The unregulated use of highly purified arachidonic acid (AA) supplements among Chinese fitness enthusiasts raises concerns about cardiovascular safety. To evaluate these risks, we integrated population-based, genetic, and experimental evidence. Cross-sectional analysis of NHANES data demonstrated a higher risk of hypertension in individuals within the highest AA intake quartile (OR = 1.262, 95% CI: 1.109-1.438, P < 0.001). Two-sample Mendelian randomization confirmed causal effects of AA metabolites, including thromboxane (OR = 1.006, P < 0.001), eicosanoid C20H28O4 (OR = 1.305, P = 0.009), and 20-HETE-related C20H32O3 (OR = 1.290, P = 0.043). Single-cell transcriptomic profiling revealed increased renal expression of CYP4A11 in hypertensive patients, supporting a mechanistic link between AA metabolism and blood pressure regulation. In vivo, Wistar-Kyoto and spontaneously hypertensive rats fed a high-dose AA diet for six weeks exhibited significant elevations in systolic, diastolic, and mean arterial pressure, accompanied by increased renal vascular resistance. Mechanistic analyses showed that AA upregulated CYP4A1 expression and enhanced 20-HETE production without altering thromboxane synthase activity. Histological assessments revealed glomerular edema, tubular injury, and marked cardiac and renal fibrosis in AA-treated animals. Together, these convergent findings indicate that chronic high-dose AA intake promotes hypertension and multiorgan fibrosis via CYP4A/20-HETE activation. These results highlight the translational importance of AA metabolism in cardiovascular disease and underscore the need for regulatory oversight of AA supplements and therapeutic targeting of this pathway.

Hypertension is considered a potential risk factor for perioperative ischemic stroke (PIS). However, the association between elevated first systolic blood pressure measured in the operating room (first-OR-SBP) and the incidence of PIS has not been well documented. We conducted a single-center retrospective cohort study including patients who underwent elective non-brain, non-cardiac surgery at Peking University First Hospital between January 1, 2018, and December 31, 2024. Data were extracted from a perioperative database, and patient demographics, intraoperative and perioperative variables-particularly the relationship between first-OR-SBP and PIS-were analyzed. Multivariate logistic regression was performed before and after propensity score matching to adjust for perioperative confounders. The minimum p value approach was used to identify a potential threshold of first-OR-SBP independently associated with PIS risk. We found that, among 105 059 surgeries, 195 patients (0.19%) experienced PIS. The threshold for first-OR-SBP associated with PIS was identified as 186 mm Hg. The adjusted odds ratios for PIS were 1.69 (95% CI, 1.12-2.55; p = 0.013) before matching and 1.62 (95% CI, 1.03-2.54; p = 0.036) after propensity score matching. We conclude that a first-OR-SBP≥186 mm Hg was significantly associated with an increased risk of perioperative ischemic stroke in patients undergoing elective non-brain, non-cardiac surgery.

This study investigated whether patients receiving renin-angiotensin system inhibitors (RASIs) can undergo reliable screening for primary aldosteronism (PA) without discontinuation of therapy. Consecutive patients with hypertension who underwent PA screening at our hospital between 2016 and 2024 while on RASIs were recruited. Plasma aldosterone concentration (PAC) and direct renin concentration (DRC) were measured at three time points: pre-washout, post-washout, and post-captopril-challenge test (CCT). Subsequently, the aldosterone-to-renin ratio (ARR) was calculated, and PAC, DRC, and ARR were compared across time points. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal diagnostic cutpoints. A total of 412 patients on RASIs, with or without calcium-channel blockers (CCBs) or α1-receptor antagonists, were analyzed. Among these, 175 had PA and 237 had essential hypertension (EH). PAC, DRC, and ARR were significantly different between the PA and EH groups across all three time points. Within the PA cohort, PAC (p < 0.001) and ARR (p = 0.016) differed significantly between the pre-washout and post-CCT measurements, whereas DRC did not (p = 0.456). The optimal pre-washout ARR cutpoint of 2.69 demonstrated a sensitivity of 83.3%, specificity of 87.2%, positive predictive value (PPV) of 82.2%, and negative predictive value (NPV) of 88.1% for diagnosing PA. These findings indicate that pre-washout PAC, DRC, and ARR retain high diagnostic performance for PA in patients treated with RASIs, provided that other agents affecting the renin-angiotensin-aldosterone system are not co-administered.

Early reperfusion (ER) following intravenous thrombolysis improves outcomes in large vessel occlusion stroke (LVOS). Tenecteplase (TNK) has been associated with higher ER rates than alteplase (TPA), but findings across studies remain inconsistent, possibly due to limited adjustment for thrombus burden, characteristics, and collateral status. We compared TNK and TPA in a real-world cohort incorporating imaging-based assessment of thrombus and collateral status.

