Updated evidence on epidemiology, diagnosis, and treatment for colonic diverticular bleeding

Since 2020, multiple large-scale studies (CODE BLUE-J) in Japan have accelerated the accumulation of evidence on colonic diverticular bleeding (CDB). This review summarizes the latest findings regarding CDB epidemiology and endoscopic hemostasis. Recent data show that CDB has become the most common cause of lower gastrointestinal bleeding in Japan, driven by an aging population and the increased use of antithrombotic medications. Although 70%-90% of patients achieve spontaneous hemostasis, rebleeding occurs in up to 35% of cases within 1 year. Despite an overall mortality rate of < 1%, patients with CDB can present with hypovolemic shock and may require urgent intervention. There are no effective pharmacological treatments for controlling CDB. Therefore, endoscopic therapy plays a crucial role in its management. Based on available evidence, both clipping and endoscopic band ligation are considered effective initial treatments. Recent studies indicate that direct clipping reduces early rebleeding compared with indirect clipping, while endoscopic band ligation achieves lower rebleeding rates (13%-15%) than clipping. The choice between direct clipping and endoscopic band ligation depends on the diverticulum location and the presence of active bleeding. Newer techniques, such as over-the-scope clip and self-assembling peptide application, have shown potential, but require further study. The detection of the bleeding source remains challenging because accurate identification is essential for successful hemostasis. Additional research is needed to refine the endoscopic diagnostic and therapeutic techniques, prevent rebleeding, and improve patient outcomes.

Role of mitophagy in spinal cord ischemia-reperfusion injury

Spinal cord ischemia-reperfusion injury, a severe form of spinal cord damage, can lead to sensory and motor dysfunction. This injury often occurs after traumatic events, spinal cord surgeries, or thoracoabdominal aortic surgeries. The unpredictable nature of this condition, combined with limited treatment options, poses a significant burden on patients, their families, and society. Spinal cord ischemia-reperfusion injury leads to reduced neuronal regenerative capacity and complex pathological processes. In contrast, mitophagy is crucial for degrading damaged mitochondria, thereby supporting neuronal metabolism and energy supply. However, while moderate mitophagy can be beneficial in the context of spinal cord ischemia-reperfusion injury, excessive mitophagy may be detrimental. Therefore, this review aims to investigate the potential mechanisms and regulators of mitophagy involved in the pathological processes of spinal cord ischemia-reperfusion injury. The goal is to provide a comprehensive understanding of recent advancements in mitophagy related to spinal cord ischemia-reperfusion injury and clarify its potential clinical applications.

Tryptophan metabolism and ischemic stroke: An intricate balance

Ischemic stroke, which is characterized by hypoxia and ischemia, triggers a cascade of injury responses, including neurotoxicity, inflammation, oxidative stress, disruption of the blood-brain barrier, and neuronal death. In this context, tryptophan metabolites and enzymes, which are synthesized through the kynurenine and 5-hydroxytryptamine pathways, play dual roles. The delicate balance between neurotoxic and neuroprotective substances is a crucial factor influencing the progression of ischemic stroke. Neuroprotective metabolites, such as kynurenic acid, exert their effects through various mechanisms, including competitive blockade of N-methyl-D-aspartate receptors, modulation of α7 nicotinic acetylcholine receptors, and scavenging of reactive oxygen species. In contrast, neurotoxic substances such as quinolinic acid can hinder the development of vascular glucose transporter proteins, induce neurotoxicity mediated by reactive oxygen species, and disrupt mitochondrial function. Additionally, the enzymes involved in tryptophan metabolism play major roles in these processes. Indoleamine 2,3-dioxygenase in the kynurenine pathway and tryptophan hydroxylase in the 5-hydroxytryptamine pathway influence neuroinflammation and brain homeostasis. Consequently, the metabolites generated through tryptophan metabolism have substantial effects on the development and progression of ischemic stroke. Stroke treatment aims to restore the balance of various metabolite levels; however, precise regulation of tryptophan metabolism within the central nervous system remains a major challenge for the treatment of ischemic stroke. Therefore, this review aimed to elucidate the complex interactions between tryptophan metabolites and enzymes in ischemic stroke and develop targeted therapies that can restore the delicate balance between neurotoxicity and neuroprotection.

Exosomes in neurodegenerative diseases: Therapeutic potential and modification methods

In recent years, exosomes have garnered extensive attention as therapeutic agents and early diagnostic markers in neurodegenerative disease research. Exosomes are small and can effectively cross the blood-brain barrier, allowing them to target deep brain lesions. Recent studies have demonstrated that exosomes derived from different cell types may exert therapeutic effects by regulating the expression of various inflammatory cytokines, mRNAs, and disease-related proteins, thereby halting the progression of neurodegenerative diseases and exhibiting beneficial effects. However, exosomes are composed of lipid bilayer membranes and lack the ability to recognize specific target cells. This limitation can lead to side effects and toxicity when they interact with non-specific cells. Growing evidence suggests that surface-modified exosomes have enhanced targeting capabilities and can be used as targeted drug-delivery vehicles that show promising results in the treatment of neurodegenerative diseases. In this review, we provide an up-to-date overview of existing research aimed at devising approaches to modify exosomes and elucidating their therapeutic potential in neurodegenerative diseases. Our findings indicate that exosomes can efficiently cross the blood-brain barrier to facilitate drug delivery and can also serve as early diagnostic markers for neurodegenerative diseases. We introduce the strategies being used to enhance exosome targeting, including genetic engineering, chemical modifications (both covalent, such as click chemistry and metabolic engineering, and non-covalent, such as polyvalent electrostatic and hydrophobic interactions, ligand-receptor binding, aptamer-based modifications, and the incorporation of CP05-anchored peptides), and nanomaterial modifications. Research into these strategies has confirmed that exosomes have significant therapeutic potential for neurodegenerative diseases. However, several challenges remain in the clinical application of exosomes. Improvements are needed in preparation, characterization, and optimization methods, as well as in reducing the adverse reactions associated with their use. Additionally, the range of applications and the safety of exosomes require further research and evaluation.

Neuroserpin alleviates cerebral ischemia-reperfusion injury by suppressing ischemia-induced endoplasmic reticulum stress

JOURNAL/nrgr/04.03/01300535-202601000-00037/figure1/v/2025-06-09T151831Z/r/image-tiff Neuroserpin, a secreted protein that belongs to the serpin superfamily of serine protease inhibitors, is highly expressed in the central nervous system and plays multiple roles in brain development and pathology. As a natural inhibitor of recombinant tissue plasminogen activator, neuroserpin inhibits the increased activity of tissue plasminogen activator in ischemic conditions and extends the therapeutic windows of tissue plasminogen activator for brain ischemia. However, the neuroprotective mechanism of neuroserpin against ischemic stroke remains unclear. In this study, we used a mouse model of middle cerebral artery occlusion and oxygen-glucose deprivation/reperfusion-injured cortical neurons as in vivo and in vitro ischemia-reperfusion models, respectively. The models were used to investigate the neuroprotective effects of neuroserpin. Our findings revealed that endoplasmic reticulum stress was promptly triggered following ischemia, initially manifesting as the acute activation of endoplasmic reticulum stress transmembrane sensors and the suppression of protein synthesis, which was followed by a later apoptotic response. Notably, ischemic stroke markedly downregulated the expression of neuroserpin in cortical neurons. Exogenous neuroserpin reversed the activation of multiple endoplasmic reticulum stress signaling molecules, the reduction in protein synthesis, and the upregulation of apoptotic transcription factors. This led to a reduction in neuronal death induced by oxygen/glucose deprivation and reperfusion, as well as decreased cerebral infarction and neurological dysfunction in mice with middle cerebral artery occlusion. However, the neuroprotective effects of neuroserpin were markedly inhibited by endoplasmic reticulum stress activators thapsigargin and tunicamycin. Our findings demonstrate that neuroserpin exerts neuroprotective effects on ischemic stroke by suppressing endoplasmic reticulum stress.

