial strain and aortic elasticity will be impaired in girls with TS. Cardiac MRI of 45 girls with TS and 14 healthy control girls was performed. Tissue tracking was used to assess LV Global Longitudinal (GLS), circumferential (GCS), radial short and long axes (GRS SAX and GRS LAX) in patients compared to controls. Maximal and minimal aortic areas were measured in ascending aorta, proximal descending, and aorta at diaphragm. Regional strain and distensibility were calculated using previously validated formulas. Comparisons were made between patients with and without bicuspid aortic valve (BAV). Inter-observer agreement was assessed for myocardial strain and aortic strain and distensibility. Results of the study showed GLS was significantly impaired in TS patients - 15.6 ± 1.8% compared to the control group - 17.2 ± 1%, p value = 0.013. No significant differences were observed in other strain parameters. Aortic diameter was similar in patients and control groups. Ascending aorta strain and distensibility were significantly lower in TS patients (33 ± 19% and 9.1 ± 5.5 mm Hg- 1) compared to control group (55 ± 17% and 13.9 ± 4.9 10- 3 mm Hg- 1), p values 0.004 and 0.013. No significant differences were found in aortic strain and distensibility in the other 2 regions. No significant differences were observed between TS patients with and without BAV in myocardial strain and aortic strain and distensibility. Substantial to perfect inter-observer agreement was found for myocardial strain and aortic strain and distensibility. Cardiac MRI measurements of LV deformation and aortic function carry potential value as markers for early detection of myocardial and aortic disease in TS patients. Validation of the clinical impact and prognostic role require further longitudinal studies.

Mitochondrial DNA in atherosclerosis: Mechanisms, biomarker potential, and therapeutic perspectives

Atherosclerosis is a chronic inflammatory disease in which mitochondrial DNA (mtDNA) has emerged as a key contributor to its pathogenesis. We synthesized evidence from experimental and clinical studies showing that mtDNA damage, release, and mutation profoundly affect endothelial cells, macrophages, and vascular smooth muscle cells, thereby driving plaque initiation and progression. By activating immune signaling pathways-including cGAS-STING, NLRP3 inflammasome, and TLR9-mtDNA amplifies inflammation and oxidative stress, exacerbating atherosclerotic lesion development. We further highlight that mtDNA copy number variations and specific mtDNA mutations may serve as biomarkers for early atherosclerosis detection and risk stratification. In reviewing these data, we also discuss promising therapeutic interventions aimed at mitigating mtDNA damage, such as mitochondria-targeted antioxidants and enhanced mitophagy, which have shown preliminary efficacy in delaying plaque progression. Overall, this review underscores mtDNA's dual role as both a driver of atherosclerosis and a potential diagnostic and therapeutic target.

A comprehensive review on cardiovascular disorders development due to salt intake: an emphasis on policy implementation

Excessive salt consumption has been linked with the emergence of hypertension, which further leads to cardiovascular disease development among other medical conditions. This has resulted in leading world institutions such as the WHO coming up with relevant plans to minimize its use. Lower-middle-income countries (LMICs) have greatest burden of noncommunicable diseases (NCDs), with hypertension being a common condition. Reduction of salt intake is a great control measure in minimizing the rise in prevalence of hypertension or cardiovascular diseases. Many countries have agreed and even formulated their salt reduction policies as recommended by the WHO, however, the challenge is widely noted in implementation. Thus, few countries have been able to achieve the global WHO recommended standards of daily salt intake. Salt is the main source of sodium in our diets, which is an essential component responsible for the balance of the extracellular fluid volume but may lead to salt-induced hypertension when used excessively. The achievement of salt reduction is predicated on multiple factors such as knowledge, attitude and practice of the public. Therefore, localizing interventions with strategies such as public media campaigns, reformulation of processed foods (mandatory and voluntary) and front-of-packaging labelling awareness. Some of the reasons for failure in implementation include economic challenges, lack of visionary leadership, stakeholder struggles and poor planning and execution of strategies. This review aims to elaborate on the development of cardiovascular diseases or hypertension due to salt usage and the recent advancement regarding salt reduction policies. Further, we assess the need for proper implementation with the United Kingdom as a case study. In conclusion, most governments have made the right decisions in developing or recommending salt reduction strategies to the food industry. However, more focus is needed to ensure effective implementation of the plans.

