Obesity indices and cardiometabolic diseases in postmenopausal women in Ilorin, Nigeria

OBJECTIVE

Obesity is a known risk factor for the development of cardiometabolic diseases (CMD) globally. The study focus was finding the best predictor of CMD among the four anthropometric indices of obesity studied: body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and visceral adiposity index (VAI).

METHOD

A total of 310 postmenopausal women participated in the study. Sociodemographic data, anthropometric measurements, serum high-density lipoprotein and serum triglycerides were taken for all participants. The receiver operating characteristic curve was used to detect the valid cut-off point for the VAI.

RESULTS

The VAI cut-off point for diagnosing visceral adiposity dysfunction (VAD) in the study was >1.92. The prevalence of peripheral obesity in the study was 18.1%, while that of truncal obesity was 76.5% using the WHR and 81.9% using the WHtR. The prevalence of CMD in the study was 51.6% while that for VAD was 60.3%. The WHtR (p = 0.041) and the VAI (p < 0.001) had statistically significant associations with the presence of CMD among the participants but only the VAI was found to be a significant predictor of CMD.

CONCLUSION

We recommend use of the VAI for CMD screening among postmenopausal women.

Intersection of Cardio-Oncology: An Overview of Radiation-Induced Heart Disease in the Context of Tumors

Radiation-induced heart disease (RIHD) is a prevalent cardiovascular complication of radiation therapy, with coronary heart disease being the most common manifestation. Clinical presentations of RIHD vary and may include conduction abnormalities, ischemic heart disease, cardiomyopathy, heart failure, and valvular damage. Even low doses of radiation significantly increase the risk of cardiovascular disease, often associated with severe stenosis detected via angiography. Radiation-induced damage to the cardiac endothelium triggers inflammatory responses and oxidative stress, which contribute to the progression of atherosclerosis. This study explores how radiation activates multiple signaling pathways through the generation of reactive oxygen species, resulting in vascular endothelial damage, cellular senescence, inflammatory responses, and DNA damage. It further examines the impact of radiation on vascular integrity and tight junction proteins, leading to increased vascular permeability and infiltration by inflammatory cells. From a clinical perspective, we emphasize the challenges posed by the coexistence of tumors in many patients with RIHD, as tumors complicate the microenvironment and may have mutually reinforcing interactions with radiation-induced damage. We also discuss various therapeutic strategies, including novel approaches targeting cellular senescence and immune responses, with a focus on the potential use of navitoclax and IL-6 (interleukin-6) inhibitors to prevent irreversible cardiomyocyte fibrosis and ongoing vascular damage. In conclusion, RIHD is a multifaceted disease involving complex biological processes and signaling pathways. Early intervention and targeted therapies are crucial for improving patient outcomes. Future research should prioritize uncovering the molecular mechanisms of RIHD and developing more effective therapeutic strategies.

Prognostic impact of left ventricular strain by feature tracking in acute myocardial infarction treated with PCI: A meta-analysis

PURPOSE

To perform a meta-analysis to evaluate the prognostic value of feature tracking (FT)-derived left ventricular (LV) strain parameters in patients following acute myocardial infarction (AMI).

MATERIALS AND METHODS

We conducted a comprehensive search of PubMed, Embase, and the Cochrane library for studies published between January 2000 and July 2024, evaluating the prognostic value of FT-derived LV strain parameters in predicting major adverse cardiovascular events (MACE) in patients following AMI. We included studies of patients who underwent cardiac magnetic resonance feature tracking analysis following reperfusion by percutaneous coronary intervention (PCI), as well as reporting multivariate analyses of global longitudinal strain (GLS) or global circumferential strain (GCS). Using RStudio, we calculated pooled hazard ratios (HR) with 95 % confidence intervals (CI) using random-effects models and evaluated heterogeneity with I2 statistics.

RESULTS

Nine studies involving 3651 patients were included. Seven studies focused on GLS, while five evaluated GCS in relation to MACE. The meta-analysis revealed a significant association between GLS and MACE occurrence (HR 1.15; 95 % CI: 1.07-1.23; I2 = 76 %; p ≤ 0.0001). For GCS, the pooled HR was 1.11 (95 % CI: 1.04-1.19; I2 = 50 %; p = 0.0024). However, a leave-one-out sensitivity analysis showed that the prognostic effect of GCS was not robust, as the pooled HR adjusted to 1.09 (95 % CI: 1.00-1.19).

CONCLUSION

GLS was identified as a sensitive marker of early myocardial injury with incremental prognostic value, potentially enhancing risk stratification for post-AMI patients. Conversely, GCS did not demonstrate a significant prognostic effect.

Therapeutic Management of LDL-C: Efficacy and Economic Impact Assessment

Cardiovascular disease (CVD) is one of the largest global disease burdens. Despite guidelines and recommendations and the proven advantages of lipid-lowering therapies (LLTs) in preventing CVD, achieving treatment targets remains disappointing. A key barrier to optimal LLT is therapy discontinuation. To be widely adopted in clinical practice, new lipid-lowering therapies must both prevent major adverse cardiovascular events (MACEs) and exhibit cost effectiveness to ensure widespread utilization by patients, physicians, and insurers. While non-statin LLTs have shown cardiovascular value, their cost effectiveness is controversial. This review highlights the LLTs that are currently widely adopted and summarizes the available evidence on their cost effectiveness.

Information about task duration influences energetic cost during split-belt adaptation and retention of walking patterns post-adaptation

Studies of locomotor adaptation have shown that adaptation can occur in short bouts and can continue for long bouts or across days. Information about task duration might influence the adaptation of gait features, given that task duration influences the time available to explore and adapt the aspects of gait that reduce energy cost. We hypothesized that information about task duration influences adaptation to split-belt walking based on two competing mechanisms: individuals anticipating a prolonged adaptation period may either (1) extend exploration of energetically suboptimal gait patterns, or (2) adapt toward a more energy-efficient pattern earlier to maintain an energetic reserve to sustain the task longer. We tested three groups: N=19 participants received minute-by-minute updates during a 10-minute adaptation duration (True group), N=19 participants received no updates during a 10-minute adaptation duration and were misled to expect a prolonged 30-minute adaptation duration (False group), and N=14 participants received one update halfway through a 10-minute adaptation duration (Control group). We measured step length asymmetry, leg work, and metabolic cost. Our results partially supported our hypothesis but did not confirm the underlying mechanisms. While step length asymmetry did not differ significantly between groups during adaptation, the True group generated a more effortful gait pattern with a greater increase in metabolic cost (p=0.002) and higher work with the leg on the slow belt (p=0.012). Additionally, the True group showed no association between step length asymmetry and metabolic cost (p=0.203), contrary to the Control (r=-0.55, p=0.043) and False groups (r=-0.51, p=0.027). Finally, we observed that the False group showed greater retention of the split-belt aftereffects than the Control and False groups (p<0.001). Thus, adapted locomotor and energetic patterns are influenced by information about task duration, indicating that Information about task duration should be controlled for, or can be manipulated to elicit different efforts during adaptation.

Evaluation of the protective effects of raw and roasted pumpkin (Cucurbita pepo L.) seed-supplemented diets on cisplatin-induced cardiotoxicity in rats

Cardiovascular diseases are among the top killer diseases globally. This work assessed the cardioprotective ability of raw and roasted pumpkin (Cucurbita pepo L.) seed-supplemented diets on cisplatin-induced heart damage in rats. The cardiotoxicity was induced with cisplatin (7 mg/kg) intraperitoneally. The rats' six groups were treated for 14 days: control rats fed a normal diet; group 2: cisplatin-induced (CIS) untreated; groups 3 and 4: CIS + 5% raw pumpkin seed (RW) and CIS + 10% RW; groups 5 and 6: CIS + 5% and 10% roasted pumpkin seed (RT). The biochemical assays were done using standard procedures, and Schrödinger suites were used for in silico studies of C. pepo phytocompounds with phosphodiesterase 5. There was a significant (p < 0.05) elevation in arginase, phosphodiesterase-5, adenosine deaminase, acetylcholinesterase, and butyrylcholinesterase activities, ROS and TBARS in cisplatin-induced rats relative to control. Cisplatin-induced rats also have their nitric oxide, antioxidant (catalase, GST, and GSH) levels reduced, and the heart's histoarchitectural structure degenerated relative to control. These conditions were reversed upon treatment with raw and roasted pumpkin seeds (5% and 10%). Molecular docking of C. pepo phytocompounds like chlorogenic acid (-11.4 kcal/mol), beta-sitosterol (-11.013 kcal/mol), quercetin (-10.323 kcal/mol), and epicatechin (-10.168 kcal/mol) suggests that they are potent inhibitors of phosphodiesterase 5, better than standard drug pravastatin (-9.809 kcal/mol), with a good pharmacotoxicity profile. The study suggests that the cardioprotective effect of raw and roasted pumpkin seeds could be via their ability to inhibit phosphodiesterase 5, improve vasodilation, increase antioxidant levels, and alleviate oxidative stress.