Enhanced neurogenesis after ischemic stroke: The interplay between endogenous and exogenous stem cells

Ischemic stroke is a significant global health crisis, frequently resulting in disability or death, with limited therapeutic interventions available. Although various intrinsic reparative processes are initiated within the ischemic brain, these mechanisms are often insufficient to restore neuronal functionality. This has led to intensive investigation into the use of exogenous stem cells as a potential therapeutic option. This comprehensive review outlines the ontogeny and mechanisms of activation of endogenous neural stem cells within the adult brain following ischemic events, with focus on the impact of stem cell-based therapies on neural stem cells. Exogenous stem cells have been shown to enhance the proliferation of endogenous neural stem cells via direct cell-to-cell contact and through the secretion of growth factors and exosomes. Additionally, implanted stem cells may recruit host stem cells from their niches to the infarct area by establishing so-called "biobridges." Furthermore, xenogeneic and allogeneic stem cells can modify the microenvironment of the infarcted brain tissue through immunomodulatory and angiogenic effects, thereby supporting endogenous neuroregeneration. Given the convergence of regulatory pathways between exogenous and endogenous stem cells and the necessity for a supportive microenvironment, we discuss three strategies to simultaneously enhance the therapeutic efficacy of both cell types. These approaches include: (1) co-administration of various growth factors and pharmacological agents alongside stem cell transplantation to reduce stem cell apoptosis; (2) synergistic administration of stem cells and their exosomes to amplify paracrine effects; and (3) integration of stem cells within hydrogels, which provide a protective scaffold for the implanted cells while facilitating the regeneration of neural tissue and the reconstitution of neural circuits. This comprehensive review highlights the interactions and shared regulatory mechanisms between endogenous neural stem cells and exogenously implanted stem cells and may offer new insights for improving the efficacy of stem cell-based therapies in the treatment of ischemic stroke.

Potential biofluid markers for cognitive impairment in Parkinson's disease

Cognitive impairment is a particularly severe non-motor symptom of Parkinson's disease that significantly diminishes the quality of life of affected individuals. Identifying reliable biomarkers for cognitive impairment in Parkinson's disease is essential for early diagnosis, prognostic assessments, and the development of targeted therapies. This review aims to summarize recent advancements in biofluid biomarkers for cognitive impairment in Parkinson's disease, focusing on the detection of specific proteins, metabolites, and other biomarkers in blood, cerebrospinal fluid, and saliva. These biomarkers can shed light on the multifaceted etiology of cognitive impairment in Parkinson's disease, which includes protein misfolding, neurodegeneration, inflammation, and oxidative stress. The integration of biofluid biomarkers with neuroimaging and clinical data can facilitate the development of predictive models to enhance early diagnosis and monitor the progression of cognitive impairment in patients with Parkinson's disease. This comprehensive approach can improve the existing understanding of the mechanisms driving cognitive decline and support the development of targeted therapeutic strategies aimed at modifying the course of cognitive impairment in Parkinson's disease. Despite the promise of these biomarkers in characterizing the mechanisms underlying cognitive decline in Parkinson's disease, further research is necessary to validate their clinical utility and establish a standardized framework for early detection and monitoring of cognitive impairment in Parkinson's disease.

Early effects of acetazolamide on hemoglobin mass and plasma volume in chronic mountain sickness at 5100 m

INTRODUCTION AND OBJECTIVES

Chronic Mountain Sickness (CMS) syndrome, combining excessive erythrocytosis and clinical symptoms in highlanders, remains a public health concern in high-altitude areas, especially in the Andes, with limited therapeutic approaches. The objectives of this study were to assess in CMS-highlanders permanently living in La Rinconada (5100-5300 m, Peru, the highest city in the world), the early efficacy of acetazolamide (ACZ) and atorvastatin to reduce hematocrit (Hct), as well as the underlying mechanisms focusing on intravascular volumes.

MATERIALS AND METHODS

Forty-one males (46±8 years of age) permanently living in La Rinconada for 15 [10-20] years and suffering from CMS were randomized between ACZ (250 mg once-daily; N = 13), atorvastatin (20 mg once-daily; N = 14) or placebo (N = 14) uptake in a double-blinded parallel study. Hematocrit (primary endpoint) as well as arterial blood gasses, total hemoglobin mass (Hbmass) and intravascular volumes were assessed at baseline and after a mean (±SD) treatment duration of 19±2 days.

RESULTS

ACZ increased PaO2 by +13.4% (95% CI: 4.3 to 22.5%) and decreased Hct by -5.2% (95% CI: -8.3 to -2.2%), whereas Hct remained unchanged with placebo or atorvastatin. ACZ tended to decrease Hbmass (-2.6%, 95% CI: -5.7 to 0.5%), decreased total red blood cell volume (RBCV, -5.3%, 95% CI: -10.3 to -0.3%) and increased plasma volume (PV, +17.6%, 95% CI: 4.9 to 30.3%). Atorvastatin had no effect on intravascular volumes, while Hbmass and RBCV increased in the placebo group (+6.1%, 95% CI: 4.2 to 7.9% and +7.0%, 95%CI: 2.7 to 11.4%, respectively).

CONCLUSIONS

Short-term ACZ uptake was effective to reduce Hct in CMS-highlanders living at extreme altitude >5,000 m and was associated with both an increase in PV and a reduction in RBCV.

Combination of exhaled volatile organic compounds with serum biomarkers predicts respiratory infection severity

OBJECTIVE

During respiratory infections, host-pathogen interaction alters metabolism, leading to changes in the composition of expired volatile organic compounds (VOCs) and soluble immunomodulators. This study aims to identify VOC and blood biomarker signatures to develop machine learning-based prognostic models capable of distinguishing infections with similar symptoms.

METHODS

Twenty-one VOCs and fifteen serum biomarkers were quantified in samples from 86 COVID-19 patients, 75 patients with non-COVID-19 respiratory infections, and 72 healthy donors. The populations were categorized into severity subgroups based on their oxygen support requirements. Descriptive and statistical analyses were conducted to assess group differentiation. Additionally, machine learning classifiers were developed to predict disease severity in both COVID-19 and non-COVID-19 patients.

RESULTS

VOC and biomarker profiles differed significantly among groups. Random Forest models demonstrated the best performance for severity prediction. The COVID-19 model achieved 93% accuracy, 100% sensitivity, and 89% specificity, identifying IL-6, IL-8, thrombomodulin, and toluene as key severity predictors. In non-COVID-19 patients, the model reached 89% accuracy, 100% sensitivity, and 67% specificity, with CXCL10 and methyl-isobutyl-ketone as key markers.

CONCLUSION

VOCs and serum biomarkers differentiated HD, COVID-19, and non-COVID-19 patients, and enabled the development of high-performance severity prediction models. While promising, these findings require validation in larger independent cohorts.

How Health Systems World-wide Fail Type 2 Diabetics

For over 50 years, health systems the world over have failed people with type 2 diabetes mellitus (T2DM). The WHO documents a quadrupling of people with diabetes in a 34-year period to 422 million in 2014, the overwhelming majority of whom were T2DM. This happened despite extensive scientific literature on the causes of, as well as proven treatments for, this disease. Using a health systems prism to review the extensive medical and nutritional T2DM published research, we identified three main shortcomings of health systems in T2DM: (i) failure in early detection; (ii) failure in understanding the actionable lifestyle drivers; and (iii) subsidizing the causes of the disease. Although small-scale success stories in T2DM control exist, the lack of documented evidence of any country-wide health system's successful attempt to address this epidemic is alarming. The immense and ever-growing health and economic burdens of T2DM should provide all the motivation needed for national and global efforts to counteract the political-economy constraints standing in the way of successful whole-of-system approaches to T2DM.

In-hospital mortality of high-risk pulmonary embolism: a nationwide population-based cohort study in Portugal from 2010 to 2018

BACKGROUND

The mortality associated with high-risk pulmonary embolism (PE) is remarkably high, and reperfusion to unload right ventricle should be a priority. However, several registries report reperfusion underuse. In Portugal, epidemiological data about the incidence, rate of reperfusion and mortality of high-risk PE are not known.

METHODS

Nationwide population-based temporal trend study in the incidence and outcome of high-risk PE, who were admitted to hospitals of the National Health Service in Portugal between 2010 and 2018. High-risk PE was defined as patients with PE who developed cardiogenic shock or cardiac arrest. International Classification of Diseases (ICD), 9th and 10th revision, Clinical Modification codes, were used for data from the period between 2010 and 2016 (ICD-9-CM) and 2017-2018 (ICD-10-CM), respectively. The assessment focused on trends in the use of reperfusion treatment, which was defined by application of thrombolysis or pulmonary embolectomy. A comparison was made between the use or non-use of reperfusion therapy in order to examine trends in in-hospital mortality among high-risk PE cases.

RESULTS

From 2010 and 2018, there were 40.311 hospitalization episodes for PE in adult patients at hospitals of the National Health Service in mainland Portugal. There was a significant increase in the annual incidence of PE (41/100.000 inhabitants in 2010 to 46/100.000 in 2018; R2=0.582, p = 0.010). The average annual incidence was 45/100.000 inhabitants/year, with 2,7% of the PE episodes (1104) categorized as high-risk. The mortality rate associated with high-risk PE was high, although it has decreased over the years (74.2% in 2010 to 63.6% in 2018; R2=0.484; p = 0.022). Thrombolytic therapy was underused in high-risk PE, and its usage has not increased in recent years (17.3% in 2010 to 21.1% in 2018, R2=-0.127; p = 0.763). Surgical pulmonary embolectomy was used in 0.27% of cases, and there was no registry of catheter-directed thrombolysis. Patients with high-risk PE undergoing reperfusion therapy had lower in-hospital mortality compared to non-reperfused patients (OR=0.52; IC95% 0.38-0.70).

