Metformin alleviates oxidized low-density lipoprotein (ox-LDL)-induced macrophage senescence, a key process in atherosclerosis. Our in vitro findings demonstrate that metformin suppresses ox-LDL-induced overexpression of the nuclear receptor NR4A1 in macrophages. This inhibition subsequently reduces excessive mitophagy, improves mitochondrial membrane potential and decreases reactive oxygen species (ROS) production. The amelioration of this mitochondrial dysfunction directly attenuated cellular senescence markers and reduced the secretion of inflammatory cytokines. Furthermore, we identified Caveolin-1 as a critical regulator of metformin's protective effects. Overexpression of Caveolin-1 was shown to reverse metformin-mediated improvements in mitochondrial function. These results establish that metformin mitigates macrophage senescence by targeting the NR4A1-mitophagy pathway, with Caveolin-1 serving as an essential modulator. This NR4A1-mitophagy axis represents a promising therapeutic target, positioning metformin as a potential candidate for slowing atherosclerosis progression by preserving mitochondrial health in macrophages.

Prehospital delays remain critical barriers to timely acute coronary syndrome (ACS) care, particularly for patients referred from resource-constrained primary healthcare to hospitals with percutaneous coronary intervention (PCI) capabilities. This study evaluated the associations between China Chest Pain Unit (CPU) programme, with prehospital delays, management and in-hospital outcomes for ACS patients.

This retrospective cohort study used registry data from the Chinese Cardiovascular Association Database. We included patients diagnosed with ACS who were referred from primary healthcare facilities to chest pain centres (CPCs). The CPU-referral group received standardised triage and referral protocols; the non-CPU-referral group received routine referral. All patients were treated at CPCs. Primary outcomes included in-hospital heart failure, in-hospital mortality, door-in-door-out (DIDO) time and time from onset to CPC door. Secondary outcomes included time from onset to first medical contact, door-to-balloon time, discharge medication use, length of stay and total hospital expenditure. Propensity score matching and generalised linear mixed models were used to evaluate the associations.

A cohort consisting of 8834 patients was constructed by propensity score matching among 119 723 eligible referred ACS patients (5000 CPU-referrals and 114 723 non-CPU-referrals). CPU referral was associated with lower odds of in-hospital heart failure (OR 0.16, 95% CI 0.08 to 0.30) and in-hospital mortality (OR 0.68, 95% CI 0.50 to 0.92), shorter DIDO time (β=-0.33, 95% CI -0.40 to -0.25) and shorter times from onset to arrival at the CPC door (β=-0.19, 95% CI -0.27 to -0.11). CPU referral was also associated with shorter time to first medical contact and door-to-balloon time, improved adherence to guideline-recommended discharge medications, reduced length of stay and lower total hospital expenditure.

The regionalised quality improvement programme for CPUs was associated with reduced prehospital delays, lower in-hospital heart failure and mortality, better care quality and lower costs among referred ACS patients.

Continuous pressure measurement of traumatized muscle has been shown to be an accurate method of diagnosing acute compartment syndrome (ACS), but no baseline data have been released to show the reaction to surgery in extremity fracture. We sought to establish normal values for perioperative pressures.

We obtained pressure tracings from prospective clinical trials of forearm and tibia fractures requiring surgery. We standardized data and produced graphs using the ggplot2 library in R version 4.2.2. We generated generalized pressure curves based on the mean pressure and quantile distribution for each time point.

We retrieved data from 79 preoperative and 50 postoperative patients. The mean age was 43 years in both groups. Patients exhibited higher pressures postoperatively whether or not they developed ACS. In both the preoperative and postoperative ACS groups, muscle pressure trended upward at an average rate of 0.078 and 0.073 mmHg per hour, respectively, but trended downward in non-ACS groups, at a rate of 0.24 and 0.27 mm Hg per hour pre- and postoperatively, respectively. Patients younger than 45 years registered the highest initial postoperative pressure. Postoperative initial pressures were higher than preoperative pressures and were higher among males than females. Females had steeper decreasing pressure curves in both pre- and postoperative scenarios.

