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Zhang G, Lian Y, Li Q, Zhou S, Zhang L, Chen L, Tang J, Liu H, Li N, Pan Q, Gu Y, Lin N, Wang H, Wang X, Guo J, Zhang W, Jin Z, Xu B, Su X, Lin M, Han Q, Qin J. Vagal pathway activation links chronic stress to decline in intestinal stem cell function. Cell Stem Cell 2025; 32:778-794.e10. [PMID: 40120585 DOI: 10.1016/j.stem.2025.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 01/11/2025] [Accepted: 02/26/2025] [Indexed: 03/25/2025]
Abstract
Chronic stress adversely affects intestinal health, but the specific neural pathways linking the brain to intestinal tissue are not fully understood. Here, we show that chronic stress-induced activation of the central amygdala-dorsal motor nucleus of the vagus (CeA-DMV) pathway accelerates premature aging and impairs the stemness of intestinal stem cells (ISCs). This pathway influences ISC function independently of the microbiota, the hypothalamic-pituitary-adrenal (HPA) axis, the immune response, and the sympathetic nervous system (SNS). Under chronic stress, DMV-mediated vagal activation prompts cholinergic enteric neurons to release acetylcholine (ACh), which engages ISCs via the M3 muscarinic acetylcholine receptor (CHRM3). This interaction activates the p38 mitogen-activated protein kinase (MAPK) pathway, triggering growth arrest and mitochondrial fragmentation, thereby accelerating an aging-like decline in ISCs. Together, our findings provide insights into an alternative neural mechanism that links stress to intestinal dysfunction. Strategies targeting the DMV-associated vagal pathway represent potential therapeutic approaches for stress-induced intestinal diseases.
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Affiliation(s)
- Guoying Zhang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China; Jinfeng Laboratory, Chongqing 401329, China
| | - Yannan Lian
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai 200032, China
| | - Shudi Zhou
- Department of Endocrinology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Lili Zhang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Liting Chen
- Department of Emergency and Critical Disease, Songjiang Hospital and Songjiang Research Institute, Shanghai Key Laboratory of Emotions and Affective Disorders, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; Department of Anatomy and Physiology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Junzhe Tang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai 200032, China
| | - Hailong Liu
- Department of General Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ni Li
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China; Jinfeng Laboratory, Chongqing 401329, China
| | - Qiang Pan
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China; Jinfeng Laboratory, Chongqing 401329, China
| | - Yongqiang Gu
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Naiheng Lin
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Hanling Wang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Xuege Wang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Jiacheng Guo
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Wei Zhang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Zige Jin
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Beitao Xu
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Xiao Su
- Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China.
| | - Moubin Lin
- Department of General Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Qi Han
- Department of Emergency and Critical Disease, Songjiang Hospital and Songjiang Research Institute, Shanghai Key Laboratory of Emotions and Affective Disorders, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; Department of Anatomy and Physiology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Jun Qin
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China; Jinfeng Laboratory, Chongqing 401329, China.
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202
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Zhao Y, Liu S, Mo H, Hua X, Chen X, Zhang Y, Wang W, Zhao Q, Song J. MYH7 Mutations in Restrictive Cardiomyopathy. JACC. ADVANCES 2025; 4:101693. [PMID: 40286359 PMCID: PMC12102527 DOI: 10.1016/j.jacadv.2025.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 02/24/2025] [Accepted: 02/24/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Restrictive cardiomyopathy (RCM) is a rare cardiac disease characterized by impaired ventricular filling and relaxation, with preserved systolic function. This study investigates the genetic basis of RCM and its impact on clinical outcomes, particularly heart transplantation (HTx). OBJECTIVES The aim of the study was to identify genetic variations associated with RCM and assess their impact on disease progression and HTx necessity. METHODS A retrospective analysis was conducted on 94 RCM patients from Fuwai Hospital (2003-2021), diagnosed via echocardiography or pathological examination. Whole exome sequencing screened patient samples for variants in key genes associated with RCM, validated via Sanger sequencing. Histopathological analysis of explanted hearts included systematic sampling from ventricles and interventricular septum, with Masson's trichrome staining for fibrosis quantification. RESULTS Genetic variants were identified in 54% of patients, with a higher prevalence in HTx patients (73%) compared to non-HTx patients (27%). Myosin heavy chain 7 (MYH7) mutations were found in 15% of cases, significantly associated with HTx (P < 0.001) and atrial fibrillation (P = 0.025). Patients with MYH7 mutations exhibited extensive fibrosis in the interventricular septum compared to nonmutation patients (P < 0.05). The mean age at diagnosis was 47.8 years, with HTx patients diagnosed at a younger age (mean 36.0 years) and transplanted at a mean age of 37.4 years, compared to non-HTx patients diagnosed at a mean age of 57.9 years. The median follow-up time was 5 years. CONCLUSIONS Genetic variations, particularly in the MYH7 gene, are significant risk factors for RCM progression and HTx. Genetic screening may guide early interventions, while fibrosis and MYH7 pathways offer potential therapeutic targets.
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Affiliation(s)
- Yiqi Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shun Liu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Mo
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Xiumeng Hua
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Chen
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiteng Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China.
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203
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Clothier JS, Kobsa S. Management of Acute Type A Aortic Dissection. Cardiol Clin 2025; 43:261-277. [PMID: 40268355 DOI: 10.1016/j.ccl.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
This article reviews the management of acute type A aortic dissection (ATAAD), from initial temporizing medical therapy to the technical aspects of urgent surgical repair, which is the definitive treatment for ATAAD. Surgical repair and the extent of aortic resection and replacement are dictated by the location and extent of intimal tears, as well as aneurysmal dilation of the aorta. Cardiopulmonary bypass, hypothermic circulatory arrest, and cerebral perfusion are major considerations in management of this acute process. Several techniques pertinent to each portion of the involved aorta and relevant intraoperative management points are also discussed.
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Affiliation(s)
- Jessica S Clothier
- USC Comprehensive Aortic Center, Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo St, Suite 4300 Los Angeles, CA 90033, USA
| | - Serge Kobsa
- USC Comprehensive Aortic Center, Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo St, Suite 4300 Los Angeles, CA 90033, USA.
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204
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Bradley-Watson J, Glatzel H, Turner HE, Orchard E. Elective Aortic Surgery for Prevention of Aortic Dissection in Turner Syndrome: The Potential Impact of Updated European Society of Cardiology and International Turner Syndrome Consensus Group Guidelines on Referrals to the Heart Team. Clin Endocrinol (Oxf) 2025; 102:559-564. [PMID: 39806877 DOI: 10.1111/cen.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/24/2024] [Accepted: 01/02/2025] [Indexed: 01/16/2025]
Abstract
OBJECTIVE The risk of aortic dissection is increased in Turner Syndrome (TS). Aortic dilation is thought to contribute to this risk and may be managed with elective aortic surgery. New TS guidance has lowered the aortic size thresholds for consideration of aortic surgery. We investigated the impact of new guidance on potential heart team referrals in a UK cohort of TS individuals. METHODS A cross-sectional study of 156 individuals with TS was performed. Up to date transthoracic echocardiography or cardiac MRI derived aortic dimensions, anthropometric data and the presence of aortic dissection risk factors were analysed. RESULTS Twenty-one individuals (13%) met updated guideline criteria for consideration of aortic surgery, 15 more than met 2016 TS guideline criteria. Use of aortic size index (ASI) and aortic height index (AHI) together identified additional individuals meeting criteria for surgical consideration compared with the use of ASI or AHI alone. Z-score identified no additional individuals for surgical consideration, nor did it reclassify any individuals into moderate or severe aortic dilation groups. Twelve of 13 individuals with moderate aortic dilation met criteria for surgical consideration due to the presence of additional risk factors for aortic dissection. There was no positive correlation between height or body surface area and ascending aorta diameter in this cohort. CONCLUSIONS New TS guidelines are likely to significantly increase the number of individuals with TS who might be considered for elective aortic surgery. Centres caring for individuals with TS should re-evaluate their TS cohorts for aortic dissection risk considering these new guidelines.
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Affiliation(s)
| | - Hannah Glatzel
- Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Helen E Turner
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elizabeth Orchard
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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205
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Dehghani MR, Moeini M, Masoumi M, Rezaei Y. Prognostic Value of Fragmented QRS on Admission Electrocardiogram among Patients Hospitalized with COVID-19: A Single-Center Report, Systematic Review, and Meta-Analysis. ACTA CARDIOLOGICA SINICA 2025; 41:323-334. [PMID: 40416568 PMCID: PMC12099251 DOI: 10.6515/acs.202505_41(3).20241111d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 11/11/2024] [Indexed: 05/27/2025]
Abstract
Background The novel coronavirus disease 2019 (COVID-19) is associated with life-threatening complications. Electrocardiogram (ECG) changes associated with COVID-19 have also been reported in the majority of critically ill patients. Methods In this study, we aimed to investigate the prevalence of fragmented QRS (fQRS) and its prognostic value in hospitalized patients with COVID-19. In addition, we performed a systematic review and meta-analysis of the literature to evaluate the effect of fQRS on the outcomes of COVID-19 patients. Results A total of 310 patients with a mean age of 65.7 ± 14.5 years were followed up for 3 months, of whom 139 (44.8%) had fQRS on their ECGs. The rates of in-hospital mortality (8.8% vs. 8.6%), rehospitalization during follow- up (13.7% vs. 12.3%), and 90-day mortality (6.5% vs. 5.3%) were comparable between the patients with and without fQRS, respectively. In the meta-analysis, 9 studies in addition to our study reported outcomes, with a total of 2928 patients with a mean age of 53.8 years, and 1431 (48.9%) were males. The rate of fQRS was 0.31 (95% confidence interval [CI], 0.23-0.38; I2 = 95.21%). In addition, the pooled proportion of in-hospital mortality reported by 5 studies was 0.31 (95% CI, 0.12-0.51; I2 = 98.36). The rate of in-hospital mortality was higher among patients with fQRS compared to those without fQRS (odds ratio, 2.33; 95% CI, 1.52-3.58; p = 0.0001; I2 = 74%). Conclusions The rate of fQRS on ECG was relatively high in COVID-19 patients, and according to the meta-analysis, it was associated with worse outcomes in hospitalized COVID-19 patients.
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Affiliation(s)
- Mohammad Reza Dehghani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia
| | - Mehdi Moeini
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia
| | - Mehdi Masoumi
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences
- Behyan Clinic, Pardis New Town, Tehran, Iran
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Savage PD, Beckie TM, Kaminsky LA, Lavie CJ, Ozemek C. Volume of Aerobic Exercise to Optimize Outcomes in Cardiac Rehabilitation: An Official Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2025; 45:161-168. [PMID: 40019287 DOI: 10.1097/hcr.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2025]
Abstract
Exercise training is a core component of cardiac rehabilitation (CR) programming. Exercise and, more broadly, physical activity are critical elements to secondary prevention of cardiovascular disease. The central components of the exercise prescription are well-defined and include frequency (how many bouts of exercise per week), intensity (how hard to exercise), time (duration of exercise session), type (modality of exercise), and progression (rate of increase in the dose of exercise). Specific targets for the volume (total amount) of exercise, however, are less well-defined. This Position Statement provides a general overview of the specific goals for the volume of aerobic exercise to optimize long-term outcomes for participants in CR. Additionally, examples are provided to illustrate how to integrate the various aspects of the exercise.
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Affiliation(s)
- Patrick D Savage
- Author Affiliations: University of Vermont Medical Center, South Burlington, Vermont (Mr.Savage); College of Nursing, University of South Florida, Tampa, Florida (Dr.Beckie); Fisher Institute of Health and Well-Being, Clinical Exercise Physiology Program, Ball State University, Muncie, Indiana (Dr.Kaminsky);Department of Cardiovascular Diseases , John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana (Dr.Lavie); and Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois (Dr.Ozemek)
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207
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Jansook P, Sigurdsson HH, Loftsson T. A look to the future: cyclodextrins and cyclodextrin-based drug delivery to the retina. Expert Opin Drug Deliv 2025; 22:693-710. [PMID: 40105773 DOI: 10.1080/17425247.2025.2482049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 03/06/2025] [Accepted: 03/17/2025] [Indexed: 03/20/2025]
Abstract
INTRODUCTION Retinal diseases are a leading cause of vision loss, affecting millions of people worldwide. Current treatment options are based on invasive methods such as intravitreal injections. Therefore, there is a need for alternative therapeutic strategies that are both effective and more patient-friendly. AREAS COVERED Topical drug delivery has gained attention as a preferred noninvasive approach, although it is hindered by several ocular barriers. Cyclodextrin (CD)-based nanoparticles have emerged as a promising strategy to overcome these limitations by enhancing drug permeability in the posterior segment of the eye. This review discusses the potential of CDs as enabling pharmaceutical excipients, their role in improving ocular drug bioavailability, and provides examples of CD-based eye drop formulations currently under development or undergoing clinical trials. Also, the role of CDs as active pharmaceutical agents in ophthalmology is discussed. EXPERT OPINION CD-based nanoparticle eye drops present a promising solution and have shown clinical success. CDs are approved pharmaceutical excipients for eye drop formulations and can act as active pharmaceutical ingredients for the treatment of inherent retinal diseases. Future innovations in hybrid CD-based delivery systems and integration of novel therapeutic compounds could provide more efficient and targeted treatment options for retinal diseases.
