Cardiovascular problems are one of the major causes of morbidity and mortality among renal transplant and hemodialysis patients. This study evaluates the preoperative risk factors and postoperative outcomes in patients undergoing heart surgery.

A total of 83 patients (47 post-renal transplant recipients and 36 on hemodialysis) who underwent cardiac surgery and percutaneous coronary artery procedures at Dr. Siyami Ersek Heart Hospital between 2015 and 2022 were retrospectively analyzed using hospital electronic records without selection bias. Demographic information, such as age, sex, height, weight, and body mass index, cardiac surgery type, and preoperative laboratory findings were recorded.

Renal transplant recipients and hemodialysis patients undergoing heart surgery showed no significant differences in age, sex, or comorbidities (P > 0.05). Both groups had a high percentage of patients with elevated fasting blood glucose, triglycerides, and low-density lipoprotein levels. Additionally, body mass index and the triglyceride-glucose index were elevated, indicating insulin resistance. Renal transplant recipients with low preoperative glomerular filtration rate and hemoglobin levels < 10 g/dL had a higher risk of developing acute kidney injury. Four patients (9%) experienced graft loss after acute kidney injury, requiring hemodialysis. Mortality rates did not differ significantly between the groups (P > 0.56).

Cardiovascular surgery can be safely performed in both renal transplant recipients with functional allografts and end-stage kidney disease patients on hemodialysis. Identifying and managing risk factors in these patients, who frequently experience cardiovascular complications, will lead to better outcomes.

Acute blood pressure (BP) elevations are common in emergency settings and are traditionally classified into hypertensive urgencies (HU) and hypertensive emergencies (HE). Malignant hypertension (MHT) represents a severe form of HE characterised by small vessel damage. Although international guidelines provide clear definitions and treatment strategies, real-world data have shown persistent fragmentation and heterogeneity in the diagnosis and management of these patients.

A web-based, anonymous survey promoted by the European Society of Hypertension (ESH) was distributed among physicians from 18 European and 4 non-European countries. The questionnaire assessed definitions, diagnostic work-up, BP measurement practices, and therapeutic strategies for HU, HE, and MHT.

Sixty-four participants in 56 centres completed the survey. HU was correctly defined as a severe BP elevation without acute clinically symptomatic hypertension-mediated organ damage (A-HMOD) by 45.3% of respondents. Small cuffs were available to 79.7% and extra-large cuffs to 70.3% of respondents.. Intravenous antihypertensive therapy was used for HE by 88.7% of participants, while 20.6% also used intravenous drugs for HU. Parenteral clonidine and sublingual nifedipine were prescribed by 29.7% and 26.6% of respondents, respectively. Definitions and therapeutic approaches for MHT varied substantially, with 62.9% adopting a recently proposed definition involving at least three target organ damages in patients with BP >200/120 mmHg.

This international survey highlights considerable variability in the definition, diagnostic work-up, and therapeutic management of acute BP elevations, emphasising the need for harmonised protocols and further education.

High intraoperative blood pressure variability (HIBPV) is significantly associated with postoperative adverse complications. However, practical tools to characterize perioperative factors associated with HIBPV remain limited. This study aimed to develop explainable supervised machine learning (ML) models to classify patients with HIBPV and to identify structural perioperative patterns associated with HIBPV through model interpretation.

This retrospective cohort study analyzed 47,520 noncardiac surgery cases from Beijing Tsinghua Changgung Hospital. We applied four ML algorithms-Extreme Gradient Boosting (XGBoost), Random Forest (RF), Light Gradient Boosting Machine (LightGBM), and Logistic Regression (LR)-to classify patients with or without HIBPV. The overall population and each age subgroup (pediatric, adult, elderly) underwent independent 70/30 train-test splits for model development. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC). SHapley Additive exPlanations (SHAP) values were used to interpret model outputs and assess feature importance.

Among 47,520 noncardiac surgeries, 1,996 (4.2%) were classified as HIBPV. XGBoost and RF achieved the best performance, with AUROC values of 0.85 (95% confidence intervals (CI): 0.84-0.86) and 0.84 (95% CI: 0.82-0.85). Intraoperative average heart rate (HR) and bispectral index (BIS) were the most influential variables. In patients aged 50 ∼ 70, higher sevoflurane dosage was associated with reduced HIBPV risk. Among hypertensive patients, elevated intraoperative blood calcium (>1.10 mmol/L) was associated with increased HIBPV risk.

