Network Meta-analysis was performed to evaluate the efficacy and safety of different traditional Chinese medicine(TCM) injections combined with conventional western medicine in the treatment of patients with coronary heart disease complicated with heart failure. Computer searches were conducted in CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science databases for randomized controlled trial(RCT) of TCM injections from database establishment to December 15, 2024. Literature meeting inclusion criteria were evaluated using the Cochrane risk of bias tool, with network Meta-analysis performed by RevMan 5.4 and Stata 16 software. 237 RCTs were finally included, involving 22 730 total samples and 17 TCM injections. RESULTS:: show:(1) clinical total effective rate improvement, the top three surface under the cumulative ranking curve(SUCRA) rankings were Shuxuetong Injection + conventional western medicine, Sodium Tanshinone Ⅱ_A Sulfonate Injection + conventional western medicine, and Shuxuening Injection + conventional western medicine.(2) Left ventricular ejection fraction(LVEF) improvement, the top three SUCRA rankings were Xuesaitong Injection + conventional western medicine, Shenqi Fuzheng Injection + conventional western medicine, and Ginkgo Leaf Extract and Dipyridamole Injection + conventional western medicine.(3) Brain natriuretic peptide(BNP) reduction, the top three SUCRA rankings were Sofren Injection + conventional western medicine, Shenmai Injection + conventional western medicine, and Shuxuetong Injection + conventional western medicine.(4) N-terminal pro-brain natriuretic peptide(NT-proBNP) reduction, the top three SUCRA rankings were Shengmai Injection + conventional western medicine, Yiqi Fumai Injection + conventional western medicine, and Xinmailong Injection + conventional western medicine.(5) TCM syndrome efficacy improvement, the top three SUCRA rankings were Shenmai Injection + conventional western medicine, Xinmailong Injection + conventional western medicine, and Shenfu Injection + conventional western medicine.(6) Left ventricular end-diastolic diameter(LVEDD) reduction, the top three SUCRA rankings were Salvianolic Acids for Injection + conventional western medicine, Yiqi Fumai Injection + conventional western medicine, and Tanshinone Ⅱ_A Sodium Sulfonate Injection + conventional western medicine.(7) Cardiac output(CO) improvement, the top three SUCRA rankings were Shenqi Fuzheng Injection + conventional western medicine, Salvianolic Acids for Injection + conventional western medicine, and Shengmai Injection + conventional western medicine.(8) 6 min walk test(6MWT) improvement, the top three SUCRA rankings were Danhong Injection + conventional western medicine, Shenmai Injection + conventional western medicine, and Shenfu Injection + conventional western medicine.(9) High-sensitivity C-reactive protein(hs-CRP) reduction, the top three SUCRA rankings were Shenfu Injection + conventional western medicine, Xinmailong Injection + conventional western medicine, and Shengmai Injection + conventional western medicine. The results show that TCM injections combined with conventional western medicine can improve clinical efficacy in patients with coronary heart disease complicated with heart failure. However, given large differences in literature quality and study numbers, the above conclusions need to be verified by more high-quality clinical RCT.

Cardiac glycosides have been used for more than two centuries in patients with heart failure with reduced ejection fraction (HFrEF), but their use has steadily declined in recent decades, largely due to safety concerns raised by observational studies and the availability of outcome-modifying therapies with more favorable safety profiles. Evidence from earlier randomized trials suggested that digoxin improves symptoms and reduces heart-failure hospitalizations without affecting survival, but these studies were conducted before the widespread adoption of contemporary guideline-directed medical therapy (GDMT). Digitoxin is a cardiac glycoside that differs from digoxin through its hepatic clearance and more stable pharmacokinetics, diminishing the impact of renal dysfunction and serum concentration fluctuations, thereby improving safety and facilitating long-term use in routine care. Here, we critically discuss in the context of available evidence the findings of the recently published DIGIT-HF (Digitoxin to Improve Outcomes in Patients with Advanced Chronic Heart Failure) trial, which for the first time evaluated the efficacy and safety of digitoxin in contemporary patients with HFrEF.