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Affiliation(s)
- Phatsawee Jansook
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
- Cyclodextrin Application and Nanotechnology-Based Delivery Systems Research Unit, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Hákon H Sigurdsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
| | - Thorsteinn Loftsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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208
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Ülgen Kunak A, Öztürk B, Arslan Ş. Takotsubo Cardiomyopathy Following Scorpion Sting: A Rare and Life-Threatening Complication. ACTA CARDIOLOGICA SINICA 2025; 41:431-434. [PMID: 40416561 PMCID: PMC12099246 DOI: 10.6515/acs.202505_41(3).20250224b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 02/24/2025] [Indexed: 05/27/2025]
Affiliation(s)
- Ayşegül Ülgen Kunak
- Department of Cardiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Bahadır Öztürk
- Department of Cardiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Şakir Arslan
- Department of Cardiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
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209
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Yang G, Alarcon C, Chanfreau C, Lee NH, Friedman P, Nutescu E, Tuck M, O'Brien T, Gong L, Klein TE, Chang K, Tsao PS, Meltzer DO, Lynch JA, Million Veteran Program, Tuteja S, Perera MA. Investigation of Genomic and Transcriptomic Risk Factors of Clopidogrel Response in African Americans. Clin Pharmacol Ther 2025; 117:1313-1324. [PMID: 39868839 PMCID: PMC11993291 DOI: 10.1002/cpt.3552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 12/17/2024] [Indexed: 01/28/2025]
Abstract
Clopidogrel, an anti-platelet drug, is used to prevent thrombosis after percutaneous coronary intervention. Clopidogrel resistance results in recurring ischemic events, with African Americans (AA) suffering disproportionately. The aim of this study was to discover novel biomarkers of clopidogrel resistance in African Americans using genome and transcriptome data. We conducted a genome-wide association study (GWAS), including local ancestry adjustment, in 141 AA on clopidogrel to identify genetic associations with high on-treatment platelet reactivity (HTPR), with validation of genome-wide significant and suggestive loci in an independent cohort of AA clopidogrel patients (N = 823) from the Million Veteran's Program (MVP) along with in vitro functional analysis. We performed differential gene expression (DGE) analysis in whole blood to identify transcriptomic predictors of response, followed by functional validation in MEG-01 cells. GWAS identified one signal on Chromosome 7 as significantly associated with increasing risk of HTPR. The lead single-nucleotide polymorphism (SNP), rs7807369, within thrombospondin 7A (THSD7A) was associated with an increased risk of HTPR (odds ratio (OR) = 4.02, P = 4.56 × 10-9). Higher THSD7A gene expression was associated with HTPR in an independent cohort of clopidogrel-treated patients (P = 0.004) and carrying a risk allele showed increased gene expression in primary human endothelial cells. Notably, the CYP2C19*2 variants showed no association with clopidogrel response in the discovery or MVP cohorts. DGE analysis identified an association with decreased LAIR1 and AP3B2 expression to HTPR. LAIR1 knockdown in MEG-01 cells resulted in increased expression of SYK and AKT1, suggesting an inhibitory role of LAIR1 in the Glycoprotein VI pathway. In summary, these findings suggest that other variants and genes outside of CYP2C19 star alleles play an important role in clopidogrel response in AA.
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Affiliation(s)
- Guang Yang
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Center for Applied BioinformaticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Cristina Alarcon
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Catherine Chanfreau
- VA Informatics and Computing Infrastructure (VINCI)VA Salt Lake City Health Care SystemSalt Lake CityUtahUSA
| | - Norman H. Lee
- Department of Pharmacology and PhysiologyGeorge Washington UniversityWashingtonDCUSA
- GW Cancer CenterGeorge Washington UniversityWashington, DCUSA
| | - Paula Friedman
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Edith Nutescu
- Department of Pharmacy PracticeRetzky College of Pharmacy, University of Illinois ChicagoChicagoIllinoisUSA
| | - Matthew Tuck
- Washington DC VA Medical CenterWashingtonDCUSA
- The George Washington UniversityWashingtonDCUSA
| | - Travis O'Brien
- Department of Pharmacology and PhysiologyGeorge Washington UniversityWashingtonDCUSA
| | - Li Gong
- Department of Biomedical Data ScienceStanford UniversityStanfordCaliforniaUSA
| | - Teri E. Klein
- Department of Biomedical Data Science and Department of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Kyong‐Mi Chang
- Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Philip S. Tsao
- VA Palo Alto Healthcare System and Stanford UniversityPalo AltoCaliforniaUSA
| | - David O. Meltzer
- Section of Hospital Medicine, Department of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Julie A. Lynch
- VA Informatics and Computing Infrastructure (VINCI)VA Salt Lake City Health Care SystemSalt Lake CityUtahUSA
| | | | - Sony Tuteja
- Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Minoli A. Perera
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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Yin H, Zhang J, Lian M, Zhang Y. A systematic review and meta-analysis of the effectiveness of high-intensity interval training for physical fitness in university students. BMC Public Health 2025; 25:1601. [PMID: 40312686 PMCID: PMC12044783 DOI: 10.1186/s12889-025-22829-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 04/17/2025] [Indexed: 05/03/2025] Open
Abstract
BACKGROUND Extensive research has demonstrated the effectiveness of high-intensity interval training (HIIT) in children and adults; however, evidence specific to university students remains limited. This study aimed to evaluate the effects of HIIT on promoting physical health in university students and to identify potential factors influencing intervention outcomes. METHOD A systematic search was conducted across five electronic databases (Web of Science, Scopus, PubMed, SportDiscus, and MEDLINE) up to December 2024 using Boolean operators and keywords related to HIIT and university students. INCLUSION CRITERIA (1) Experimental studies; (2) Physical-related outcomes; (3) Intervention duration of at least 3 weeks; (4) Meets the definition of high-intensity activity; (5) Participants are general university students. A meta-analysis was conducted using RevMan 5.4 software, comparing intervention and control groups. Effect sizes were calculated using Cohen's d, and heterogeneity was assessed with the I² statistic. Subgroup analyses were performed based on intervention duration and rest interval duration. RESULTS Results showed that HIIT significantly reduced BMI, body fat percentage, waist-to-hip ratio, and heart rate, while significantly improving VO2max and muscle strength in university students. Interventions lasting longer than eight weeks demonstrated greater improvements in muscle strength compared to those lasting eight weeks or less. However, there are no significant differences in rest interval across any of the groups. Notably, HIIT also has positive effects on agility and speed with varying effect sizes. CONCLUSION The unique characteristics of university students make HIIT a time-efficient and effective intervention strategy for this population. Future studies should consider the specific needs of the university environment, incorporating the latest technological advancements and developing tailored intervention strategies that align with students' preferences.
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Affiliation(s)
- Hang Yin
- Department of Sport Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Jia Zhang
- School of Physical Education, Chongqing University, Chongqing City, China.
| | - Menglong Lian
- Zhengzhou Vocational College of Automobile Engineering, Zhengzhou City, Henan Province, China
| | - Yajing Zhang
- Huaihe Road Primary School, Zhongyuan District, Zhengzhou City, Henan Province, China
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Ma M, Zhang X, Yu X, Ma L. Perioperative Management and Outcome of Catecholamine-Induced Takotsubo and Dilated Cardiomyopathy in Pheochromocytoma and Paraganglioma. J Cardiothorac Vasc Anesth 2025; 39:1275-1281. [PMID: 39988505 DOI: 10.1053/j.jvca.2025.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/13/2025] [Accepted: 02/02/2025] [Indexed: 02/25/2025]
Abstract
OBJECTIVES To outline and compare the clinical features, preoperative preparation, perioperative management, and outcome of Takotsubo cardiomyopathy (TCM) and dilated cardiomyopathy (DCM) associated with pheochromocytomas and paragangliomas (PPGLs). DESIGN A retrospective cohort study. SETTING A single tertiary hospital. PARTICIPANTS All patients scheduled for elective surgery of PPGL resection with TCM and DCM between March 2005 and June 2023 were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS This study enrolled 29 patients: 20 patients were in the TCM group and 9 patients were in the DCM group. The tumor size of the DCM group was bigger and the level of 24-hour urine norepinephrine was higher than those in the TCM group. After the preoperative medication preparation (111 median days) and anti-heart failure treatment (if necessary), the mean preoperative ejection fraction in the TCM group was significantly higher than that in the DCM group (66.8% ± 4.4% v 48.8% ± 7.8%, p<0.001), both elevated compared to ejection fraction at presentation (p<0.001). The intraoperative hemodynamic instability score was rather high in PPGL-TCM and PPGL-DCM patients (84.6 points), as well as in the hemodynamic variables section (13.7 points). Patients with DCM were more prone to present hemodynamic disturbances and to require a lower volume of fluids but a higher infusion of vasoactive agents than patients with TCM. The incidence of complications was 6.9% and there was no perioperative mortality. CONCLUSIONS Following the preoperative medication preparation and anti-heart failure treatment, patients with TCM had better left ventricular recovery before surgery and fewer cardiovascular risks compared to patients with DCM. Optimal perioperative management and individualized anesthetic strategies are essential for this unique patient population.
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Affiliation(s)
- Manjiao Ma
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiuhua Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lulu Ma
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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212
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Ruiz JI, Zhao B, Palaskas N, Deswal A, Zhao H, McQuade J, Suarez-Almazor ME. Major Adverse Cardiovascular Events in Patients with Melanoma Receiving Immune Checkpoint Inhibitors. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2025; 8:1-9. [PMID: 40224298 PMCID: PMC11987079 DOI: 10.36401/jipo-24-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 02/01/2024] [Accepted: 02/20/2025] [Indexed: 04/15/2025]
Abstract
Introduction Immune checkpoint inhibitors (ICIs) might increase the risk of major adverse cardiovascular events (MACEs). This study aimed to evaluate the risk of MACE in patients with melanoma after ICI initiation. Methods We conducted a before-after cohort study using claims data from Optum's deidentified Clinformatics Data Mart Database. We included adult patients with melanoma who received any approved ICI between 2011 and 2021 with a minimum of 12 months of observable data before ICI. The main outcome was time to first MACE (myocardial infarction, coronary revascularization, stroke, heart failure hospitalization) and rate of MACE before and after ICI, ascertained using International Classification of Diseases, 9th/10th Revision diagnostic codes. Hazard ratio (HR) and incidence rate ratio (IRR) were calculated. Results We identified 4024 patients with ICI-treated melanoma. Mean age was 67.4 years (SD 14.1), 36% were women; 3066 (76.2%) received monotherapy and 958 (23.8%) combination immunotherapy. A total of 160 (4%) patients had a MACE before ICI and 224 (5.6%) after ICI (HR, 1.76; 95% CI, 1.47-2.12). MACE rate in the year before ICI was 56.16 per 1000 person-years compared with 80.91 per 1000 person-years the year after ICI (IRR, 1.44; 95% CI, 1.21-1.72). Ten cases of myocarditis were observed after ICI, 50% of them had a MACE. Risk factors associated with MACE after ICI were prior MACE, other cardiovascular conditions, hypertension, and older age. Glucocorticoid use was not associated with MACE. Conclusion Our results suggest that ICI might increase the risk of MACE in patients with melanoma during the first year after ICI.
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Affiliation(s)
- Juan I. Ruiz
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bo Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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213
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Cardoso I, Melo M, Brás P, Viegas JM, Almeida I, Nunes S, Custódio I, Trigo C, Laranjo S, Graça R, Cruz Ferreira R, Oliveira M, Aguiar Rosa S, Antunes D. The contribution of genetics to the understanding and management of cardiomyopathies: Part 2. Rev Port Cardiol 2025; 44:321-329. [PMID: 40154602 DOI: 10.1016/j.repc.2024.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/19/2024] [Accepted: 11/06/2024] [Indexed: 04/01/2025] Open
Abstract
Cardiomyopathies may present as a manifestation of various inherited syndromes. Recognizing the rarity and diagnostic challenges of syndromic and metabolic cardiomyopathies is crucial, as their identification holds significant implications for targeted treatment and enables the use of specific risk stratification tools. Genetics has assumed a pivotal role in clarifying the pathophysiology of cardiomyopathies, facilitating molecular diagnosis, and enabling effective family screening. The advent of next-generation sequencing has revolutionized genetic testing, enabling cost-effective, high-throughput analyses, facilitating the diagnosis of these rare conditions, and allowing the provision of specific management and therapeutics.
