The brain-computer interface-based soft robotic glove (BCI-SRG) holds promise for upper limb rehabilitation in subacute stroke patients, yet its efficacy and neural mechanisms are unclear. This study aimed to investigate the therapeutic effects and neural mechanisms of BCI-SRGs by functional near-infrared spectroscopy (fNIRS).

Forty subacute stroke patients with left-sided hemiparesis were randomized into the BCI-SRG (n = 20) and soft robotic glove (SRG) (n = 20) groups. Both groups received 20 sessions of intervention over 4 weeks in addition to conventional rehabilitation. The BCI-SRG group was trained using a soft robotic glove controlled by a brain‒computer interface (BCI), whereas the SRG group used the same soft robotic glove without BCI control. The clinical outcomes included the Action Research Arm Test (ARAT), the Fugl-Meyer Assessment Upper Limb (FMA-UL), and Modified Barthel Index (MBI) scores. In addition, fNIRS was used to explore potential clinical brain mechanisms. All assessments were performed before treatment and after 4 weeks of treatment.

A total of 39 participants completed the intervention and clinical assessments (BCI-SRG: n = 20; SRG: n = 19). Compared with the SRG group, the BCI-SRG group showed greater improvements in the ARAT (Z = - 2.139, P = 0.032) and FMA-UL (Z = - 2.588, P = 0.010), with no notable difference in the MBI (Z = - 1.843, P = 0.065). fNIRS data were available for 35 participants (BCI-SRG: n = 17; SRG: n = 18). Within-group comparisons revealed significant postintervention increases in cortical activation in the bilateral sensorimotor cortex (SMC) and medial prefrontal cortex (MPFC) in the BCI-SRG group, whereas no significant changes were observed in the SRG group. Between-group comparisons further revealed significantly greater changes in HbO concentrations in the BCI-SRG group than in the SRG group across the same cortical regions. Moreover, changes in prefrontal activation (post-pre) were positively correlated with improvements in ARAT scores, with significant correlations observed in the left dorsal lateral prefrontal cortex (LDLPFC) (Ch9, r = 0.592, P = 0.012; Ch25, r = 0.488, P = 0.047) and right dorsal lateral prefrontal cortex (RDLPFC) (Ch19, r = 0.671, P = 0.003).

BCI-SRG training significantly enhances upper limb function and facilitates bilateral motor and sensory cortical reorganization. PFC activation is correlated with functional improvements, suggesting a potential mechanism underlying the benefits of rehabilitation in stroke patients.

This trial was registered under the Chinese Clinical Trial Registry (ChiCTR2400082786) and was retrospectively registered on April 8, 2024.

Coronary artery disease (CAD) remains a leading cause of global mortality, with stroke constituting a significant complication among patients undergoing coronary revascularization procedures, such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Previous research has demonstrated the successful application of machine learning (ML) in predicting various postoperative outcomes, including poor prognosis following cardiac surgery and the risk of postoperative stroke. Despite these advancements, a critical gap persists in studies quantitatively linking the risk of postoperative stroke to revascularization using ML-based approaches. This study aims to address this gap by developing and validating ML models to predict the risk of stroke in CAD patients undergoing coronary revascularization, with the ultimate goal of enhancing clinical decision-making and improving patient outcomes.

We developed an ML framework to predict stroke risk in patients with CAD undergoing revascularization. A total of 5,757 patients were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Feature selection was performed using a combination of Pearson correlation analysis, least absolute shrinkage and selection operator (LASSO), ridge regression, and elastic net. Initially, 35 features were identified based on expert opinion and a comprehensive literature review; the integrated results of the feature selection methods reduced the feature set to 14. The dataset was randomly divided into training, testing, and validation subsets with proportions of 70%, 15%, and 15%, respectively. Several ML models were evaluated, including logistic regression, XGBoost, random forest, AdaBoost, Bernoulli naive Bayes, k-nearest neighbors (KNN), and CatBoost. Model performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC), accuracy, and 500 bootstrapped 95% confidence intervals (CIs) to ensure robust evaluation.

The CatBoost model demonstrated superior performance, achieving an AUC of 0.8486 (95% CI: 0.8124-0.8797) on the test set and 0.8511 (95% CI: 0.8203-0.8793) on the validation set. Shapley Additive Explanations (SHAP) analysis identified the Charlson Comorbidity Index (CCI), length of stay (LOS), and treatment types as the most influential predictors. Notably, compared to the best existing literature, which reported an AUC of 0.760 on the test set, our model exhibited a 9% improvement in predictive performance while utilizing a more parsimonious feature set.

By integrating four feature selection methods, we significantly streamlined the feature set, resulting in a more efficient and reliable predictive model. We propose the CatBoost model for the prediction of postoperative stroke in patients with CAD undergoing coronary revascularization. With its high accuracy, the proposed model offers valuable insights for medical practitioners, enabling informed decision-making and the implementation of preventive measures to mitigate stroke risk.