We observed trends in muscle pressure by sex, age, and diagnosis of ACS among trauma patients. Understanding these variations is essential for improving timely diagnosis of ACS.

Anticoagulation for stroke prevention is often recommended for patients with non-valvular atrial fibrillation (AF), yet many eligible patients do not receive guideline-concordant anticoagulation. Prior quality improvement (QI) initiatives to improve anticoagulation in AF have had mixed results.

Preventing Preventable Strokes: Scalability used a triad of interventions to increase the number of eligible patients with AF receiving guideline-concordant anticoagulation, including (1) a best practice alert integrated with the electronic health record, (2) clinician education and (3) patient communication about the anticoagulation therapy that encouraged shared decision-making with clinicians. These interventions were conducted in primary care and cardiology outpatient clinics at (University of Florida Health). Patient-level data were collected during a 6-month intervention period and compared with a 6-month historical control period. Generalised estimating equations with a logistic link were used to estimate the odds of anticoagulant use, adjusting for demographic and clinical characteristics.

A total of 3274 individuals were included during the intervention period and 3200 during the preintervention period. The average anticoagulation rate increased from 75.7% to 79.2% across the two periods. In the fully adjusted model, patients in the intervention period had significantly higher odds of anticoagulant use compared with the preintervention period (adjusted OR (aOR) 1.13, 95% CI 1.05 to 1.21, p=0.0007). MyChart activation (aOR 1.38, 95% CI 1.19 to 1.61, p<0.0001) was also associated with increased anticoagulant use. Older age and higher CHA₂DS₂-VASc scores were associated with greater odds of anticoagulant use, while higher HAS-BLED scores and care in primary care (rather than cardiology) were associated with lower odds.

A triad of QI interventions at the practice, clinician and patient levels increased guideline-concordant anticoagulation use among patients with AF in half of the primary care and cardiology clinics in the University of Florida Health system.

A middle childhood boy with homozygous sickle cell disease (SCD) on hydroxyurea, previously healthy, presented with acute bilateral limb pain progressing rapidly to altered sensorium and signs of raised intracranial pressure. Cranial CT revealed bilateral epidural haematomas with a large left fronto-parietal epidural haematoma (EDH) and midline shift. He underwent urgent craniotomy, mechanical ventilation, blood transfusion and phenobarbitone coma for autonomic instability. He recovered with initial right hemiparesis that improved to independent ambulation without limitation, with no recurrence on follow-up. This case represents the youngest documented survivor of spontaneous EDH in SCD, emphasising that non-traumatic intracranial bleeding can occur even at early ages in SCD patients. Emergency physicians should remain alert to this rare possibility in young children with SCD.

Coronary CT-derived fractional flow reserve (CT-FFR) is a noninvasive alternative to invasive FFR for assessing the hemodynamic significance of coronary artery stenosis. CT-FFR uses routinely acquired coronary CT angiography (CCTA) with artificial intelligence and computational fluid dynamics to estimate pressure gradients, thereby supporting clinical decision-making without procedural risk. Adoption and implementation vary widely across regions. In Asia, South Korea exclusively uses HeartMedi+, which enables rapid analysis, streamlined workflow integration, and high user satisfaction. Japan relies primarily on FFR_CT, which has national reimbursement and significantly influences treatment strategies, reducing unnecessary invasive procedures. Hong Kong, Singapore, Taiwan, Thailand, and Vietnam remain in early or exploratory phases due to cost, reimbursement, and infrastructure barriers. In the United States, CT-FFR is guideline-endorsed and reimbursed, where HeartFlow is the most widely used, supported by robust clinical validation and outcome data. Despite regional variability, CT-FFR offers a noninvasive solution that enhances patient management, reduces unnecessary invasive testing, and is poised for broader clinical integration as technology and validation advance.