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Affiliation(s)
- Isabel Cardoso
- Serviço de Cardiologia, Centro de Referência de Cardiopatias Miocardiopatias do Centro Hospitalar Universitário de Lisboa Central (CHULC), Santa Marta Hospital, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal.
| | - Mafalda Melo
- Medical Genetics Department, Dona Estefânia Hospital, Central Lisbon Hospital and University Centre, Lisbon, Portugal
| | - Pedro Brás
- Serviço de Cardiologia, Centro de Referência de Cardiopatias Miocardiopatias do Centro Hospitalar Universitário de Lisboa Central (CHULC), Santa Marta Hospital, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal
| | - José Miguel Viegas
- Serviço de Cardiologia, Centro de Referência de Cardiopatias Miocardiopatias do Centro Hospitalar Universitário de Lisboa Central (CHULC), Santa Marta Hospital, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal
| | - Inês Almeida
- Serviço de Cardiologia, Centro de Referência de Cardiopatias Miocardiopatias do Centro Hospitalar Universitário de Lisboa Central (CHULC), Santa Marta Hospital, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal
| | - Sofia Nunes
- Medical Genetics Department, Dona Estefânia Hospital, Central Lisbon Hospital and University Centre, Lisbon, Portugal
| | - Inês Custódio
- Medical Genetics Department, Dona Estefânia Hospital, Central Lisbon Hospital and University Centre, Lisbon, Portugal
| | - Conceição Trigo
- Serviço de Cardiologia Pediátrica, Centro de Referência de Cardiopatias Congénitas do CHULC, Hospital de Santa Marta, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network Guard-Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal
| | - Sérgio Laranjo
- Serviço de Cardiologia Pediátrica, Centro de Referência de Cardiopatias Congénitas do CHULC, Hospital de Santa Marta, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network Guard-Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal
| | - Rafael Graça
- GenoMed - Diagnósticos de Medicina Molecular, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Serviço de Cardiologia, Centro de Referência de Cardiopatias Miocardiopatias do Centro Hospitalar Universitário de Lisboa Central (CHULC), Santa Marta Hospital, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal
| | - Mário Oliveira
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisboa, Portugal; Centro Clínico Académico de Lisboa, Lisboa, Portugal; Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, CHLC, Lisbon, Portugal; Institute of Physiology and CCUL, Faculty of Medicine of Lisbon, Portugal; Cardiology Center, Hospital CUF Tejo, Lisbon, Portugal
| | - Sílvia Aguiar Rosa
- Serviço de Cardiologia, Centro de Referência de Cardiopatias Miocardiopatias do Centro Hospitalar Universitário de Lisboa Central (CHULC), Santa Marta Hospital, CHULC, EPE, Lisboa, Portugal; Member of the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Centro Clínico Académico de Lisboa, Lisboa, Portugal; CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisboa, Portugal; Centro Clínico Académico de Lisboa, Lisboa, Portugal
| | - Diana Antunes
- Medical Genetics Department, Dona Estefânia Hospital, Central Lisbon Hospital and University Centre, Lisbon, Portugal; GenoMed - Diagnósticos de Medicina Molecular, Instituto de Medicina Molecular, Lisbon, Portugal
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214
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Hirten RP, Danieletto M, Sanchez-Mayor M, Whang JK, Lee KW, Landell K, Zweig M, Helmus D, Fuchs TJ, Fayad ZA, Nadkarni GN, Keefer L, Suarez-Farinas M, Sands BE. Physiological Data Collected From Wearable Devices Identify and Predict Inflammatory Bowel Disease Flares. Gastroenterology 2025; 168:939-951.e5. [PMID: 39826619 DOI: 10.1053/j.gastro.2024.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 11/05/2024] [Accepted: 12/24/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND & AIMS Wearable devices capture physiological signals noninvasively and passively. Many of these parameters have been linked to inflammatory bowel disease (IBD) activity. We evaluated the associative ability of several physiological metrics with IBD flares and how they change before the development of flare. METHODS Participants throughout the United States answered daily disease activity surveys and wore an Apple Watch (Apple), Fitbit (Google), or Oura Ring (Oura Health). These devices collected longitudinal heart rate (HR), resting heart rate (RHR), heart rate variability (HRV), steps, and oxygenation. C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin were collected as standard of care. Linear mixed-effect models were implemented to analyze HR, RHR, steps, and oxygenation, and cosinor mixed-effect models were applied to HRV circadian features. Mixed-effect logistic regression was used to determine the predictive ability of physiological metrics. RESULTS Three hundred and nine participants were enrolled across 36 states. Circadian patterns of HRV differed significantly between periods of inflammatory flare and remission and symptomatic flare and remission. Marginal means for HR and RHR were higher during periods of inflammatory flare and symptomatic flare. There were fewer daily steps during inflammatory flares. HRV, HR, and RHR differentiated whether participants with symptoms had inflammation. HRV, HR, RHR, steps, and oxygenation were significantly altered up to 7 weeks before inflammatory and symptomatic flares. CONCLUSIONS Longitudinally collected physiological metrics from wearable devices can identify and change before IBD flares, suggesting their feasibility to monitor and predict IBD activity.
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Affiliation(s)
- Robert P Hirten
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Matteo Danieletto
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Milagros Sanchez-Mayor
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jessica K Whang
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kyung Won Lee
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kyle Landell
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Micol Zweig
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Drew Helmus
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas J Fuchs
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Girish N Nadkarni
- Division of Data-Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; The Charles Bronfman Department of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurie Keefer
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mayte Suarez-Farinas
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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215
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Benjanuwattra J, Castillo‐Rodriguez C, Das M, Zulfiqar S, Arif I. Troponin May Lie: Recognizing an Atypical Case of Wellens Syndrome. Clin Case Rep 2025; 13:e70440. [PMID: 40357384 PMCID: PMC12067551 DOI: 10.1002/ccr3.70440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/21/2025] [Accepted: 04/05/2025] [Indexed: 05/15/2025] Open
Abstract
Wellens syndrome is associated with a critical coronary artery stenosis and an impending extensive myocardial infarction. Despite having chest pain, both ECG and troponin can be misleading. It is crucial to recognize this syndrome to allow urgent revascularization. Failure to recognize and noninvasive stress tests were shown to be detrimental.
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Affiliation(s)
| | | | - Manisha Das
- Division of CardiologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Shaheer Zulfiqar
- Division of Intervention CardiologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Imran Arif
- Division of Intervention CardiologyUniversity of CincinnatiCincinnatiOhioUSA
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216
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Ng YT, Kratz A, Turkelson A, Birditt K. Daily interactions with care recipients and cardiovascular reactivity among dementia caregivers: The buffering role of friend interactions. Alzheimers Dement 2025; 21:e70281. [PMID: 40371630 PMCID: PMC12079534 DOI: 10.1002/alz.70281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Revised: 03/20/2025] [Accepted: 04/22/2025] [Indexed: 05/16/2025]
Abstract
INTRODUCTION Caregiver-care recipient (CR) interactions are central to caregiving, yet little is known about dementia caregivers' daily experiences with CRs. This study examines within-day effects of time interacting with CRs and interaction quality on caregivers' heart rate (HR) and whether friend interactions buffer these effects. METHODS Dementia caregivers (N = 221) completed baseline interviews and 5-day ecological momentary assessments (EMAs), reporting time and interaction quality with CRs and friend interactions every 3 hours while wearing heart monitors. RESULTS Within-day analyses revealed time with CRs was associated with increased HR, primarily due to negative interactions. Friend interactions buffered the adverse effects of time interacting with CR and negative CR interactions on elevated HR. Moreover, positive CR interactions were linked to lower HR when paired with friend interactions. DISCUSSION Findings provide insights into interventions that reduce negative exchanges within the caregiver-CR dyad and friend-based programs, which could enhance cardiovascular health among dementia caregivers. HIGHLIGHTS More time interacting with the care recipient (CR) was associated with an elevated heart rate (HR). Negative daily experiences with CRs are more salient in contributing to caregivers' cardiovascular strain. Friend interactions can temporarily buffer the adverse effects mentioned above. Positive CR interactions linked to lower HR when paired with friend interactions. Socializing with friends can be beneficial, even if some interactions are negative.
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Affiliation(s)
- Yee To Ng
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMichiganUSA
| | - Anna Kratz
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMichiganUSA
| | - Angela Turkelson
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
| | - Kira Birditt
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
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Canelli R, Karim P, Bilotta F. Enhanced recovery after neurosurgery. Curr Opin Anaesthesiol 2025:00001503-990000000-00293. [PMID: 40492728 DOI: 10.1097/aco.0000000000001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2025]
Abstract
PURPOSE OF REVIEW The enhanced recovery after surgery (ERAS) approach to the surgical patient optimizes perioperative care to improve outcomes and facilitate recovery. Despite the success of ERAS in many surgical specialties, neurosurgery has been reluctant to adopt ERAS. The aim of this review was to examine recently published ERAS protocols for elective neurosurgical procedures with a focus on brain and spine surgeries. RECENT FINDINGS There were few ERAS protocols published for brain and spine surgery in comparison to other surgical specialties. ERAS elements specific to brain surgery seem to address thromboprophylaxis planning, antiepileptic management, steroid administration, strict blood pressure control, and avoidance of mannitol. When implemented, protocols have yielded similar results to protocols for other surgical specialties, including reduced morbidity, hospital length of stay, and health care cost. However, widespread implementation was limited by difficulties in obtaining a consensus agreement on ERAS elements to include, achieving adoption across neurosurgeons, and protocol adherence. SUMMARY While the adoption of ERAS in neurosurgery remains limited, emerging evidence supports its feasibility and effectiveness, particularly in reducing hospitalization costs and postoperative complications.
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Affiliation(s)
- Robert Canelli
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Paul Karim
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome, Italy
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Dumbre D, Upendra S, Zacharias BS. Unraveling the Relationship Between Vitamin D and Noncommunicable Diseases: A Systemic Review and Meta-Analysis. Public Health Nurs 2025; 42:1302-1314. [PMID: 39777920 DOI: 10.1111/phn.13521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 11/28/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Subclinical vitamin D insufficiency is frequent in both developing and developed countries. Even after rickets was eliminated in the 1930s by fortifying milk, up to 1 billion people worldwide suffer from subclinical vitamin D deficiency (VDD). Numerous noncommunicable diseases (NCDs), including depression, autoimmune illnesses, diabetes, osteoporosis, and cardiovascular disease, are linked to this deficiency. METHODOLOGY The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was applied when conducting a systematic review. Relevant studies published between 2010 and 2023 were found by searching databases such as Web of Science, Scopus, and PubMed. To find correlations between deficiency of vitamin D and NCDs, data was extracted from the studies and analyzed using the Mixed Method Appraisal Tools (MMAT). In meta-analysis data combined from multiple observational Unraveling the Relationship Between Vitamin D and Noncommunicable Diseases-A Systemic Review and Meta-Analysis studies to evaluate the relationship between vitamin D insufficiency and health outcomes. Statistical techniques, such as calculating effect sizes and constructing confidence ranges, are employed to determine combined outcomes and investigate possible causal connections. RESULTS Fourteen studies-including cross-sectional studies, prospective cohorts, randomized controlled trials, and longitudinal studies-met the inclusion criteria. Significant correlations among deficiency of vitamin D and a number of NCDs, including anemia, diabetes, hypertension, rheumatoid arthritis (RA), mental health issues, and autoimmune hypothyroidism, were found in the review. The results highlight the prevalence of deficiency of vitamin D worldwide and its detrimental impact on health. In order to lower the risk of numerous NCDs, this review emphasizes the need for greater awareness and possible interventions to maintain appropriate vitamin D levels. A meta-analysis was conducted to investigate the potential causal connections between vitamin D insufficiency and different health disorders. It elucidates the connections between deficient levels of vitamin D and conditions such as mental health disorders, anemia, diabetes, hypertension, and autoimmune diseases. The study prioritizes the examination of temporal correlations, biological plausibility, and the removal of confounding factors to provide support for these associations. While the text acknowledges that experimental data, such as randomized controlled trials, would enhance the argument for causation, it mostly depends on observational studies.
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Affiliation(s)
- Dipali Dumbre
- Symbiosis College of Nursing, Symbiosis International (Deemed University), Pune, India
| | - Sheela Upendra
- Symbiosis College of Nursing, Symbiosis International (Deemed University), Pune, India
| | - Betsy Sara Zacharias
- Symbiosis College of Nursing, Symbiosis International (Deemed University), Pune, India
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Sivashanmugathas V, El-Baba M, Jones MK, Kiss A, Meyers HP, Smith SW, Chartier LB, McLaren JT. Equity Gaps in the Diagnosis and Treatment of Occlusion Myocardial Infarction. CJC Open 2025; 7:632-640. [PMID: 40433216 PMCID: PMC12105483 DOI: 10.1016/j.cjco.2025.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 01/20/2025] [Indexed: 05/29/2025] Open
Abstract
Background Patients with occlusion myocardial infarction (OMI) who meet the ST-elevation myocardial infarction (STEMI) criteria experience inequitable delays in care, because of sociodemographic factors, such as age and sex. OMI patients who do not meet STEMI criteria and are admitted to the hospital as non-STEMI patients, experience further delays. However, whether equity gaps exist in OMI care remains unknown. Methods A retrospective chart review included patients with acute coronary syndrome admitted to the hospital through 2 academic emergency departments, in the period from January 1, 2021 to December 31, 2022. Patients were categorized as having one of the following: OMI (acute culprit with Thrombolysis In Myocardial Infarction [TIMI] 0-2 flow, or acute culprit with TIMI 3 flow, and a troponin I level > 10,000 ng/L; or if they had no angiogram, a troponin I level > 10,000 ng/L plus new regional wall-motion abnormality on echocardiogram); non-OMI (MI that did not meet the OMI threshold); or MI ruled out. Results Among 662 charts, 260 were OMI patients, 296 were non-OMI patients, and 106 were patients with MI ruled out. Of the 260 OMI patients, 116 were admitted to the hospital as STEMI patients (true-positive), and 144 (55.4%) were admitted as non-STEMI patients (false-negative). In bivariate analyses, true-positive STEMI patients with atypical symptoms had a longer door-to-electrocardiogram (ECG) time (P < 0.0001) and a longer ECG-to-catheterization time (P < 0.001). False-negative STEMI patients had a longer door-to-ECG time for atypical symptoms (P < 0.0001), a longer ECG-to-catheterization time for atypical symptoms (P = 0.003), and were aged ≥75 years (P = 0.006). Conclusions True-positive STEMI patients had delayed ECGs and catheterization for those presenting with atypical symptoms. More than half of those with OMI were admitted as non-STEMI patients, with further reperfusion delays for older patients and those presenting with atypical symptoms. Shifting to the OMI paradigm highlights reperfusion delays and equity gaps in the management of ACS.