CONCLUSION

In Portugal, between 2010 and 2018, very few patients with PE developed high-risk forms of the disease, but the mortality rate among those patients was high. The low reperfusion rate could be associated with high in-hospital mortality and highlights the need to implement advanced therapies, as an alternative to systemic thrombolysis.

A Health Systems Approach to Nurse-Led Implementation of Diabetes Prevention and Management in Vulnerable Populations

Diabetes mellitus is seventh-leading cause of death in the United States, and has a substantial economic burden, contributing $237 billion in direct medical costs. The incidence rate of type 2 diabetes (T2DM) is expected to continue to increase, disproportionally impacting vulnerable groups. The increasing prevalence and disproportionate burden emphasize the need for health systems to effectively integrate and implement large- and small-scale, culturally tailored nurse-led diabetes prevention programs (DPP) and diabetes self-management education programs (DSME). This two-stage analysis uses a health system approach to provide a synopsis of evidence-based nurse-led DPP and DSME implementation across various health system settings. Using the results from an integrative review, a health system focused framework was developed and applied to two case studies highlighting specific aspects of how successful large- and small-scale nurse-led interventions are integrated into health systems across varying vulnerable populations specifically Veterans, Asian Americans and Haitians. Case study results use examples to show large-scale implementation of DSME across the federal Veterans Health Administration (VHA) improves diabetes self-management and access for Veterans and smaller-scale DPP and DSME programs within community health centers targeting vulnerable populations impact health literacy and diabetes self-management. These examples demonstrate key steps toward improving access and outcomes for diabetes management and the critical role of nurse-led diabetes interventions as a priority across the health system and the importance of financial and organizational support for DPP and DSME programs to overcome access barriers to improve diabetes interventions and management.

TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and complex or multivessel coronary disease (TCW): an international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial

BACKGROUND

Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease.

METHODS

This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed.

FINDINGS

Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010).

INTERPRETATION

The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment.

FUNDING

Isala Heart Centre and Medtronic.

C. P. Long-term cognitive and autonomic effects of COVID-19 in young adults: a cross-sectional study at 28 months

OBJECTIVES

The COVID-19 pandemic, caused by SARS-CoV-2, has had profound global impacts since its emergence in late 2019. Whilst acute symptoms are well-documented, increasing evidence suggests long-term consequences extending beyond the acute phase. This study aimed to investigate the long-term cognitive and autonomic effects of COVID-19 in young adults.

MATERIALS AND METHODS

We conducted a cross-sectional study comparing young adults with a history of COVID-19 (n = 34) to matched controls (n = 34). Cognitive function was assessed using the Sternberg Task, Stroop Task, and Go/No-Go Task (GNG). Autonomic function was evaluated using heart rate variability (HRV) parameters.

RESULTS

The average time interval between COVID-19 infection and testing was 28.2 months. The COVID-19 group showed significantly increased reaction time in the 2-item absent condition (p = 0.044) and errors in the 4-item present condition (p = 0.012) of the Sternberg Task and increased neutral response time (p = 0.028) and the normalized time for completing the task (p = 0.022) in the Stroop Task. No significant differences were found in the GNG Task. HRV parameters did not differ significantly between groups, although trends toward higher overall HRV were observed in the COVID-19 group.

CONCLUSION

Young adults who had COVID-19 infection approximately 28 months ago show minimal long-term impact on cognitive function and autonomic regulation. However, subtle cognitive inefficiencies persist, particularly in working memory and executive function tasks. These findings suggest a generally favorable long-term prognosis for young adults following mild to moderate COVID-19 but highlight the need for further investigation into persistent subtle cognitive effects and autonomic effects.

Gut-derived lactic acid enhances tryptophan to 5-hydroxytryptamine in regulation of anxiety via Akkermansia muciniphila

The gut microbiota plays a pivotal role in anxiety regulation through pathways involving neurotransmitter production, immune signaling, and metabolic interactions. Among these, gut-derived serotonin (5-hydroxytryptamine, 5-HT), synthesized from tryptophan metabolism, has been identified as a key mediator. However, it remains unclear whether specific microbial factors regulate tryptophan metabolism to influence 5-HT production and anxiety regulation. In this study, we analyzed 110 athletes undergoing closed training and found that fecal lactate levels were significantly associated with anxiety indicators. We observed a significant negative correlation between Akkermansia abundance and anxiety levels in athletes. Co-supplementation with lactate and Akkermansia muciniphila (A. muciniphila) modulated tryptophan metabolism by increasing key enzyme TPH1 and reducing IDO1, thus shifting metabolism from kynurenine (Kyn) to 5-HT. In addition, lactate enhanced the propionate production capacity of A. muciniphila, potentially contributing to anxiety reduction in mice. Taken together, these findings suggest that enteric lactate and A. muciniphila collaboratively restore the imbalance in tryptophan metabolism, leading to increased 5-HT activity and alleviating anxiety phenotypes. This study highlights the intricate interplay between gut metabolites and anxiety regulation, offering potential avenues for microbiota-targeted therapeutic strategies for anxiety.

Predictive risk factors for adverse events during tooth extraction among elderly patients with cardiovascular diseases

BACKGROUND

Tooth extraction is a risk factor for cardiovascular events, particularly in elderly patients. However, no clinical tool has been developed to date to predict the risk of adverse events (AEs) during tooth extraction.

MATERIALS AND METHODS

We prospectively enrolled 774 elderly patients (aged ≥ 60 years) with cardiovascular disease (CVD) who were scheduled to undergo tooth extraction at the dental surgery department of Shanghai Ninth People's Hospital from January 2021 to July 2022. To determine the predictive risk factors for AEs, we collected and recorded 62 factors on general characteristics, clinical information, physical and imaging examinations, psychological tests, perioperative characteristics, and surgical characteristics.

RESULTS

We used a univariate logistic regression model to explore the 62 potential risk factors and included 21 factors in a multivariate model (all P-values < 0.05). After stepwise selection, 11 factors, including age, systolic blood pressure, severe hypertension, history of pacemaker use, stroke, ejection fraction, valvular insufficiency, atrial premature beats, ventricular premature beats, extraction of more than one tooth and the General Health Questionnaire-28 score, were included in the predictive model (all P-values < 0.05). In the test group, the area under the curve was 0.893 (0.866, 0.919), sensitivity was 0.878 (0.827, 0.93), specificity was 0.735 (0.697, 0.773) and accuracy was 0.768 (0.736, 0.800). In the validation group, these values were 0.857 (0.760, 0.954), 0.938 (0.819, 1.056) and 0.524 (0.417, 0.631), respectively. We created a nomogram to predict the risk factors for AEs during tooth extraction. Mental status plays a critical role in the risk of adverse effects, and the blood pressure also has a key influence on the prediction of adverse effects.

CONCLUSIONS

We developed and validated a predictive model with 11 clinical factors for the AEs during tooth extraction in elderly patients with CVD with well efficiency.

METTL14-mediated m6A modification of DDIT4 promotes its mRNA stability in aging-related idiopathic pulmonary fibrosis

Although N6-methyladenosine (m6A) may be related to the pathogenesis of fibrotic process, the mechanism of m6A modification in aging-related idiopathic pulmonary fibrosis (IPF) remains unclear. Three-milliliter venous blood was collected from IPF patients and healthy controls. MeRIP-seq and RNA-seq were utilized to investigate differential m6A modification. The expressions of identified m6A regulator and target gene were validated using MeRIP-qPCR and real-time PCR. Moreover, we established an animal model and a senescent model of A549 cells to explore the associated molecular mechanism. Our study provided a panorama of m6A methylation in IPF. Increased peaks (3756) and decreased peaks (4712) were observed in the IPF group. The association analysis showed that 749 DEGs were affected by m6A methylation in IPF. Among the m6A regulators, the expression of METTL14 decreased in IPF. The m6A level of our interested gene DDIT4 decreased significantly, but the mRNA level of DDIT4 was higher in IPF. This was further verified in bleomycin-induced pulmonary fibrosis. At the cellular level, it was further confirmed that METTL14 and DDIT4 might participate in the senescence of alveolar epithelial cells. The downregulation of METTL14 might inhibit the decay of DDIT4 mRNA by reducing the m6A modification level of DDIT4 mRNA, leading to high expression of DDIT4 mRNA and protein. Our study provided a panorama of m6A alterations in IPF and discovered METTL14 as a potential intervention target for epigenetic modification in IPF. These results pave the way for future investigations regarding m6A modifications in aging-related IPF.

The association between the cystatin C- and creatinine-based estimated GFR ratio and post-ablation outcomes in patients with atrial fibrillation

BACKGROUND

The difference between the cystatin C-based eGFR (eGFRcys) and the creatinine-based eGFR (eGFRcr) is associated with the risk of developing atrial fibrillation (AF) risk. However, its impact on AF ablation outcomes is unknown.

