Moyamoya disease (MMD) is a rare degenerative stenosis and occlusive cerebrovascular illness. It is characterized by cerebral ischemia and/or cerebral hemorrhage as the two main clinical signs. It is a common cause of stroke in both children and adults. Several recent studies illustrated the crucial role of microRNAs (miRNAs) in the pathophysiology of MMD via the regulation of endothelial cells and smooth muscle cells. Furthermore, other studies highlighted the decisive role of miRNAs in the underlying molecular pathophysiological mechanisms in MMD via regulation of cellular proliferation, angiogenesis, extracellular matrix remodeling, and vascular inflammation. This review aims to explore the involvement of miRNAs in MMD pathogenesis and to assess their potential use as biomarkers for stroke risk and their utility as therapeutic targets for the treatment of MMD.

Atrial fibrillation (AF) is a common cardiac arrhythmia. Its detection rates vary significantly across ethnic groups, impacting epidemiological and clinical outcomes. We aim to explore ethnic differences in self-reported versus hospital-reported AF using the MESA (Multi-Ethnic Study of Atherosclerosis).

Six thousand seven hundred seventy-five adults aged 45 to 84 years, free from baseline AF and major cardiovascular events, were monitored over 8.4 years (2000-2012) across 6 US locations. AF incidence was measured via hospital discharge International Classification of Diseases codes and self-reported data, validated by follow-up questionnaires. AF incidence per 1000 person-years was assessed by ethnic group and reporting method. Incidence rate ratios and adjusted hazard ratios were calculated with White participants as the referent group.

The study comprised 2611 White, 800 Chinese, 1485 Hispanic, and 1879 Black participants, with a mean age of 62.15 (10.24) years; 47.1% were male. Chinese had significantly lower incidence rate ratio (0.40 [95% CI, 0.19-0.75]; P=0.009) for AF reported only during hospitalization, whereas Hispanic group had significantly lower incidence rate ratio (0.29 [95% CI, 0.15-0.51]; P<0.001) for AF only via self-reporting. The combined overall reported AF incidence was 6.4%, or 7.72 per 1000 person-years, highest in the White group (10.69 per 1000 person-years) and lower in in Chinese (6.43 [95% CI, 4.61-8.71]; P=0.003), Hispanics (4.79 [95% CI, 3.61-6.24]; P<0.001), and Blacks (6.39 [95% CI, 5.16-7.84]; P<0.001).

The reported incidence of AF varies with the inclusion of self-reported data and across ethnic and racial groups. The inclusion of self-reported data increased the reported incidence of AF the most among Chinese individuals and the least among Hispanic participants. In the MESA study, the inclusion of self-reported data reveals heterogeneous changes across ethnic and racial groups, which may be due to differences in true incidence, methods of ascertainment, symptom perception, or health care access, and deserves further exploration.

Background: The tryptophan/kynurenic acid (KYNA) pathway plays a crucial role by modulating inflammation, oxidative stress, and immune activation. The clinical value of tryptophan metabolites in the KYNA pathway for the early diagnosis and prognosis of STEMI patients, as well as the underlying functional mechanisms, remains to be elucidated. Objectives: This study evaluated the prognostic value of KYNA, a metabolite of the tryptophan pathway, in STEMI patients. Methods: Untargeted metabolomics by ¹H-nuclear magnetic resonance (NMR) analysis was used to examine metabolite changes between 50 control subjects and 50 STEMI patients with an onset time of < 3 h. Furthermore, targeted metabolomic analysis was employed to investigate the association between KYNA and the prognosis of STEMI patients by LC-Q-TOF MS analysis. Results: Fifteen differential metabolites were identified between STEMI patients and control subjects by ¹H-NMR analysis. KYNA as an important metabolite upregulated obviously in the tryptophan pathway was 337.67 nmol/L in STEMI patients (interquartile range: 241.16-500.29 nmol/L). In addition, KYNA was significantly associated with major adverse cardiovascular events (MACEs) (HR: 5.95, 95% CI: 2.03-17.44; p = 0.0012) and all-cause mortality (HR: 7.11, 95% CI: 1.52-33.29; p = 0.013) and showed moderate predictive value for 12-month MACE (area under the curve (AUC) = 0.72, 95% CI: 0.65-0.80) and all-cause mortality (AUC = 0.74, 95% CI: 0.65-0.83). KAT1 expression was upregulated in infiltrating macrophages of thrombus tissue coming from the culprit coronary artery of STEMI patients. KAT1 upregulation was also observed in macrophages located within the peri-infarct myocardium. Conclusions: The KYNA level may correspond to the underlying status of acute myocardial infarction and is a promising biomarker for predicting STEMI progression.