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Affiliation(s)
| | - Mazen El-Baba
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcella K. Jones
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto Ontario, Canada
| | - Alex Kiss
- Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - H. Pendell Meyers
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Stephen W. Smith
- Department of Emergency Medicine, Hennepin County Medical Centre and University of Minnesota, Minneapolis, Minnesota, USA
| | - Lucas B. Chartier
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jesse T.T. McLaren
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto Ontario, Canada
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Zeng F, Dai J, Zhang X, Guo Y, Wang H, Shen J. Management of PICC rupture in a multidisciplinary collaborative model: A case report. J Vasc Access 2025; 26:1051-1054. [PMID: 38800968 DOI: 10.1177/11297298241254564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
A peripherally inserted central catheter (PICC) is commonly used for fluid infusion in patients. However, rupture is one of the most serious complications associated with PICC placement. We investigated an 81-year-old patient who experienced a catheter break nearly 11 months after the placement of PICC, followed by a catheter break during catheter capture that was removed after accessing the superior vena cava with a catcher. This case suggests that silicone-based PICCs are fragile and have a high risk of spontaneous dislocation. Therefore, they should be replaced with polyurethane-based PICCs.
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Affiliation(s)
- Fenghua Zeng
- Department of Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Jun Dai
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Xueqing Zhang
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Yafen Guo
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Hui Wang
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Jinhua Shen
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
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221
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Pintea Bentea G, Awada A, Berdaoui B. Should We Revisit the Clinical Value of Fractional Flow Reserve in the Era of Coronary Microvascular Dysfunction? Biomedicines 2025; 13:1086. [PMID: 40426914 PMCID: PMC12108706 DOI: 10.3390/biomedicines13051086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2025] [Revised: 04/27/2025] [Accepted: 04/28/2025] [Indexed: 05/29/2025] Open
Abstract
The understanding of coronary artery disease is evolving, with more attention given currently to the microcirculation compartment. Coronary microvascular dysfunction (CMD) is defined by any structural or functional alteration of the coronary microcirculation, and is prevalent in current clinical practice, being associated with pejorative cardiovascular prognosis. CMD can exist by itself as primary microvascular angina, or in association with a variety of cardiovascular diseases. On the other hand, fractional flow reserve (FFR) represents the gold standard for estimating the hemodynamic impact of moderate coronary artery stenosis, and as such guiding coronary revascularization in clinical practice. The fundamental clinical trials that introduced and validated the use of FFR in current clinical practice were published before acquiring more in-depth knowledge on CMD and the impact it can have on FFR measurements. However, in the setting of CMD, studies have shown that FFR can underestimate the severity of coronary stenosis. In addition, recent findings underline the limitations of FFR to guide revascularization in terms of clinical outcome in specific conditions associated with CMD, such as acute coronary syndrome or multivessel coronary artery disease. As such, new research efforts must be made to investigate the reliability of FFR or to reposition its use in guiding coronary revascularization in the context of CMD, in order to define the clinical value of FFR in this particular setting.
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222
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Muttiah B, Hanafiah A. Gut Microbiota and Cardiovascular Diseases: Unraveling the Role of Dysbiosis and Microbial Metabolites. Int J Mol Sci 2025; 26:4264. [PMID: 40362500 PMCID: PMC12072866 DOI: 10.3390/ijms26094264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2025] [Revised: 04/29/2025] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
Cardiovascular diseases (CVDs), including heart failure (HF), hypertension, myocardial infarction (MI), and atherosclerosis, are increasingly linked to gut microbiota dysbiosis and its metabolic byproducts. HF, affecting over 64 million individuals globally, is associated with systemic inflammation and gut barrier dysfunction, exacerbating disease progression. Similarly, hypertension and MI correlate with reduced microbial diversity and an abundance of pro-inflammatory bacteria, contributing to vascular inflammation and increased cardiovascular risk. Atherosclerosis is also influenced by gut dysbiosis, with key microbial metabolites such as trimethylamine-N-oxide (TMAO) and short-chain fatty acids (SCFAs) playing crucial roles in disease pathogenesis. Emerging evidence highlights the therapeutic potential of natural compounds, including flavonoids, omega-3 fatty acids, resveratrol, curcumin, and marine-derived bioactives, which modulate the gut microbiota and confer cardioprotective effects. These insights underscore the gut microbiota as a critical regulator of cardiovascular health, suggesting that targeting dysbiosis may offer novel preventive and therapeutic strategies. Further research is needed to elucidate underlying mechanisms and optimize microbiome-based interventions for improved cardiovascular outcomes.
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Affiliation(s)
- Barathan Muttiah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Alfizah Hanafiah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- GUT Research Group, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Palmiero P, Caretto P, Ciccone MM, Maiello M, on behalf of the I.C.I.S.C.U. (Italian Chapter of International Society Cardiovascular Ultrasound). Long-Term Cardiovascular Risk and Maternal History of Pre-Eclampsia. J Clin Med 2025; 14:3121. [PMID: 40364153 PMCID: PMC12072551 DOI: 10.3390/jcm14093121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Revised: 04/22/2025] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
Pre-eclampsia is a severe pregnancy complication affecting 5-8% of pregnancies worldwide, marked by high blood pressure and organ damage typically occurring after 20 weeks of gestation. It is a leading cause of maternal and fetal morbidity and mortality. Though its exact cause is unknown, it involves placental abnormalities and improper blood vessel development. Risk factors include a history of pre-eclampsia, chronic hypertension, diabetes, obesity, and autoimmune disorders. Symptoms include high blood pressure, proteinuria, headaches, vision changes, and abdominal pain. Untreated, it can lead to seizures, stroke, preterm birth, or death. Delivery is the definitive treatment, with management strategies such as monitoring and blood pressure control. Pre-eclampsia significantly increases long-term cardiovascular disease (CVD) risks, including hypertension, ischemic heart disease, and stroke, linked to shared mechanisms like endothelial dysfunction and inflammation. Women with severe or recurrent pre-eclampsia have heightened risks, often developing chronic hypertension within a decade postpartum. It also impacts offspring, with daughters at elevated risk for pre-eclampsia and CVD. Hypertensive disorders of pregnancy, including pre-eclampsia, induce changes like left ventricular hypertrophy and diastolic dysfunction, raising risks for heart failure with preserved ejection fraction and coronary atherosclerosis. Overlapping with peripartum cardiomyopathy, pre-eclampsia underscores a spectrum of pregnancy-related cardiovascular disorders. Long-term monitoring and lifestyle interventions are crucial for managing risks, with research into genetic and biological mechanisms offering the potential for targeted prevention.
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Affiliation(s)
- Pasquale Palmiero
- ASL Brindisi, Cardiology Equipe, District of Brindisi, 72100 Brindisi, Italy;
- Medical School, University of Bari, 70122 Bari, Italy
| | - Pierpaolo Caretto
- University Cardiology Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (P.C.); (M.M.C.)
| | - Marco Matteo Ciccone
- University Cardiology Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (P.C.); (M.M.C.)
| | - Maria Maiello
- ASL Brindisi, Cardiology Equipe, District of Brindisi, 72100 Brindisi, Italy;
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Gruenbaum SE, Kulikov A, Logvinov I, Erac I, Jones PM, Bilotta F. Perioperative Management of Patients on Chronic Aspirin Therapy for Elective Brain Surgery: A Delphi Study. J Neurosurg Anesthesiol 2025:00008506-990000000-00156. [PMID: 40304213 DOI: 10.1097/ana.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 03/18/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND The perioperative management of chronic aspirin therapy in patients undergoing elective brain surgery is challenging due to the risk of bleeding and thromboembolic events. Although aspirin discontinuation reduces the bleeding risk, it can increase thrombotic complications, particularly in patients at high risk of cardiovascular complications. This Delphi study aimed to develop consensus-based guidelines to address these clinical challenges. METHODS A 2-round Delphi survey was conducted among an international panel of 42 experienced anesthesiologists and neurosurgeons. Participants assessed the risks and benefits of perioperative aspirin management, including bleeding risk, thrombotic risk, timing of cessation and resumption, and the utility of platelet function testing. Consensus was defined as ≥80% agreement in round 2. RESULTS Round 1 highlighted significant variability in practice patterns. In round 2, consensus was reached on several key areas. Most experts (84%) agreed that continuing aspirin increases perioperative bleeding risk in high-risk procedures, with 87% recommending discontinuing aspirin 5 to 7 days before surgery. Nearly all experts (97%) supported continuing low-dose aspirin in high-thrombotic-risk patients. Conversely, for low-thrombotic-risk patients, only 65% agreed on aspirin continuation, reflecting an ongoing debate. No consensus was reached regarding routine platelet function testing. CONCLUSIONS This Delphi study provides experience-based recommendations for managing chronic aspirin therapy in neurosurgical patients. The panel strongly supports aspirin continuation in high-thrombotic-risk patients, with cessation 5 to 7 days before high-bleeding-risk surgeries. Individualized management is advised for low-bleeding-risk procedures and low-thrombotic-risk patients. Future research should further clarify aspirin management in these groups and explore the role of platelet function testing in neurosurgical settings.
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Affiliation(s)
- Shaun E Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic-Florida, FL
| | - Alexander Kulikov
- Department of Anesthesiology Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Ilana Logvinov
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic-Florida, FL
| | - Ivana Erac
- Austin Health, Heidelberg, VIC, Melbourne, Australia
| | - Philip M Jones
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic-Florida, FL
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Rome, Italy
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225
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Renon S, Ramses R, Aggarwal A, Good R, McGinty S. Drug coated balloons in percutaneous coronary intervention: how can computational modelling help inform evolving clinical practice? FRONTIERS IN MEDICAL TECHNOLOGY 2025; 7:1546417. [PMID: 40370491 PMCID: PMC12075205 DOI: 10.3389/fmedt.2025.1546417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 03/18/2025] [Indexed: 05/16/2025] Open
Abstract
Drug-coated balloons (DCB) represent an emerging therapeutic alternative to drug-eluting stents (DES) for the treatment of coronary artery disease (CAD). Among the key advantages of DCB over DES are the absence of a permanent structure in the vessel and the potential for fast and homogeneous drug delivery. While DCB were first introduced for treatment of in-stent restenosis (ISR), their potential wider use in percutaneous coronary intervention (PCI) has recently been explored in several randomized clinical trials, including for treatment of de novo lesions. Moreover, new hybrid techniques that combine DES and DCB are being investigated to more effectively tackle complex cases. Despite the growing interest in DCB within the clinical community, the mechanisms of drug exchange and the interactions between the balloon, the polymeric coating and the vessel wall are yet to be fully understood. It is, therefore, perhaps surprising that the number of computational (in silico) models developed to study interventions involving these devices is small, especially given the mechanistic understanding that has been gained from computational studies of DES procedures over the last two decades. In this paper, we discuss the current and emerging clinical approaches for DCB use in PCI and review the computational models that have been developed thus far, underlining the potential challenges and opportunities in integrating in silico models of DCB into clinical practice.
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Affiliation(s)
- Silvia Renon
- Division of Biomedical Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
- Glasgow Computational Engineering Centre, University of Glasgow, Glasgow, United Kingdom
| | - Rafic Ramses
- Division of Biomedical Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, University of Glasgow, Glasgow, United Kingdom
- Division of Infrastructure & Environment Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Richard Good
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Regional Heart & Lung Centre, NHS Golden Jubilee, Glasgow, United Kingdom
| | - Sean McGinty
- Division of Biomedical Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
- Glasgow Computational Engineering Centre, University of Glasgow, Glasgow, United Kingdom
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226
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Haouzi A, Khayata M, Jaber WA, Xu B. Applications of multi-modality imaging in the diagnosis of infective endocarditis: a real-life case based contemporary narrative review. Cardiovasc Diagn Ther 2025; 15:465-479. [PMID: 40385279 PMCID: PMC12082189 DOI: 10.21037/cdt-2024-605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 02/25/2025] [Indexed: 05/20/2025]
Abstract
Background and Objective Recent major international society guidelines have highlighted the utility of multi-modality imaging in the evaluation of infective endocarditis (IE). This article aims to discuss the contemporary applications of multimodality imaging in IE through real-life cases, demonstrating how emerging imaging modalities, including cardiac computed tomography (CCT) and nuclear imaging techniques can be used. Methods A literature search of the PubMed database was performed between Jan 01, 2024 and Oct 01, 2024. Relevant articles on the subjects of "infective endocarditis" and "multi-modality imaging" were used in our review. Four clinical cases from the Cleveland Clinic Foundation were incorporated to supplement this literature review with real-world examples. Key Content and Findings This literature review encompasses international cardiology guidelines, as well as investigational studies, meta-analyses, and dedicated reviews highlighting the specific roles, strengths, and weaknesses of different imaging modalities in the evaluation of IE, including transthoracic and transesophageal echocardiography (TEE), CCT, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), and white blood cell single-photon emission computed tomography (WBC SPECT). This review demonstrates the emerging role for these multi-modality imaging tools in light of an increasingly complex patient population with growing numbers of prosthetic valves and devices. Conclusions The current literature and guidelines are discussed with reference to complex clinical cases, with the aim of illustrating the relative advantages and disadvantages, and appropriate utility of multimodality cardiac imaging in IE.