The Michigan Risk Score (MRS) was developed to predict peripherally inserted central catheter (PICC)-related thrombosis. This study aimed to externally validate the MRS in a Brazilian cohort.

Adults hospitalized in 16 Brazilian hospitals who received a PICC were followed until catheter removal, death, or 30 days. The MRS assigned risk points based on 5 clinical variables: presence of another central line, white blood cell count >12 000, multi-lumen PICC, history of deep vein thrombosis (DVT), and active cancer. Mixed-effects logistic regression assessed MRS performance, including calibration and discrimination.

A total of 12 725 PICCs in 11 135 patients (mean age 66.4 ± 19 years; 51% female) were included. Deep vein thrombosis occurred in 129 cases (1.0%). Only the number of PICC lumens and history of venous thromboembolism (VTE) were significantly associated with DVT risk. Compared to risk class I, the odds ratios for risk classes III and IV were 2.83 (95% CI, 1.51-5.3) and 3.01 (95% CI, 1.41-6.41), respectively. The area under the curve was 0.70 for the multivariable model and 0.67 for the MRS classification.

Peripherally inserted central catheter lumens and VTE history were independently associated with DVT risk. Classes III and IV of the MRS had higher event rates than class I.

Peripheral arterial disease (PAD) is a condition most commonly caused by atherosclerotic narrowing of lower limb arteries, resulting in intermittent claudication, chronic limb-threatening ischaemia or acute limb ischaemia. There are various treatment strategies, including atherectomy, a technique used during endovascular surgery where the atheroma is cut or ground away within the artery. Another procedure, such as balloon angioplasty, is often performed at the same time. The studies investigating atherectomy for PAD have all been small-scale, with varying methodologies and, as a result, it is unclear if atherectomy is a more effective treatment for PAD compared to more conventional treatments. Despite this, rates of atherectomy use are increasing, especially in the United States. This review focuses on randomised controlled trials and is the second update of a Cochrane review, following the original publication in 2014 and the first update in 2020.

To evaluate the benefits and harms of atherectomy as a treatment for peripheral arterial disease compared to other treatments.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers from 13 August 2019 to 28 January 2025.

We included all randomised controlled trials that compared atherectomy with other established treatments. All participants had symptomatic PAD with either claudication or chronic limb-threatening ischaemia and evidence of atherosclerotic lower limb arterial disease.

Outcomes of interest were: primary patency, all-cause mortality, fatal and non-fatal cardiovascular events, target vessel revascularisation rates and complication rates.

We used the Cochrane risk of bias tool (RoB 1) to assess the risk of bias in the studies. We judged all included studies to have a high risk of overall bias.

Two review authors screened studies for inclusion, extracted data, assessed risk of bias and used the GRADE criteria to assess the certainty of the evidence. Any disagreements were resolved through discussion. We synthesised results for each outcome using meta-analysis where possible (random-effects model, dichotomous outcomes assessed using the Mantel-Haenszel method, continuous outcomes assessed using the inverse variance method).

We included 11 studies, with a total of 814 participants and 872 treated lesions.