METHODS

The associations between the baseline eGFR ratio (eGFRcys/eGFRcr) and the risk of experiencing post-ablation endpoints were evaluated on a continuous scale (restricted cubic splines) and by a priori defined centile categories with Cox proportional hazards regression models. The primary endpoints were AF recurrence and adverse events; the secondary endpoint was rehospitalization.

RESULTS

Among 989 participants (49.2% women; mean age 65.7 years), 313 experienced AF recurrence after a median follow-up of 28 months. After full adjustment for confounding factors, a U-shaped association was observed between eGFR ratio and AF recurrence risk (minimum risk at 0.797). Although a U-shaped trend was observed, there was no statistically significant association between the eGFR ratio and adverse events or rehospitalization. Hazard ratios for AF recurrence, compared to the second quartile, were 1.68 (1.20-2.37) for the first quartile, 1.64 (1.15-2.34) for the third quartile, and 1.96 (1.37-2.80) for the fourth quartile. According to the subgroup analysis, the above association was strongly U-shaped for males and linear for females.

CONCLUSION

In the AF population, both low and high eGFR ratios were associated with an increased risk of post-ablation AF recurrence.

The value of triglyceride glucose-body mass index, fasting blood glucose to HDL-C ratio, and platelet to HDL-C ratio in predicting abdominal aortic calcification in maintenance hemodialysis patients

BACKGROUND

The triglyceride glucose-body mass index (TyG-BMI), fasting blood glucose (FBG) to high-density lipoprotein cholesterol (HDL-C) ratio (GHR), and platelet (PLT) to HDL-C ratio (PHR) are well-established markers of insulin resistance (IR), closely linked to cardiovascular and cerebrovascular diseases. Abdominal aortic calcification (AAC), a key indicator of subclinical atherosclerotic, is highly prevalent in maintenance hemodialysis (MHD) patients. This study aimed to explore the cross-sectional relationship between these IR indices and AAC in MHD patients and identify the most reliable predictive marker.

METHODS

We recruited 391 MHD patients from two hemodialysis medical centers, with 297 meeting the inclusion criteria. AAC was detected via X-ray scanning of the lumbar spine, quantified by the Kauppila scoring system. Receiver operating characteristic (ROC) curve analysis determined optimal cutoff values for dividing the subjects into high-index and low-index groups. Multivariable logistic regression models evaluated the association between AAC and these IR indices.

RESULTS

The prevalence of AAC in the whole group was 72.4%. The occurrence of AAC in the high-index group was significantly higher than that in the low-index group. Among the three IR indices, PHR demonstrated the highest predictive stability when integrated into a combined model. Subgroup analyses confirmed the robustness of this association across different age groups, sex, hypertension levels, comorbidities (CVD and stroke history), and smoking status.

CONCLUSION

TyG-BMI, GHR and PHR were independently associated with the presence of AAC among MHD patients. Notably, PHR showed the strongest correlation with AAC, suggesting its potential clinical utility in risk stratification.

Evaluation of the effect of 48 weeks of BIC/F/TAF and DRV/c/F/TAF on platelet function in the context of rapid ART start

INTRODUCTION

The BIC-T&T study aimed to determine the efficacy of bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) and darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/c/F/TAF) at suppressing viral load in a two-arm, open-label, multi-centre, randomised trial under a UK test-and-treat setting. This sub-study aimed to evaluate potential off-target cardiovascular impact by examining ex vivo platelet function.

METHODS

Platelets were isolated by centrifugation of citrated blood from participants attending Chelsea and Westminster Hospital or St Mary's Hospital at Week 48 following enrolment. Platelet activation was assessed by real-time flow cytometry to examine integrin activation and granule release and platelet aggregation was evaluated by light transmission aggregometry. Statistical significance was determined by 2-way ANOVA with a Šidák's multiple comparisons post-test.

RESULTS

An analysis of 21 participants was performed at Week 48 (96% male and 48% white; mean (range) age was 37 (23-78) years). No difference between arms was observed in ADP-, collagen- or thrombin receptor activator for peptide (TRAP)-6-evoked platelet αIIbβ3 integrin activation, granule release or platelet aggregation in response to any of the agonists tested. Despite differences in the demographics between treatment arms, the presence of an unboosted integrase inhibitor or boosted protease inhibitor in a test-and-treat setting did not impact platelet function.

CONCLUSIONS

Our study provides no evidence of differences in downstream platelet responses between participants taking BIC/F/TAF compared to DRV/c/F/TAF following 48 wk of treatment. Further data are required to explore whether there are biologically significant off-target effects, including effects on platelets and other components of the cardiovascular system between these two test-and-treat regimens.

CLINICAL TRIAL NUMBER

NCT04653194.

Perinuclear organelle trauma at the nexus of cardiomyopathy pathogenesis arising from loss of function LMNA mutation

Over the past 25 years, nuclear envelope (NE) perturbations have been reported in various experimental models with mutations in the LMNA gene. Although the hypothesis that NE perturbations from LMNA mutations are a fundamental feature of striated muscle damage has garnered wide acceptance, the molecular sequalae provoked by the NE damage and how they underlie disease pathogenesis such as cardiomyopathy (LMNA cardiomyopathy) remain poorly understood. We recently shed light on one such consequence, by employing a cardiomyocyte-specific Lmna deletion in vivo in the adult heart. We observed extensive NE perturbations prior to cardiac function deterioration with collateral damage in the perinuclear space. The Golgi is particularly affected, leading to cytoprotective stress responses that are likely disrupted by the progressive deterioration of the Golgi itself. In this review, we discuss the etiology of LMNA cardiomyopathy with perinuclear 'organelle trauma' as the nexus between NE damage and disease pathogenesis.

A vascular endothelial growth factor-loaded chitosan-hyaluronic acid hydrogel scaffold enhances the therapeutic effect of adipose-derived stem cells in the context of stroke

JOURNAL/nrgr/04.03/01300535-202512000-00028/figure1/v/2025-01-31T122243Z/r/image-tiff Adipose-derived stem cell, one type of mesenchymal stem cells, is a promising approach in treating ischemia-reperfusion injury caused by occlusion of the middle cerebral artery. However, its application has been limited by the complexities of the ischemic microenvironment. Hydrogel scaffolds, which are composed of hyaluronic acid and chitosan, exhibit excellent biocompatibility and biodegradability, making them promising candidates as cell carriers. Vascular endothelial growth factor is a crucial regulatory factor for stem cells. Both hyaluronic acid and chitosan have the potential to make the microenvironment more hospitable to transplanted stem cells, thereby enhancing the therapeutic effect of mesenchymal stem cell transplantation in the context of stroke. Here, we found that vascular endothelial growth factor significantly improved the activity and paracrine function of adipose-derived stem cells. Subsequently, we developed a chitosan-hyaluronic acid hydrogel scaffold that incorporated vascular endothelial growth factor and first injected the scaffold into an animal model of cerebral ischemia-reperfusion injury. When loaded with adipose-derived stem cells, this vascular endothelial growth factor-loaded scaffold markedly reduced neuronal apoptosis caused by oxygen-glucose deprivation/reoxygenation and substantially restored mitochondrial membrane potential and axon morphology. Further in vivo experiments revealed that this vascular endothelial growth factor-loaded hydrogel scaffold facilitated the transplantation of adipose-derived stem cells, leading to a reduction in infarct volume and neuronal apoptosis in a rat model of stroke induced by transient middle cerebral artery occlusion. It also helped maintain mitochondrial integrity and axonal morphology, greatly improving rat motor function and angiogenesis. Therefore, utilizing a hydrogel scaffold loaded with vascular endothelial growth factor as a stem cell delivery system can mitigate the adverse effects of ischemic microenvironment on transplanted stem cells and enhance the therapeutic effect of stem cells in the context of stroke.

Eggerthella lenta down regulated flavone and flavonol biosynthesis promoted Kawasaki disease

Kawasaki Disease (KD) is a multisystemic vasculitis of unknown aetiology in children. The incidence of KD varies by geographic area and correlates with differences in gut microbiota patterns, with the highest incidence in Asian. This study aimed to investigate alterations in faecal microbiota and assess their relationship with systemic inflammation in KD patients. A total of 59 patients and 55 matched controls were included. Fecal samples were collected at the onset of KD. The V3/V4 regions of 16S rDNA were sequenced using the MiSeq platform. PICRUSt 2 was used to analyse the potential functional pathways involved in gut dysbiosis. Alpha (p < 0.042) and beta (p < 0.001) diversity in KD were significantly decreased when compared to the control group. After multivariate regression, among the seven critical microbes, increased Eggerthella lenta (p = 0.016) and decreased Bacteroides ovatus (p = 0.014) could also predict KD risk using receiver operating characteristic curve (ROC) analysis (Eggerthella lenta: area under the ROC curve, AUC = 0.841, odds ratio = 23.956; Bacteroides ovatus: AUC = 0.816, odds ratio = 31.365). Notably, Bacteroides ovatus was positively correlated with blood segment cells (p = 0.006), but negatively correlated with blood lymphocytes (p = 0.013). After multivariate regression, flavone and flavonol biosynthesis decreased in children with KD (p < 0.001). Our results indicated that both Bacteroides ovatus and Eggerthella lenta may deregulate flavone and flavonol biosynthesis, consequently modulating immune cells and potentially triggering KD. This study suggests that alterations in the gut microbiota are closely associated with immune responses and provides a new perspective on the aetiology, pathogenesis, and treatment of KD.