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Affiliation(s)
- Alice Haouzi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Khayata
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wael A. Jaber
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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227
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Poli L, Petrelli A, Fischetti F, Morsanuto S, Talaba L, Cataldi S, Greco G. The Effects of Multicomponent Training on Clinical, Functional, and Psychological Outcomes in Cardiovascular Disease: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:822. [PMID: 40428780 PMCID: PMC12112913 DOI: 10.3390/medicina61050822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2025] [Revised: 04/27/2025] [Accepted: 04/28/2025] [Indexed: 05/29/2025]
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of death globally. In recent years, interest in multicomponent interventions has grown as a response to the multifactorial complexity of CVDs. However, the literature still shows little systematic investigation into the effectiveness of multicomponent training (MCT) in the field of CVDs, accompanied by terminological confusion. This study aims to summarize and critically appraise the recent literature through a narrative review. A narrative review was conducted, synthesizing evidence from studies published between 2010 and January 2025. The databases searched included PubMed, Scopus, and Google Scholar using predefined search terms related to CVDs and MCT, and medical subject headings (MeSHs) and Boolean syntax. Two team authors independently extracted relevant information from the included studies. MCT significantly improved hemodynamic parameters in CVD patients, with reductions in systolic, diastolic, mean blood pressure, and heart rate. Physical fitness measures showed consistent enhancements whereas anthropometric improvements often corresponded with blood pressure reductions. Psychological outcomes varied across studies, with intervention duration emerging as a key factor in effectiveness. MCT interventions could lead to improvements in clinical outcomes, risk factor reduction, and patient adherence. Although findings on psychological parameters remain inconsistent, the overall evidence supports their integration into both clinical and community settings.
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Affiliation(s)
- Luca Poli
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Study of Bari, 70124 Bari, Italy; (L.P.); (A.P.); (G.G.)
| | - Alessandro Petrelli
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Study of Bari, 70124 Bari, Italy; (L.P.); (A.P.); (G.G.)
| | - Francesco Fischetti
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Study of Bari, 70124 Bari, Italy; (L.P.); (A.P.); (G.G.)
| | - Stefania Morsanuto
- Department of Education and Sport Sciences, Pegaso Telematic University, 80143 Naples, Italy; (S.M.); (S.C.)
| | - Livica Talaba
- Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy;
| | - Stefania Cataldi
- Department of Education and Sport Sciences, Pegaso Telematic University, 80143 Naples, Italy; (S.M.); (S.C.)
| | - Gianpiero Greco
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Study of Bari, 70124 Bari, Italy; (L.P.); (A.P.); (G.G.)
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228
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Rajić S, Delerue T, Ronkainen J, Zhang R, Ciantar J, Kostiniuk D, Mishra PP, Lyytikäinen LP, Mononen N, Kananen L, Peters A, Winkelmann J, Kleber ME, Lorkowski S, Kähönen M, Lehtimäki T, Raitakari O, Waldenberger M, Gieger C, März W, Harville EW, Sebert S, Marttila S, Raitoharju E. Regulation of nc886 (vtRNA2-1) RNAs is associated with cardiometabolic risk factors and diseases. Clin Epigenetics 2025; 17:68. [PMID: 40301926 PMCID: PMC12042507 DOI: 10.1186/s13148-025-01871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 04/01/2025] [Indexed: 05/01/2025] Open
Abstract
Non-coding 886 (nc886, vtRNA2-1) is a polymorphically imprinted gene. The methylation status of this locus has been shown to be associated with periconceptional conditions, and both the methylation status and the levels of nc886 RNAs have been shown to associate with later-life health traits. We have previously shown that nc886 RNA levels are associated not only with the methylation status of the locus, but also with a genetic polymorphism upstream from the locus. In this study, we describe the genetic and epigenetic regulators that predict lifelong nc886 RNA levels, as well as their association with cardiometabolic disease (CMD) risk factors and events. We utilised six population cohorts and one CMD cohort comprising 9058 individuals in total. The association of nc886 RNA levels, as predicted by epigenetic and genetic regulators, with CMD phenotypes was analysed using regression models, with a meta-analysis of the results. The meta-analysis showed that individuals with upregulated nc886 RNA levels have higher diastolic blood pressure (β = 0.07, p = 0.008), lower HDL levels (β = - 0.07, p = 0.006) and an increased incidence of type 2 diabetes (OR = 1.260, p = 0.013). Moreover, CMD patients with upregulated nc886 RNA levels have an increased incidence of stroke (OR = 1.581, p = 0.006) and death (OR = 1.290, p = 0.046). In conclusion, we show that individuals who are predicted to present elevated nc886 RNA levels have poorer cardiovascular health and are at an elevated risk of complications in secondary prevention. This unique mechanism yields metabolic variation in human populations, constituting a CMD risk factor that cannot be modified through lifestyle choices.
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Affiliation(s)
- Sonja Rajić
- Molecular Epidemiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Thomas Delerue
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Justiina Ronkainen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ruiyuan Zhang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Joanna Ciantar
- Molecular Epidemiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Daria Kostiniuk
- Molecular Epidemiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pashupati P Mishra
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Nina Mononen
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Laura Kananen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Faculty of Social Sciences (Health Sciences), Gerontology Research Center, Tampere University, Tampere, Finland
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
- German Research Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
- Institute of Human Genetics, Technical University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
- SYNLAB MVZ Humangenetik Mannheim, Mannheim, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich-Schiller-University, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Jena, Germany
| | - Mika Kähönen
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Research Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Gieger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Research Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
- Synlab Academy, SYNLAB Holding Deutschland GmbH, Augsburg & Mannheim, Germany
| | - Emily W Harville
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Sylvain Sebert
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Saara Marttila
- Molecular Epidemiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Gerontology Research Center, Tampere University, Tampere, Finland
| | - Emma Raitoharju
- Molecular Epidemiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Fimlab Laboratories, Tampere, Finland.
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland.
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Rizzo A, Viccaro V, Pavon AG, Leo LA, Treglia G. [ 18F]FDG PET imaging in the differentiation of cardiac masses: an updated systematic review and dual Meta-Analysis of diagnostic performance and parameter variability. Eur J Nucl Med Mol Imaging 2025:10.1007/s00259-025-07289-w. [PMID: 40298987 DOI: 10.1007/s00259-025-07289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 04/14/2025] [Indexed: 04/30/2025]
Abstract
INTRODUCTION Cardiac masses (CMs) encompass a heterogeneous group of benign, malignant, and pseudotumoural lesions, posing diagnostic challenges due to their rarity and varied aetiologies. Given the limitations of conventional imaging modalities in differentiating benign from malignant masses, [18F]FDG PET/CT has emerged as a promising technique by providing metabolic information. This systematic review and meta-analysis aimed to evaluate the diagnostic performance of [18F]FDG PET/CT in characterising CMs and assess semi-quantitative parameters' role in distinguishing malignant from benign lesions. METHODS A systematic review and meta-analysis were conducted, including studies evaluating the diagnostic accuracy of [18F]FDG PET/CT in CMs. Sensitivity and specificity were pooled using a random-effects model, and a secondary analysis examined differences in SUVmax between malignant and benign lesions. RESULTS Fifteen studies enrolling 1114 patients met inclusion criteria. The pooled sensitivity and specificity of [18F]FDG PET/CT in detecting malignant CMs were 89.2% (95% CI: 85-92%) and 82.8% (95% CI: 78-87%), respectively. Malignant lesions exhibited significantly higher SUVmax values (range: 5.6-14.3) than benign masses (range: 1.1-5.3, p < 0.001). PET/CT proved particularly effective in cases with inconclusive findings from echocardiography, cardiac magnetic resonance, or CT, contributing to biopsy guidance and treatment planning. CONCLUSIONS [18F]FDG PET/CT demonstrates robust diagnostic accuracy in differentiating benign from malignant cardiac masses, with SUVmax as a valuable malignancy marker. Its integration into multimodal imaging strategies enhances diagnostic certainty and optimises patient management. Despite these advantages, standardised imaging protocols and further multicentre prospective studies are warranted to refine its clinical application and validate its prognostic potential.
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Affiliation(s)
- Alessio Rizzo
- Nuclear Medicine, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Vincenzo Viccaro
- Division of Cardiac Imaging, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Anna Giulia Pavon
- Division of Cardiac Imaging, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Laura Anna Leo
- Division of Cardiac Imaging, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
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230
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Fashina OA, Gleich SJ, Opp DN, Ouellette Y, Kawai Y. Case Report: Complex cardiac arrhythmia management in the ICU for an adolescent with Friedreich ataxia. Front Pediatr 2025; 13:1542513. [PMID: 40364815 PMCID: PMC12069360 DOI: 10.3389/fped.2025.1542513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 04/04/2025] [Indexed: 05/15/2025] Open
Abstract
Background Friedreich ataxia (FRDA) is a progressive neurodegenerative disorder with specific clinical manifestations, such as scoliosis, which may impact the management of cardiac arrhythmias and heart failure. Case description A 17-year-old male with FRDA and hypertrophic cardiomyopathy presented with atrial flutter and resultant acute-on-chronic systolic and diastolic heart failure with reduced ejection fraction. The arrhythmias were refractory to medical management with adenosine and amiodarone. An attempted cavotricuspid isthmus ablation was unsuccessful due to abnormal cardiac positioning caused by severe scoliosis. Despite optimization with dofetilide and metoprolol, he was readmitted with recurrent atrial arrhythmias and cardiogenic shock, secondary to probable amiodarone-induced thyrotoxicosis, requiring extracorporeal membrane oxygenation. His clinical course involved multisystem complications, prolonged hospitalization, and disease progression, with no recovery in systolic function despite control of his arrhythmia burden. Conclusion Intensivists should be cognizant of multisystem complications that can arise when treating refractory cardiac arrhythmias, especially in those with concomitant genetic conditions.
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Affiliation(s)
| | - Stephen J. Gleich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
- Division of Pediatric Critical Care, Mayo Clinic Children's, Rochester, MN, United States
| | - Derek N. Opp
- Division of Pediatric Cardiology, Mayo Clinic Children's, Rochester, MN, United States
| | - Yves Ouellette
- Division of Pediatric Critical Care, Mayo Clinic Children's, Rochester, MN, United States
| | - Yu Kawai
- Division of Pediatric Critical Care, Mayo Clinic Children's, Rochester, MN, United States
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231
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Kandasamy G, Subramani T, Almanasef M, Orayj K, Shorog E, Alshahrani AM, Alanazi TS, Majeed A. Exploring Factors Affecting Health-Related Quality of Life in Coronary Artery Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:824. [PMID: 40428782 PMCID: PMC12113040 DOI: 10.3390/medicina61050824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Revised: 04/23/2025] [Accepted: 04/24/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: Coronary artery disease (CAD) significantly impacts health-related quality of life (HRQoL), with lifestyle factors and comorbidities influencing various dimensions of well-being. This study aimed to assess HRQoL and its association with sociodemographic and lifestyle factors in CAD patients. Materials and Methods: A cross-sectional study was conducted at the Rajiv Gandhi Co-operative Multispecialty Hospital, South India, from July 2022 to April 2023, where lifestyle factors were assessed, and HRQoL was measured using the EQ-5D-3L. The differences and associations of sociodemographic and lifestyle factors with HRQoL were analyzed using the chi-square test and multivariate regression. Results: A total of 212 CAD patients were included in this study. Female gender and comorbid disease were more likely to be associated with reported problems in mobility (89.7%, 78.8%) and anxiety/depression (97.4%, 92.7%) (p < 0.05). Factors such as age ≥ 50 years, family history of CAD, current smoking, comorbid disease, and a moderate- to high-risk diet significantly influenced anxiety/depression (p < 0.05). Patients with comorbid disease and moderate- to high-risk dietary intake were significantly associated with all five dimensions (p < 0.05). Gender, educational level, alcohol intake, and sleep duration did not show a significant association with all dimensions (p > 0.05). Conclusions: This study found that CAD patients undergoing treatment for secondary prevention exhibited inadequate HRQoL, particularly in terms of mental health. Factors such as comorbid disease and moderate- to high-risk dietary intake were significantly associated with reduced HRQoL. Older age, family history of CAD, current smoking habit, comorbid disease, and a moderate- to high-risk diet were significantly associated with anxiety/depression.