We retrospectively analyzed consecutive anterior circulation LVOS patients who received intravenous thrombolysis prior to thrombectomy at two U.S. comprehensive stroke centers (2020-2024). ER was defined as eTICI ≥ 2b50 on initial angiography or confirmed recanalization in clinically improving patients who did not undergo thrombectomy. Imaging review included clot burden score, thrombus length, thrombus permeability, and collateral status (Tan scale). Multivariable logistic regression identified predictors of ER. Ordinal logistic regression assessed the association between ER and 90-day modified Rankin Scale (mRS) shift.

Among 299 patients (TNK 201, TPA 98), ER occurred in 60 (20.1%). ER was more frequent with TNK than TPA (24.4% vs 11.2%, p = 0.008). TNK was independently associated with ER (adjusted OR 2.54, 95% CI 1.19-5.42). Additional predictors included thrombus permeability (aOR 3.30, 95% CI 1.73-6.30) and lower NIHSS (aOR 0.94 per point, 95% CI 0.89-0.98), while tandem occlusion reduced ER likelihood (aOR 0.18, 95% CI 0.05-0.62). ER independently predicted better 90-day mRS (aOR 2.09, 95% CI 1.21-3.60).

Tenecteplase achieved superior early reperfusion compared to alteplase after accounting for clot burden, thrombus features, and collateral status, reinforcing its clinical advantage in LVOS thrombolysis.

By adopting the shared decision-making (SDM) model, this study aims to improve treatment adherence and patients' subjective initiative. It intends to systematically explore the barriers and facilitating conditions for patients who had a stroke to participate in rehabilitation SDM through the analysis and integration of qualitative research methods. The ultimate goal is to provide a basis for optimising the formulation of rehabilitation plans, enhancing the quality of nursing services and improving patients' medical experience.

The following databases were searched, with only literatures published in English or Chinese included: Cochrane Library, PubMed, Embase, Scopus, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (Chinese Biomedical Literature Database) and Wanfang Database. The search covered the period from the establishment of each database to 1 March 2025. The quality of the included literatures was evaluated using the Qualitative Research Quality Assessment Tool provided by the Joanna Briggs Institute in 2016, with a focus on factors affecting participation of patients who had a stroke in rehabilitation SDM.

A total of 1502 articles were retrieved in the preliminary search, and 10 were finally included. From these included literatures, 31 findings were extracted. Similar results were categorised and grouped into 10 new categories, which were further integrated into 3 core integrated findings: (1) patient-related factors, including interference from negative emotions, the gap between rehabilitation expectations and reality, the impact of socio-demographic factors and self-efficacy with stage-specific autonomous needs; (2) family-related factors, including family support, the impact of patients' sense of responsibility to their families on decision choices and trade-offs forced by economic burden; (3) healthcare provider and environmental factors, including paternalistic models undermining autonomy, insufficient information and difficulty in screening hindering decision-making and discontinuity in the rehabilitation system and lack of resources increasing decision-making burden.

Through the meta-synthesis of qualitative studies, this research shows that negative emotions and realistic gaps reduce patients' participation in decision-making. While family support helps enhance patients' confidence in decision-making, economic burden affects their decision choices. Additionally, one-way doctor-patient communication, insufficient information support and discontinuity in the rehabilitation service system increase patients' decision-making burden.

Cardio-kidney-metabolic (CKM) syndrome is a complex, multi-system health condition that affects aging populations, potentially contributing to frailty. This study aimed to examine the association between baseline CKM syndrome, its transitions over time, and the onset of frailty, using data from the China Health and Retirement Longitudinal Study (CHARLS).

Data from 11,031 participants in the 2011 baseline and 7454 individuals with follow-up data from 2015 were analyzed. CKM syndrome was categorized into five stages based on metabolic, renal, and cardiovascular dysfunction. Frailty was assessed using a 32-item frailty index (FI), with participants categorized as frail (FI ≥ 0.25) or non-frail (FI < 0.25). Logistic regression models were used to investigate the associations between CKM stages, transitions, and frailty risk, adjusting for potential confounders.

Our findings revealed that participants in advanced stages of CKM (Stages 3-4) exhibited a significantly increased risk of frailty, with adjusted odds ratios of 1.97 (95% CI 1.29-3.01) and 4.45 (95% CI 2.83-7.00), respectively. Of particular note, 30.23% of participants experienced progression to more severe CKM stages during the study duration, while only 10.66% displayed improvement, further emphasizing the chronic nature of the syndrome. Logistic regression indicated that frailty risk was significantly associated with CKM stage transitions, particularly for those moving from stages 0 to 1.

Both baseline severity and progression of CKM syndrome are independently associated with a higher risk of frailty development. Early identification and intervention in CKM may help mitigate frailty risk in later life.

Cardiovascular-kidney-metabolic (CKM) syndrome is a major health burden. Stroke, the third leading cause of death globally, is strongly linked to insulin resistance (IR). The cholesterol-high-density lipoprotein-glucose (CHG) index offers superior diagnostic accuracy for diabetes, but its association with stroke in patients with early CKM syndrome (stages 0-3) is uncertain.