Accurate identification of acute coronary syndrome (ACS) in the prehospital setting is important for timely treatments that reduce damage to the compromised myocardium. Current machine learning approaches lack sufficient performance to safely rule-in or rule-out ACS. Our goal is to identify a method that bridges this gap. To do so, we retrospectively evaluate two promising approaches, an ensemble of gradient boosted decision trees (GBDT) and selective classification (SC) on consecutive patients transported by ambulance to the ED with chest pain and/or anginal equivalents. On the task of ACS classification with 23 prehospital covariates, we found the fusion of the two (GBDT+SC) improves the best reported sensitivity and specificity by 8% and 23% respectively. Accordingly, GBDT+SC is safer than current machine learning approaches to rule-in and rule-out of ACS in the prehospital setting.

In recent years, brain hemorrhage has become one of the leading causes of death and disability worldwide. Microwave-induced thermoacoustic imaging (MITAI) has demonstrated significant potential for detecting brain hemorrhages.

However, qualitative thermoacoustic imaging alone is insufficient for characterizing physiological changes in hemorrhage areas, making it difficult to grade the extent of hemorrhage. Therefore, the purpose of this paper is to quantitatively reconstruct the electrical conductivity parameters of brain hemorrhage.

Given the pronounced changes in dielectric properties in the hemorrhage area, we focus on conductivity as the imaging target and have proposed a quantitative conductivity reconstruction network (QCR-Net). This network achieves the end-to-end quantitative reconstruction from thermoacoustic signals to conductivity parameter firstly and is applied to brain hemorrhage detection. Due to the complex end-to-end mapping relationship, we decompose the reconstruction problem into two sub-tasks, including specific absorption rate (SAR) and conductivity reconstruction, to weaken the nonlinearity and ill-posedness of the reconstruction problem.

Additionally, we validated the effectiveness of this network through finite element modeling simulations and in phantom experiments with porcine brain tissue, providing a reliable physical metric for brain hemorrhage detection. We conducted multiple numerical simulations for brain hemorrhage, with results showing that the reconstruction errors for single and dual targets were limited to 4.7 % $\%$ and 5.9 % $\%$ , respectively. Correspondingly, in experiments with pig brains and skull phantoms validated the effectiveness of this network, with reconstruction errors for single and dual targets confined to 7.0 % $\%$ and 12.7 % $\%$ , respectively, which validates the feasibility thermoacoustic quantitative imaging in the transcranial hemorrhage detection. The network can distinguish hemorrhage target as small as 3 mm at a confidence probability 95 % $\%$ .

The above results validate the feasibility of QCR-Net for transcranial hemorrhage detection and highlight its potential as a reliable tool for quantitative thermoacoustic imaging in clinical applications. This work provides a foundation for further development of MITAI as a non-invasive, high-resolution imaging modality for brain hemorrhage diagnosis and grading.

While paediatric cardiac arrest is a rare event, consequences for the patients are significant with a considerable risk of morbidity, disability and mortality. The risk of cardiac arrest is substantially increased in children with congenital heart disease. Nevertheless, there is a lack of data concerning this population. To close this knowledge gap, this multicentre, prospective, open registry aims to implement a standardised structure for data collection and follow-up of paediatric cardiac arrests associated with heart diseases in Germany.

All paediatric patients who experience a cardiac arrest and receive at least 2 minutes of cardiopulmonary resuscitation are invited to participate in this registry. The dataset comprises demographical, clinical, resuscitation and outcome data, collected in accordance with the Utstein guidelines. Neurological assessments, cognitive and motor tests are conducted at fixed intervals. Additionally, patient-reported outcome measures will be surveyed. Primary outcomes are survival to discharge and neurodevelopmental outcome after discharge and 2 years. The data are pseudonymised prior to submission to an online REDCap database, which is centrally hosted on a server located in Leipzig, Germany.