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Affiliation(s)
- Geetha Kandasamy
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia; (G.K.); (M.A.); (K.O.); (E.S.)
| | - Thangamani Subramani
- Department of Pharmacy Practice, Grace College of Pharmacy, Palakkad 678004, India
| | - Mona Almanasef
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia; (G.K.); (M.A.); (K.O.); (E.S.)
| | - Khalid Orayj
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia; (G.K.); (M.A.); (K.O.); (E.S.)
| | - Eman Shorog
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia; (G.K.); (M.A.); (K.O.); (E.S.)
| | - Asma M. Alshahrani
- Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Dawadimi 11911, Saudi Arabia
| | - Tahani S. Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia; (G.K.); (M.A.); (K.O.); (E.S.)
| | - Anusha Majeed
- Department of Pharmacy Practice, Grace College of Pharmacy, Palakkad 678004, India
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232
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Zook N, Kochanski J, Vellore Govardhan S, Nigro J, Ray M, Anton-Martin P. Transthoracic intracardiac line use and complications in the paediatric single ventricle population. Cardiol Young 2025:1-6. [PMID: 40289743 DOI: 10.1017/s1047951125001623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
Transthoracic intracardiac lines provide a unique access point for postoperative monitoring and management in paediatric cardiothoracic surgeries, particularly within the single ventricle population where preserving vasculature is crucial for future interventions. This retrospective review examined paediatric single ventricle patients undergoing cardiothoracic surgeries at a tertiary children's hospital between 2011 and 2018, focusing on the use of and factors associated with transthoracic line complications (infection, thrombosis, malfunction, and migration). A total of 338 lines were placed during the study period, with the majority occurring during palliative surgeries (86.5%). Lines remained in place for a median of 14 days postoperatively. Complications occurred in 21 lines (6.2%), comprising 8 migrations (2.4%), 7 thrombosis (2.1%), 4 malfunctions (1.2%), and 2 infections (0.6%). The presence of a surgical shunt was significantly associated with line complications (odds ratio 2.58, confidence interval 1.05 - 6.31; P 0.03). The use of transthoracic intracardiac lines seems to be safe and should be considered as a primary alternative to other central lines in the single ventricle population. A prospective assessment of transthoracic line complications, along with delineation of unit protocols, may further enhance outcomes in this complex population.
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Affiliation(s)
- Nina Zook
- Department of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
| | - Justin Kochanski
- Department of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
| | - Shilpa Vellore Govardhan
- Department of Pediatric Cardiology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - John Nigro
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Meredith Ray
- School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Pilar Anton-Martin
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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233
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Addleman JS, Lackey NS, Tobin MA, Lara GA, Sinha S, Morse RM, Hajduczok AG, Gharbo RS, Gevirtz RN. Heart Rate Variability Applications in Medical Specialties: A Narrative Review. Appl Psychophysiol Biofeedback 2025:10.1007/s10484-025-09708-y. [PMID: 40293647 DOI: 10.1007/s10484-025-09708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
HRV is clinically considered to be a surrogate measure of the asymmetrical interplay of the sympathetic and parasympathetic nervous system. While HRV has become an increasingly measured variable through commercially-available wearable devices, HRV is not routinely monitored or utilized in healthcare settings at this time. The purpose of this narrative review is to discuss and evaluate the current research and potential future applications of HRV in several medical specialties, including critical care, cardiology, pulmonology, nephrology, gastroenterology, endocrinology, infectious disease, hematology and oncology, neurology and rehabilitation, sports medicine, surgery and anesthesiology, rheumatology and chronic pain, obstetrics and gynecology, pediatrics, and psychiatry/psychology. A narrative literature review was conducted with search terms including HRV and relevant terminology to the medical specialty in question. While HRV has demonstrated promise for some diagnoses as a non-invasive, easy to use, and cost-effective metric for early disease detection, prognosis and mortality prediction, disease monitoring, and biofeedback therapy, several issues plague the current literature. Substantial heterogeneity exists in the current HRV literature which limits its applicability in clinical practice. However, applications of HRV in psychiatry, critical care, and in specific chronic diseases demonstrate sufficient evidence to warrant clinical application regardless of the surmountable research issues. More data is needed to understand the exact impact of standardizing HRV monitoring and treatment protocols on patient outcomes in each of the clinical contexts discussed in this paper.
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Affiliation(s)
| | - Nicholas S Lackey
- Center for Applied Biobehavioral Sciences (CABS), Alliant International University, San Diego, CA, USA.
| | - Molly A Tobin
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Grace A Lara
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Sankalp Sinha
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Rebecca M Morse
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Alexander G Hajduczok
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Raouf S Gharbo
- Virginia Commonwealth University School of Medicine Department of Physical Medicine and Rehabilitation, Richmond, VA, USA
| | - Richard N Gevirtz
- Center for Applied Biobehavioral Sciences (CABS), Alliant International University, San Diego, CA, USA
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234
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Duan X, Zhang X, Sun B. The landscape of novel antidiabetic drugs in diabetic HFpEF: relevant mechanisms and clinical implications. Cardiovasc Diabetol 2025; 24:186. [PMID: 40295996 PMCID: PMC12038999 DOI: 10.1186/s12933-025-02750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 04/19/2025] [Indexed: 04/30/2025] Open
Abstract
As a heterogeneous syndrome, heart failure with preserved ejection fraction (HFpEF) has become the leading form of heart failure worldwide. Increasing evidence has identified that diabetes mellitus (DM) increases the risk of HFpEF. Worse still, the coexistence of both diseases poses a great threat to human health by further worsening the cardiovascular system and accelerating the progression of diabetes. Although several studies have indicated that the novel antidiabetic drugs, including sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dipeptidyl peptidase 4 inhibitors (DPP4i) provide the cardiovascular benefits in T2DM patients with HFpEF, the elaborated roles and mechanisms are not fully understood. In this review, we summarize the state-of-the-art evidence regarding the epidemiology and pathophysiology of diabetic HFpEF, and the landscape of the novel antidiabetic drugs in the treatment of diabetic HFpEF, as well as discuss the relevant mechanisms, aiming to broaden the understanding of diabetic HFpEF and gain new insight into the treatment of this disease.
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Affiliation(s)
- Xiangling Duan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139, People's Middle Street, Changsha, 410011, China
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xiaomeng Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Bao Sun
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139, People's Middle Street, Changsha, 410011, China.
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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235
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Pena DL, Ilieșiu AM, Aurelian J, Grigore M, Hodorogea AS, Ciobanu A, Weiss E, Badilă E, Balahura AM. Assessment of Decongestion Status Before Discharge in Acute Decompensated Heart Failure: A Review of Clinical, Biochemical, and Imaging Tools and Their Impact on Management Decisions. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:816. [PMID: 40428774 PMCID: PMC12112801 DOI: 10.3390/medicina61050816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2025] [Revised: 04/18/2025] [Accepted: 04/18/2025] [Indexed: 05/29/2025]
Abstract
Acute decompensated heart failure (ADHF) represents a major healthcare burden, with residual congestion at discharge being a critical determinant of poor outcomes. Despite its prognostic significance, the assessment of decongestion status before discharge remains suboptimal, highlighting the need for a more comprehensive evaluation approach. This descriptive review synthesizes current evidence on congestion assessment methods in ADHF, focusing on their role in discharge decision-making and prognostic value. We describe various evaluation tools, including clinical examination, biomarkers, imaging techniques, and congestion scores, presenting their integration into a practical assessment algorithm. A comprehensive algorithm for congestion assessment before discharge is presented, incorporating multimodal evaluation techniques, with the aim of highlighting the practical utility of various assessment methods in guiding treatment decisions and determining optimal discharge timing. Integration of multiple parameters provides superior accuracy in evaluating decongestion status compared to single-method approaches. A standardized, multimodal approach to congestion assessment before discharge is essential for optimal ADHF management. The proposed assessment algorithm, combining clinical, biochemical, and imaging parameters, offers a practical framework for more reliable discharge decision-making, potentially improving patient outcomes.
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Affiliation(s)
- Diana-Ligia Pena
- Department of Cardiology, “Prof. Dr. Theodor Burghele” Clinical Hospital, 061344 Bucharest, Romania;
| | - Adriana-Mihaela Ilieșiu
- Department of Cardiology, “Prof. Dr. Theodor Burghele” Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.G.); (A.-S.H.); (A.-M.B.)
| | - Justin Aurelian
- Department of Urology, “Prof. Dr. Theodor Burghele” Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Mihai Grigore
- Department of Cardiology, “Prof. Dr. Theodor Burghele” Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.G.); (A.-S.H.); (A.-M.B.)
| | - Andreea-Simona Hodorogea
- Department of Cardiology, “Prof. Dr. Theodor Burghele” Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.G.); (A.-S.H.); (A.-M.B.)
| | - Ana Ciobanu
- Department of Cardiology, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Emma Weiss
- Department of Cardiology, Colentina Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.W.); (E.B.)
| | - Elisabeta Badilă
- Department of Cardiology, Colentina Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.W.); (E.B.)
| | - Ana-Maria Balahura
- Department of Cardiology, “Prof. Dr. Theodor Burghele” Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.G.); (A.-S.H.); (A.-M.B.)
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Street ME, Casadei F, Di Bari ER, Ferraboschi F, Montani AG, Mele MC, Shulhai AM, Esposito S. The Role of Nutraceuticals and Probiotics in Addition to Lifestyle Intervention in the Management of Childhood Obesity-Part 2: Comorbidities. Nutrients 2025; 17:1487. [PMID: 40362796 PMCID: PMC12073779 DOI: 10.3390/nu17091487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2025] [Revised: 04/19/2025] [Accepted: 04/21/2025] [Indexed: 05/15/2025] Open
Abstract
Pediatric obesity is associated with a wide range of comorbidities beyond metabolic changes, affecting cardiovascular, endocrine, reproductive, musculoskeletal systems, and also mental health. Hypertension, commonly observed in children with obesity, increases the risk of long-term cardiovascular disease. Polycystic ovary syndrome (PCOS) presents another significant endo-reproductive challenge that often develops during adolescence in females, leading to further comorbidities in adulthood. Additionally, excess adiposity can negatively impact bone health by modifying bone metabolism and increasing fracture risk. Obesity is also strongly linked to mental health disorders, including depression, anxiety, and low self-esteem, which can further exacerbate unhealthy lifestyle behaviors and disorders. Given the limitations and poor adherence of traditional treatment strategies, nutraceuticals have emerged as potential complementary therapies due to their bioactive properties. Various compounds have demonstrated antihypertensive, insulin-sensitizing, and anti-inflammatory effects, while others support bone metabolism and promote mental well-being. Herewith, we discuss the role of nutraceuticals in managing hypertension, PCOS, bone health, and mental health issues in individuals with obesity, evaluating their mechanisms of action and clinical relevance. Integrating nutraceutical compounds with dietary and lifestyle interventions may improve treatment outcomes and prevent obesity-related comorbidities. Further, we emphasize the need for further large-scale clinical studies, especially in pediatric patients.
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Affiliation(s)
- Maria Elisabeth Street
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (F.C.); (E.R.D.B.); (F.F.); (A.G.M.); (A.-M.S.); (S.E.)
- Unit of Paediatrics, P. Barilla Children’s Hospital, University Hospital of Parma, 43121 Parma, Italy;
| | - Federica Casadei
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (F.C.); (E.R.D.B.); (F.F.); (A.G.M.); (A.-M.S.); (S.E.)
| | - Erika Rita Di Bari
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (F.C.); (E.R.D.B.); (F.F.); (A.G.M.); (A.-M.S.); (S.E.)
| | - Francesca Ferraboschi
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (F.C.); (E.R.D.B.); (F.F.); (A.G.M.); (A.-M.S.); (S.E.)
| | - Anna Giuseppina Montani
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (F.C.); (E.R.D.B.); (F.F.); (A.G.M.); (A.-M.S.); (S.E.)
| | - Maria Concetta Mele
- Unit of Paediatrics, P. Barilla Children’s Hospital, University Hospital of Parma, 43121 Parma, Italy;
| | - Anna-Mariia Shulhai
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (F.C.); (E.R.D.B.); (F.F.); (A.G.M.); (A.-M.S.); (S.E.)
| | - Susanna Esposito
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (F.C.); (E.R.D.B.); (F.F.); (A.G.M.); (A.-M.S.); (S.E.)
- Unit of Paediatrics, P. Barilla Children’s Hospital, University Hospital of Parma, 43121 Parma, Italy;
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237
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Agoglia L, Chindamo MC, Villela-Nogueira C. Psoriasis, metabolic syndrome and methotrexate: Is this association suitable for a new subcategory in steatotic liver disease? World J Hepatol 2025; 17:102978. [PMID: 40308817 PMCID: PMC12038415 DOI: 10.4254/wjh.v17.i4.102978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 03/08/2025] [Accepted: 03/27/2025] [Indexed: 04/25/2025] Open
Abstract
Psoriasis is a prevalent inflammatory disease that shares chronic inflammation pathways with the pathophysiology of metabolic syndrome (MetS), type-2 diabetes mellitus and atherosclerosis. A high prevalence of steatosis and advanced liver fibrosis has been described in psoriasis. The influence of MetS and its compounds, patatin-like phospholipase domain containing 3 and transmembrane 6 superfamily member 2 gene polymorphisms and the cumulative dose of methotrexate (MTX) in the progression of steatotic disease are still under debate. A suitable new classification for psoriasis-related liver disease, under the umbrella of steatotic liver disease (SLD), might be evaluated due to the potential impact of MTX on liver steatosis. Considering the interplay between the MetS, steatosis and MTX, a new definition for this complex disease might be discussed since it is not entirely addressed under the umbrella of SLD and metabolic-dysfunction associated SLD. Hence, shortly, a discussion could be raised on the feasible term "Met-Drug SLD", metabolic and drug-induced SLD, which comprises both metabolic dysfunction and drug-related SLD. This review aims to report the best evidence to accurately classify liver disease in psoriasis, considering the new definition of SLD, allowing appropriate management once it is carefully defined.