"Unveiling the impacts of climatic cold events on the cardiovascular health in animal models"

Climate change is increasingly driving extreme weather events, leading to drastic temperature fluctuations worldwide. While overall temperatures rise, many regions are simultaneously experiencing severe cold spells that threaten the health of human populations, especially to vulnerable populations including the elderly and those with pre-existing conditions. Exposure to cold stress triggers significant physiological and biochemical disruptions. As cardiovascular diseases (CVDs) rank among the leading causes of global morbidity and mortality, the exacerbation of these conditions by cold exposure underscores critical public health challenges. The complex pathophysiological processes in cold-induced CVDs require careful analysis at an organ-system level, making animal models an ideal tool for replicating human physiological and molecular responses in a controlled environment. However, a detailed mechanism linking cold exposure and cardiovascular dysfunction remains incompletely understood, particularly in the context of animal models. Therefore, this comprehensive review aims to address and analyze from traditional rodent models to less conventional ruminants, broilers, canines, and primate animal models to understand cold stress-induced CVDs, with an extensive account of the potential molecular mechanisms and pathways such as oxidative stress, inflammation, vasomotor dysfunction, and apoptosis, along with emerging roles of cold shock proteins (CSPs), etc. We also delve into various potential therapeutic approaches and preventive measures in cold stress conditions. In conclusion, this review is the first to comprehensively address the underexplored cardiovascular complications arising from cold stress and their underlying mechanisms, particularly using animal models. Furthermore, it provides a foundation for advancing the development of more effective and targeted therapies through translational research.

Impact of hypotonic hyponatremia on outcomes in patients undergoing transcatheter aortic valve replacement: a national inpatient sample

BACKGROUND

Transcatheter aortic valve replacement (TAVR) has emerged as a major therapeutic option for treating aortic stenosis. Hyponatremia is a common electrolyte disorder closely associated with adverse cardiovascular outcomes. However, large-scale studies investigating the impact of hypotonic hyponatremia on outcomes among TAVR patients are lacking.

METHODS

We queried patients who underwent TAVR with concomitant hypo-osmolar hyponatremia (defined as a serum sodium concentration < 135 mEq/L with a serum osmolality < 280 mOsm/kg) using the National Inpatient Sample (2016-2021). Multivariate regression analysis and 1:1 propensity score matching (PSM) were performed to assess the associations between hypo-osmolar hyponatremia and in-hospital mortality and major adverse events (including acute kidney injury [AKI], acute myocardial infarction [AMI], and cardiogenic shock [CS]). Furthermore, sensitivity analysis was performed to assess the robustness of the findings.

RESULTS

Among the total weighted national estimate of 370,680 patients who underwent TAVR, 13,865 (3.7%) had concomitant hypo-osmolar hyponatremia. These patients had a significantly increased risk of in-hospital mortality (aOR: 1.37; 95% CI: 1.08-1.74) and a greater likelihood of developing AKI (aOR: 3.39; 95% CI: 3.07-3.74), AMI (aOR: 3.20; 95% CI: 2.77-3.70), and CS (aOR: 2.96; 95% CI: 2.52-3.47). After PSM and sensitivity analysis, these associations remained significant.

CONCLUSION

In TAVR patients, hypo-osmolar hyponatremia is associated with increased in-hospital mortality and adverse events, including AKI, AMI, and CS.

Biological effects of high-LET irradiation on the circulatory system

PURPOSE

High-linear energy transfer (LET) radiation is generally thought to be more biologically effective in various tissues than low-LET radiation, but whether this also applies to the circulatory system remains unclear. We therefore reviewed biological studies about the effects of high-LET radiation on the circulatory system.

CONCLUSIONS

We identified 76 relevant papers (24 in vitro, 2 ex vivo, 51 in vivo, one overlapping). In vitro studies used human, bovine, porcine or chick vascular endothelial cells or cardiomyocytes, while ex vivo studies used porcine hearts. In vivo studies used mice, rats, rabbits, dogs or pigs. The types of high-LET radiation used were neutrons, α particles, heavy ions and negative pions. Most studies used a single dose, although some investigated fractionation effects. Twenty-one studies estimated the relative biological effectiveness (RBE) that ranged from 0.1 to 130, depending on radiation quality and endpoint. A meta-analysis of 6 in vitro and 8 in vivo studies (selected based on the feasibility of estimating the RBE and its uncertainty) suggested an RBE of 6.69 (95% confidence intervals (CI): 2.51, 10.88) for in vitro studies and 1.14 (95% CI: 0.91, 1.37) for in vivo studies. The meta-analysis of these 14 studies yielded an RBE of 2.88 (95% CI: 1.52, 4.25). This suggests that high-LET radiation is only slightly more effective than low-LET radiation, although substantial inter-study heterogeneity complicates interpretation. Therapeutic effects have also been reported in disease models. Further research is needed to better understand the effects on the cardiovascular system and to improve radiation protection.