Introduction: Stroke significantly impacts survivors' lives, affecting their physical, cognitive, and emotional well-being. Understanding how these individuals participate in daily activities and societal roles is crucial for optimal rehabilitation and support. Patient-reported outcome measures (PROMs) offer valuable insights into stroke survivors' experiences and perceptions regarding their participation in various life aspects. This systematic review focuses on PROMs specifically designed to evaluate participation following stroke, based on the International Classification of Functioning, Disability and Health (ICF). By analyzing existing measures, this review is aimed at identifying gaps, strengths, and opportunities for enhancing participation assessment in stroke rehabilitation. Method: A comprehensive search of keywords related to stroke, participation, and assessment was conducted across multiple databases, including Scopus, Embase, Medline, Cochrane Library, PEDro, and OTseeker. The review process was conducted based on the PRISMA-Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. The COSMIN checklist was utilized to investigate the psychometric properties of the studies, and the results were synthesized narratively. Results: Thirty-seven studies were ultimately included in the review after the full-text evaluation. The review identified 10 PROMs, including the Functional Behavior Profile, Meaningful Activities Participation Assessment, Nottingham Extensive Activities of Daily Living Scale, Rivermead Mobility Index, Reintegration to Normal Living Index, The Subjective Index for Physical and Social Outcome, and Stroke Impact Scales. While these tools are developed with appropriate psychometric properties and focus on varying dimensions of survivors' participation, significant gaps remain in fully addressing their comprehensive needs. Specifically, the tools often overlook contextual differences and fail to adequately assess satisfaction in daily activities. Conclusion: The identified gaps illustrate the need for more comprehensive measures that accurately capture stroke survivors' diverse experiences. Improving these assessments is essential for informing clinical practice and rehabilitation strategies, ultimately enhancing patient engagement, satisfaction, and quality of life and improving rehabilitation outcomes for stroke survivors.

Ozone pollution has significantly worsened in recent years. In the context of global warming, the frequency and intensity of heat waves have significantly increased. Ozone levels exhibit a significant dose-response relationship with cardiovascular disease risk, and high temperatures have been demonstrated to be one of the critical risk factors for cardiovascular disease. Notably, these two hazards potentially create synergistic health impacts through combined exposure effects.

We aimed to estimate the interaction effects between high temperature, ozone and the death of multiple cardiovascular diseases.

We analyzed daily mortality records for cardiovascular disease types alongside meteorological and environmental parameters in Chengdu (2014-2023) through a two-stage analytical framework. In the first stage, we explored the relations between ozone exposure and multiple cardiovascular diseases, then the Distributed Lag Non-Linear Model (DLNM) was utilized to capture the lagged and cumulative effects of temperature and ozone levels on the death of different cardiovascular disease types. In the second stage, both quantitative and qualitative analyses were conducted to further explore their dose-response relationships. Additionally, stratification analyses on gender, age, education level and marital status were also performed.

We observed positive correlations between ozone levels and the death of cardiovascular disease, cerebrovascular disease, coronary heart disease, cerebral infarction, heart attack, hypertension and stroke. The highest cumulative lag effect observed was 3 days. Furthermore, the associations were stronger in women, the older adult, individuals with lower education levels, and unmarried people. High temperature and elevated ozone levels synergistically increased the mortality risk, and the relative excess risk to interaction (RERI, 95% CI) values were cardiovascular disease 0.201 (0.149-0.268), cerebrovascular disease 0.177 (0.099-0.255), coronary heart disease 0.281 (0.169-0.394), cerebral infarction 0.582 (0.369-0.794), stroke 0.287 (0.135-0.441), and 0.482 (0.269-0.694), respectively.

We observed the synergistic interactions between ozone levels and high temperature on the death of cardiovascular disease, cerebrovascular disease, coronary heart disease, cerebral infarction, heart attack and stroke. The associations were stronger in women, the older adult, individuals with lower education levels, and unmarried people.

Socioeconomic status links to exposure of air pollutants. This study evaluates global PM_2.5-attributable ischemic heart disease (IHD) burden from 1990 to 2021.

Using Global Burden of Disease (GBD) 2021 data, PM_2.5-related IHD burdens were analyzed. Joinpoint regression identified annual percentage changes (AAPCs); Pearson correlation assessed associations with Socio-demographic Index (SDI); Slope Index of Inequality (SII) and Concentration Index (CI) were applied to quantify inequality; Frontier analysis was conducted to evaluate the efficiency of health outcomes relative to development level; Decomposition analysis was performed to identify key drivers of burden changes over time.

From 1990 to 2021, age-standardized rates (ASMR, ASDR) of IHD attributable to ambient PM_2.5 declined to 20.85 per 100,000 (AAPC = -0.7), with attributable to household PM_2.5 decreased to 9.02 per 100,000 (AAPC = -2.49). Middle-low SDI regions exhibited the highest increases in ambient PM_2.5-related burden, whereas high SDI regions showed marked declines (AAPC = -4.31). All regions showed downward in household PM_2.5-attributable ASMR and ASDR. Disease burden was disproportionately higher among males and older populations. ASMR and ASDR of IHD exhibited a nonlinear association with SDI. PM_2.5 demonstrated positive correlation in regions with SDI < 0.49, and negative correlation in regions with SDI > 0.623. SII and CI indicated rising inequality in ambient PM_2.5-related burden. Frontier analysis revealed efficiency gaps in low-SDI regions. Decomposition highlighted population aging and ambient PM_2.5 exposure as major drivers of burden trends.

Ambient pollution burdens increase in middle-SDI and household pollution impacts focus on low-SDI, which needs prioritizing clean energy and protecting high-risk populations.