Cost-of-illness of heart failure with preserved and reduced ejection fraction in the Philippines

AIM

Heart Failure (HF) poses a significant clinical and economic burden globally. Due to its progressive and chronic nature, HF requires both continuous medical management and acute care related to hospitalization. This study aimed to estimate the economic burden of HF in the Philippines, covering both outpatient care and inpatient management.

METHODS

The study utilized a bottom-up micro-costing approach to determine the economic burden of heart failure with mildly reduced ejection fraction (HFmrEF)/heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) across all NYHA classifications using a societal perspective. Price data were gathered from clinical experts, public and private hospitals, while quantity and probability assumptions were derived from published literature, subsequently validated through clinical expert consensus.

RESULTS

In 2022, an estimated 914,892 individuals were diagnosed with HF in the Philippines, based on a prevalence rate of 0.82%. This equates to a total economic burden of PHP 80.9B (USD 1.5B). Direct costs accounted for 90% of the total burden at PHP 72.8B (USD 1.3B). Hospital and medication expenses represented 61% of the total cost-of-illness, amounting to PHP 49.2B (USD 887.6 M).

CONCLUSIONS

HF management poses a significant burden-of-disease for Filipinos. The annual societal costs of HF management potentially expose Filipinos to catastrophic health spending and impoverishment, especially in a system where a substantial portion of healthcare expenses are paid out-of-pocket. These findings highlight the urgent need to prioritize preventive public health interventions and enhance financial risk protection for HF patients.

Case report of LVEF derived from gated FDG-PET: potential to streamline cardiotoxic surveillance in melanoma patients

BACKGROUND

Advances in cancer therapy have improved patient outcomes, but cardiotoxicity remains a significant risk. In melanoma patients treated with BRAF and MEK inhibitors, monitoring left ventricular ejection fraction (LVEF) during treatment is recommended to detect cardiac dysfunction. Despite the widespread use of FDG-PET in oncology, its potential for concurrent cardiac assessment remains underexplored.

METHODS

A 42-year-old male undergoing treatment for disseminated melanoma underwent measurements of LVEF using four modalities: 3D-MUGA, 3D echocardiography, Rb-PET, and gated FDG-PET.

RESULTS

LVEF was within the normal range across all modalities: 60% (3D-MUGA), 61% (3D echocardiography), 63% (Rb-PET), and 65% (FDG-PET).

CONCLUSION

This case presents an estimation of LVEF derived from a clinically indicated, FDG-PET scan, performed alongside three conventional modalities on the same day. This approach may be particularly useful in melanoma patients who undergo frequent FDG-PET scans. While the findings are promising, broader validation is needed.

Joint impacts of air pollution and healthy lifestyles on kidney function decline: insights from a nationwide cohort study

Long-term exposure to ambient air pollution is a recognized environmental risk factor for chronic kidney disease (CKD), but its dynamic effects on kidney function remain incompletely understood. This nationwide longitudinal study included 5,306 participants from the China Health and Retirement Longitudinal Study (CHARLS) to examine associations between five major air pollutants (PM1, PM2.5, PM10, NO2, and O3) and kidney function decline, measured by the annual slope of estimated glomerular filtration rate (eGFR). Air pollutant exposures were assessed both as continuous variables and dichotomized by median levels. Higher exposure to PM1, PM2.5, PM10, and NO2 was consistently associated with faster eGFR decline. In fully adjusted models, each 1 μg/m3 increase in PM2.5 corresponded to a steeper decline in eGFR (β = -0.02; 95% CI: -0.03 to -0.02), while participants in high PM2.5 areas had an annual decline of -0.51 mL/min/1.73 m2 (95% CI: -0.72 to -0.31). O3 showed a significant association only in binary models. Weighted quantile sum regression identified PM2.5 and PM1 as dominant contributors. A favorable lifestyle markedly mitigated pollution-related decline; under high PM1 exposure, eGFR declined by -0.69 (95% CI: -1.06 to -0.33) in those with favorable lifestyles versus -2.20 (95% CI: -2.65 to -1.75) in those with unfavorable lifestyles. These findings were robust across multiple sensitivity analyses. These findings emphasize the adverse impact of long-term air pollution exposure on kidney function and suggest that healthy lifestyle behaviors may offer significant protective benefits.

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.

Associations between procedural volume, costs, and outcomes of septal reduction therapies for obstructive hypertrophic cardiomyopathy in US hospitals

AIM

We assessed the relationship between hospital septal reduction therapy (SRT) procedural volume and clinical outcomes, healthcare resource utilization, and hospital costs.

METHODS

This cross-sectional study used 2012-2022 US hospital data from the PINC AI Healthcare Database for adults with hypertrophic cardiomyopathy (HCM) undergoing alcohol septal ablation (ASA) or septal myectomy (SM; with or without mitral valve repair or replacement [MVRR]). We categorized hospital procedural volume into tertiles according to the numbers of procedures performed and made pairwise comparisons of patient characteristics, clinical events, healthcare utilization, and hospital costs between tertiles. We conducted multivariable analyses (adjusted for patient, clinical, and hospital characteristics) for index hospitalization length of stay, cost, and 30-day readmission rates.

RESULTS

Overall, 3,068 patients with HCM (across 315 hospitals) underwent SRT (ASA: 1,400; SM: 1,668). Index visit in-hospital mortality was 1.1-1.5% among individuals undergoing ASA, 3.2-7.4% for SM with MVRR, and 2.8-3.8% for SM without MVRR. There were no significant differences in in-hospital mortality or stroke/transient ischemic attack at index visits between the hospital procedural volume tertiles for ASA or SM. Adjusted hospital length of stay, costs, and readmission rates were significantly greater in low-volume than high-volume hospitals for ASA (p < 0.001). Similar trends were reported for SM for length of stay and costs (p < 0.001).

LIMITATIONS

This study relied upon accurate and complete reporting of diagnoses and procedures by hospitals. Patients were not randomly assigned, potentially leading to selection bias. Only in-hospital costs were evaluated. Follow-up events were only captured if they occurred in the same healthcare facility.

CONCLUSIONS

Resource utilization and in-hospital costs for patients undergoing SRT are lower in high procedural volume hospitals than low procedural volume hospitals. SRT procedure volume remains low even in hospitals with the highest relative procedural volumes, highlighting a need for globally accessible therapies that improve outcomes.

Personalized prediction of psoriasis relapse post-biologic discontinuation: a machine learning-driven population cohort study

BACKGROUND

Identifying the risk of psoriasis relapse after discontinuing biologics can help optimize treatment strategies, potentially reducing relapse rates and alleviating the burden of disease management.

OBJECTIVE

To develop and validate a personalized prediction model for psoriasis relapse following the discontinuation of biologics.

METHODS

This study enrolled patients who achieved remission following biologic therapy. Relapse predictors were identified using the Boruta algorithm combined with multivariate Cox regression. A nomogram and an online calculator were created to aid in the visualization and computation of outcomes. The model's performance was thoroughly assessed using Receiver Operating Characteristic (ROC) curves, Area Under the Curve (AUC), C-statistics, calibration plots, and Decision Curve Analysis (DCA).

RESULTS

The study included 597 patients, with 534 in the derivation cohort and 63 in the validation cohort. Anxiety, disease duration, prior biologic treatments, treatment duration, time to achieve PASI 75, and maximum PASI response were identified as influential factors for relapse and were incorporated into the model. Both internal and external evaluations indicate that the model exhibits good predictive accuracy.

CONCLUSION

A multivariate model leveraging standard clinical data can relatively accurately predict the risk of psoriasis relapse post-biologic discontinuation, guiding personalized treatment strategies.

Association between life's essential 8 and diabetic kidney disease: a population-based study

BACKGROUND AND AIMS

Diabetic patients are highly susceptible to cardiovascular and renal diseases. As a newly updated comprehensive index for assessing cardiovascular health (CVH), Life's essential 8 (LE8) has the potential to serve as a practical tool for evaluating the risk of diabetic kidney disease (DKD). We are committed to exploring the relationship between LE8 and its subscales with DKD in diabetic patients, aiming to provide preliminary evidence for the formulation of clinical strategies.