Revisiting the renin-angiotensin-aldosterone system in the eye: Mechanistic insights and pharmacological targets

The renin-angiotensin-aldosterone system (RAAS) plays a fundamental role in regulating blood pressure and fluid homeostasis through key effectors such as angiotensin II and aldosterone. These agents and their receptors have become crucial molecular targets in several cardiovascular and renal diseases. Over the past few decades, a growing body of evidence has revealed the presence of RAAS components in ocular structures, suggesting a tissue-specific RAAS within the eye. Building on this knowledge, studies have indicated that the ocular RAAS plays a significant role in the pathogenesis of various eye diseases. An impaired and overactivated RAAS contributes to the development of severe and widespread disorders affecting both the anterior and posterior segments of the eye. In this context, the current work aims to delve into the pivotal molecular pathways involving the RAAS, with an in-depth exploration of the ocular pathophysiology. It focuses on the relationship between overactivation of the RAAS and oxidative stress, as well as the exacerbation of neovascularization and inflammatory processes. The objective is to provide an updated and comprehensive understanding of the role of the RAAS in ophthalmological diseases, highlighting the therapeutic potential of RAAS modulators and discussing the controversies and challenges in this area of research.

Development of myocardial perfusion imaging from coronary angiography for clinical application

This study aimed to generate myocardial perfusion images from coronary angiography (CAG) using Patlak plot analysis and evaluate their effectiveness in detecting ischemia. Data from 29 patients were analyzed. Electrocardiogram-synchronized CAG images of the left coronary artery were registered and processed for pixel-wise Patlak analysis. Image generation succeeded in 18 cases (62%) and failed in 11 due to motion artifacts caused by irregular heartbeats, table panning, or deep breathing. The resulting images clearly distinguished ischemic from normal regions. Perfusion values were significantly lower in ischemic regions compared to normal regions (p < 0.001). Despite technical challenges and variability in patient conditions, this method enabled consistent identification of perfusion deficits. Enhancing image processing increases the success rate. This approach allows ischemia assessment directly from CAG data and supports timely treatment planning, contributing to improved diagnostic precision and clinical decision-making in selected cases.

Under the Influence: The Epidemic of Excessive Alcohol Use and Its Impact on Heart and Liver Health

Alcohol use disorder (AUD) is seen in 7% of the world population. In 2019, nearly 3 in 10 adults in the United States (US) consumed аlсоhοl in an unhealthy manner. This alcohol misuse that further increased during the coronavirus disease 2019 pandemic is now persisting, and is associated with rising rates of alcohol-associated hospitalizations, end-organ disease, death, and need for liver transplantation. The current lifetime risk of AUD in the US is estimated to be >30%, and with the steadily rising alcohol consumption in the US, this risk is expected to continue to increase. The effect of excessive alcohol on human health is associated with its lifetime cumulative use and is further impacted by factors like age, gender, nutritional status, concurrent cigarette smoking or drug use, diabetes, increased body weight, kidney disease, other cardiovascular diseases and socio-economic status. In this review we present the complex interplay between alcoholic liver and heart diseases, describing the natural history of each organ involvement and identifying risk factors that are associated with the progression of various alcohol-related end-organ diseases. Abstaining from alcohol or moderating its consumption has been shown to reduce the progression of heart failure, arrhythmias, and hypertension linked to excessive alcohol intake, as well as help prevent alcoholic liver disease. Focus on the identification of other modifiable risk factors associated with various organ injuries in conjunction with public health policies for the safe use of alcohol is needed to mitigate the risk of an impending epidemic of AUD.

Telecardiology unleashed: probing the depths of effectiveness in remote monitoring and telemedicine applications for acute cardiac conditions

Telecardiology has emerged as a promising approach in acute cardiac care through advancements in digital health technologies. This review explores the current evidence of telemedicine applications in acute coronary syndrome, arrhythmias, and acute heart failure. Telecardiology strategies are already implemented in clinical practice today. Examples such as pre-hospital electrocardiogram transmission and remote monitoring using non-invasive and invasive devices have shown to enhance diagnostic accuracy, reduce treatment delays, and improve outcomes. However, despite multiple meta-analyses, the effectiveness of telecardiology remains uncertain due to heterogeneity in study designs and lack of high-quality randomized controlled trials. Increasingly, the integration of artificial intelligence offers unprecedented opportunities for diagnostic precision, predictive analytics, and personalized care yet requires rigorous validation and ethical considerations. This article underscores the pivotal role of the cardiologist in bridging the gaps between technology and clinical practice by providing an evidence-based scaffold on telecardiology effectiveness and clinical implementation.

Evaluating atherosclerosis prevalence via coronary calcium in executives with normal LDL levels in the US: a cohort study-the clear protocol

INTRODUCTION

The coronary artery calcium (CAC) scan serves as a crucial tool in assessing the risk of coronary atherosclerosis in patients with hyperlipidaemia, particularly when there is ambiguity surrounding pharmacotherapy decisions. In addition to CAC, advanced glycation end products (AGEs), glycated proteins and lipids involved in ageing are emerging as markers for atherosclerosis. However, the relationship between AGEs score and CAC scores has not been evaluated to date. Our primary objective is to evaluate abnormal CAC scores in patients with low and borderline ASCVD risk and normal low-density lipoprotein cholesterol (LDL-C) levels ≤100 mg/dL. The secondary objective is to explore potential associations between CAC and AGEs scores.

METHODS AND ANALYSIS

We will retrospectively review health records of adult patients seen at the General Internal Medicine Executive Health Program (Mayo Clinic; Rochester, Minnesota) between 1 September 2023 and 31 March 2024, where all patients were offered the option of a baseline CAC scan. For our primary aim, we will determine the percentage of patients with low and borderline 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk, not receiving pharmacotherapy for hyperlipidaemia, who have LDL-C levels ≤100 mg/dL and have an abnormal CAC score. For our secondary aim, we will examine potential associations between CAC and AGEs scores.

ETHICS AND DISSEMINATION

This study was determined to be exempt from institutional review board approval (ID 24-0 03 921; 45 CFR 46.104d, category/subcategory 4(iii)) at the Mayo Clinic, Rochester. The findings of this study will be published in a peer-reviewed journal.

Low Vitamin D Status Attenuates Hypolipidemic and Pleiotropic Effects of Atorvastatin in Women

Background/Objectives: Low vitamin D status seems to be associated with increased cardiometabolic risk, and was found to attenuate cardiometabolic benefits of statins in men. The aim of the current study was to investigate whether a different vitamin D status determines the pleiotropic effects of statins in women. Methods: This pilot, single-center, prospective, matched-cohort study included 78 women with hypercholesterolemia requiring statin therapy, assigned into one of three age-, plasma lipid-, and body mass index-matched groups: women with vitamin D deficiency (group I), women with vitamin D insufficiency (group II), and women with normal vitamin D homeostasis (group III). Throughout the study (16 weeks), all patients were treated with atorvastatin. The outcome of interest included plasma lipids, glucose homeostasis markers (fasting glucose, HOMA-IR and glycated hemoglobin), plasma levels of 25-hydroxyvitamin D, creatine kinase, uric acid, high-sensitivity C-reactive protein, homocysteine, fibrinogen, urinary albumin-to-creatinine ratio (UACR), and computed values of a 10-year risk of atherosclerotic events. Results: Compared to the control group (group III), group I was characterized by higher values of HOMA-IR, glycated hemoglobin, uric acid, hsCRP, homocysteine, fibrinogen, a UACR, and a 10-year risk of atherosclerotic events, whereas group II had higher values of hsCRP, homocysteine and a UACR. Atorvastatin reduced plasma levels of total and LDL cholesterol and a 10-year risk of atherosclerotic events in all study groups, but this effect was weakest in group I and strongest in group III. In group III, the drug decreased uric acid, hsCRP, homocysteine, fibrinogen, and the UACR. In the remaining groups, its effect was limited to a small decrease in only hsCRP (group I) or in hsCRP and homocysteine (group II). In group I, atorvastatin treatment was associated with an increase in HOMA-IR, glycated hemoglobin, and creatine kinase. Conclusions: Low vitamin D status may exert an unfavorable effect on the lipid-dependent and lipid-independent effects of atorvastatin in middle-aged or elderly women.

Correlation Between PhenoAgeAccel and Clinical Outcomes in Atrial Fibrillation Patients Undergoing Radiofrequency Catheter Ablation

Purpose

To investigate the relationship between phenotypic age (PhenoAge) and accelerated phenotypic age (PhenoAgeAccel) and recurrence of atrial fibrillation (AF) in patients after radiofrequency catheter ablation (RFCA).

Patients and Methods

Preoperative PhenoAge and PhenoAgeAccel were determined in AF patients undergoing RFCA. We used logistic regression models and subgroup analysis to study the relationship between PhenoAge and PhenoAgeAccel and the risk of AF recurrence. As for revealing the value of PhenoAgeAccel in predicting AF recurrence, the ROC curve analysis was performed. To further detect the enhancement role of in PhenoAgeAccel in the APPLE score and a model of established risk factors in predicting AF recurrence, C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was conducted.

Results

A total of 322 patients with AF who underwent RFCA in our hospital were included in the present study. The mean follow-up period was 21 months. The frequency of AF recurrence increased gradually as the PhenoAgeAccel index rose. The optimal cut-off value of the PhenoAgeAccel index was -0.338. Patients with PhenoAgeAccel ≥ -0.338 had a significantly greater likelihood of experiencing recurrent AF than those with PhenoAgeAccel <-0.338 (OR 3.989, 95% CI 2.006-7.933, p < 0.001). The association was also reflected in each subgroup. Incorporating the PhenoAgeAccel into the APPLE score and the existing model of established risk factors for recurrence may result in enhancements to the C-statistics, NRI and IDI (p<0.05), respectively.