This study follows the Declaration of Helsinki and received ethical approval from the Ethics Committee in Leipzig. Registry results will allow us to understand the epidemiology, guideline adherence, risk factors and will be presented at conferences and submitted to a peer-reviewed journal for publication.

NCT05373498.

Early detection of carotid plaque prevents stroke and myocardial infarction. Individuals with fatty liver might be at an increased risk of developing carotid plaque, yet limited access to carotid artery ultrasound underscores the need for predictive models.

We aimed to construct six predictive models for males and females separately to predict carotid plaque among individuals with fatty liver disease.

A cross-sectional study.

We included 8361 participants aged ≥40 years (4871 males; 3490 females) with fatty liver who underwent at least one health check-up between 1 January 2020 and 31 December 2023.

The sex-stratified dataset was randomly divided into 70% training and 30% internal testing datasets. With 24 potential predictors, we applied four machine learning (ML) algorithms and two conventional logistic regression (LR) models: stepwise LR and LR based on ML-selected features (LR-ML) to develop sex-specific carotid plaque prediction models. The performances were evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score, accuracy, calibration curve and decision curve analysis.

Carotid plaque was determined when the local carotid intima-media thickness was ≥1.5 mm in any of the arterial segments.

Four predictors (age, hypertension, total bilirubin, total cholesterol and white blood cell count) in males and three (age, systolic blood pressure and fasting blood glucose) in females were identified by consensus across the four ML algorithms and subsequently used to construct LR models. Among all 4 ML and two LR models, the gradient boosting machine model demonstrated the best overall performance in males (AUC=0.773, 95% CI 0.749 to 0.797), while the LR-ML model was optimal in females (AUC=0.817, 95% CI 0.791 to 0.843). Calibration and decision curve analyses further demonstrated satisfactory agreement and higher net benefit across sexes. Risk stratification identified distinct low-, intermediate- and high-risk groups with progressively higher observed prevalence of carotid plaque (20.25%, 48.58% and 69.41% in males; 15.28%, 50.89% and 66.56% in females).

Our findings highlight significant sex differences in practical carotid plaque prediction, providing crucial insights for public health implications in the early identification and risk assessment of carotid plaque among individuals with fatty liver.

The implantable cardioverter defibrillator (ICD) is a cardiac device recommended for use to prevent the occurrence of sudden cardiac death (SCD) in post-myocardial infarction (MI) patients with reduced left ventricular ejection fraction (LVEF). The evidence informing this guidance comes from landmark trials that are now more than 20 years old. The risk-benefit profile of ICD for the contemporary target population may have changed substantially since then, which raises the question of whether there is evidence for sparing patients a procedure associated with potentially severe complications and high healthcare costs. A main part of the PRevention Of sudden cardiac death aFter myocardial Infarction by Defibrillator implantation (PROFID) project is the PROFID EHRA trial, which is supported by the European Heart Rhythm Association. PROFID EHRA is a European Union-funded, prospective, randomised, multi-centre, non-inferiority study designed to compare optimal medical therapy (OMT) alone to ICD with OMT, for post-MI patients with reduced LVEF. The study also describes economic evaluation methods to quantify the cost and health implications of using OMT alone in place of ICD implantation plus OMT in this group of patients.

The economic evaluation has been designed to conduct a pre-trial cost-effectiveness analysis (CEA) prior to the availability of trial data, followed by a within-trial cost-consequences analysis (CCA) and a long-term post-trial CEA, conducted from the National Health Service and Personal Social Service perspective in England. The pre-trial CEA uses simulation modelling informed by available evidence to assess the lifetime costs and quality-adjusted life years of OMT alone and ICD+OMT in post-MI patients with reduced LVEF at risk of SCD, as defined in the PROFID EHRA trial. The within-trial CCA is intended to summarise the health-related quality of life (HRQoL), healthcare resource use and associated costs observed during the PROFID EHRA trial follow-up period. The post-trial CEA updates the pre-trial model by incorporating contemporary evidence about the HRQoL and costs observed during the trial and the occurrence of those events and outcomes accruing during the trial follow-up period and projecting them into the expected lifetime of the patients. Sensitivity analyses are performed to assess the robustness of the CEA results with respect to both model assumptions and uncertainty in the value of the model input parameters. Finally, a value of information analysis will identify the key drivers of uncertainty surrounding the model conclusions regarding the optimal treatment strategy, establishing if further research may be required.