METHODS AND RESULTS

A total of 3,715 NHANES participants were included in this study, representing 18.9 million non-institutionalized residents of the United States. The mean age of all subjects was 59.72 years, and the weighted prevalence of DKD among diabetic patients was 36.39%. After adjusting for potential confounding factors, it was found that compared to the low LE8 group, the risk of developing DKD was significantly lower in the moderate LE8 group (OR: 0.54, 95% CI: 0.43-0.66) and the high LE8 group (OR: 0.18, 95% CI: 0.08-0.42). A similar trend was observed across the subscales of the LE8 score. The results of the fully adjusted restricted cubic spline regression analysis revealed a linear relationship between LE8 and its subscales with DKD. The findings remained consistent in subgroup and sensitivity analyses, with no significant interactions observed between subgroups.

CONCLUSION

Higher scores on the LE8 and its subscales were associated with a lower risk of developing DKD. However, the long-term causal relationship between LE8 and DKD risk necessitates further validation and exploration through large-scale, rigorously designed prospective studies.

Back to the pre-industrial age? FAOSTAT statistics of food supply reveal radical dietary changes accompanied by declining body height, rising obesity rates, and declining phenotypic IQ in affluent Western countries

Meta-analyses of observational and clinical studies conducted in recent years have raised serious doubts about the validity of the low-fat dietary recommendations introduced in the late 1970s/early 1980s, due to the absence of any convincing link between saturated fat and the risk of cardiovascular diseases. At the same time, long-term food supply statistics from the FAOSTAT database show that these recommendations were at the root of fundamental dietary changes in Western countries, which resulted in a lower consumption of eggs and red meat, a higher consumption of cereals and poultry, a decline in average protein quality and, overall, in a higher glycemic load of the diet. Because current views on human nutrition are based primarily on highly unreliable questionnaire data from observational studies, the purpose of this commentary is to provide an alternative ecological (country-level) perspective and to trace the consequences of these nutritional changes using the FAOSTAT database in combination with available anthropological and health statistics. This comparison shows a close connection between the decline in protein quality and the sudden reversal of the positive height trend in some Western countries, after ∼150 years of continuous growth, which points to suboptimal levels of child nutrition. The sharp increase in the prevalence of obesity and type 2 diabetes is strongly correlated with the increasing consumption of high-glycemic carbohydrates and sweeteners, and is also interconnected with the decrease in body height, because a high-quality, growth-stimulating diet during adolescence is inversely related to obesity. Given the long-term association between height and phenotypic IQ, the lower quality of nutrients in children's diet may also seriously affect intellectual potential and future civilizational development. In light of these findings, current nutritional strategies should be seriously reconsidered and recommended protein intakes for children must be urgently reevaluated.

Exploring the association of natriuretic peptides with QTc interval in hemodialysis patients

BACKGROUND

In patients undergoing hemodialysis (HD), cardiovascular (CV) disease, particularly sudden cardiac death (SCD), is a major cause of mortality. Independent predictors of SCD include a prolonged QT interval on electrocardiography (ECG) and elevated levels of natriuretic peptides (NPs). This study explores the association between the QTc interval and NPs in HD patients.

METHODS

This cross-sectional study involved 207 HD patients, having a heart rate of 57 to 103 bpm, displaying sinus rhythm and no extrasystoles in ECG reports. Before the 2nd HD of the week, we conducted ECG and blood tests for atrial NP (ANP), brain NP (BNP), and N-terminal proBNP (NT-proBNP). The heart rate-corrected QT (QTc) was calculated using Bazett formula. Our analysis focused on the association between QTc and each NP, along with evaluating clinically relevant variables related to the QTc interval.

RESULTS

Univariate analyses indicated robust correlations among the NPs, with each NP significantly associated with the QTc interval. Multiple regression analyses of the three NPs revealed that NT-proBNP demonstrated the strongest predictive ability for the QTc interval. Independent predictors of prolonged QTc included lower corrected calcium (cCa) levels (p = 0.001), lower potassium (K) levels (p < 0.001), and higher log NT-proBNP (p = 0.004).

CONCLUSION

In HD patients, NT-proBNP shows a stronger link with the QTc interval than BNP or ANP. Integrating clinical management considering both QTc and log NT-proBNP levels might help reduce CV events. Additionally, vigilance regarding low K or cCa levels is recommended from the perspective of the QTc interval.

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.

Recent advances in immunotherapy targeting CETP proteins for atherosclerosis prevention

Cholesteryl ester transfer protein (CETP) plays a key role in lipoprotein metabolism, and its activity has been linked to the risk of atherosclerosis (AS). CETP inhibitors, such as obicetrapib, represent a novel approach in immunotherapy to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) by targeting lipid metabolism. In addition, CETP vaccines are being explored as a novel strategy for the prevention and treatment of ASCVD by inducing the body to produce antibodies against CETP, which is expected to reduce CETP activity, thereby increasing high-density lipoproteins (HDL) levels. This paper provides a comprehensive overview of the structure of CETP, the mechanisms of lipid transfer and the progress of immunotherapy in the last decade, which provides possible ideas for future development of novel drugs and optimization of immunization strategies.

Nuclear envelope components in vascular mechanotransduction: emerging roles in vascular health and disease

The vascular network, uniquely sensitive to mechanical changes, translates biophysical forces into biochemical signals for vessel function. This process relies on the cell's architectural integrity, enabling uniform responses to physical stimuli. Recently, the nuclear envelope (NE) has emerged as a key regulator of vascular cell function. Studies implicate nucleoskeletal elements (e.g. nuclear lamina) and the linker of nucleoskeleton and cytoskeleton (LINC) complex in force transmission, emphasizing nucleo-cytoskeletal communication in mechanotransduction. The nuclear pore complex (NPC) and its component proteins (i.e. nucleoporins) also play roles in cardiovascular disease (CVD) progression. We herein summarize evidence on the roles of nuclear lamina proteins, LINC complex members, and nucleoporins in endothelial and vascular cell mechanotransduction. Numerous studies attribute NE components in cytoskeletal-related cellular behaviors to insinuate dysregulation of nucleocytoskeletal feedback and nucleocytoplasmic transport as a mechanism of endothelial and vascular dysfunction, and hence implications for aging and vascular pathophysiology.

Gut microbiota and derived metabolites mediate obstructive sleep apnea induced atherosclerosis

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia/hypercapnia (IHC), affects predominantly obese individuals, and increases atherosclerosis risk. Since we and others have implicated gut microbiota and metabolites in atherogenesis, we dissected their contributions to OSA-induced atherosclerosis. Atherosclerotic lesions were compared between conventionally-reared specific pathogen free (SPF) and germ-free (GF) Apoe-/- mice following a high fat high cholesterol diet (HFHC), with and without IHC conditions. The fecal microbiota and metabolome were profiled using 16S rRNA gene amplicon sequencing and untargeted tandem mass spectrometry (LC-MS/MS) respectively. Phenotypic data showed that HFHC significantly increased atherosclerosis as compared to regular chow (RC) in both aorta and pulmonary artery (PA) of SPF mice. IHC exacerbated lesions in addition to HFHC. Differential abundance analysis of gut microbiota identified an enrichment of Akkermansiaceae and a depletion of Muribaculaceae (formerly S24-7) family members in the HFHC-IHC group. LC-MS/MS showed a dysregulation of bile acid profiles with taurocholic acid, taurodeoxycholic acid, and 12-ketodeoxycholic acid enriched in the HFHC-IHC group, long-chain N-acyl amides, and phosphatidylcholines. Interestingly, GF Apoe-/- mice markedly reduced atherosclerotic formation relative to SPF Apoe-/- mice in the aorta under HFHC/IHC conditions. In contrast, microbial colonization did not show a significant impact on the atherosclerotic progression in PA. In summary, this research demonstrated that (1) IHC acts cooperatively with HFHC to induce atherosclerosis; (2) gut microbiota modulate atherogenesis, induced by HFHC/IHC, in the aorta not in PA; (3) different analytical methods suggest that a specific imbalance between Akkermansiaceae and Muribaculaceae bacterial families mediate OSA-induced atherosclerosis; and (4) derived bile acids, such as deoxycholic acid and lithocholic acid, regulate atherosclerosis in OSA. The knowledge obtained provides novel insights into the potential therapeutic approaches to prevent and treat OSA-induced atherosclerosis.