Conclusion

PhenoAgeAccel was positively and independently associated with AF recurrence following RFCA.

Effects of yogic practices on physiological and biochemical parameters of hypertensive patients: A systematic review of clinical trials

BACKGROUND

Hypertension affects around 1.28 billion adults worldwide. If not managed properly, it can lead to life threatening conditions. While various pharmacological treatments are available, they are associated with various short- and long-term side effects. Hence it is crucial to explore alternative approaches to complement the standard medical interventions.

OBJECTIVE

This systematic review aims to explore the impacts of yogic practices on various physiological and biochemical parameters in hypertensive patients.

METHODS

Various electronic databases including PubMed, Cochrane library, Directory of Open Access Journals and Google scholar were systematically searched until October 31, 2023 to collect relevant data.

RESULTS

A total of 15 articles comprising 5 RCTs and 10 clinical trials were identified. The number of participants ranged between 33 and 300, with Yoga intervention lasting from two months to a year. The analyses revealed that Yogic practices, such as loosening practices, Surya Namaskar, Tadasana, Trikonasana, Paschimottanasana, Shavasana. Anulom-Vilom Pranayama, Bhramari Pranayama, meditation and Yoga Nidra, positively influenced physiological and biochemical markers linked to Hypertension such as autonomic nervous system activity, angiotensin II expression, oxidative stress, lipid metabolism, immune system function and inflammatory gene expression.

CONCLUSION

The findings of this systematic review indicate that the Yoga practices have a positive impact on physiological and biochemical markers associated with hypertension which may help in its proper management and treatment. Future studies need to assess additional markers associated with hypertension, such as vasopressin, adrenocorticotropic hormone, gamma-aminobutyric acid and others to enhance the understanding of the mechanism of the effects of Yoga on hypertension.

STUDY REGISTRATION

PROSPERO ID: CRD42024497060.

Circulating mitochondrial biomarkers in acute coronary syndrome

Background

Acute coronary syndrome (ACS) is the leading cause of mortality in developed countries. Mitochondrial dysfunction is a hallmark of various cardiometabolic diseases, including ACS. Emerging evidence suggests that evaluating mitochondrial biomarkers in plasma may offer valuable insights into the pathophysiology and management of these conditions. The present study aims to analyse the effect of ACS, sex and their interaction on plasma levels of mitochondrial markers, such as peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), mitochondrial open reading frame of the 12S rRNA type-c (MOTS-c) and citrate syntetase (CS).

Methods

A total of 18 ACS patients (8 women and 10 men) and 20 controls (8 women and 12 men) were included in this study. Venous blood samples were collected from participants after a 12-h overnight fast. Plasma levels of mitochondrial PGC-1α, MOTS-c and CS were measured.

Results

ACS significantly reduced plasma levels of PGC-1α and MOTS-c. Sex did not shown a significant effect on these markers. Additionally, MOTS-c positively correlated with the first troponin and hemoglobin, PGC-1α negatively correlated with glucose and positively with HDL-cholesterol, and CS showed negative correlations with NT-proBNP, C-reactive protein, and hemoglobin.

Conclusion

Mitochondria markers, MOTS-c and PGC-1α, are altered in ACS patients, with no observed sex differences. These findings represent an initial step toward integrating personalized medicine into the clinical management of ACS. Nonetheless, further studies are required to fully elucidate the role of these markers in this pathology.

Comparisons of various insulin resistance indices for new-onset metabolic syndrome before midlife: The CHIEF cohort study, 2014-2020

BACKGROUND

Some non-insulin-based insulin resistance (IR) indices have been found to be associated with metabolic syndrome (MetS); however, few cohort studies have compared the capacities of these indices for predicting incident MetS in young adults.

AIM

To investigate the associations of various non-insulin-based IR (NI-IR) indices with new-onset MetS in young military personnel.

METHODS

A total of 2890 armed forces personnel in Taiwan who were aged 18-39 years and did not have MetS at baseline were followed to monitor the incidence of new-onset MetS from 2014 to the end of 2020. Six NI-IR indices, including the metabolic score for IR (METS-IR), triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio, TG glucose (TyG) index, Zhejiang University (ZJU) index, total cholesterol (TC)-to-HDL-C ratio, and alanine transaminase (ALT)-to-aspartate transaminase (AST) ratio, were defined according to specific criteria. Incident MetS was identified on the basis of each annual health examination using the International Diabetes Federation criteria. Multiple Cox regression analyses were conducted, adjusting for age, sex, waist circumference, smoking status, alcohol consumption status, and physical activity, to assess the associations of the NI-IR indices with incident MetS. The area under the receiver operating characteristic curve (AUROC) was used to compare the capacities of these NI-IR indices for predicting new-onset MetS.

RESULTS

During a median follow-up of 5.8 years, there were 673 patients with new-onset MetS (23%). All six of the NI-IR indices were significantly and positively associated with incident MetS. In the entire cohort, the greatest AUROC was found for the METS-IR [0.782; 95% confidence interval (CI): 0.762-0.801; all P values compared to the other NI-IR indices < 0.05], followed by the TG/HDL-C ratio (0.752; 95%CI: 0.731-0.772), ZJU index (0.743; 95%CI: 0.722-0.764), TyG index (0.734; 95%CI: 0.713-0.756), TC/HDL-C ratio (0.731; 95%CI: 0.709-0.752), and then the ALT/AST ratio (0.734; 95%CI: 0.713-0.756).

CONCLUSION

This study suggests that almost all the NI-IR indices are associated with the development of MetS in military young adults. The METS-IR is the strongest predictor of new-onset MetS before midlife.

Inflammatory Burden Index Associated with Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation

Background

Recurrence rates of atrial fibrillation (AF) remain high after radiofrequency catheter ablation (RFCA), and inflammation plays an important role in the process. Inflammatory burden index (IBI) as a new inflammatory marker has been found to be associated with worse prognosis in cardiovascular disease. But there are no studies on its role in predicting AF recurrence. The aim of this study was to assess the value of IBI in predicting recurrence of AF after RFCA.

Methods

This was a single-center retrospective observational study. Consecutive enrolment of PersAF who underwent first-time radiofrequency ablation between January 2021 and June 2024. Inflammatory Burden Index (IBI) was calculated as C-reactive protein (CRP) × neutrophil/lymphocyte (NLR).

Results

A total of 142 (27.2%) patients experienced recurrence after RFCA. Multivariate analysis showed that PersAF (OR = 1.599; 95% CI: 1.028 ~ 2.486, p = 0.018), CHA2DS2-VASc score≥2 (OR = 1.769; 95% CI: 1.142 ~ 2.741, p = 0.011), LAD (OR = 1.098; 95% CI: 1.054 ~ 1.145, p < 0.001) and IBI (OR = 1.028; 95% CI: 1.007 ~ 1.050, p = 0.009), were independent predictors of recurrence. ROC analysis shows superiority of IBI (AUC=0.695, 95% CI: 0.647 ~ 0.743, p < 0.001) over CRP and NLR in predicting AF recurrence. When IBI was integrated into the traditional model (including PersAF, LAD and CHA2DS2-VASc Score), the discrimination and reclassification accuracy for the recurrence were significantly improved.

Conclusion

Inflammatory load index associated with the recurrence of AF after RFCA. Integration of IBI can improve the model about the recurrence of AF after RFCA.

Analyzing cardiovascular disease hospitalization risks due to cold and heat waves in Dezful

Given the increasing health risks associated with climate change, particular attention is focused on the elderly as a vulnerable group. This study aimed to analyze how these climate extremes impact the health and hospitalization rates of these patients. In this ecological time series study, daily Meteorological and environmental pollutants data for Dezful and hospitalization records for cardiovascular diseases based on International Classification of Diseases, 10th codes were collected from 2013 to 2019. Definitions for heat waves and cold waves were established Based on previous studies in this field. The study utilized a combination of Distributed Lag Nonlinear Models and Quasi Poisson analysis to investigate the association between each definition of cold and heat waves and hospitalization. The results indicate that heat waves are associated with an increased risk of hospital admissions due to cardiovascular disease in individuals over 75 years of age. Additionally, cold waves significantly increase the risk of hospitalization due to cardiovascular disease in individuals aged 65 to 74 years. Specifically, in the section on added effects, the results show that Cold Wave impacts the risk of hospitalization in patients aged 56 to 74 years (added effects: lags of 0, 0-2, 0-6, and 0-13). This study highlights the significant impact of heat and cold waves on the risk of hospitalization for cardiovascular diseases in Dezful. Older adults, especially those over 65, are particularly vulnerable to these climate-related health risks. As climate change progresses, it is essential to implement public health strategies that protect at-risk populations during extreme weather events.

Risk of major adverse cardiovascular events in treatment-resistant or severe depression

BACKGROUND

Depression is associated with higher risk of major adverse cardiovascular events (MACE). Whether patients with treatment-resistant depression (TRD) or severe depression have an even higher risk is uncertain.

METHODS

Patients 18-75 years old with a depressive episode in specialized psychiatric care were identified using national Swedish registers. Patients with depression were matched with population comparators, patients with TRD with non-TRD comparators, and severe depression with non-severe depression comparators. The primary outcome was MACE, including acute myocardial infarction, stroke, heart failure, and cardiovascular death. Hazard ratios were calculated, adjusting for sociodemographic and clinical covariates.