Although the left atrium (LA) plays a key role in diastolic function, LA dysfunction in patients with repaired tetralogy of Fallot (rTOF) remains unclear. Recently, LA strains assessed using a speckle tracking system have been used as novel sensitive indicators of LA function. Therefore, we aimed to evaluate LA function and investigate changes with age in patients with rTOF using speckle-tracking echocardiography.

We analyzed three age-based subgroups of patients with rTOF (T1, T2, T3) and their corresponding healthy control groups (C1, C2, C3) to assess phasic left atrial function: T1 and C1 (3-9 years [children]), T2 and C2 (10-19 years [adolescents and young adults]), and T3 and C3 (20-44 years [adults]). LA strain was assessed by two-dimensional speckle-tracking echocardiography and defined according to its three distinct phases, with the LA serving as a reservoir during systole, a conduit during early diastole, and a booster pump at the end of diastole. Furthermore, we examined the correlations between LA strains and left ventricular longitudinal strain (LVLS) as well as conventional echocardiographic parameters.

LA reservoir and pump strains were lower in the T3 group than in the C3 group (35.5 (30.1/41.3) vs. 42.9 (41.1/48.1), P = 0.010; 8.3 (7.4/10.6) vs. 11.4 (10.7/13.5), P = 0.025, respectively). In the T1 and T2 groups, no significant differences in LA strains were reported. LA functions based on LA volume did not show any difference between rTOF and controls among all age groups. All LA strains only moderately or weakly correlated with LVLS and mitral E/A, but not with left ventricular (LV) lateral e' nor E/e'. Reservoir strain-LVLS (ρ = 0.476, P < 0.001), conduit strain-LVLS (r = 0.382, P < 0.001), pump strain-LVLS (ρ = 0.337, P < 0.001), reservoir strain-E/A (ρ = 0.200, P = 0.026), conduit strain-E/A (ρ = 0.282, P = 0.002), and pump strain-E/A (ρ = -0.209, P = 0.02).

LA phasic function decreases in adult patients with rTOF. LA reservoir and pump strains may serve as sensitive indicators of diastolic dysfunction in these patients.

The objective of this study was to perform a cost-utility analysis of dapagliflozin, as an add-on therapy to standard of care (SoC), compared with SoC, for patients with symptomatic chronic heart failure (HF) in Spain, including patients with reduced and preserved ejection fraction.

A Markov model was designed to simulate the progression of chronic HF over a lifetime horizon using pooled data from the DAPA-HF and DELIVER trials. Disease progression was captured by transitions between health states, defined by the Kansas City Cardiomyopathy Questionnaire Total Symptom Score. Transient events of hospitalization for HF (HHF), urgent HF visits (UHFV) and cardiovascular (CV) and non-CV death were included. The analysis was conducted from the Spanish National Health System perspective. The results were expressed as cost per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to assess the robustness of the results.

Dapagliflozin + SoC showed an increase in effectiveness (0.31 QALY) and total cost per patient (€1,441) compared to SoC, yielding an incremental cost-utility ratio of €4,611/QALY. Dapagliflozin reduced the incidence of HHF by 136.4 events (752.2 vs. 886.6), UHFV by 38.8 (217.6 vs. 254.4) and CV death by 23.0 (505.8 vs. 528.8) for every 1,000 patients. Dapagliflozin + SoC was cost-effective compared to SoC in 99.9% of iterations at a willingness-to-pay (WTP) threshold of €25,000/QALY.

The analysis shows that dapagliflozin, as add-on therapy to SoC, would be a cost-effective option compared to SoC for the treatment of adult patients with symptomatic chronic HF in Spain at a WTP of €25,000/QALY.

Cardiovascular diseases, particularly atherosclerosis, remain a leading cause of global mortality, presenting significant challenges with non-ST-segment elevation myocardial infarction (NSTEMI). Novel biomarkers such as cluster of differentiation 47 (CD47) and adenylate cyclase-associated protein 1(CAP1) have emerged as potential candidates for improving early diagnosis and risk stratification in NSTEMI patients.

This prospective cohort study was conducted at Tianjin Chest Hospital from November 2023 to June 2024, involving a total of 270 patients categorized into NSTEMI and unstable angina (UA) groups. We used multivariable logistic regression analysis to elucidate the relationship between CD47, CAP1, and the onset of NSTEMI. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of CD47 and CAP1 as biomarkers for the early diagnosis of NSTEMI in the population.Subsequently, Cox regression models were utilized to conduct short-term (median follow-up of 146 days) assessments of patients, evaluating the role of CD47 and CAP1 in early risk stratification.