We found two comparisons: atherectomy versus balloon angioplasty (atherectomy versus BA) and atherectomy versus BA with primary stenting (atherectomy versus stenting). No studies compared atherectomy with bypass surgery. Overall, the evidence from this review was of very low certainty, due to a high risk of bias, imprecision and inconsistency. Ten studies (659 participants, 717 treated lesions) compared atherectomy versus BA. There was no evidence of differences between atherectomy and BA for the primary outcomes: six-month primary patency rates (risk ratio (RR) 1.24, 95% confidence interval (CI) 0.92 to 1.68; 6 studies, 298 participants; very low-certainty evidence); 12-month primary patency rates (RR 1.13, 95% CI 0.96 to 1.34; 5 studies, 326 participants; very low-certainty evidence); mortality rates (RR 0.50, 95% CI 0.24 to 1.02; 7 studies, 493 participants; very low-certainty evidence) or cardiovascular events at 12 months (RR 0.59, 95% CI 0.13 to 2.70; 2 studies, 163 participants; very low-certainty evidence). There was no evidence of differences when examining: six-month target vessel revascularisation (TVR) rates (RR 0.61, 95% CI 0.24 to 1.56; 5 studies, 348 treated vessels; very low-certainty evidence), 12-month TVR (RR 0.68, 95% CI 0.41 to 1.12; 6 studies, 371 treated vessels; very low-certainty evidence) or complication rates (RR 0.84, 95% CI 0.34 to 2.04; 7 studies, 457 participants; very low-certainty evidence). One study (155 participants, 155 treated lesions) compared atherectomy versus stenting, so the comparison was extremely limited and subject to imprecision. This study did not report primary patency. There was no evidence of a difference in the atherectomy versus stenting arms for mortality rates (RR 0.38, 95% CI 0.04 to 3.23; 155 participants; very low-certainty evidence), cardiovascular events (RR 0.38, 95% CI 0.04 to 3.23; 155 participants; very low-certainty evidence) and TVR rates at six months (RR 2.27, 95% CI 0.95 to 5.46; 155 participants; very low-certainty evidence). The study did not report on TVR at 12 months. There was no evidence of a difference in complication rates between the two arms (RR 7.04, 95% CI 0.80 to 62.23; 155 participants; very low-certainty evidence). There are several limitations to the evidence. The studies were of small sample size, with poor methodological quality, considerable variations in protocols and a high overall risk of bias due to high attrition and a lack of blinding.

This review update shows that the evidence is still very uncertain about the effect of atherectomy on primary patency, mortality and cardiovascular event rates compared to plain balloon angioplasty with or without stenting alone. We identified no evidence of differences in target vessel revascularisation rates and complication rates, although this is again uncertain. The included studies were small, heterogeneous and at high risk of bias. Larger studies that are powered to detect clinically meaningful, patient-centred outcomes are required.

This Cochrane review had no dedicated funding.

Protocol and previous versions available via 10.1002/14651858.CD006680, 10.1002/14651858.CD006680.pub3.

The purpose of this study was to evaluate bedside cranial ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) for demonstrating changes in neonatal arterial ischemic stroke (NAIS). Fifteen newborns with symptomatic NAIS underwent a cranial ultrasound examination and subsequently confirmed by magnetic resonance imaging (MRI), were enrolled. Color Doppler Flow Imaging (CDFI) and Pulsed-Wave Doppler (PW) were performed to acquire data from 6 coronal, 5 sagittal, and 3 cerebellar planes through the anterior or mastoid fontanelle. For CEUS, a 2-minute wash-in cine clip and static images were captured. CUS showed all lesions in the blood-supplying region of the middle cerebral artery (MCA), with 10(66.7%) located on the left hemisphere, and on the right. CEUS was performed on 3 neonates to evaluate microvascular perfusion. Two cases showed a large area of non-enhancement on the lesion side, while the third case showed significantly higher enhancement on the lesion side. MRI confirmed all lesions in the MCA blood-supplying region, with 10 on the left hemisphere and 5 on the right. Magnetic resonance angiography (MRA) identified abnormalities in the trunk or branches of the MCA in 8 neonates. Our preliminary results suggest that CUS can evaluate NAIS in conjunction with MRI and CEUS metrics may have potential for clinical quantification, warranting future validation studies.

Cardiovascular disease is currently the second leading cause of death among women in France. The menopause period is probably the ideal time to screen for all cardiovascular risk factors. This step is essential before offering menopausal hormone therapy to women suffering from disabling climacteric syndrome. If such treatment is authorized, transdermal estradiol combined with natural progesterone is the safest treatment for women with no history of hysterectomy. The tolerability of this treatment, as well as all cardiovascular risk factors, must be assessed annually in order to optimize the benefit/risk balance.