RESULTS

We identified 143,731 patients with depression, including 23,335 with TRD and 45,217 with severe depression. Patients with depression had a higher hazard of MACE vs comparators (aHR 1.50, 95%CI 1.40-1.62). Hazards of MACE were overall similar in patients with TRD vs comparators (aHR 1.06, 95%CI 0.93-1.22) and severe depression vs comparators (aHR 1.04, 95%CI 0.96-1.13). Analyzing separate outcomes, patients with TRD had a higher hazard of cardiovascular death (aHR 1.32, 95 %CI 1.03-1.69). Stratified by age, there was an elevated hazard of MACE among patients 18-29 years old with severe depression (aHR 2.82, 95%CI 1.24-6.41).

LIMITATIONS

Register data lacks information on some potential confounders.

CONCLUSIONS

Patients with TRD or severe depression are not at additional overall risk of MACE compared to other depressed patients. However, an additional risk may exist in younger patients with severe depression and specifically of cardiovascular death in patients with TRD.

Biology-Informed Matrix Factorization: An AI-Driven Framework for Enhanced Drug Repositioning

Advances in artificial intelligence (AI) and intelligent computing have significantly accelerated drug discovery by enabling accurate modeling of complex biomedical relationships. Among these efforts, drug repositioning-identifying novel therapeutic uses for approved or investigational drugs-offers a cost-effective and time-efficient alternative to de novo drug development. While non-negative matrix factorization (NMF) has been widely adopted for uncovering latent drug-disease associations, conventional implementations often neglect the biological context that underpins these relationships. In this work, we propose a novel NMF-based drug repositioning model that incorporates biological context (NMFIBC), which integrates drug and disease similarity networks through graph-regularized optimization to enhance predictive performance. This design enhances both the robustness and interpretability of association prediction. Extensive benchmarking on multiple gold-standard datasets demonstrates that NMFIBC outperforms existing methods across a range of metrics, including AUC, precision, and F1-score. Moreover, case studies involving clinically relevant drugs validate the biological plausibility of the predicted associations using public databases such as DrugBank, CTD, and KEGG. The proposed framework provides a powerful, context-aware AI strategy for discovering actionable insights in drug repositioning research.

How and Why to Add Autonomic Phenotyping and Autonomic Balancing Interventions Into Eating Disorder Treatment

Autonomic assessment has traditionally been used for cardiovascular evaluation, but its applications extend into the field of eating disorders and psychiatry at large. By measuring heart rate, heart rate variability, and electrodermal activity with wearable sensor technology, one can observe state and trait adaptive responses of the parasympathetic and sympathetic nervous systems. Individuals on the anorexia and atypical anorexia nervosa spectrum often present with high heart rate variability, conventionally considered cardioprotective, yet likely maladaptive in these disorders. With this phenotype, it may be advantageous to employ a unique, yet logical therapeutic strategy of enhancing sympathetic response while reducing parasympathetic response. With the integration of autonomic phenotyping (i.e., aggregating psychophysiological indices), data-driven idiographic treatment approaches have the potential to go beyond choosing the most effective psychotherapy for an individual. Determining individual autonomic phenotypes, regardless of eating disorder diagnosis, can augment other idiographic outcomes to inform treatment options and monitor progression of the disorder.

Left atrial appendage occlusion in patients with atrial fibrillation and intracerebral haemorrhage associated with cerebral amyloid angiopathy: a multicentre observational study and pooled analysis of published studies

BACKGROUND

Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO.

METHODS

We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis.

RESULTS

We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35-74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively.

CONCLUSIONS

LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population.

PROSPERO REGISTRATION NUMBER

CRD42023415354.

Physical activity interventions for the cardiac population: A generic logic model based on intervention mapping

Regular physical activity constitutes a crucial secondary prevention behaviour for people who have had an acute cardiac event. Nonetheless, sustained physical activity levels of the cardiac population are in need of improvement. Applying the Intervention Mapping approach, we describe a generic logic model for developing behavioural interventions to increase and maintain physical activity among those who have had an acute cardiac event. The development of the logic model was both data- and theory-driven, which enhances the effectiveness of the behavioural interventions developed using the logic model. The logic model may additionally be used to indicate research gaps, to solidify the underpinnings of already established behavioural interventions, and as a reflection tool for healthcare providers and individuals' behaviour. A generic logic model like the one presented here can be developed for key behavioural outcomes related to preventing other highly relevant health problems. We further recommend that future empirical research focuses on determinants of social support provision for cardiac patients' physical activity.

Psychotic symptoms following consumption of energy drinks: a systematic review

INTRODUCTION

Energy drinks (EDs) is an umbrella term for a family of beverages which contain high dosages of caffeine. ED consumption is increasing worldwide, and it is possible that excess ED consumption can cause or worsen symptoms of severe mental disorders (SMD) such as schizophrenia and bipolar affective disorder.

METHODS

We searched three electronic databases for studies on patients with SMD who had experienced psychotic symptoms following the consumption of energy drinks, as well as patients who developed psychotic symptoms after ED consumption without any prior severe psychiatric disorder. We conducted and reported this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We assessed the included case reports with the CARE criteria.

RESULTS

We included 11 publications, all of which were case reports. Two of these described two patients with a primary diagnosis of schizophrenia and three described six patients with a primary diagnosis of bipolar disorder. The remaining eight case reports described eight patients with no prior psychiatric diagnosis. All had experienced deterioration or onset of psychotic symptoms following intake of EDs.

DISCUSSION

ED use may be an emerging clinical challenge in psychiatry. However, it is also possible that EDs are simply a surrogate which indicate the occurrence of other factors associated with psychosis, such as male sex and poor socioeconomic status. Overall, limited research exists on the subject. Future research could aim at quantifying the use of EDs among psychiatric patients, and patients with SMH specifically.

The effects of SGLT2i on cardiac metabolism in patients with HFpEF: Fact or fiction?

The rising prevalence of Type 2 diabetes (T2D) has been closely associated with an increased incidence of cardiovascular diseases, particularly heart failure with preserved ejection fraction (HFpEF). Cardiometabolic disturbances in T2D, such as insulin resistance, hyperglycemia, and dyslipidemia, contribute to both microvascular and macrovascular complications, thereby intensifying the risk of heart failure. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as glucose-lowering agents for T2D, have demonstrated promising cardiovascular benefits in patients with heart failure, including those with preserved ejection fraction (HFpEF), regardless of T2D status. These benefits include reduced heart failure hospitalization rates and improvements in various metabolic parameters. This review aims to critically examine the effects of SGLT2i on cardiac metabolism in HFpEF, evaluating whether the observed benefits can truly be attributed to their impact on myocardial energy regulation or whether they represent other, potentially confounding, mechanisms. We will focus on the key metabolic processes possibly modulated by SGLT2i, including myocardial glucose utilization, fatty acid oxidation, and mitochondrial function, and explore their effects on heart failure pathophysiology. Additionally, we will address the role of SGLT2i in other pathogenetic factors involved in HFpEF, such as sodium and fluid balance, inflammation, and fibrosis, and question the extent to which these mechanisms contribute to the observed clinical benefits. By synthesizing the current evidence, this review will provide an in-depth analysis of the mechanisms through which SGLT2i may influence cardiac metabolism in HFpEF, assessing whether their effects are supported by robust scientific data or remain speculative. We will also discuss the potential for personalized treatment strategies, based on individual patient characteristics, to optimize the therapeutic benefits of SGLT2i in managing both T2D and cardiovascular risk. This review seeks to clarify the true clinical utility of SGLT2i in the management of cardiometabolic diseases and HFpEF, offering insights into their role in improving long-term cardiovascular outcomes.

Percutaneous Coronary Intervention Outcomes by 5 Major Race and Ethnic Subgroups

BACKGROUND

Racial and ethnic disparities in cardiovascular disease outcomes, including percutaneous coronary intervention (PCI), are well-documented. However, studies do not stratify certain subgroups, such as separating South Asian and East Asian patients, who exhibit varying burdens of cardiovascular disease and PCI outcomes. Additionally, socioeconomic status (SES) further complicates outcomes, with low SES serving as an independent predictor of adverse outcomes post-PCI.

OBJECTIVES

This study aimed to analyze PCI outcomes across 5 racial and ethnic groups-White, Black, Hispanic, South Asian, and East Asian populations-while accounting for comorbidities and SES to better understand how race and ethnicity influence cardiovascular outcomes.

METHODS

We conducted a retrospective cohort study of patients undergoing PCI from 2012 to 2022. Patients were stratified by race/ethnicity and matched to median household income based on U.S. Census Zone Improvement Plan code data. The primary endpoint was 1-year major adverse cardiovascular events (MACE). Multivariable Cox regression models were used to assess outcomes, adjusting for comorbidities and SES.

RESULTS

A total of 21,236 patients were included: 47.8% White, 11.3% Black, 18.0% Hispanic, 20.7% South Asian, and 2.2% East Asian. South Asian patients had significantly lower MACE (adjusted HR: 0.62; P < 0.001) compared with White patients. Black patients, in contrast, had a higher risk of MACE (adjusted HR: 1.27; P = 0.032).