A total of 6,836 adults with CKM stages 0-3 from CHARLS (2011-2020) were analysed after excluding participants with missing baseline data for exposures or covariates, yielding an analytic sample with a somewhat higher proportion of men and CKM stage 3 than the parent CHARLS cohort. Multivariable Cox models were used to estimate the associations of the CHG index and its derivatives (CHG-BMI, CHG-WC, and CHG-WHtR) with incident stroke. Dose-response associations were examined using restricted cubic splines (RCS). When non-linear patterns were detected, two-piecewise Cox models were fitted to quantify threshold effects. Discrimination was summarised using ROC curves. This selection may limit the generalisability of the findings to the broader CHARLS population.

Over a 9-year follow-up period, 575 strokes occurred (8.41%). In multivariable models, higher CHG-related indices were modestly but consistently associated with incident stroke. RCS analyses indicated an approximately linear association for CHG, a saturation pattern for CHG-BMI (risk rising below but flattening above its inflection point), and threshold-like non-linear patterns for CHG-WC and CHG-WHtR, with little change in risk at low values and increasing hazards beyond their inflection points. Subgroup analyses revealed generally consistent associations by age and sex and stronger effects in CKM stages 2-3, without significant interactions. ROC performance was modest and comparable across indices (AUCs ≈0.64-0.65).

The CHG index and its derivatives were consistently associated with incident stroke amongst adults in the early CKM stages, and their clinical adoption may enhance early detection and prevention of stroke events in populations with vulnerable metabolism.

Malnutrition is associated with adverse outcomes in certain cardiovascular diseases. This study investigates the prognostic value of nutritional status in patients with atrial fibrillation (AF).

This retrospective observational study included 2444 patients with permanent AF admitted between January 2021 and June 2024. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, and patients were divided into two groups: CONUT < 5 (n = 2194) and 5-12 (n = 250). The association between nutritional status and all-cause mortality was evaluated using Cox regression and Kaplan-Meier analyses.

Patients with higher CONUT scores were older (74 ± 12 vs. 70.4 ± 12.6 years, p < 0.001) and had significantly higher mortality (36.4% vs. 11.3%, p < 0.001). Cox regression analysis identified the CONUT score as an independent predictor of mortality (HR 3.56, 95% CI 2.76-4.58, p < 0.001). ROC analysis showed an area under the curve of 0.65 (95% CI 0.62-0.69, p < 0.001), with the CONUT score predicting mortality at a cut-off of 4.5 (sensitivity 67.4%, specificity 78.3%). Kaplan-Meier analysis confirmed a significant survival difference between groups (p < 0.001).

The CONUT score is an independent prognostic factor for all-cause mortality in AF patients and may serve as a simple nutritional screening tool, though its clinical utility requires further validation.

Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD) and pulmonary sarcoidosis, are major global causes of mortality and morbidity. Although the COVID-19 pandemic has influenced acute respiratory health, its impact on chronic respiratory conditions remains unclear. We estimated the global, regional and national burden of chronic respiratory diseases from 1990 to 2023, including risk factors, and evaluated how these burdens have shifted during the COVID-19 pandemic using the Global Burden of Disease Study 2023. In 2023, chronic respiratory diseases accounted for 569.2 million (95% uncertainty interval (UI), 508.8-639.8) cases and 4.2 million (3.6-5.1) deaths. The age-standardized death rate declined by 25.7% globally from 1990 to 2023 despite an increase in ILD and pulmonary sarcoidosis. Mortality declined in younger males, especially for asthma, whereas older adults experienced a rise in ILD and pulmonary sarcoidosis. Smoking was the primary risk factor for COPD, whereas high body mass index and silica exposure were key risk factors for asthma and pneumoconiosis. During the pandemic, the incidence of chronic respiratory diseases increased modestly, but the decline in mortality rates became more pronounced, highlighting the need for sustained global attention and action to address their long-term burden.

Developing a therapeutic transcatheter device for cardiovascular diseases requires precise preclinical large animal models and robust evaluation methods. Three key aspects are essential for evaluating the safety and efficacy of a device: (1) types of swine heart failure models, (2) appropriate echocardiographic methods, and (3) the specific implantation approaches in swine. Common heart failure models include rapid pacing heart failure models, volume overload models, and ischemic models. Among the ischemic models, several approaches are performed to replicate the pathological conditions, such as coronary artery ligation, ameroid constrictor implantation, balloon occlusion, and coronary embolization. The optimal choice of echocardiographic method varies based on the procedure and includes transthoracic, transesophageal, intracardiac, and epicardial techniques. Echocardiographic imaging serves as an invaluable tool in both preclinical and clinical settings, providing structural and functional assessments, procedural guidance during device placement, and comprehensive evaluations of cardiac function and structural changes before and after implantation. Implantation approaches, such as trans-atrial, trans-apical, trans-septal, and trans-right pulmonary methods, each offer unique advantages and challenges. A thorough understanding of these approaches, including the orientation of the catheter tip relative to critical anatomical structures like the mitral annulus or coronary vasculature, is essential for ensuring procedural success. This review explores these aspects to contribute to the development and refinement of catheter-based cardiovascular interventions, ensuring reliability in preclinical data and successful clinical translation.