The PROFID EHRA trial, under legal sponsorship of Charité-Universitätsmedizin Berlin, Germany, received its first ethics approval by the Medicine Research Ethics Committee of the La Paz University Hospital in Madrid, Spain (reference number LHS-2019-0209). Before including patients, for all participating study centres, the required local, central and/or national ethical approval has to be obtained. As of the date 13 November 2025, at least one participating study centre in the following countries has received ethical approvals from relevant ethics committees: Austria, Belgium, Czech Republic, Denmark, France, Germany, Great Britain, Hungary, Israel, the Netherlands, Poland and Spain. Results will be shared with the general public through various media channels and additionally with healthcare professionals and the scientific community through scientific meetings, conferences and publications.

NCT05665608.

Objective: To investigate the intra-individual variability of the plasma aldosterone concentration (PAC) and the plasma renin concentration (PRC) and explore its impact on screening for primary aldosteronism (PA). Methods: This cross-sectional study enrolled patients with PA and patients with essential hypertension (EH) who were admitted to the First Affiliated Hospital of Chongqing Medical University from July 2018 to December 2024. Clinical and biochemical data, including PAC and PRC, were collected. The intra-individual coefficient of variation (CV) and percentage difference (PD) were calculated. The rates of PA diagnosis missed were further analyzed. Results: In total, 431 patients with PA [mean age 48.2 years; 192 males (44.5%)] and 495 patients with EH [mean age 49.6 years; 198 males (40.0%)] were included. In the PA group, the intra-individual CVs for PAC, PRC, and the aldosterone-to-renin ratio (ARR) were 21.3%, 36.9%, and 39.5%, respectively, and the corresponding mean PDs were 23.1%, 38.5%, and 43.5%. In the EH group, the intra-individual CVs for PAC, PRC, and ARR were 23.5%, 33.5%, and 32.5%, respectively, and the mean PDs were 25.7%, 36.1%, and 36.3%, respectively. Due to intra-individual variability, 10.2% (44/431) of PA patients may be missed during screening, 70.5% (31/44) of whom exhibit a history of hypokalemia and/or adrenal nodules. Conclusions: Plasma aldosterone and renin levels display considerable intra-individual variability, which may compromise the accuracy of PA screening. Repeat testing is recommended for patients with an initial negative screening result who have a history of hypokalemia and/or adrenal nodules.