CONCLUSIONS

Significant racial and ethnic disparities exist in 1-year PCI outcomes, with South Asian patients exhibiting favorable outcomes compared with White patients, and Black patients experiencing worse outcomes. Baseline comorbidities and estimated SES do not fully explain these disparities, suggesting that targeted strategies are needed to address the multifactorial influences on PCI outcomes across racial and ethnic groups.

Associating electrocardiographic abnormalities with coronary artery disease: insights into microvascular dysfunction from dynamic CT perfusion

OBJECTIVES

Electrocardiographic (ECG) abnormalities serve as important predictors of future cardiovascular events. However, the specific cardiac abnormalities that bridge the gap between ECG abnormalities and subsequent events remain poorly understood. This study aimed to evaluate the relationship between ECG abnormalities and the prevalence of coronary artery disease (CAD) in propensity score-matched patients with suspected CAD who underwent comprehensive cardiac computed tomography (CT).

MATERIALS AND METHODS

A total of 357 patients suspected of CAD underwent ECG and cardiac CT assessments, including calcium scoring, stress dynamic CT perfusion (CTP), coronary CT angiography (CCTA), and CT late enhancement. Propensity score matching based on demographic parameters and CAD risk factors was performed, resulting in 286 matched patients (143 without ECG abnormalities and 143 with ECG abnormalities).

RESULTS

In both unadjusted and propensity score-matched analyses, ECG abnormalities were significantly associated with microvascular dysfunction and myocardial scarring (p < 0.05 for both analyses). However, no significant associations were observed between ECG abnormalities and coronary calcification severity or obstructive CAD (≥ 50% luminal narrowing) in the propensity score-matched patients. Among matched patients without obstructive CAD on CCTA, those with ECG abnormalities exhibited a higher prevalence (30%) of microvascular dysfunction, particularly in the diffuse-transmural pattern, compared to that (14%) of patients without ECG abnormalities (p < 0.01).

CONCLUSION

ECG abnormalities may not be reliable indicators of the presence of obstructive CAD. However, given their association with microvascular dysfunction, CAD evaluation with comprehensive cardiac CT, including dynamic CTP, is recommended for patients exhibiting ECG abnormalities, particularly to evaluate myocardial perfusion abnormalities.

KEY POINTS

Question We investigated whether ECG abnormalities in patients suspected of having CAD are linked to epicardial stenosis, microvascular dysfunction, or myocardial scarring. Findings After adjusting for traditional risk factors using propensity-score matching, ECG abnormalities were associated with microvascular dysfunction and myocardial scarring, but not with epicardial coronary stenosis. Clinical relevance These results suggest that ECG abnormalities may offer important insights into tissue-level changes and microvascular pathology, rather than simply reflecting epicardial stenosis, thereby underlining the need for comprehensive cardiac assessment in patients with ECG changes.

Platelet Extracellular Vesicles as Natural Delivery Vehicles for Mitochondrial Dysfunction Therapy?

Mitochondria are vital for energy production, metabolic regulation, and cellular signaling. Their dysfunction is strongly implicated in neurological, cardiovascular, and muscular degenerative diseases, where energy deficits and oxidative stress accelerate disease progression. Platelet extracellular vesicles (PEVs), once called "platelet dust", have emerged as promising agents for mitigating mitochondrial dysfunction. Like other extracellular vesicles (EVs), PEVs carry diverse molecular cargo and surface markers implicated in disease processes and therapeutic efficacy. Notably, they may possibly contain intact or partially functional mitochondrial components, making them tentatively attractive for targeting mitochondrial damage. Although direct research on PEVs-mediated mitochondrial rescue remains limited, current evidence suggests that PEVs can modulate diseases associated with mitochondrial dysfunction and potentially enhance mitochondrial health. This review explores the therapeutic potential of PEVs in neurodegenerative and cardiovascular disorders, highlighting their role in restoring mitochondrial health. By examining recent advancements in PEVs research, we aim to shed light on novel strategies for utilizing PEVs as therapeutic agents. Our goal is to underscore the importance of further fundamental and applied research into PEVs-based interventions, as innovative tools for combating a wide range of diseases linked to mitochondrial dysfunction.

Choroidal vascular alterations in patients with Helicobacter pylori gastritis

BACKGROUND AND STUDY AIMS

This study aims to examine the impact of Helicobacter pylori (H. pylori) gastritis, a condition that induces chronic inflammation in the body, on subfoveal choroidal thickness (SFCT) and choroidal vascular index (CVI) measurements.

PATIENTS AND METHODS

In this prospective study, data were collected from 76 patients who visited the gastroenterology clinic, had their H. pylori diagnosis confirmed through gastric biopsy, and had not yet received treatment. An additional 76 age- and gender-matched healthy individuals formed the control group. Subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging optical coherence tomography (EDI-OCT) (Spectralis, Heidelberg Engineering, Heidelberg, Germany). CVI measurements were obtained by dividing the subfoveal choroidal area in the EDI-OCT images into luminal and stromal areas using the image binarization technique.

RESULTS

The mean SFCT was 359.14 ± 24.23 µm in the H. pylori-positive group and 353.62 ± 12.78 µm in the control group, with no statistically significant difference between the groups (p = 0.782). Similarly, the choroidal vascular index (CVI) was 0.63 in the H. pylori group and 0.62 in the control group, with no significant difference observed (p = 0.08).

CONCLUSION

Results indicate that SFCT and CVI measurements do not undergo significant changes during the active phase of H. pylori infection compared to the control group.

The Effect of Transcranial Direct Current Stimulation on Basketball Performance-A Scoping Review

Introduction: Basketball performance requires not only intermittent high-intensity movements-such as sprinting, jumping, and rapid directional changes-but also rapid decision-making under cognitive and psychological stress. Transcranial direct current stimulation (tDCS) has emerged as a potential modality to enhance both physical and mental performance due to its capacity to modulate cortical excitability and promote synaptic plasticity. Although the broader literature suggests that tDCS can benefit motor performance and endurance across various sports, its specific impact on basketball remains underexplored. Methods: This scoping review aimed to summarize current evidence on the effects of tDCS in basketball. A comprehensive literature search was conducted across databases including PubMed/Medline, Google Scholar, and Cochrane, identifying studies published between January 2008 and February 2025. Only clinical trials investigating tDCS interventions in basketball players were included. Eleven articles met the inclusion criteria and were synthesized narratively, with a focus on stimulation parameters (site, duration, intensity) and performance outcomes (shooting accuracy, dribbling, sprinting, decision-making, fatigue). Results: The reviewed studies indicated that tDCS-particularly when applied over the motor cortex-was associated with moderate improvements in shooting accuracy, dribbling time, repeated-sprint performance, and decision-making under fatigue. Some studies reported delayed rather than immediate benefits, suggesting that tDCS may prime neural networks for enhanced learning and retention. However, not all findings were consistent; certain interventions produced minimal or no significant effects, especially regarding subjective mental fatigue and cognitive workload. The variability in electrode placements and stimulation protocols highlights the need for methodological standardization. Conclusions: Current evidence partially supports the potential of tDCS to improve specific performance domains in basketball, particularly in skill acquisition, neuromuscular efficiency, and decision-making. Nevertheless, the findings are limited by small sample sizes, heterogeneous protocols, and a lack of long-term follow-up. Future research should prioritize larger, multisite studies with standardized tDCS parameters and ecologically valid outcome measures to confirm the efficacy and practical relevance of tDCS in competitive basketball settings.

Does perioperative electroacupuncture reduce the incidence of atrial fibrillation after lung cancer surgery? A randomized, controlled, assessor-blinded clinical trial

Background

Atrial fibrillation (AF) is a common complication of lung cancer surgery, with high incidence during the perioperative period. Electroacupuncture is considered a potential complementary therapy for the management of AF. We aimed to evaluate the preventive effects of perioperative electroacupuncture on new-onset AF in patients undergoing lung cancer surgery.

Methods

This was a single-center, randomized, controlled, assessor-blinded clinical trial. We randomly divided 90 patients with cancer who underwent lung surgery into an electroacupuncture group (EA) and a sham electroacupuncture group (SA). Four acupuncture points on the surgical side were selected for the intervention. The EA group was needled with an EA instrument using sparse and dense waves alternating at 2/100 Hz. Electroacupuncture treatments were administered thrice. The incidence of newly developed AF within 72 h after surgery was used as the main indicator, and the Visual Analog Scale, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and blood levels of Interleukin-6 (IL-6) were used as secondary outcomes.

Results

The EA group showed a 14.6% absolute risk reduction in POAF incidence compared to the SA group (P = 0.013). NT-proBNP level (MD: +32.57 pg/mL, 95% CI: 5.8-59.3, P = 0.018) and interleukin-6 level (MD: +9.29 pg/mL, 95% CI: 1.45-17.1, P = 0.021) increased significantly in the SA group compared to the EA group at 72h. No significant differences were observed in VAS scores (12 h: MD -0.27, 95% CI: -0.8 to 0.2, P = 0.572; 72h: MD -0.50, 95% CI: -0.4 to 0.3, P = 0.238).

Conclusion

This study confirmed that electroacupuncture reduced the incidence of new-onset AF in the perioperative period, providing a possible complementary therapy for the prevention of arrhythmia after lung cancer surgery.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=127920, identifier ChiCTR2100047499.