Guidance for stem cell therapy for juvenile systemic sclerosis patients

INTRODUCTION

Autologous stem cell transplantation (ASCT) and cellular therapies (CTs) are emerging therapeutic options for both adult and juvenile-onset systemic sclerosis (jSSc) patients. However, most efficacy data are derived from adult studies, and it remains unclear whether adult stem cell transplant criteria are fully applicable to pediatric patients with jSSc. Given pediatric patients' unique potential for recovery and tissue remodeling, the stringent criteria used in adults need adaptation for children.

AREAS COVERED

We reviewed the current data on indications, patient selection and outcomes of ASCT and CTs in both adult and pediatric patients with systemic sclerosis. At a multidisciplinary expert workshop held in Hamburg, Germany, in December 2023, we developed consensus guidance on when to consider ASCT and cellular therapies in jSSc.

EXPERT OPINION

HSCT and CT hold promise as treatment options for jSSc. Our proposed guidance aims to standardize inclusion criteria globally, enhancing comparability of outcomes across future procedures. Establishing consistent inclusion/exclusion criteria and transplant protocols will enable better data collection, interpretation, and ultimately improve outcomes and care for jSSc patients.

Association between blood group antigens ABO, Rh, Kell, Kidd, Duffy and MNS and clinical forms of Chagas disease

BACKGROUND

The mechanisms that determine the progression to cardiac or digestive forms of chronic Chagas disease (CD) are still unclear. We assessed the association between blood group antigens ABO, Rh, Kell, Kidd, Duffy and MNS, and chronic CD clinical forms.

METHODS

Patients were included consecutively between March 2013 and April 2016. Clinical and epidemiological data were obtained from electronic medical records and interviews. Classification of CD clinical forms followed the Brazilian Consensus on CD. The ID-Gel Card technology from Bio-Rad (Diamed/Bio-Rad Latin America, MG, Brazil) was used to analyze the blood group antigens.

RESULTS

A total of 619 adult patients (56.9% women, mean age 60±12 y) were included. Patients' clinical forms of CD were classified as follows: indeterminate 29.1%, cardiac 55.4%, digestive 5.5% and mixed 10.0%. Logistic regression analysis adjusted for age, comorbidities and time away from an endemic area revealed that the S+s- allele of the MNS blood type was associated with a lower odds of cardiac disease and that the B blood group type was associated with a higher odds of digestive disease. All other blood types did not have an association with CD clinical form.

CONCLUSIONS

Blood group systems ABO and MNS were associated with chronic CD clinical forms.

Technology-enabled hybrid cardiac rehabilitation: Qualitative study of healthcare professional and patient perspectives at three cardiac rehabilitation centres in England

Coronary heart disease (CHD) is a leading cause of death in the UK. Clinical guidelines recommend cardiac rehabilitation (CR), including health education, cardiovascular risk reduction advice, physical activity and stress management components. However, uptake of standard in-person, group-based CR is only around 50%. Hybrid cardiac rehabilitation (CR), combining in-person and remote service delivery, may improve CR uptake and reduce inequalities in service access. This study used focus groups and semi-structured interviews to explore staff and patient experiences of using the Active+me REMOTE hybrid CR app, a cloud-based platform providing access to education modules, behaviour change support, live exercise classes, physical activity and health monitoring across three sites in the East of England. Twelve staff and six patients participated. Topic guides explored participants' experiences of delivering or receiving hybrid CR, barriers and facilitators associated with the hybrid CR pathway, and implications for future implementation of Active+me REMOTE. Qualitative data were collected remotely, audio-recorded and independently transcribed. Staff data were analysed deductively, using the Consolidated Framework for Implementation Research (CFIR). Patient data were analysed inductively using thematic analysis. Despite some technical issues and governance delays, Active+me REMOTE was perceived as acceptable, convenient and allowed tailoring of support to meet patients' needs and circumstances. Data upload from wearable devices (blood pressure monitors) allowed staff to monitor patients' progress and empowered patients to direct their recovery. Staff initially felt they should screen patients to ensure that hybrid CR was offered to digitally literate, physically active individuals, although screening became less common as staff familiarity with the app increased. Findings suggest that effective implementation of hybrid CR requires system-level resource to facilitate governance approvals and embed hybrid CR delivery as standard care. Sufficient time must be allowed for staff training and to support patient enrolment to hybrid services. The study was registered on 3/7/2023 (ISRCTN320764).