In our study, CD47 and CAP1 exhibited strong correlations with NSTEMI patients. Furthermore, in ROC analysis, CAP1 (AUC = 0.827, 95% CI: 0.778-0.875, P<0.001) and CD47 (AUC = 0.807, 95% CI: 0.756-0.859, P<0.001) demonstrated robust diagnostic value. Cox regression analysis identified CD47 (HR, 1.059; 95% CI 1.010-1.110; P = 0.018) and CAP1(HR, 5.385; 95% CI 1.769-16.388; P = 0.003) as independent predictors of short-term major adverse cardiovascular events (MACE) in NSTEMI patients. After adjusting some variables, high CD47 group (HR: 4.017, 95%CI 1.320-12.224, P = 0.014) and high CAP1 group (HR: 3.893, 95% CI 1.366-11.090, P = 0.011) the risk of developing MACE was significantly increased in the lower group.

CD47 and CAP1 demonstrated robust diagnostic value for early NSTEMI and great predictive power for short-term MACE in NSTEMI patients.

Emerging triglyceride-glucose (TyG)-related indices, such as the TyG-related body roundness index (TyG-BRI), a body shape index (TyG-ABSI), weight-adjusted waist index (TyG-WWI), and Chinese visceral adiposity index (TyG-CVAI), have gained attention as promising predictors of diverse cardiometabolic conditions. Nevertheless, their prospective associations with stroke onset remain insufficiently characterized, especially in individuals affected by cardiovascular-kidney-metabolic (CKM) syndrome.

This prospective cohort study included 7,503 middle-aged and older adults with CKM syndrome stages 0-3 (see Methods: Definition of CKM Stages 0 to 4) from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to evaluate the associations between TyG-related indices and incident stroke, with potential non-linear relationships examined via restricted cubic splines (RCS). Discriminative performance was compared using receiver operating characteristic (ROC) curves. Mediation analysis was conducted to assess whether systolic blood pressure (SBP) mediated the associations. Subgroup and sensitivity analyses were also performed to verify robustness.

Over a median follow-up of 5.2 years, 625 participants (8.33%) experienced a first stroke (incidence rate 102.18 per 10,000 person-years). In fully adjusted models, each 1-SD increase in TyG-BRI, TyG-ABSI, TyG-WWI, and TyG-CVAI was associated with stroke hazards of 1.16 (95% CI, 1.06-1.27), 1.10 (1.01-1.21), 1.13 (1.03-1.25), and 1.20 (1.10-1.31), respectively. Participants in the highest TyG-CVAI quartile had a 67% higher risk than those in the lowest (HR, 1.67; 95% CI, 1.28-2.18). Nonlinear thresholds were identified at TyG-BRI 18.16 and TyG-WWI 78.93. ROC analysis indicated that TyG-CVAI had the greatest discriminative ability for predicting stroke. SBP mediated 26.3-32.9% of these associations. The findings were consistent across multiple subgroup and sensitivity analyses.

Novel TyG-related indices, particularly TyG-CVAI, showed significant and incremental predictive value for stroke risk among individuals with CKM syndrome stages 0-3. Their incorporation into risk stratification frameworks may enhance early detection and prevention of cerebrovascular events in metabolically vulnerable populations.

Metabolic syndrome (MetS) and cardiovascular disease (CVD) are growing occupational health concerns, particularly among sedentary and high-stress professions. This study investigates the prevalence of MetS and related cardiovascular risk factors among Iranian bank employees.

This cross-sectional study included 1,661 bank employees in Tehran, enrolled between January and March 2023. Participants completed physician interviews, provided fasting blood samples, and underwent clinical assessments. Demographic and occupational data, smoking status, blood pressure, and biochemical markers were collected. MetS was defined using ATP III criteria, and 10-year ASCVD risk was calculated using the 2019 ACC/AHA Pooled Cohort Equations. Data analysis was performed with SPSS 27.