Transcarotid Artery Approach for Endovascular Aortic Repair in Treating Complex Descending Thoracic Aortic Pseudoaneurysm With Aortoiliac Occlusion: A Case Report

BackgroundEndovascular aortic repair has emerged as the preferred treatment modality over open surgery for aortic diseases, primarily because of its association with lower perioperative morbidity and mortality rates. Current diagnostic and treatment guidelines generally advocate for endovascular aortic repair in most cases, with the femoral artery serving as the conventional access route. However, this approach may not be feasible for all patients, particularly those with aortoiliac artery occlusion, necessitating alternative access strategies.Case SummaryThis paper presents a complex case study of a patient with aortoiliac artery occlusion who underwent endovascular aortic repair via the left carotid artery approach for a pseudoaneurysm at the anastomotic site of a descending aortic prosthetic graft. This case underscores the potential value of utilizing the carotid artery as an alternative access route in anatomically challenging situations.ConclusionResearch on transcarotid artery approach endovascular aortic repair is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This case report suggests that endovascular aortic repair via the carotid artery approach may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. While our single case demonstrated successful management with minimal complications, larger studies are needed to fully establish the safety profile and determine if perioperative complications and mortality rates are indeed manageable across diverse patient populations.Clinical ImpactThis study provides valuable insights into the feasibility of the carotid artery as an alternative access route for endovascular aortic repair in patients with aortoiliac artery occlusion. It offers clinicians a potential strategy for cases where the conventional femoral artery route is not feasible. The findings presented herein aim to demonstrate the practicality and relative safety of utilizing the carotid artery for endovascular procedures in anatomically challenging scenarios, contributing to the broader understanding of access alternatives in aortic repair interventions.

Physiological adjustment effects of viewing natural environment images on heart rate variability in individuals with depressive and anxiety disorders

Nature-based interventions improve mood and reduce stress, but their effects on heart rate variability (HRV) remain inconsistent. The physiological adjustment effect theory proposes HRV adjusts to an optimal value during nature contact-increasing when baseline HRV is low and decreasing when high. This study tested this theory in patients with depressive and anxiety disorders and investigated its association with mood changes. A randomized crossover trial was conducted with 60 patients. We assessed the correlation between baseline HRV during control images and HRV change after 3 min natural image viewing. We also examined mood changes in comfort, relaxation, and vigor. A significant negative correlation was found between baseline low-frequency/high-frequency (LF/HF) ratio and changes after viewing natural images, indicating a physiological adjustment effect in sympathetic activity. No significant correlation was found with the parasympathetic indicator, HF. Participants with adjustment effects in LF/HF had greater improvement in vigor. Those without these effects had higher alcohol use and tended towards more comorbid hypertension. Natural interventions may enhance vigor through physiological adjustment in sympathetic activity. The lack of adjustment effects is linked to behaviors and conditions associated with autonomic dysfunction, highlighting the need for targeted therapies in depressive and anxiety disorders.

Role of Residual Inflammation as a Risk Factor Across Cardiovascular-Kidney-Metabolic (CKM) Syndrome: Unpacking the Burden in People with Type 2 Diabetes

Type 2 diabetes mellitus (T2DM) is a global health crisis, with cardiovascular disease (CVD) accounting for 75% of mortality in this population. Despite advances in managing traditional risk factors, such as low-density lipoprotein cholesterol (LDL) cholesterol reduction (IMPROVE-IT, FOURIER), antithrombotic therapies (PEGASUS, COMPASS), and triglyceride-lowering agents (REDUCE-IT), a substantial residual cardiovascular risk persists, driven in part by chronic low-grade systemic inflammation. Chronic low-grade inflammation is a central driver of cardiovascular-kidney-metabolic (CKM) syndrome in T2DM, perpetuating residual cardiovascular risk despite optimal management of traditional risk factors. This narrative review synthesizes evidence on how inflammation accelerates coronary heart disease (CHD), heart failure (HF), stroke, diabetic kidney disease (DKD), and peripheral artery disease (PAD). We evaluate the anti-inflammatory mechanisms of current therapies such as statins, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 (GLP-1) receptor agonists, as well as emerging agents like colchicine and interleukin (IL)-1β/IL-6 inhibitors, emphasizing their differential efficacy across CKM traits. By integrating pathophysiological insights with clinical trial data, we propose biomarker-guided strategies to target inflammation as a modifiable risk factor, offering a roadmap to bridge the gap in diabetes-related cardiovascular care.

Developments in Digital Wearable in Heart Failure and the Rationale for the Design of TRUE-HF (Ted Rogers Understanding of Exacerbations in Heart Failure) Apple CPET Study

BACKGROUND

Heart failure (HF) is a highly prevalent condition characterized by exercise intolerance, an important metric for ambulatory prognostication. However, current methods to assess exercise capacity are often limited to tertiary HF centers, lacking scalability or accessibility. Wearable devices have the potential to provide near-continuous dynamic biometrics including exercise tolerance.

METHODS

Leveraging the capabilities of Apple Watch and a custom application, the TRUE-HF (Ted Rogers Understanding of Exacerbations in Heart Failure) Apple cardiopulmonary exercise testing study aims to investigate whether HealthKit data from Apple Watch can estimate cardiorespiratory fitness, as compared with the gold standard peak oxygen uptake from cardiopulmonary exercise testing. The TRUE-HF study will evaluate the potential impact of wearable technology in the functional assessment of ambulatory patients with HF. The primary end point is to use HealthKit variables to estimate a TRUE-HF peak oxygen uptake. We outline key features of this trial designed to reduce the burden of wearable technology. In addition, we highlight the benefits of various machine learning analyses, with a particular focus on transformer models for the wearable space.

CONCLUSIONS

Using cutting-edge wearable technology and machine learning analytics, TRUE-HF may provide state-of-the-art assessment of functional capacity by measuring participant-generated free-world data.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT05008692.

Relationship of serum phosphorus level with acute cerebrovascular disease

There are no sufficient studies on laboratory parameters associated with acute stroke. Laboratory parameters associated with acute stroke may become important in the prevention or follow-up of the disease. To investigate the relationship between cerebrovascular disease (CVD) and serum phosphorus levels. This study was conducted prospectively to evaluate the relationship between cerebrovascular disease and phosphorus in patients who applied to the Emergency Medicine Clinic of the Faculty of Medicine Hospital and underwent central imaging between March 1, 2023, and December 31, 2023. 299 patients who applied to the university emergency department were prospectively included in the study with brain computed tomography (CT) and diffusion magnetic resonance imaging (MRI). The lactate, white blood cell, hgb, neutrophil, lymphocyte, urea, creatine and phosphorus values ​​of the patients at their first admission were recorded. The patients were divided into two groups: CVD group and control group. The laboratory parameters of the patients were compared according to the groups. In the ROC analysis performed to evaluate the power of laboratory parameters in predicting the diagnosis of CVD, the AUC value of phosphorus was obtained as 0.935, lactate as 0.620 and urea as 0.596. The optimum cut-off value for phosphorus was calculated as 3.47 (mg/dl) and the sensitivity of this cut-off value was found to be 89%, specifically 86.9%, positive predictive value (ppv) as 77.4% and negative predictive value (npv) as 94%. Lactate, urea and phosphorus values were found to be significantly higher in the CVD group compared to the control group. With this study, we found that serum phosphorus levels were higher than our cut-off value in patients with acute ischemic CVD. We believe that serum phosphorus level will be useful in excluding acute cerebrovascular disease due to its high negative predictive value when evaluated according to the cut-off value of 3.47 (mg/dl).

Association between urinary albumin-to-creatinine ratio and all-cause and cardiovascular-cause mortality among MASLD: NHANES 2001-2018

Background

Urinary albumin-to-creatinine ratio (UACR) is an established biomarker for assessing kidney damage, but recent studies suggest it may also reflect broader health risks. This study aimed to investigate the association between UACR and all-cause and cardiovascular disease (CVD)-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

In this prospective cohort study, we included sample of 3,412 MASLD enrolled in the National Health and Nutrition Examination Survey 2001-2018. The study population was divided into three different risk categories based on urinary UACR: low level (<4.67 mg/g), intermediate level (4.67-7.67 mg/g), and high level (7.68-30 mg/g). Cox proportional hazards models were used to estimate the hazard ratios (HR) for the association between UACR level and both all-cause and CVD-cause mortality. Restricted cubic spline (RCS) curve analysis was employed to assess the non-linear association between UACR and mortality. Kaplan-Meier (KM) survival curves were used to evaluate survival rates across UACR groups.

Results

The study found that higher UACR levels, even within the normal range, were independently associated with increased risks of both all-cause and CVD-cause mortality. Each 1 mg/g increase in UACR was associated with a 4% higher risk of all-cause mortality (HR 1.04, 95% CI 1.03-1.05) and a 5% higher risk of cardiovascular mortality (HR 1.05, 95% CI 1.02-1.08). Compared with the low UACR group, high UACR both showed an increased all-cause mortality risk [HR, 2.69 (95% CI, 2.07-3.50)] and CVD-cause mortality risk [HR, 2.97 (95% CI, 1.76-4.99)]. RCS curve analysis revealed a non-linear positive correlation between UACR and both all-cause and CVD-cause mortality, identifying UACR thresholds of 7.467 mg/g for all-cause mortality and 7.195 mg/g for CVD-cause mortality. The KM survival curves confirmed that participants with lower UACR levels had higher survival rates.