The models enabled accurate classification of HIBPV cases and highlighted key discriminative perioperative variables through SHAP-based interpretation. Intraoperative HR and BIS were significant contributing factors. Moreover, interactions between sevoflurane and age and between hypertension and calcium levels may inform individualized hemodynamic management strategies.

Advanced glycation end products(AGEs)/RAGE(receptor for AGEs) play divergent roles in cardiovascular disease. Our study is to evaluate the correlation between AGEs/RAGE in circulation (soluble AGEs/RAGE, sAGEs/sRAGE) and in myocardium (mAGEs/mRAGE), and to explore their relationship with cardiac function and prognostic value in hypertrophic obstructive cardiomyopathy (HOCM).

78 HOCM patients under septal myectomy were recruited. The soluble and myocardial AGEs/RAGE levels were determined by a commercial available ELISA kit at the time of baseline examination. Strain analysis in HOCM patients derived from cardiac magnetic resonance feature tracking, including global/septal radial strains (GRS/SRS), circumferential strains(GCS/SCS), and longitudinal strains(GLS/SLS). Histological fibrosis was assessed through masson's staining as collagen volume fraction (CVF). All patients were followed up for a composite endpoint for a median duration of 3.8 years.

sAGEs/sRAGE were higher in HOCM patients than healthy controls(p = 0.025; p = 0.028). Log sRAGE was correlated with log mRAGE(r = 0.739, p < 0.01), CVF(r = -0.411, p < 0.01), GRS (r = 0.412, p < 0.01), GCS(r = 0.463, p < 0.01). Log mRAGE also showed a correlation with CVF(r = -0.439, p = 0.003), SRS (r = 0.4, p = 0.013) and SCS (r = 0.362, p = 0.03). Log mAGEs was correlated with log mRAGE(r = 0.376, p = 0.012). Multivariate COX analysis revealed that log sRAGE was a significant predictor for the occurrence of adverse events in HOCM patients(HR, 0.013; 95% CI, 0.001-0.313; p = 0.007).

Circulating RAGE appears to act as a protective biomarker, as it is associated with better prognosis after septal myectomy, reducing fibrosis and improving cardiac function in HOCM patients. It is plausible that higher circulating RAGE levels may be derived from higher expression levels in the myocardium.

To determine the association between blood pressure variability (BPV), coagulation indexes, and germinal matrix-intraventricular hemorrhage (GMH-IVH) in preterm infants with gestational age ≤ 32 weeks. In addition, we aimed to determine whether the combination can predict the occurrence and outcome of GMH-IVH.

This retrospective study included 106 preterm infants. According to the presence of GMH-IVH, the preterm infants were divided into GMH-IVH (51 patients) and no GMH-IVH (55 patients) groups. Furthermore, according to the short-term prognoses, the GMH-IVH group was subdivided into good outcome (30 patients) and poor outcome (21 patients) groups. Coagulation function and BPV indexes were collected at admission. Univariate analysis, logistic regression model, and receiver operating characteristic curve were used to analyze the relationship between indexes and the occurrence and outcome of GMH-IVH in preterm infants.

Univariate analysis showed that the difference between maximum and minimum (Max-Min); standard deviation (SD); coefficient of variation (CV) of BPV, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and proportion of premature rupture of membranes (PROM) were higher in the GMH-IVH group than the no GMH-IVH group (P < 0.05). Logistic regression analysis showed that INR and DBP SD were directly correlated with GMH-IVH, and the joint curve had the largest area under the curve (AUC) (82.4% sensitivity and 79.7% specificity). BPV SD, BPV CV, APTT, and INR were higher in the poor outcome group than in the good outcome group (P < 0.05). Logistic regression analysis showed that INR and DBP SD were directly correlated with poor outcomes in preterm infants with GMH-IVH. The joint curve had the largest AUC (sensitivity 76.2% and specificity 90.0%).