Cardiovascular diseases (CVDs) continue to drive global mortality rates, underscoring an urgent need for advancements in healthcare solutions. The development of point-of-care (POC) devices that provide rapid diagnostic services near patients has garnered substantial attention, especially as traditional healthcare systems face challenges such as delayed diagnoses, inadequate care, and rising medical costs. The advancement of machine learning techniques has sparked considerable interest in medical research and engineering, offering ways to enhance diagnostic accuracy and relevance. Improved data interoperability and seamless connectivity could enable real-time, continuous monitoring of cardiovascular health. Recent breakthroughs in computing power and algorithmic design, particularly deep learning frameworks that emulate neural processes, have revolutionized POC devices for CVDs, enabling more frequent detection of abnormalities and automated, expert-level diagnosis. However, challenges such as data privacy concerns and biases in dataset representation continue to hinder clinical integration. Despite these barriers, the translational potential of machine learning-assisted POC devices presents significant opportunities for advancement in CVDs healthcare.

Endoscopic Retrograde Cholangiopancreatography (ERCP) and Percutaneous Coronary Intervention (PCI) are minimally invasive procedures that treat diseases with minimal scarring and rapid recovery. However, catheterisation under fluoroscopy exposes medical staff to radiation, and navigating flexible guidewires through complex anatomical pathways requires precise control.

To address these challenges, we propose a novel insertion robot based on a Chebyshev lambda mechanism that makes a linear grasp path and an arc-shaped quick return path using a single motor. An integrated roll module enables continuous insertion and rotation, yielding a robot with two degrees of freedom.

Experiments show robots can make sufficient insertion force for real procedures, with robot's maximum mean translational and rotational errors of 0.11 mm and 1.47°, respectively. Phantom model tests show its applicability to human anatomy.

The proposed robotic system demonstrated sufficient precision and force for real surgical applications, indicating its potential for clinical use in minimally invasive procedures.

Post-stroke dysphagia (PSD) is a frequent yet overlooked complication of stroke with significant implications for rehabilitation. While international guidelines provide structured recommendations for early screening and management, guidance on long-term care remains inconsistent. This position paper synthesizes existing guidelines, identifies critical gaps, and highlights the need for standardized long-term management strategies.

Guidelines on PSD management were identified through a two-step approach. Fourteen guidelines were included from a previous systematic review (2014-2023), and two additional guidelines were identified through a systematic PubMed search (2014-2025). Inclusion criteria mandated guidelines of moderate-to-high quality (AGREE II assessment) that were published in peer-reviewed journals and provided specific recommendations for managing PSD during acute, subacute, and chronic phases.

Analysis of 10 moderate-to-high quality guidelines revealed strong consensus on acute-phase screening and early interventions. All recommend dysphagia screening within 24 h of admission, with nine advising nil-per-os status until screening completion. There is consensus on instrumental assessments (videofluoroscopy, endoscopy), though application criteria vary. Management strategies include dietary modifications, nutritional support, oral health care, behavioral interventions, neurostimulation, and pharmacological therapies. While acute-phase recommendations are well defined, structured long-term follow-up guidance remains limited, with only one guideline specifying reassessment intervals beyond hospital discharge.

The absence of standardized long-term PSD management likely reflects limited availability of high-quality evidence on long-term care. Further research is needed to establish optimal reassessment intervals, high-risk subgroups, and long-term rehabilitation strategies to improve care for stroke survivors with persistent dysphagia.

BackgroundAtrial fibrillation (AF) significantly increases the risk of ischemic stroke and often remains asymptomatic until stroke onset. Identifying stroke survivors at high risk for incident AF is critical for targeted anticoagulation therapy. This study aimed to evaluate the predictive utility of the ECG-based SIMP3L2E score alone and combined with Holter-detected supraventricular ectopy for incident AF and recurrent stroke in ischemic stroke survivors.MethodsThis prospective observational study enrolled 77 patients hospitalized with acute ischemic stroke between January and September 2021. Although the SIMP3L2E score was published in 2024, all required ECG parameters were collected prospectively during initial hospitalization and retrospectively calculated for analysis. Incident AF and recurrent strokes were assessed retrospectively over a three-year follow-up. Predictive performance was evaluated using logistic regression and receiver operating characteristic (ROC) analysis.ResultsOf the participants, 27 (35.1%) had high SIMP3L2E scores (≥12). Incident AF occurred in 12 patients (15.6%) and recurrent stroke in 9 patients (11.7%). The SIMP3L2E score alone had modest predictive ability (AUC = 0.588). However, supraventricular ectopy detected by Holter was independently predictive of incident AF (OR: 0.092; 95% CI: 0.016-0.538; p = .008) and significantly improved predictive accuracy (AUC = 0.797).ConclusionThe SIMP3L2E ECG score demonstrated limited predictive power alone in older post-stroke patients but showed substantially improved discrimination when combined with Holter-detected supraventricular ectopy. Integrating static ECG scores with dynamic rhythm monitoring could enhance risk stratification for incident AF following ischemic stroke. Future studies should validate these findings in larger, diverse populations.