Conclusion

Elevated UACR levels within the normal range, are associated with increased all-cause and cardiovascular mortality in patients with MASLD. UACR may serve as a useful early biomarker for identifying individuals at higher risk of mortality, supporting more proactive clinical interventions to manage MASLD-related risks.

Inverse Agonists of Peroxisome Proliferator-Activated Receptor Gamma: Advances and Prospects in Cancer Treatment

Peroxisome proliferator-activated receptor gamma (PPARγ) is a ligand-dependent nuclear transcription factor that modulates metabolic homeostasis and cell proliferation. Inverse agonism of PPARγ is an emerging anticancer strategy, particularly for the treatment of bladder cancer. The first-in-class PPARγ inverse agonist, FX-909, is currently being studied in clinical trials for cancer treatment. However, PPARγ inverse agonists are still in the early stages of development. The discovery of compounds with novel chemical structures, potent efficacy, and favorable pharmacokinetic properties is urgently needed. In this perspective, the biological functions of PPARγ and its role in cancer pathology are introduced, and currently available PPARγ inverse agonists and their preliminary structure-activity relationships (SARs) are discussed from a medicinal chemistry viewpoint. These findings inform the development of anticancer agents that act as PPARγ inverse agonists. Furthermore, our discussion of the complex biological functions of PPARγ provides insights into the exploration of its role in various diseases.

Heart rate variability in children and adolescents with incidentally found early repolarization pattern

BACKGROUND

Early repolarization pattern (ERP) on electrocardiogram (ECG) was long considered benign, but recent data suggest a potential association with fatal arrhythmia and sudden cardiac death. Its relevance in pediatric populations remains unclear. This study investigated the risk of premature death and arrhythmia in children with incidentally found early repolarization using ECG and heart rate variability parameters.

METHODS

This cross-sectional study included healthy children aged 6-18 years with incidentally detected ERP (study group) and age- and sex-matched controls without ERP. All participants underwent medical history evaluation, physical examination, 12-lead ECG, transthoracic echocardiography, and 24-h Holter monitoring. ECG parameters (P wave, QTc, JT, Tp-e, and their dispersions), time-domain (SDNN, SDANN, SDNN-i, r-MSSD, pNN50), and frequency-domain (HF, LF, LF/HF) HRV parameters were analyzed.-i, r-MSSD, pNN50 and "Frequency-domain" parameters HF, LF, LF/HF were obtained.

RESULTS

The study group had lower heart rates (p = 0.020) and increased JT dispersion (p = 0.025). Interventricular septal thickness was significantly greater in the ERP group (p = 0.030). LF/HF ratio (p = 0.045), awake HF (p = 0.046), and awake LF/HF (p = 0.036) were significantly higher in ERP patients. Parasympathetic activity predominance was more evident in males. ERP localized in inferolateral leads was associated with higher heart rate and lower SDNN and VLF during sleep (p = 0.049, p = 0.040, p = 0.040, respectively).

CONCLUSION

Incidental ERP in children was not associated with arrhythmic events but correlated with increased parasympathetic tone. Inferolateral ERP may indicate a relatively higher autonomic imbalance risk.

The positive relationship between the Alternative Healthy Diet Index and serum klotho levels: A cross-sectional analysis in middle-to-older Americans

BACKGROUND AND AIM

The Alternative Healthy Eating Index (AHEI-2010) is a dietary index associated with chronic diseases and serves as an important metric for assessing the healthiness of one's diet. Serum Soluble Klotho (S-Klotho) is a protein related to anti-aging. There is currently a lack of research on the relationship between AHEI and S-Klotho. This study evaluated the relationship between the AHEI index and S-Klotho in the U.S. middle-aged and elderly population from the National Health and Nutrition Examination Survey (NHANES) 2011-2016.

METHODOLOGY

This study includes 6,305 middle-aged and elderly participants (aged 40-79 years old). The interrelationship between the AHEI-2010 and S-klotho concentration was explored using multivariate regression models, and the nonlinear relationship between the two was investigated through curve fitting. The stability of this relationship in different populations was explored through subgroup analysis.

RESULTS

There was a positive correlation between AHEI and S-klotho (β=1.1, 95% CI: 0.1, 2.1, P = 0.035). The multivariate-adjusted β and 95% confidence intervals (CIs) from the lowest to the highest AHEI-2010 categories (＜31.9, 31.9-39.3, 39.3-47.9, and > 47.9) were 0.0 (reference), 15.7 (-13.5, 44.9), 12.5 (-16.5, 41.6), and 31.9 (2.9, 60.9), respectively. The curve fitting found that the relationship between AHEI-2010 and S-Klotho is essentially linear, with S-Klotho levels increasing linearly as AHEI improves.

CONCLUSION

AHEI is positively associated with S-Klotho levels in American middle-to-older adults. Further research is needed to elucidate the causal relationship and specific mechanisms.

Wearable Artificial Intelligence for Sleep Disorders: Scoping Review

BACKGROUND

Worldwide, 30%-45% of adults have sleep disorders, which are linked to major health issues such as diabetes and cardiovascular disease. Long-term monitoring with traditional in-lab testing is impractical due to high costs. Wearable artificial intelligence (AI)-powered solutions offer accessible, scalable, and continuous monitoring, improving the identification and treatment of sleep problems.

OBJECTIVE

This scoping review aims to provide an overview of AI-powered wearable devices used for sleep disorders, focusing on study characteristics, wearable technology features, and AI methodologies for detection and analysis.

METHODS

Seven electronic databases (MEDLINE, PsycINFO, Embase, IEEE Xplore, ACM Digital Library, Google Scholar, and Scopus) were searched for peer-reviewed literature published before March 2024. Keywords were selected based on 3 domains: sleep disorders, AI, and wearable devices. The primary selection criterion was the inclusion of studies that utilized AI algorithms to detect or predict various sleep disorders using data from wearable devices. Study selection was conducted in 2 steps: first, by reviewing titles and abstracts, followed by full-text screening. Two reviewers independently conducted study selection and data extraction, resolving discrepancies by consensus. The extracted data were synthesized using a narrative approach.

RESULTS

The initial search yielded 615 articles, of which 46 met the eligibility criteria and were included in the final analysis. The majority of studies focused on sleep apnea. Wearable AI was widely deployed for diagnosing and screening disorders; however, none of the studies used it for treatment. Commercial devices were the most commonly used type of wearable technology, appearing in 30 out of 46 (65%) studies. Among these, various brands were utilized rather than a single large, well-known brand; 19 (41%) studies used wrist-worn devices. Respiratory data were used by 25 of 46 (54%) studies as the primary data for model development, followed by heart rate (22/46, 48%) and body movement (17/46, 37%). The most popular algorithm was the convolutional neural network, adopted by 17 of 46 (37%) studies, followed by random forest (14/46, 30%) and support vector machines (12/46, 26%).

CONCLUSIONS

Wearable AI technology offers promising solutions for sleep disorders. These devices can be used for screening and diagnosis; however, research on wearable technology for sleep disorders other than sleep apnea remains limited. To statistically synthesize performance and efficacy results, more reviews are needed. Technology companies should prioritize advancements such as deep learning algorithms and invest in wearable AI for treating sleep disorders, given its potential. Further research is necessary to validate machine learning techniques using clinical data from wearable devices and to develop useful analytics for data collection, monitoring, prediction, classification, and recommendation in the context of sleep disorders.

Establishing a left bundle branch area pacing program: Results from a high-volume pacing center

INTRODUCTION AND OBJECTIVES

Left bundle branch area pacing (LBBAP) is a technique suitable for treating both symptomatic bradycardia and cardiac resynchronization therapy (CRT). Our study aims to describe the first experience of LBBAP in a high-volume cardiac implantable electronic device (CIED) center.

METHODS

This prospective single-center observational registry included consecutive patients who underwent pacemaker implantation with LBBAP technique for sinus node disease, bradycardia and CRT indications between January 2023 and January 2024. Procedural data, outcomes, and lead parameters were recorded at hospital discharge, at one and six months of follow-up.

RESULTS

A total of 164 consecutive patients undergoing LBBAP implantation were included, of whom 142 had a stylet-driven lead. LLBAP was achieved in 94.5% patients. Average QRS duration was 139.8±33.4 ms. Complete atrioventricular block was the most common indication (42.7%). CRT was performed in 24 (14.5%) patients. Mean procedural duration was 82.7±24.4 min and mean fluoroscopy time was 13.7±7.1 min. Average LVAT was 78.8±8.7 ms and paced QRS width 114.8±14.4 ms. Median acute R-wave amplitude was 14.0 mV, pacing threshold was 0.5 V and impedance 526 Ω. No relevant per-operative complications occurred. After one month of follow-up, median pacing threshold had significantly increased to 0.75 V (p<0.001) while R-wave amplitude and impedance remained unchanged (p=0.242 and p=0.101 respectively). During follow-up, no changes occurred in the evaluated parameters. Loss of left bundle branch capture occurred in five patients and macro-dislodgement in 2.

CONCLUSION

LBBAP is a feasible pacing technique which reduces QRS duration and improves LV synchrony and can be adopted at most centers, with favorable success rates and safety profile.