Increased INR and DBP SD are directly associated factors for the developement and poor short-term outcome of GMH-IVH, and combined monitoring of INR and DBP SD has certain reference value for the early identification and prognosis evaluation of GMH-IVH in preterm infants with gestational age ≤ 32 weeks.

Stroke is a leading cause of death and disability, placing a significant burden on survivors and their families. To address the lack of African-specific data, we investigated the cost of stroke management and the recovery of health-related quality of life in the post-discharge period in Mozambique.

A prospective, cost-of-illness study examining the direct and indirect costs of acute stroke presentations to a first referral urban public hospital in Maputo, Mozambique (June-December 2019). Direct costs were derived from medical records to estimate the cost of hospital care. Indirect costs were derived from interviews using a semi-structured questionnaire administered to patients or their caregivers during the index hospitalization and 28-days post-discharge to estimate additional expenditure and loss of productivity due to disability which varied by employment status (informal, formal, pensioner and unemployed). Health-related quality-of-life was assessed at 28-days post stroke using the EQ-5D-3L questionnaire. Cost analysis was conducted from a societal perspective and reported in $USD.

50 of 80 patients admitted with an acute stroke were consecutively recruited during the study period. Median age was 61 (IQR 38-68) years, 56% were women and 44% presented with a hemorrhagic stroke. Median length of stay in the hospital was 7.0 (IQR 4.0 to 8.0) days. Within 28-days post-discharge 20% patients had died. Estimated total direct cost of hospital care for 50 patients (hospital days, medication, and investigations) was $36,315.28, the median cost per patient was $721.45 (IQR 582; $790). Estimated direct non-medical costs per patient during hospitalization median $12,59 (IQR, 8.19; 16.39) and mean $13.62 (SD 8.02). In the first 28 days after discharge the non-medical cost was: $32.04 (IQR, 19,01; 49.83) and mean $41.37 (SD, 36.11). Overall, loss of productivity was very high in informal employment and quality of life in survivors severely compromised. The mean EQ-5D index and VAS scores of stroke patients were 0.514 (SD, 0.298), and 49.39 (SD, 20.95), respectively. Anxiety/depression 92.5% and Pain/discomfort 82.5% were the most frequently reported issues.

The economic cost of stroke in low-income sub-Saharan African countries such as Mozambique is substantially high, with considerable out-of-pocket spending, poor survival rate and a compromised health-related quality-of-life. Health system reforms designed to mitigate the individual to societal burden imposed by stroke are required.

Aims/Background An unruptured intracranial aneurysm (UIA) is a cerebrovascular disease with a potential risk of rupture. Rupture of UIA is a leading cause of spontaneous subarachnoid hemorrhage, which carries a high mortality rate. While endovascular intervention emerged as the primary treatment option for UIA, postoperative cognitive dysfunction (POCD) remains a common complication, affecting patients' postoperative recovery. Therefore, identifying effective interventions is clinically crucial for improving postoperative cognitive function. Tirofiban, an antiplatelet agent, has shown potential neuroprotective effects in neurointerventional procedures. Hence, this study aims to evaluate the effect of tirofiban on postoperative cognitive function in patients with UIA. Methods This retrospective study analyzed 125 UIA patients who underwent treatment between January 2021 and December 2024. All patients underwent simple coil embolization and were divided into two groups: an observation group (treated with tirofiban) and a control group (without tirofiban). Before surgery, these patients were routinely treated with aspirin and clopidogrel. However, patients in the observation group were given tirofiban in addition to standard care for 12 hours after the procedure. Furthermore, cognitive function was assessed before and after surgery using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores. Additionally, the incidence of postoperative silent cerebral infarction (SCI) and variations in inflammatory marker levels were compared between the two groups. Results Cognitive function showed no significant difference between the two groups before surgery. After the procedure, the observation group demonstrated significantly higher MoCA (p < 0.001) and MMSE (p = 0.001) scores than the control group, indicating a significant advantage of tirofiban in improving cognitive function. Within 72 hours postoperatively, 7 cases in the observation group developed SCI compared to 18 cases in the control group, with a significantly lower incidence of SCI in the observation group (p = 0.025). Preoperative comparison of inflammatory markers revealed no difference between the two groups (p > 0.05). However, their postoperative levels were significantly lower in the observation group (p < 0.05). The cognitive function scores remained significantly higher in the observation group than in the control group over one month follow-up period (p < 0.05). Conclusion Tirofiban improves cognitive function and reduces SCI and inflammation following UIA embolization, possibly via antiplatelet and anti-inflammatory mechanisms. While statistically significant, the clinical relevance of cognitive improvement (1 point) is limited and requires further investigation. Furthermore, prospective randomized trials are needed to validate the long-term efficacy of tirofiban and elucidate underlying mechanisms.