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Affiliation(s)
- Luciana Agoglia
- Department of Internal Medicine, School of Medicine, Section of Gastroenterology, Hospital Universitário Antônio Pedro, Federal University Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
| | - Maria Chiara Chindamo
- Department of Internal Medicine, School of Medicine and Hepatology Division, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Cristiane Villela-Nogueira
- Department of Internal Medicine, School of Medicine and Hepatology Division, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil.
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238
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Riepl HS, Santner V, Schwegel N, Hoeller V, Wallner M, Kolesnik E, von Lewinski D, Ablasser K, Kreuzer P, Zorn-Pauly K, Aziz F, Sourij H, Zirlik A, Platzer D, Verheyen N. Ambient Temperature and the Frequency of Subsequent Heart Failure Decompensations in an Emergency Department. Biomedicines 2025; 13:1054. [PMID: 40426882 PMCID: PMC12109250 DOI: 10.3390/biomedicines13051054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Revised: 04/23/2025] [Accepted: 04/25/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: The impact of cold temperature on heart failure (HF) decompensations in continental climate zones is unclear. We aimed to evaluate the association between daily temperature and the subsequent frequency of HF decompensations in an emergency department (ED) in Eastern Austria. Methods: A systematic retrospective medical chart review of all admissions to the ED of a tertiary care center within 12 months was conducted. Maximal daily temperature and further meteorological data were obtained from the National Institute for Meteorology and Geodynamics. Results: Among 32.028 ED admissions, there were 1.248 HF decompensations. Median maximal daily temperature ranged from 4.3 °C in January to 28.7 °C in August, and the frequency of decompensations ranged from 65 in August to 143 in January. Maximal daily temperature correlated negatively with the number of decompensations on the subsequent day (beta = -0.07 [95% confidence interval, -0.09 to -0.05], p < 0.001). The association remained significant in a multivariate linear regression model adjusted for other meteorological parameters (adjusted beta = -0.07 [-0.10 to -0.04], p < 0.001). Moreover, it was present across HF with preserved (n = 375; beta = -0.08 [-0.14 to -0.03], p = 0.004) and reduced (n = 331; beta = -0.08 [-0.13 to -0.02], p = 0.005) ejection fraction, but not with mildly reduced ejection fraction (n = 160; beta = -0.03 [-0.07 to 0.01], p = 0.200). Conclusions: In a European continental climate zone region, lower temperature was associated with a linear increase in subsequent HF decompensations. The sequelae of climate change on HF decompensations may burden healthcare systems in the future and should be systematically investigated in further studies.
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Affiliation(s)
- Hermann Stefan Riepl
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Viktoria Santner
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Nora Schwegel
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Viktoria Hoeller
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Markus Wallner
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Ewald Kolesnik
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Dirk von Lewinski
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Klemens Ablasser
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Philipp Kreuzer
- Emergency Medicine Unit, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria;
| | - Klaus Zorn-Pauly
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Division of Medical Physics and Biophysics, Medical University of Graz, 8010 Graz, Austria; (K.Z.-P.); (D.P.)
| | - Faisal Aziz
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (F.A.); (H.S.)
| | - Harald Sourij
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (F.A.); (H.S.)
| | - Andreas Zirlik
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
| | - Dieter Platzer
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Division of Medical Physics and Biophysics, Medical University of Graz, 8010 Graz, Austria; (K.Z.-P.); (D.P.)
| | - Nicolas Verheyen
- Division of Cardiology, University Heart Center and Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (H.S.R.); (V.S.); (N.S.); (V.H.); (M.W.); (E.K.); (D.v.L.); (K.A.); (A.Z.)
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Seth L, Stabellini N, Doss S, Patel V, Shah V, Lip G, Dent S, Fradley MG, Køber L, Guha A. Atrial fibrillation and ischemic stroke in cancer: the latest scientific evidence, current management, and future directions. J Thromb Thrombolysis 2025:10.1007/s11239-025-03104-3. [PMID: 40281267 DOI: 10.1007/s11239-025-03104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2025] [Indexed: 04/29/2025]
Abstract
Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for ischemic stroke. Atrial fibrillation and ischemic stroke are major cardiovascular complications in cancer patients, who have a higher burden and worse outcomes than the general population. Clinical risk stratification scores for stroke and bleeding, commonly used in the general population to estimate thromboembolic and bleeding risk, respectively, are less well validated in cancer patients, who have historically been excluded in clinical trials. There is a lack of consensus opinion on how to effectively risk-stratify cancer patients based on the currently available tools and a need for cancer-specific scores that offer a tailored approach to each patient in order to more effectively stratify ischemic stroke and bleeding risk in this cohort of patients. Cancer-mediated physiologic changes and adverse effects of antineoplastic therapy have been implicated as etiologies of the increased risk for both atrial fibrillation and ischemic stroke. Risk stratifying scores such as CHA2DS2-VASc and HAS-BLED, commonly used in the general population, are less well validated in cancer patients. There is a need for cancer-specific scores that can more effectively stratify ischemic stroke and bleeding risk in cancer patients, although given the heterogeneity of cancers, whether a "one score fits all" is uncertain.
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Affiliation(s)
- Lakshya Seth
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Nickolas Stabellini
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Shawn Doss
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Vraj Patel
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Viraj Shah
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, Bialystok, Poland
| | - Susan Dent
- Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Michael G Fradley
- Thalheimer Center for Cardio-Oncology, Division of Cardiology, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Avirup Guha
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA.
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240
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Byeon H. Impact of night sentry duties on cardiometabolic health in military personnel. World J Cardiol 2025; 17:102133. [PMID: 40308619 PMCID: PMC12038707 DOI: 10.4330/wjc.v17.i4.102133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 02/14/2025] [Accepted: 02/27/2025] [Indexed: 04/21/2025] Open
Abstract
This article examines the study by Lin et al, which explores the effects of night sentry duties on cardiometabolic health in military personnel. The research identifies significant correlations between the frequency of night shifts and negative cardiometabolic outcomes, such as elevated resting pulse rates and lowered levels of high-density lipoprotein cholesterol. These outcomes underscore the health risks linked to partial sleep deprivation, a common challenge in military environments. The editorial highlights the clinical significance of these findings, advocating for the implementation of targeted health interventions to mitigate these risks. Strategies such as structured sleep recovery programs and lifestyle modifications are recommended to improve the health management of military personnel engaged in nocturnal duties. By addressing these issues, military health management can better safeguard the well-being and operational readiness of its personnel.
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Affiliation(s)
- Haewon Byeon
- Department of Future Technology, Worker's Care and Digital Health Lab, Korea University of Technology and Education, Cheonan 31253, South Korea.
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241
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Zhang JJ, Cheng L, Qiao Q, Xiao XL, Lin SJ, He YF, Sha RL, Sha J, Ma Y, Zhang HL, Ye XR. Adenosine triphosphate-induced cell death in heart failure: Is there a link? World J Cardiol 2025; 17:105021. [PMID: 40308621 PMCID: PMC12038699 DOI: 10.4330/wjc.v17.i4.105021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 02/22/2025] [Accepted: 04/02/2025] [Indexed: 04/21/2025] Open
Abstract
Heart failure (HF) has emerged as one of the foremost global health threats due to its intricate pathophysiological mechanisms and multifactorial etiology. Adenosine triphosphate (ATP)-induced cell death represents a novel form of regulated cell deaths, marked by cellular energy depletion and metabolic dysregulation stemming from excessive ATP accumulation, identifying its uniqueness compared to other cell death processes modalities such as programmed cell death and necrosis. Growing evidence suggests that ATP-induced cell death (AICD) is predominantly governed by various biological pathways, including energy metabolism, redox homeostasis and intracellular calcium equilibrium. Recent research has shown that AICD is crucial in HF induced by pathological conditions like myocardial infarction, ischemia-reperfusion injury, and chemotherapy. Thus, it is essential to investigate the function of AICD in the pathogenesis of HF, as this may provide a foundation for the development of targeted therapies and novel treatment strategies. This review synthesizes current advancements in understanding the link between AICD and HF, while further elucidating its involvement in cardiac remodeling and HF progression.
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Affiliation(s)
- Jing-Jing Zhang
- Department of Cardiovascular Medicine, Fuwai Yunnan Hospital, Chinese Academy Medical Sciences, Kunming 650000, Yunnan Province, China
| | - Lu Cheng
- Department of Cardiovascular Medicine, Fuwai Yunnan Hospital, Chinese Academy Medical Sciences, Kunming 650000, Yunnan Province, China
| | - Qian Qiao
- Department of Cardiovascular Medicine, Fuwai Yunnan Hospital, Chinese Academy Medical Sciences, Kunming 650000, Yunnan Province, China
| | - Xue-Liang Xiao
- Department of Critical Care Medicine, Ninglang Yi Autonomous County People's Hospital, Lijiang 674300, Yunnan Province, China
| | - Shao-Jun Lin
- Department of Critical Care Medicine, Ninglang Yi Autonomous County People's Hospital, Lijiang 674300, Yunnan Province, China
| | - Yue-Fang He
- Department of Critical Care Medicine, Ninglang Yi Autonomous County People's Hospital, Lijiang 674300, Yunnan Province, China
| | - Ren-Luo Sha
- Department of Critical Care Medicine, Ninglang Yi Autonomous County People's Hospital, Lijiang 674300, Yunnan Province, China
| | - Jun Sha
- Department of Critical Care Medicine, Ninglang Yi Autonomous County People's Hospital, Lijiang 674300, Yunnan Province, China
| | - Yin Ma
- Department of Critical Care Medicine, Ninglang Yi Autonomous County People's Hospital, Lijiang 674300, Yunnan Province, China
| | - Hao-Ling Zhang
- Department of Biomedical Science, Advanced Medical and Dental Institute, University Sains Malaysia, Penang 13200, Malaysia.
| | - Xue-Rui Ye
- Department of Cardiovascular Medicine, Fuwai Yunnan Hospital, Chinese Academy Medical Sciences, Kunming 650000, Yunnan Province, China
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242
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Lian LY, Chen QF, Zhou XD. Lifestyle changes for cardiometabolic health: Planting the seeds for long-term benefit. World J Cardiol 2025; 17:103544. [PMID: 40308626 PMCID: PMC12038703 DOI: 10.4330/wjc.v17.i4.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 02/19/2025] [Accepted: 02/25/2025] [Indexed: 04/21/2025] Open
Abstract
With nearly three-quarters of global deaths attributed to lifestyle-associated diseases, effective lifestyle modifications are more urgent than ever. The American Heart Association's framework for cardiovascular health has evolved significantly, transitioning from 'Life's Simple 7' to 'Life's Essential 8' with the incorporation of sleep, and further to 'Life's Essential 9' by adding mental health as a key component. Despite these advancements, recent evidence reveals a persistently low prevalence of ideal cardiovascular and cerebrovascular health behaviors across populations. These findings highlight the critical gap in addressing modifiable lifestyle and psychosocial factors. To reduce the global disease burden, public health strategies must prioritize comprehensive interventions that encompass physical, neurological, and mental well-being.
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Affiliation(s)
- Li-You Lian
- Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenling 325000, Zhejiang Province, China
| | - Qin-Fen Chen
- Physical Examination Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xiao-Dong Zhou
- Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenling 325000, Zhejiang Province, China.
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243
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Zounis E, Hampal R, Margineanu C, Knott K. Role of multimodality imaging in the rare diagnosis of a cardiac metastasis from a bladder squamous cell carcinoma. BMJ Case Rep 2025; 18:e264453. [PMID: 40287153 DOI: 10.1136/bcr-2024-264453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2025] Open
Affiliation(s)
- Elly Zounis
- Cardiology, St George's Hospital, London, UK
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244
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Marzoog BA, Kopylov P. Volatilome and machine learning in ischemic heart disease: Current challenges and future perspectives. World J Cardiol 2025; 17:106593. [PMID: 40308617 PMCID: PMC12038700 DOI: 10.4330/wjc.v17.i4.106593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 03/14/2025] [Accepted: 04/01/2025] [Indexed: 04/21/2025] Open
Abstract
Integrating exhaled breath analysis into the diagnosis of cardiovascular diseases holds significant promise as a valuable tool for future clinical use, particularly for ischemic heart disease (IHD). However, current research on the volatilome (exhaled breath composition) in heart disease remains underexplored and lacks sufficient evidence to confirm its clinical validity. Key challenges hindering the application of breath analysis in diagnosing IHD include the scarcity of studies (only three published papers to date), substantial methodological bias in two of these studies, and the absence of standardized protocols for clinical implementation. Additionally, inconsistencies in methodologies-such as sample collection, analytical techniques, machine learning (ML) approaches, and result interpretation-vary widely across studies, further complicating their reproducibility and comparability. To address these gaps, there is an urgent need to establish unified guidelines that define best practices for breath sample collection, data analysis, ML integration, and biomarker annotation. Until these challenges are systematically resolved, the widespread adoption of exhaled breath analysis as a reliable diagnostic tool for IHD remains a distant goal rather than an imminent reality.