Virtual adaptation of a nurse-driven strategy to improve blood pressure control among people with HIV

People with HIV are at increased risk of cardiovascular events; thus, care delivery strategies that increase access to comprehensive cardiovascular disease (CVD) risk management are a priority. We report the results of a multi-component telemedicine-based strategy to improve blood pressure control among people with HIV-Assess and Adapt to the Impact of COVID-19 on CVD Self-Management and Prevention Care in Adults Living with HIV (AAIM-High). The AAIM High strategy is a virtual adaptation of our previously published EXTRA-CVD strategy and consisted of hypertension education and six components: nurse-led care coordination (delivered by teleconference or telephone), home systolic blood pressure (SBP) monitoring, evidence-based treatment algorithms, electronic health records tools, technology coach, and communication preferences assessment. People with HIV (n = 74) with comorbid hypertension at three academic medical centers were enrolled in a single arm implementation study from January 2021 to December 2022. Over 12 months, the average patient-performed home SBP decreased by 7.7 mmHg (95% CI -11.5, -3.9). The percentage of patients at treatment goal, defined as average SBP <130 mmHg, increased from 46.0% to 72.5% at 12 months. By adapting to the growing use of telemedicine in healthcare delivery, our study effectively improved hypertension control in people with HIV through a virtual, nurse-led intervention.

Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel

Dual antithrombotic therapy (DAT) without aspirin reduces bleeding compared with triple antithrombotic therapy (TAT) in patients with atrial fibrillation who have undergone percutaneous coronary intervention, without apparently increasing ischemic events. A prospective pharmacodynamic study was performed to investigate the impact of aspirin on bleeding time, platelet function and fibrin clot analysis in this population. Patients receiving TAT (n = 16), comprising aspirin, ticagrelor/prasugrel and a direct-acting oral anticoagulant (DOAC), were compared with those receiving DAT without aspirin (n = 18). Bleeding time was reduced with DAT compared with TAT (median 27.8 vs 30.0 minutes, p = .005). Assessed by light transmission aggregometry, median platelet aggregation was significantly increased with DAT compared with TAT in response to arachidonic acid (63 vs 3%, p = .002) and collagen (72 vs 37%, p < .001) but not 5-μmol/L adenosine diphosphate (25 vs 27%, p = .966) or thrombin-receptor-activating peptide (37 vs 24%, p = .086). VerifyNow P2Y12 assay showed > 70% inhibition in all patients. Fibrin clot lysis time and maximum turbidity were similar between groups. Using P2Y12 inhibitors of consistent potency, DAT improves hemostasis through sparing cyclooxygenase-1-mediated platelet activation but has a comparable effect to TAT on other pathways and fibrin clot properties. DAT with ticagrelor/prasugrel and DOAC may provide sufficient antithrombotic effect without excessive anti-hemostatic effect.

Lycopene attenuates trimethylamine-N-oxide-induced senescence in endothelial progenitor cells via the AMPK/SIRT1 pathway

Aging-related diseases, which are associated with the senescence of endothelial progenitor cells (EPCs), are consistently accompanied by elevated levels of circulating trimethylamine-N-oxide (TMAO), a marker predictive of poor prognosis. Lycopene (Lyc) deficiency has been demonstrated to be linked to these age-related diseases. The AMPK/SIRT1 pathway plays a pivotal role in cellular senescence. In this study, we hypothesize that lycopene could mitigate TMAO-induced EPCs senescence, with involvement of the AMPK/SIRT1 pathway. EPCs were subjected to treatment with TMAO, Lyc, small interfering RNA targeting AMP-activated protein kinase (siAMPK), or sirtin-1 (siSIRT1). The biological functions of EPCs were evaluated through, CCK-8, transwell and tube formation assays, while their senescence was assessed via SA-β-gal activity assay and Western blotting. ROS generation was measured using dichlorodihydrofluorescein diacetate staining. TMAO-induced suppression of EPCs' functionality was alleviated by Lyc, but this effect was reversed by siAMPK and siSIRT1. TMAO increased SA-β-gal-positive cell number and ROS production, while reducing the expression of AMPK and SIRT1. These effects were attenuated by Lyc. However, the protective effects were diminished by siAMPK and siSIRT1. In conclusion, Lyc ameliorates TMAO-induced EPCs senescence through the AMPK/SIRT1 pathway.

Disruption of the caspase-1/IL-1β axis alleviates myocardial Ischemia/Reperfusion injury via improvement of mitochondrial homeostasis and reduction of Pyroptosis

BACKGROUND

Pyroptosis is a novel kind of programmed cell death and Caspase-1 plays key roles in driving pyroptosis. The current study aims to elucidate the molecular mechanism affecting cardiomyocyte pyroptosis in myocardial ischemia/reperfusion (I/R) injury, both in vivo and in vitro.

METHODS

A murine model of myocardial I/R injury was established and then treated with lentivirus-mediated shRNA targeting Caspase-1 to evaluate the effect of Caspase-1 on myocardial I/R injury. Further, Caspase-1 was silenced in the cardiomyocytes following hypoxia-reoxygenation (H/R) to detect the function of Caspase-1 in mitochondrial homeostasis and cardiomyocyte pyroptosis.

RESULTS

Knockdown of Caspase-1 inhibited the secretion of interleukin-1 beta (IL-1β), improved cardiac dysfunction and decreased pyroptosis in vivo. The cardio-protective effect was verified in the H/R-induced cardiomyocyte model. Recombinant IL-1β protein reversed the inhibitory effect of Caspase-1 knockdown on pyroptosis.

CONCLUSION

Overall, activating the Caspase-1/IL-1β axis by myocardial I/R injury causes mitochondrial homeostasis imbalance, pyroptosis, and the consequent cardiomyocyte injury.

Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation

Purpose. Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with longer life expectancies. The need for permanent pacemaker implantation (PPI) following TAVI has been associated with increased all-cause mortality and morbidity. This study aimed to identify ECG, CT, and procedural predictors of PPI following TAVI. Methods. We conducted a retrospective observational study at the University Hospital of North Norway. Patients who underwent TAVI with SAPIEN 3 or SAPIEN 3 Ultra valves were included, while those with prior pacemakers, self-expanding valves, or valve-in-valve procedures were excluded. Data were collected from medical records, pre-operative CT scans, and procedural angiography. Results. A total of 416 low- to intermediate-risk patients with a median age of 82 years were included. Of these, 64 patients (15.4%) required PPI within ≤30 days following the index procedure. Multivariable regression analysis identified the following predictors for PPI: pre-existing right bundle branch block (odds ratio (OR), 10.7; 95% CI, 4.74-24.3), first-degree atrioventricular block (OR, 2.62; 95% CI, 1.08-6.32), membranous septum length (OR, 0.77; 95% CI, 0.65-0.90), left ventricular outflow tract calcification (OR, 2.18; 95% CI, 1.12-4.27), and the use of 29 mm valves (OR, 2.33; 95% CI, 1.09-4.97). Conclusions. Our study found the following predictors of PPI following TAVI: pre-existing right bundle branch block, first-degree atrioventricular block, the use of 29 mm valves and the presence of left ventricular outflow tract calcification. Additionally, a short MS was found to increase the chance of PPI; therefore, MS measurements should be included in pre-operative assessments to identify at-risk patients.

Right ventricular-pulmonary arterial coupling and pulmonary hypertension in hemodialysis: insights into structural cardiac changes and clinical implications

OBJECTIVES

This cross-sectional analysis from the CZecking Heart Failure in patients with advanced Chronic Kidney Disease trial (ISRCTN18275480) examined pulmonary hypertension and right ventricular-pulmonary arterial coupling in patients on chronic hemodialysis. The aims of this analysis were: 1. To analyze relations between pulmonary hypertension and right ventricular-pulmonary arterial coupling with dialysis access flow and current hydration; 2. To analyze structural heart changes associated with right ventricular-pulmonary arterial uncoupling; 3. To reveal the prevalence, etiology and severity of pulmonary hypertension in the Czech hemodialysis population.

METHODS

We performed expert echocardiography, vascular access flow measurements, bioimpedance analysis, and laboratory testing in 336 hemodialysis patients.

RESULTS

Pulmonary hypertension was present in 34% (114/336) patients and right ventricular-pulmonary arterial uncoupling was present in 25% of patients with pulmonary hypertension. Only weak associations between the flow of the dialysis arteriovenous access and estimated pulmonary arterial systolic pressure and right ventricular-pulmonary arterial coupling was proved. There was a strong association between hydration status assessed by estimated central venous pressure with pulmonary arterial systolic pressure (Rho 0.6, p < 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.52, p < 0.0001) and association between overhydration to extracellular water ratio with pulmonary arterial systolic pressure (Rho 0.31, p = 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.29, p = 0.002). The prevalence of heart failure was significantly higher in patients with right ventricular-pulmonary arterial uncoupling (88% vs. 52%, p = 0.0003).

CONCLUSION

These findings suggest that optimizing volume status and treating heart failure should be prioritized in hemodialysis patients to prevent pulmonary hypertension progression and right ventricular-pulmonary arterial uncoupling.