Among participants, the mean age was 43.4 (5.9) years, and a body mass index of 27.3 (4) kg/m² (73.5% men; 91.8% non-smokers) were included. The prevalence of MetS was 26.2% (95% confidence interval [95%CI]: 24.1-28.3), with low HDL cholesterol as the most frequent component. Compared to operational staff, management employees had significantly higher odds of key MetS components, including high blood pressure (52.7% vs. 44.1%; OR: 1.41, 95% CI: 1.16-1.71; P = 0.001), elevated triglycerides (33.4% vs. 26.2%; odds ratio [OR]: 1.41, 95% CI: 1.14-1.75; P = 0.002), elevated FBS (10.9% vs. 5.5%; OR: 2.09, 95% CI: 1.45-3.01; P < 0.001), low HDL (82.3% vs. 70.4%; OR: 1.96, 95% CI: 1.54-2.49; P < 0.001), and abdominal obesity (26.9% vs. 18.5%; OR: 1.62, 95% CI: 1.28-2.05; P < 0.001). Older age (adjusted OR: 1.03, 95% CI: 1.01-1.05; P < 0.001) and managerial roles (adjusted OR: 0.71, 95% CI: 0.56-0.91; P < 0.001) were significant determinants of MetS. The median ASCVD risk score was higher in men than women (2.2 [IQR: 1.4-3.7] vs. 0.6 [0.4-0.9]; P < 0.001) and in management staff compared to operational staff (2.2 [1.3-3.7] vs. 0.3 [0.7-2.4]; P < 0.001). Age (adjusted OR: 1.17, 95% CI: 1.14-1.20; P < 0.001) and management position (adjusted OR: 2.24, 95% CI: 1.70-2.95; P < 0.001) were independently associated with increased ASCVD risk.

MetS is prevalent among Iranian bank employees, with older age, male sex, and managerial positions identified as significant associated factors. These findings underscore the need for targeted workplace health interventions and further research to evaluate cardiometabolic risk across occupational settings.

Little is known regarding blood pressure (BP) targets in pediatric intracerebral hemorrhage (ICH). We sought to explore associations between BP and outcomes in these children.

We conducted a single-center retrospective review of patients admitted to the pediatric intensive care unit (PICU) with ICH between January 2017 and August 2024. Hemodynamic parameters examined were percent time in systolic hypotension and percent time above stage I systolic hypertension, stage II systolic hypertension, 95^th percentile mean arterial pressure (MAP), and 99^th percentile MAP in the first 48 h of PICU admission. Outcomes observed were in-hospital mortality and unfavorable functional outcome (modified Rankin Scale > 2) among survivors 90 days after discharge. Association between BP and outcomes were assessed with univariate and multivariable analyses, adjusting for clinical covariates.

Seventy-three patients (1- to 17-years-old) were included. Most had brain arteriovenous malformations (57.5%) or cavernous malformations (20.5%); 32.9% presented with a Glasgow Coma Scale score < 9. Percent time in hypotension (p = .007), above 95^th percentile for MAP (p = .012), above 99^th percentile for MAP (p = .024), and presenting GCS < 9 (p = .01) were associated with in-hospital mortality, and percent time in hypotension (p = .002) was associated with unfavorable 90-day outcome in univariate analysis. In multivariable regression, no BP variable reached significance. Children who experienced both hypotension and hypertension more frequently had an unfavorable outcome compared to those who only experienced hypertension.

Time spent in hypotension or greater than 95^th percentile MAP was associated with outcomes, though associations were not significant after adjustment for other clinical factors.

The incidence of iodinated contrast media (ICM)-related adverse drug reactions (ADRs) varies significantly by procedure type. Compared other procedure types, cerebrovascular interventional procedures substantially increase the incidence of contrast-induced encephalopathy (0.38-2.90%). The associations of ioversol (nonionic low-osmolal ICM) with central nervous system (CNS) ADRs and iodixanol (nonionic ios-osmolal ICM) with cutaneous ADR manifestations have been establishe. This study aimed to compare the incidence of CNS ADRs and evaluate the occurrence, extent, and risk factors for ADRs associated with ioversol and iodixanol use during cerebrovascular interventional procedures. We conducted a prospective study involving 1,015 participants with suspected cerebrovascular diseases from July 2019 to July 2022. Participants underwent cerebrovascular interventional procedures with either iodixanol or ioversol administration. Data on ioversol and iodixanol-related CNS ADRs, data on other ADRs, and participants' baseline information were collected. Out of 848 participants (average age, 61.5 ± 12.6 years; 205 females) who received ICM, 16.7% (142 of 848) experienced CNS ADRs. Compared with iodixanol, ioversol was associated with a greater rate of CNS ADRs (12.6% vs. 21.1%, P = 0.001, RR = 1.666). Iodixanol was associated with higher rates of numbness and blurred vision (29.1% vs. 14.9%, P = 0.042), whereas ioversol was associated with higher incidences of headache and overall ADRs during the procedures (20.0% vs. 46.0%, P = 0.002). Logistic regression analysis revealed that a history of allergic diseases was a risk factor for iodixanol-related ADRs (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.2-4.9; P = 0.010). Severe cerebral vascular stenosis (OR, 2.8; 95% CI: 1.8-4.4; P < 0.001), female sex (OR, 0.5; 95% CI: 0.3-0.8; P = 0.005) and relatively young age (OR, 0.97; 95% CI: 0.95-0.99; P = 0.004) were risk factors for ioversol-related ADRs. Iodixanol appears to have a lower likelihood of causing ICM-related CNS ADRs than does ioversol during cerebrovascular interventional procedures.