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Affiliation(s)
- Basheer Abdullah Marzoog
- World-Class Research Center (Digital Biodesign and Personalized Healthcare), I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Street, 119991 Moscow, Russia.
| | - Philipp Kopylov
- World-Class Research Center (Digital Biodesign and Personalized Healthcare), I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Street, 119991 Moscow, Russia
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245
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Zheng LC, Liu F, Zheng PM, Xiao Z, Cui FC. Serum sST2, IL-33, and Hcy Expression in Older Adults Patients with Myocardial Infarction and Their Predictive Value for MACE. Clin Interv Aging 2025; 20:495-504. [PMID: 40303845 PMCID: PMC12039929 DOI: 10.2147/cia.s519437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Accepted: 04/14/2025] [Indexed: 05/02/2025] Open
Abstract
Objective Acute myocardial infarction (AMI) in the elderly is associated with high morbidity and mortality, with major adverse cardiovascular events (MACE) remaining a major concern despite early revascularization. This study aimed to evaluate the association of soluble suppression of tumorigenicity 2 (sST2), interleukin-33 (IL-33), and homocysteine (Hcy) with coronary stenosis severity and their predictive value for MACE in elderly AMI patients. Methods A retrospective analysis was conducted on 143 elderly AMI patients (≥65 years) admitted between June 2022 and June 2024. Patients were divided into two groups based on MACE occurrence: Group A (no MACE, n=56) and Group B (MACE, n=87). Serum sST2, IL-33, and Hcy levels were measured using ELISA, and coronary stenosis severity was assessed using the Gensini score. Statistical analyses included Spearman correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis to evaluate predictive performance. Results Serum sST2, IL-33, and Hcy levels were significantly higher in the MACE group compared to the non-MACE group (72.37±10.68 vs 38.76±11.15, p<0.05; 60.61±10.89 vs 33.74±11.23, p<0.05; 32.76±4.15 vs 15.38±4.62, p<0.05, respectively). Biomarker levels positively correlated with coronary stenosis severity (sST2: r=0.647, p<0.05; IL-33: r=0.659, p<0.05; Hcy: r=0.582, p<0.05). Multivariate logistic regression confirmed that sST2 (OR=1.056, 95% CI: 1.015-1.094, p=0.005), IL-33 (OR=1.069, 95% CI: 1.024-2.016, p=0.001), and Hcy (OR=1.037, 95% CI: 1.008-1.077, p=0.033) were independent risk factors for MACE. ROC analysis showed that sST2, IL-33, and Hcy had AUCs of 0.841 (95% CI: 0.762-0.915, p<0.001), 0.803 (95% CI: 0.724-0.878, p<0.001), and 0.729 (95% CI: 0.642-0.812, p<0.001), respectively. Combined detection of all three biomarkers significantly improved MACE prediction (AUC=0.910, 95% CI: 0.851-0.956, p<0.001). Conclusion Serum sST2, IL-33, and Hcy levels are positively correlated with coronary stenosis severity and independently associated with MACE in elderly AMI patients. Their combined detection significantly enhances MACE prediction, providing a potential strategy for improved risk stratification and management in this high-risk population.
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Affiliation(s)
- Liu-Chang Zheng
- Department of Clinical Laboratory, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Fang Liu
- Department of Medical Imaging, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Pei-Ming Zheng
- Department of Clinical Laboratory, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zheng Xiao
- Department of Clinical Laboratory, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Fa-Cai Cui
- Department of Clinical Laboratory, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
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Morcos R, Vijayaraman P, Cano Ó, Zanon F, Ponnusamy SS, Herweg B, Sharma PS, Jastrzebski M, Molina-Lerma M, Whinnett ZI, Vernooy K, Zou J, Nair GM, Pathak RK, Tung R, Upadhyay GA, Curila K, Chelu MG, Ellenbogen KA. Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS). Heart Rhythm 2025:S1547-5271(25)02312-4. [PMID: 40288475 DOI: 10.1016/j.hrthm.2025.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Revised: 04/01/2025] [Accepted: 04/03/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is an established treatment of heart failure with reduced ejection fraction and wide QRS. Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative by directly engaging the His-Purkinje system, potentially improving electrical resynchronization and clinical outcomes. OBJECTIVE The aim of the study was to compare the clinical outcomes between BVP and LBBAP in patients with left ventricular ejection fraction (LVEF) ≤50% undergoing CRT. METHODS This multicenter observational study included patients with LVEF ≤50% receiving CRT with either LBBAP or BVP at 18 centers from January 2018 to June 2023. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization (HFH). Secondary outcomes included separate analyses of HFH and all-cause mortality. Propensity score matching was used to balance baseline characteristics. Kaplan-Meier curves, Cox proportional hazards models, and competing risk analyses were performed. RESULTS A total of 2579 patients were included (BVP, 1118; LBBAP, 1461). In the propensity score-matched cohort (BVP, 780; LBBAP, 780), LBBAP demonstrated shorter paced QRS duration (129 ± 19 ms vs 143 ± 22 ms; P < .001). LBBAP was associated with a significantly lower risk of the composite primary outcome (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.98; P = .048) and reduced HFH (HR, 0.63; 95% CI, 0.49-0.82; P < .001). No significant difference in all-cause mortality was observed (HR, 0.82; 95% CI, 0.63-1.07; P = .156). Procedural complications were lower with LBBAP (3.5% vs 6.5%, P = .004). CONCLUSION LBBAP was associated with superior electrical resynchronization, fewer HFHs, and lower procedural complications compared with BVP in patients with LVEF <50% requiring CRT. Randomized trials are needed to confirm long-term benefits.
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Affiliation(s)
- Ramez Morcos
- Geisinger Heart Institute, Wilkes-Barre, Pennsylvania
| | | | - Óscar Cano
- Hospital Universitari i Politècnic La Fe, Valencia, Spain, and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | | | | | | | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kevin Vernooy
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jiangang Zou
- The First Affiliated Hospital of Nanjing Medical University, Cardiology, Nanjing, Jiangsu, China
| | - Girish M Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rajeev K Pathak
- Australian National University and Canberra Heart Rhythm, Garran, Australian Capital Territory, Australia
| | - Roderick Tung
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | | | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic, Praha, Czechia
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247
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Zhu W, Bian X, Lv J. Advances in diagnosis, management, and long-term outcomes of pediatric vasovagal syncope: a comprehensive review. Front Cardiovasc Med 2025; 12:1481749. [PMID: 40351605 PMCID: PMC12062076 DOI: 10.3389/fcvm.2025.1481749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 04/10/2025] [Indexed: 05/14/2025] Open
Abstract
Vasovagal syncope (VVS) is the most common cause of transient loss of consciousness in children and adolescents, accounting for 60%-80% of syncope cases. This review synthesizes current evidence on pediatric VVS, focusing on advances in diagnosis, management, and long-term outcomes. Through a comprehensive literature search of studies published between 2001 and 2024, we analyzed epidemiological patterns, pathophysiological mechanisms, diagnostic approaches, management strategies, and prognostic factors. Recent diagnostic advances include implantable loop recorders and smartphone applications, which have improved diagnostic accuracy. Management has evolved toward individualized approaches, emphasizing non-pharmacological interventions (hydration, salt supplementation, physical counterpressure maneuvers) as first-line treatment, with medications such as midodrine and fludrocortisone showing variable efficacy in refractory cases. Long-term studies indicate that while most children experience improvement over time, 33%-50% have recurrent episodes within three years, with factors such as lower mean arterial pressure, higher urine specific gravity, younger age, family history of syncope, and lower body mass index associated with increased recurrence risk. Though generally benign, VVS can significantly impact quality of life and carries substantial psychosocial consequences. Future research should focus on developing predictive models for recurrence risk and exploring personalized treatment approaches to improve outcomes.
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Affiliation(s)
- Wenjing Zhu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children’s Health and Disease Office, Jinan, Shandong, China
| | - Xueyan Bian
- Department of Pediatrics, Lixia District People’s Hospital, Jinan, Shandong, China
| | - Jianli Lv
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Clinical Research Center for Children’s Health and Disease Office, Jinan, Shandong, China
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248
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Li YL, Li Y, Tu H, Evans AJ, Patel TA, Zheng H, Patel KP. Stellate Ganglia: A Key Therapeutic Target for Malignant Ventricular Arrhythmia in Heart Disease. Circ Res 2025; 136:1049-1069. [PMID: 40273204 PMCID: PMC12026290 DOI: 10.1161/circresaha.124.325384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2025]
Abstract
Malignant ventricular arrhythmias (VAs), such as ventricular tachycardia and ventricular fibrillation, are the cause of approximately half a million deaths per year in the United States, which is a common lethal event in heart disease, such as hypertension, catecholaminergic polymorphic ventricular tachycardia, takotsubo cardiomyopathy, long-QT syndrome, and progressing into advanced heart failure. A common characteristic of these heart diseases, and the subsequent development of VAs, is the overactivation of the sympathetic nervous system. Current treatments for VAs in these heart diseases, such as β-adrenergic receptor blockers and cardiac sympathetic ablation, aim at inhibiting cardiac sympathetic overactivation. However, these treatments do not translate into becoming efficacious as long-term suppressors of ventricular tachycardia/ventricular fibrillation events. As a key regulatory component in the heart, cardiac postganglionic sympathetic neurons residing in the stellate ganglia (SGs) release neurotransmitters (such as norepinephrine and NPY [neuropeptide Y]) to perform their regulatory role in dictating cardiac function. Growing evidence from animal experiments and clinical studies has demonstrated that the remodeling of the SG may be intimately involved in malignant arrhythmogenesis. This identifies the SG as a key potential therapeutic target for the treatment of malignant VAs in heart disease. Therefore, this review summarizes the role of SG in ventricular arrhythmogenesis and updates the novel targeting of SG for clinical treatment of VAs in heart disease.
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Affiliation(s)
- Yu-Long Li
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Cellular and Integrated Physiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yu Li
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Huiyin Tu
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony J. Evans
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tapan A. Patel
- Department of Cellular and Integrated Physiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hong Zheng
- Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | - Kaushik P. Patel
- Department of Cellular and Integrated Physiology, University of Nebraska Medical Center, Omaha, NE, USA
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249
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Čolak E, Žorić L. Interrelation of Oxidative Stress and Genetics in Pathophysiology of Obesity and Obesity-Related Conditions. Genes (Basel) 2025; 16:489. [PMID: 40428311 PMCID: PMC12111202 DOI: 10.3390/genes16050489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 04/17/2025] [Accepted: 04/22/2025] [Indexed: 05/29/2025] Open
Abstract
Obesity is a medical condition influenced by many factors and manifested by the excessive accumulation of fat. It is well documented that oxidative stress plays a significant role in the development of obesity and its related diseases. The antioxidant system's enzymes, such as catalase, superoxide dismutase, glutathione peroxidase, paroxonase, etc., play a significant role in maintaining the oxidant-antioxidant balance in living organisms. Genetic variants of antioxidant system genes may affect the antioxidant system and its efficacy, which can lead to increased oxidative stress and higher risk for the development of obesity and its comorbidities. This review is focused on genetic variants such as single nucleotide polymorphisms of some antioxidant enzymes, ROS generators and transcription factors, and their impact on increased oxidative stress and the development of obesity and medical conditions related to obesity, like insulin resistance and metabolic syndrome.
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Affiliation(s)
- Emina Čolak
- Institute of Medical Biochemistry, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Lepša Žorić
- Clinic for Eye Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Priština in Kosovska Mitrovica (UPKM), 40000 Kosovska Mitrovica, Serbia
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Shi H, Guo X, Su C, Huang H, Chen Y, Zhang J, Zhang B, Feng X, Shen Z. A Systematic Review of Transcarotid Approach for Endovascular Aortic Repair in Treating Aortic Disease. Vasc Endovascular Surg 2025:15385744251335775. [PMID: 40278166 DOI: 10.1177/15385744251335775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2025]
Abstract
PurposeThe purpose of this study is to evaluate the feasibility, efficacy, and safety of transcarotid approach endovascular aortic repair (EVAR) in patients where conventional femoral access is not possible.Materials and MethodsA systematic review of all articles discussing transcarotid approach EVAR published in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were conducted. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsIn accordance with the inclusion criteria, 17 articles discussing transcarotid approach EVAR were retrieved, encompassing 18 patients. Among these patients, 6 patients were related to ascending aortic disease, including 4 cases of pseudoaneurysms, 1 case of penetrating ulcer, and 1 case of dissection. 9 patients had descending aortic disease, comprising 6 aneurysms, 2 penetrating ulcers, and 1 pseudoaneurysm. There were 3 cases of abdominal aortic disease, including 2 aneurysms and 1 endoleak. Among these patients, 10 cases had access through the left common carotid artery, and 8 cases had access through the right common carotid artery. One patient experienced spinal cord ischemia and subsequently died of multi-organ failure caused by acute pancreatitis. Additionally, there was one case of minor embolization in the nonsurgical carotid supply area. No cerebral infarctions were observed in the vascular territory of the ipsilateral carotid artery at the surgical approach site.ConclusionsResearch on transcarotid approach EVAR is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This systematic review suggests that transcarotid approach EVAR may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. These findings indicate that this method is associated with a relatively manageable perioperative complications and mortality rates.
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Affiliation(s)
- Haofan Shi
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingyou Guo
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Vascular Surgery, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Chengkai Su
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haoyue Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yihuan Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinlong Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bowen Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Feng
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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