This study aims to explore the mechanism of Anshen Dingxin Granules in improving isoproterenol(ISO)-induced ventricular premature beats(VPB) in rats. Sixty rats were randomly divided into six groups: a control group, a model group, a low-dose Anshen Dingxin Granules group, a middle-dose Anshen Dingxin Granules group, a high-dose Anshen Dingxin Granules group, and a propranolol group. The control and model groups were given physiological saline. Two hours after gavage, ISO was injected to induce VPB in all groups except the control group. The injection continued for 7 days. Afterward, the VPB occurrence in each group was monitored by electrocardiogram. Histopathological changes in myocardial tissues were observed by HE and Masson staining. Ultrastructural changes in myocardial tissues were examined by transmission electron microscopy(TEM). The serum superoxide dismutase(SOD), malondialdehyde(MDA), and glutathione(GSH) levels were measured using biochemical methods. The hypoxia-inducible factor-1α(HIF-1α) protein expression in myocardial tissues was analyzed by immunohistochemistry. The HIF-1α, nuclear factor E2-related factor 2(Nrf2), heme oxygenase 1(HO-1), and glutathione peroxidase 4(GPX4) protein expressions in myocardial tissues were detected by Western blot. The Nrf2, HO-1, and GPX4 mRNA expressions in myocardial tissues were measured by PCR. The results show that, compared with the control group, the model group exhibits frequent VPBs and significantly increased arrhythmia scores(P<0.01), significantly increased heart weight index(HWI)(P<0.01), significant pathological damage in myocardial tissues, elevated levels of the oxidative stress marker MDA(P<0.01), and decreased SOD and GSH levels(P<0.01), increased HIF-1α protein expression(P<0.01), decreased Nrf2, HO-1, and GPX4 protein expressions(P<0.01), as well as decreased Nrf2, HO-1, and GPX4 mRNA expressions(P<0.01). Compared with the model group, the propranolol group and the high-dose Anshen Dingxin Granules group exhibit delayed onset and reduced frequency of VPBs(P<0.01). Besides, in the two groups of the above comparison, a significant decrease occurs as follows: arrhythmia scores(P<0.05), HWI(P<0.05 or P<0.01), myocardial tissue pathological damage, oxidative stress indicator MDA level(P<0.05 or P<0.01), HIF-1α protein expression(P<0.01) while significant increase is found in the items below: SOD and GSH levels(P<0.01), Nrf2, HO-1, and GPX4 protein expressions(P<0.05 or P<0.01), Nrf2, HO-1, and GPX4 mRNA expressions(P<0.05 or P<0.01). In conclusion, Anshen Dingxin Granules can improve ISO-induced VPB in rats. This effect may stem from HIF-1 signaling pathway regulation, which inhibits oxidative stress and in turn reduces myocardial cell damage.

This study compared the pharmacodynamics and metabolomics of aqueous extracts of leech before and after talc processing, focusing on their anti-thrombotic effects in thrombotic rats, intending to clarify the impact of talc processing on the efficacy and mechanism of leech. A carrageenan-induced rat tail thrombosis model was employed. Drugs were administered for five days before modeling, and 24 hours after modeling, the black tail length/rate was measured. Blood samples were collected to assess coagulation parameters, platelet aggregation rates(maximum aggregation rate, MAR; average aggregation rate, AAR), pathological sections, and blood biomarkers(adenylate cyclase, AC; cyclic adenosine monophosphate, cAMP). Ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS) was used in combination with orthogonal partial least squares-discriminant analysis(OPLS-DA) to screen differential metabolites. Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway analysis was applied to elucidate metabolic regulatory mechanisms. The results show that compared with the blank group, the model group exhibited significantly increased black tail length and rate, significantly shortened coagulation time, markedly increased fibrinogen(FIB) content, significantly increased MAR and AAR, and decreased expression of AC and cAMP. The pathological section examination shows that thrombi occupied the vessels. Compared with the model group, raw and talc-processed leech extracts-treated groups show significantly decreased black tail length and rate, significantly prolonged coagulation time, markedly decreased FIB content, significantly reduced MAR and AAR, and increased AC and cAMP levels. The pathological section examination shows that the thrombus in the tail section of the rats in the raw and talc-processed leech extract groups was significantly reduced. Compared with the blank group, 57 differential metabolites were screened out in the model group, among which 40 and 39 biomarkers were modulated by the raw and talc-processed leech. The raw leech mainly affects glycerophospholipid metabolism, arachidonic acid metabolism, and glycerolipid metabolism. The metabolism of glycerophospholipid, the synthesis of phenylalanine, tyrosine, and tryptophan, arachidonic acid metabolism, phenylalanine metabolism, and glycerolipid metabolism are mainly affected by talc-processed leech. In conclusion, both raw leech and talc-processed leech have good antithrombotic effects, with talc-processed leech having a stronger effect. The two leech products can significantly reverse the metabolic abnormalities in rats with tail thrombosis, and the mechanism may be related to the regulation of glycerophospholipid metabolism, arachidonic acid metabolism, and glycerolipid metabolism.