Identification of two previously unreported Duchenne muscular dystrophy gene variants in a patient diagnosed with a dystrophinopathy: a case report

INTRODUCTION

Duchenne muscular dystrophy and Becker muscular dystrophy are X-linked recessive disorders affecting muscle function, which are caused by mutations in the dystrophin gene (also known as the Duchenne muscular dystrophy gene). The resulting condition is dictated by the severity of the involved mutation; for instance, Duchenne muscular dystrophy presents in early childhood with rapid progression, whereas Becker muscular dystrophy exhibits a milder, later onset with slower progression. In this report, we present the case of a young patient with clinical symptoms of a dystrophinopathy, whose genetic analysis yielded two previously undescribed mutations within the dystrophin gene.

CASE PRESENTATION

This paper focuses on a 12-year-old Syrian male patient with a 6-year history of progressive gait difficulty, lower limb weakness, and recurrent falls. Physical examination revealed a positive Gowers' sign and pseudohypertrophy, but normal muscle strength. A diagnosis of myopathy was supported by elevated serum creatine kinase and a muscle biopsy showing dystrophic changes in the right quadriceps muscle. While the initial deletion and duplication screening in the Duchenne muscular dystrophy gene using multiplex ligation-dependent probe amplification was negative, further extensive genetic analysis revealed two novel hemizygous variants of uncertain significance in the Duchenne muscular dystrophy gene (c.536A > T p.(Asp179Val) and c.680C > T p.(Ser227Phe), with no other clinically relevant variants in the neuromuscular panel.

CONCLUSION

The identification of novel variants in the Duchenne muscular dystrophy gene, alongside the absence of pathogenic mutations in other genes investigated by the neuromuscular panel, strongly suggests an X-linked dystrophinopathy diagnosis in our patient. This case highlights the need for continued exploration of dystrophinopathies' genetic variants. Further studies are required to elucidate the functional impact of these novel variants and to improve our understanding of the genotypic and phenotypic variability observed in these disorders, which may lead to a revolution in treatment approaches and potentially offer curative options for patients.

Aortic valve calcification across stages of dysglycemia in middle-aged individuals from the general population

BACKGROUND

Aortic valve calcification (AVC) is an underlying pathophysiological mechanism in aortic stenosis, which shares many risk factors with diabetes. However, the association between dysglycemia and early stages of AVC remains unclear. The aim was to examine the associations between stages of dysglycemia and signs of AVC among middle-aged individuals from the general population.

METHODS

This was a cross-sectional study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) randomly enrolling 30,154 middle-aged men and women from six study sites in Sweden between 2013 and 2018. Glycemic status was based on the World Health Organization criteria (fasting blood glucose and/or HbA1c) and questionnaire-based answers on previous diseases and categorized as normoglycemia, prediabetes, newly detected diabetes and known diabetes. AVC was assessed on cardiac computed tomography (CT) and defined as evident or not.

RESULTS

Of 29,331 individuals with data on glycemic status and AVC available, mean age was 57.5 years and normoglycemia was present in 76%, prediabetes in 16%, newly detected diabetes in 3% and known diabetes in 5%. The prevalence of AVC increased progressively across glycemic categories, particularly in males (8%, 11%, 14% and 17%; P < 0.01) compared to females (5%, 6%, 8% and 9%; P < 0.01). There was an association with AVC already in the early stages of dysglycemia; prediabetes (OR 1.16, 95% CI 1.02-1.31), newly detected diabetes (1.34 [1.05-1.71]) and known diabetes (1.61 [1.34-1.93]) after adjusting for age, sex, smoking, study site, low density lipoprotein-cholesterol and hypertension.

CONCLUSIONS

In this large, contemporary, and randomly selected population of middle-aged individuals, prediabetes, newly detected diabetes and known diabetes were all associated with CT-detected AVC. Further studies are warranted to investigate if managing dysglycemia, even in its early stages, may help slow down AVC progression.

Calcium, magnesium, and vitamin D supplementations as complementary therapy for hypertensive patients: a systematic review and meta-analysis

BACKGROUND

Hypertension, the first global modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality, is a consequential and remediable threat to the health of individuals and society. Therefore, we conducted this study to explore the role of calcium (Ca++), magnesium (Mg++), and vitamin D (Vit-D) supplementation as complementary therapies for hypertension, focusing on their effects on systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate.

METHODS

This systematic review and meta-analysis examined relevant 6509 articles in PubMed, Scopus, Web of Science, and Cochrane CENTRAL up to October 2024. The primary outcome was the difference in blood pressure measurements (systolic and diastolic) and the pulse rate. The extracted data were analyzed using Open Meta Analyst software.