SHAP analysis and comparative performance of the HEART, HET, and SVEAT scores in 30-day MACE prediction

BACKGROUND

This study aimed to compare the predictive performance of the HEART, HET, and SVEAT scores for 30-day major adverse cardiovascular events (MACE) in patients presenting with acute chest pain in the emergency department (ED).

METHODS

The HEART, HET, and SVEAT scores were retrospectively calculated, and their predictive performance for 30-day MACE was assessed using receiver operating characteristic (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analysis. Additionally, SHapley Additive exPlanations (SHAP) analysis was performed to quantify the contribution of each score to MACE prediction.

RESULTS

A total of 1330 patients were included, of whom 167 (12.6 %) experienced 30-day MACE. The HEART score exhibited the highest discriminatory performance (AUROC: 0.872, 95 % CI: 0.853-0.890), followed by the HET score (AUROC: 0.859, 95 % CI: 0.840-0.878). The SVEAT score had significantly lower predictive accuracy (AUROC: 0.823, 95 % CI: 0.802-0.844). Pairwise comparisons showed no statistically significant difference between the HEART and HET scores (p = 0.0787), whereas both HEART (p < 0.001) and HET (p < 0.001) significantly outperformed the SVEAT score. SHAP analysis confirmed that the HEART score contributed the most to MACE prediction.

CONCLUSION

Among the three risk stratification scores assessed, the HEART score demonstrated the highest predictive accuracy for 30-day MACE, followed by the HET score, while the SVEAT score showed lower performance. These findings support the HEART score as a preferred tool for risk stratification in acute chest pain evaluation in the ED.

Cardiac Conduction Disorders Due to Acquired or Genetic Causes in Young Adults: A Review of the Current Literature

Cardiac conduction disorders can manifest in young adults in isolated forms, associated with myocardial diseases or as part of a multiorgan disorder. Underlying causes of cardiac conduction disorders may be genetically determined or acquired. Cardiac conduction disorder in young adults is a complex and often underestimated and underrecognized disease that may need of a multidisciplinary team for the diagnosis, treatment, and long-term management of these patients. Therefore, it is crucial to raise clinicians' awareness of this condition. In this review, we provide a comprehensive update on the cause, diagnosis, and treatment of young adults with cardiac conduction disorders, also suggesting potential strategies to improve the current clinical management of these patients.

Efficacy of Beta-Blockers in Acute Management and Prevention of Recurrence in Takotsubo Syndrome

Takotsubo cardiomyopathy is a nonischemic cardiomyopathy characterized by a transient ballooning of the apical cardiac wall secondary to stress. Since its discovery and diagnosis in Japan in 1990, Takotsubo cardiomyopathy has been known as a disease with a generally favorable prognosis due to the transient nature of its apical wall abnormalities. However, complications, including arrhythmia, hemodynamic instability, heart failure, intracardiac thrombus, and rupture, have all been reported in the literature, requiring flexible management of this unique pathology. Although therapy is guided by inciting factors and complication management, beta-blockers are a widely accepted acute and long-term treatment modality. We review the current literature describing the pathogenesis, medical evaluation, and treatment options for Takotsubo cardiomyopathy. This article aims to provide a greater understanding of the pathophysiology and further evaluate the efficacy of beta-blocker therapy when considering acute and long-term treatment and prevention of Takotsubo cardiomyopathy.

Quantitative cardiac magnetic resonance standardized signal intensity comparison in dilated cardiomyopathy vs. cardiac sarcoidosis

BACKGROUND

Dilated cardiomyopathy (DCM) and cardiac sarcoidosis (CS) manifest unique late gadolinium enhancement (LGE) patterns on cardiac magnetic resonance (CMR), indicative of different myocardial scar distributions. However, the overlap in these patterns due to their lack of specificity complicates differentiation. This study introduces a novel quantitative method employing z-score analysis of LGE-CMR intensity to objectively compare the spatial distribution of LGE intensity between DCM and CS.

METHODS

This retrospective study included 22 NICM patients (13 DCM, 9 CS) who underwent CMR before electrophysiology study from November 2018 to May 2023. LGE images were delineated into sub-endocardial, mid-myocardial, and sub-epicardial layers across anterior, lateral, inferior, and septal walls using the AHA 17-segment model. CMR signal intensities were standardized to z-scores (z = (x - μ)/σ), with x as the signal intensity for a specific myocardial segment, and μ and σ as the mean and SD for all LV myocardial segments, to map regional intensity variations.

RESULTS

Compared to DCM, CS patients exhibited significantly higher CMR signal intensity z-scores in the septum (β = 0.32, p = 0.009), particularly in the endocardial third of the right ventricular (RV) side (β = 0.56, p = 0.001). A z-score greater than 0.40 in this area was associated with a CS diagnosis, with an area under the ROC curve of 0.692 in fivefold cross-validation.

CONCLUSION

Patients with CS exhibit higher affinity for contrast in the septum, particularly on the RV endocardium. Standardized analysis of CMR signal intensities provides a novel, quantitative method for distinguishing CS from DCM, with the former exhibiting higher CMR signal intensity z-scores in the septum.

The value of high-pitch scanning with Sn100kV and ADMIRE in CT examination of tuberculous destroyed lung: Identifying the optimal combination for ultra-low-dose imaging

OBJECTIVE

To investigate the application value of high-pitch scanning combined with energy spectrum purification using Sn100kV and ADMIRE in CT examinations of patients with tuberculous destroyed lung.

METHODS

A total of 60 patients with sputum mycobacterium tuberculosis smear positive and diagnosed with tuberculous lung damage on imaging were prospectively collected. The first CT examination utilized a conventional scanning mode with a fixed tube voltage of 120kV, CARE Dose4D activated, reference tube current set at 70mAs, and a pitch of 1.5. The interval between the initial and follow-up CT was over three months. During the follow-up CT, a high-pitch scanning mode combined with energy spectrum purification was employed, with a fixed tube voltage of Sn100kV, CARE Dose4D activated, reference tube current set at 300mAs, and a pitch of 3.2. The remaining parameters were consistent between the two CT scans. The first CT was recorded as Group A, and the follow-up CT as Group B. After the examinations, the reconstructed layer thickness was 1.00mm, and lung window and mediastinal window images with a layer spacing of 0.7mm were obtained. The image quality of the two CT examinations was scored by three physicians using a 5-point scale. Following the scoring, the consistency of the three physicians' scores was analyzed using the intraclass correlation coefficient.. A chief physician reviewed the lung window images from both CT scans, recorded the number of focal signs detected, and conducted Chi-square tests to compare these counts between the two groups. The CT values and noise levels in both the mediastinal window and pulmonary window were measured, SNR and CNR were calculated, and independent sample T-test was performed to analyze the differences in these parameters between the two groups. Motion artifacts in the two CT images were assessed and scored by three physicians using a 3-point values, and Mann-Whitney U test was applied to compare the scores between the groups. The radiation doses of two CT examinations was recorded, and the differences between the two groups were statistically analyzed using the Mann-Whitney U test. Data analysis was conducted using SPSS 26.0 software.

RESULTS

The image quality scores of both groups were 3 points or above, meeting the requirements for clinical diagnosis. The intraclass correlation coefficient (ICC) value for the consistency analysis of the pulmonary window scores among the three physicians was 0.819 (p < 0.001), and for the mediastinal window consistency analysis, the ICC value was 0.795 (p < 0.001), indicating good consistency in the subjective score diagnosis results. The detection rate of lesion signs in Group B was higher than that in Group A, but there was no statistical difference between the two groups (p > 0.05). There was no significant difference in noise, SNR, and CNR between the two groups (p > 0.05). However, the SNR and CNR in Group B were better than those in Group A. There was no statistical difference in the CT values of the aorta and muscle between the two groups of mediastinal window images, while noise, SNR, and CNR were statistically significant (p < 0.05). Noise in Group B was higher than that in Group A, while the SNR and CNR in Group B were lower than those in Group A. The motion artifacts of the two groups were significantly different (p < 0.001), with Group A having significantly more motion artifacts than Group B. The radiation dose of the two groups was statistically different (p < 0.001), with Group B's radiation dose reduced by 76.24% compared to Group A.

CONCLUSION

The combination of high-pitch scanning with Sn100kV and ADMIRE can be effectively used for ultra-low-dose CT examination of the tuberculous destroyed lung, obtaining satisfactory diagnostic images and reducing the occurrence of motion artifacts. This technique achieves conventional diagnostic outcomes at ultra-low doses and significantly reduces motion artifacts, holding significant potential and value for widespread clinical application in CT examinations for patients with tuberculous disfigured lung.

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.

Management of ventricular tachycardia in patients with advanced heart failure

Ventricular arrhythmias (VAs) are highly prevalent in patients with advanced heart failure (AHF), a condition characterized by severe signs and symptoms despite conventional HF therapy. The management of VAs in this setting remains challenging. Antiarrhythmic drug therapy options are limited and only amiodarone has demonstrated effectiveness in suppressing VA, albeit this agent is associated with a substantial risk of cardiac and noncardiac adverse effects. Catheter ablation is effective for the reduction of VAs in patients with AHF. Identification of patients at high risk for periprocedural hemodynamic decompensation has important implications in terms of procedural planning and improving patient safety and procedural outcomes. Herein, we review the current state of scientific evidence for the management of VA in patients with AHF.