Development and external validation of a machine learning model for cardiac valve calcification early screening in dialysis patients: a multicenter study

BACKGROUND

Cardiac valve calcification (CVC) is common in dialysis patients and associated with increased cardiovascular risk. However, early screening has been limited by cost concerns. This study aimed to develop and validate a machine learning model to enhance early detection of CVC.

METHODS

Data were collected at four centers between 2020 and 2023, including 852 dialysis patients in the development dataset and 661 in the external validation dataset. Predictive factors were selected using LASSO regression combined with univariate and multivariate analyses. Machine learning models including CatBoost, XGBoost, decision tree, support vector machine, random forest, and logistic regression were used to develop the CVC risk model. Model performance was evaluated in both validation sets. Risk thresholds were defined using the Youden index and validated in the external dataset.

RESULTS

In the development dataset, 32.9% of patients were diagnosed with CVC. Age, dialysis duration, alkaline phosphatase, apolipoprotein A1, and intact parathyroid hormone were selected to construct the CVC risk prediction model. CatBoost exhibited the best performance in the training dataset. The logistic regression model demonstrated the best predictive performance in both internal and external validation sets, with AUROCs of 0.806 (95% CI 0.750-0.863) and 0.757 (95% CI 0.720-0.793), respectively. Calibration curves and decision curves confirmed its predictive accuracy and clinical applicability. The logistic regression model was selected as the optimal model and achieved excellent risk stratification in CVC risk prediction.

CONCLUSION

The predictive model effectively identifies CVC risk in dialysis patients and offers a robust tool for early detection and improved management.

LncRNA SCARNA8 promotes atherosclerotic plaque instability by inhibiting macrophage efferocytosis

In recent years, findings suggest that long noncoding RNAs (lncRNAs) are closely related to the development of atherosclerosis (AS), but there is a lack of studies on the involvement of lncRNA-regulated cytosolic burial in the regulation of AS. In this study, we investigated the mechanism by which lncRNA SCARNA8 affects macrophage cell burial to regulate AS. The cytosolic burial-associated target gene regulated by lncRNA SCARNA8 was PPARG. LncRNA SCARNA8 was increased in the carotid unstable plaque group, whereas PPARG was decreased. Ox-LDL led to the up-regulation of lncRNA SCARNA8 expression and apoptosis in Raw264.7 cells in a time-, concentration-dependent manner. Knockdown of lncRNA SCARNA8 upregulated PPARG and reduced apoptosis in Raw264.7 cells. In addition, knockdown of lncRNA SCARNA8 improved the stability of atherosclerotic plaques by promoting cellular burial of Raw264.7 cells. LncRNA SCARNA8 is a key regulator of plaque vulnerability, and targeting lncRNA SCARNA8 May provide a novel means for the prevention and treatment of AS.

Development and validation of a risk prediction model for autologous arteriovenous fistula thrombosis in patients receiving maintenance hemodialysis

BACKGROUND

Thrombosis can lead to fistula failure and affect the smooth progress of hemodialysis. This study aims to develop and validate a nomogram for predicting the risk of autologous arteriovenous fistula thrombosis in patients undergoing maintenance hemodialysis.

METHODS

A total of 1,016 patients who underwent hemodialysis at a tertiary A hospital in East China from February 2020 to March 2024 were retrospectively enrolled. The participants were randomly divided into a training set (711 people) and a validation set (305 people) at a ratio of 7:3. A risk prediction model was established according to the results of multivariate logistic regression analysis. The performance of the model was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve analysis, the Hosmer-Lemeshow (H-L) test and decision curve analysis (DCA).

RESULTS

The incidence of autologous arteriovenous fistula thrombosis in patients on maintenance hemodialysis was 32%. High-sensitivity C-reactive protein (hs-CRP), catheterization history, hemodialysis duration, autologous arteriovenous fistula stenosis and non-high-density lipoprotein cholesterol (non-HDL-C) were independent risk factors for autologous arteriovenous fistula thrombosis. These five predictors were used to construct a predictive nomogram. The AUC was 0.818 in the training set and 0.826 in the validation set. The calibration curve of the nomogram was close to the standard curve, indicating that the model was well calibrated. The DCA results confirmed that the model provided good net clinical benefits.

CONCLUSION

In this study, a predictive nomogram for arteriovenous fistula thrombosis was established and validated.

The association between whole blood viscosity and CHA2DS2-VASc/CHA2DS2-VA scores in patients with atrial fibrillation

INTRODUCTION

CHA2DS2-VASc and CHA2DS2-VA scores are often used to demonstrate thromboembolic risk in nonvalvular atrial fibrillation. Elevated whole blood viscosity is an independent risk factor for ischemic stroke.

OBJECTIVE

This study aimed to ascertain the correlation between whole blood viscosity and CHA2DS2-VASc/CHA2DS2-VA scores.

METHODS

This study was performed retrospectively in a tertiary cardiac facility, encompassing 150 patients.

RESULTS

The study's results demonstrate that whole blood viscosity, concerning both high shear rate and low shear rate variables, are statistically significant in forecasting the likelihood of elevated CHA2DS2-VA and CHA2DS2-VASc scores. (AUC: 0.690, 0.693; p: <0.001; 0.647, 0.665; p: <0.05).

CONCLUSION

Whole blood viscosity had a substantial correlation with the CHA2DS2-VASc/CHA2DS2-VA scores in patients with atrial fibrillation and may be used to evaluate thromboembolism risk, akin to these scores.

Cost-effectiveness of prevention program for type 2 diabetes mellitus in high risk patients in the Republic of Srpska, Bosnia and Herzegovina

The Republic of Srpska (RS), as a part of the Western Balkans (WB) region, has a higher diabetes prevalence than the EU. This study aims to assess the cost-effectiveness of early treatment of high-risk patients with pre-diabetes and undiagnosed diabetes in our setting. We designed a Markov chain Monte Carlo (MCMC) model which reflects the current International Diabetes Federation (IDF) three-step plan for the prevention of T2DM in those at increased risk. The model captures the evolution of the disease in FINDRISC high-risk patients from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and then to T2DM and its complications. We developed two MCMC models, in order to follow the progression of the disease in high-risk cases, ie, when early treatment is undertaken or when it is not undertaken. The health costs and quality adjusted life years (QALY) were discounted at an annual rate of 3%. The key model parameters were varied in one-way and probabilistic sensitivity analysis. Early treatment resulted in increased life expectancy, postponement of the onset of diabetes and increased QALY for all patients. The discounted incremental cost-effectiveness-ratios (ICER) in NGT, IFG, IGT, and T2DM patients were -289.9, 9724.03, -1478.59 and 4084.67 €. In high-risk IGT patients, ICER was the most favorable, being both a cost saving and QALY gaining, with the consistent results confirmed by the sensitivity analysis. The results recommend the acceptance of a new health policy of identifying IGT patients with the use of FINDRISC questionnaire and plasma glucose measurements; providing them with a lifestyle change program; and implementing intensive diabetes treatment, as their disease progresses. Our results are especially significant for the Western Balkan countries, since this was the first cost-effectiveness study of T2DM prevention in this region.

Cost-effectiveness analysis of radiofrequency renal denervation for uncontrolled hypertension in Canada

AIMS

Catheter-based radiofrequency renal denervation (RF RDN) is an interventional treatment for uncontrolled hypertension. This analysis explored the therapy's lifetime cost-effectiveness in a Canadian healthcare setting.

MATERIALS AND METHODS

A decision-analytic Markov model was used to project health events, costs, and quality-adjusted life years over a lifetime horizon. Seven primary health states were modeled, including hypertension alone, stroke, myocardial infarction (MI), other symptomatic coronary artery disease, heart failure (HF), end-stage renal disease (ESRD), and death. Multivariate risk equations and a meta-regression of hypertension trials informed transition probabilities. Contemporary clinical evidence from the SPYRAL HTN-ON MED trial informed the base case treatment effect (-4.9 mmHg change in office systolic blood pressure (oSBP) observed vs. sham control). Costs were sourced from published literature. A 1.5% discount rate was applied to costs and effects, and the resulting incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of $50,000 per QALY gained. Extensive scenario and sensitivity analyses were performed.

RESULTS

Over 10 years, RF RDN resulted in relative risk reduction in clinical events (0.80 for stroke, 0.88 for MI, and 0.72 for HF). Under the base case assumptions, RF RDN was found to add 0.51 (15.81 vs. 15.30) QALYs at an incremental cost of $6,031 ($73,971 vs. $67,040) over a lifetime, resulting in an ICER of $11,809 per QALY gained. Cost-effectiveness findings were found robust in sensitivity analyses, with the 95% confidence interval for the ICER based on 10,000 simulations ranging from $4,489 to $22,587 per QALY gained.

LIMITATIONS AND CONCLUSION

Model projections suggest RF RDN, under assumed maintained treatment effect, is a cost-effective treatment strategy for uncontrolled hypertension in the Canadian healthcare system based on meaningful reductions in clinical events.