RESULTS

This systematic review and meta-analysis included 40 studies; of them, 24 studies were analyzed. Ca++ was associated with a significant drop in the DBP (MD: -2.04, 95% CI [-3.39, -0.69], P = 0.01), but not in the SBP (P = 0.34) or pulse rate (P = 0.84). Mg++ significantly reduced DBP (MD: -1.64, 95% CI [-3.19, -0.09], P = 0.04), but had no significant effect on the SBP (P = 0.16) or pulse rate (P = 0.81). The estimated effect of Vit-D showed a significant reduction in SBP (MD: -2.83, 95% CI [-5.47, -0.199], P = 0.04) and DBP (MD: -1.64, 95% CI [-2.97, -0.3], P = 0.01).

CONCLUSION

Ca++ and Mg++ significantly reduced DBP but had no significant effect on SBP or the pulse rate. Whereas, vitamin D significantly reduced SBP and DBP.

Antifreezing Ultrathin Bioionic Gel-Based Wearable System for Artificial Intelligence-Assisted Arrhythmia Diagnosis in Hypothermia

Cardiovascular disease (CAD) is a major global public health issue, with mortality rates being significantly impacted by cold temperatures. Stable and reliable electrocardiogram (ECG) monitoring in cold environments is crucial for early detection and treatment of CAD. However, existing skin sensor struggle to balance freeze resistance, breathability, flexibility, conductivity and adhesion at cold temperatures. Here, we introduce a solvent cross-linking strategy and an in situ transfer method to prepare ultrathin bioionic gels, featuring a freezing point below -80 °C and a thickness of only 12.6 μm. The strong and abundant interactions between the ionic liquid solvent and the zwitterionic polymer effectively suppress low-temperature crystallization, forming a toughened and highly adhesive network structure. This network enables the in situ formation of an ultrathin morphology, which can be seamlessly transferred onto various substrates. Furthermore, the solvent-cross-linked network maintains a large interpolymer chain spacing, facilitating rapid ion transport pathways. Even at subzero temperatures, the gel maintains its multifunctionality, demonstrating tissue-like softness (34.6 kPa), high ionic conductivity (10.06 mS cm-1), excellent stretchability (360%), high transparency, robust adhesive strength (175.3 kPa) and interfacial toughness (1146 J m-2). Integrated into a flexible wearable device, the ultrathin gel ensures excellent skin conformity, user comfort, and high signal-to-noise ECG signal acquisition. Leveraging an artificial neural network, the system analyzes bradycardia ECG signals and achieves 96.88% accuracy in arrhythmia detection under cold conditions. This bioionic gel-based system presents a promising solution for early CAD diagnosis and prediction in extreme environments.

Pulling back the mitochondria's iron curtain

Mitochondrial functionality and cellular iron homeostasis are closely intertwined. Mitochondria are biosynthetic hubs for essential iron cofactors such as iron-sulfur (Fe-S) clusters and heme. These cofactors, in turn, enable key mitochondrial pathways, such as energy and metabolite production. Mishandling of mitochondrial iron is associated with a spectrum of human pathologies ranging from rare genetic disorders to common conditions. Here, we review mitochondrial iron utilization and its intersection with disease.

Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials

OBJECTIVE

To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.

STUDY SELECTION

Eligible randomised controlled trials that compare physical exercise to routine activities, usual care, non-physical activity, or health education to measure the Pittsburgh Sleep Quality Index.

DATA SOURCE

Studies retrieved from Medline, Embase, CINAHL, Scopus, ClinicalTrial.gov and ThaiJo from the database's inception to October 2022.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently identified studies, collected data and assessed bias. In the absence of heterogeneity, a fixed effect model was used for pairwise meta-analysis. Alternatively, a random effect model was used. A two-stage network meta-analysis used the surface under the cumulative ranking curve (SUCRA) to compare exercise efficacy.

MAIN OUTCOME

Global Pittsburgh Sleep Quality Index (GPSQI) and subdomain score.

RESULTS

This review comprised 2170 people from 25 trials. Direct meta-analysis revealed significant improvement in GPSQI with combined exercise (unstandardised mean difference (USMD) -2.35, 95% CI-3.13 to -1.57, p<0.001, I2=69.13%). GPSQI decreased considerably with aerobic activity (USMD -4.36, 95% CI -7.86 to -0.86, p=0.01, I2=97.83%). For the network meta-analysis, strengthening, aerobic and combination exercise significantly lowered GPSQI (USMD-5.75, -3.76 and -2.54, respectively). Strength training improved GPSQI scores most effectively (SUCRA 94.6%).

CONCLUSION

Exercise that strengthens muscles, rather than aerobic or combination exercises, is the most effective way to enhance sleep quality.