Stroke is a leading cause of morbidity and mortality worldwide but there are significant differences in access to acute stroke care between geographical regions. Indeed, inequalities in acute stroke care continue to exist within the UK. Reperfusion therapies including mechanical thrombectomy (MT) are now the established standard of care for acute ischaemic stroke. However, availability of these therapies remains variable across the UK, with patients in rural areas potentially facing a poorer outcome. Reasons for this include delayed ambulance response times for both primary transfer to an acute stroke centre (ASC) and secondary transfers to comprehensive stroke centres (CSCs), MT only being available in CSCs and consequently neurointerventionists are disproportionately concentrated in the London/South of England, where a greater number of these centres are located. Furthermore, there has been a lack of investment in stroke care outside of comprehensive stroke centres, with imaging facilities in ASCs often suboptimal, and variability in consultant stroke physician staffing/presence, delaying decision making. The neurointerventionist workforce is undergoing a rapid expansion, however, further investment is required to ensure equity of access to acute stroke care across the UK and across the world.

Aims/Background Kawasaki disease (KD) is a systemic vasculitis primarily affecting children under five. Coronary artery lesions (CAL), a severe complication associated with KD, can lead to long-term cardiovascular problems and even life-threatening conditions. However, the pathological mechanisms underlying CAL in KD patients remain unexplored. Therefore, this study aims to investigate the risk factors affecting the severity of CAL in KD patients, providing valuable insights for early identification and clinical intervention of KD. Methods This single-center retrospective study included 326 KD patients treated at the pediatric clinic of The Second People's Hospital of Changzhou between January 2016 and December 2023. Baseline data, clinical characteristics, cardiac function-related indicators, and CAL severity-related information were retrieved from the hospital's electronic record system. Furthermore, risk factors affecting CAL severity were identified using logistic regression analysis. Results Among the 326 patients, 51 (15.64%) developed varying degrees of CAL, with 3.07% exhibiting severe CAL. KD patients were presented with clinical symptoms, such as fever, rash, oral mucosal changes, lymphadenopathy, and swelling of the hands and feet. Univariate analysis revealed younger age, longer fever duration, higher platelet count (PLT), elevated C-reactive protein (CRP) levels, faster erythrocyte sedimentation rate (ESR), increased white blood cell (WBC) count, elevated lactate dehydrogenase (LDH) levels, lower left ventricular ejection fraction (LVEF), and lower cardiac indices as significant risk factors for CAL development (p < 0.05). Furthermore, multivariate logistic regression analysis identified longer fever duration, higher PLT levels, increased CRP levels, and lower LVEF as independent risk factors for CAL development (p < 0.05). Conclusion Evaluating CAL development in KD patients requires a comprehensive assessment of clinical characteristics, inflammatory indicators, and cardiac function indices.

In recent years, digital technologies have shown possibilities for improving cognitive function after stroke, but their effectiveness and treatment options vary, the optimal treatment remains unclear, and the current evidence is somewhat contradictory.

This study aimed to evaluate the efficacy of various digital interventions in improving poststroke cognitive function and provide evidence-based support for clinical decision-making.

A systematic search was conducted across PubMed, Web of Science, Cochrane Library, Scopus, Embase, and CNKI databases from their inception to January 2025, with no restrictions on language or publication year. Randomized controlled trials evaluating digital interventions (eg, virtual reality [VR], computer-assisted cognitive therapy [CACT], and robot-assisted therapy [RAT]) for poststroke cognitive impairment in adults (aged≥18 y) were included. Eligible studies reported outcomes measured by the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE), with cognitive improvement quantified through pre- to postintervention scores. Multiple researchers independently extracted data. Network meta-analysis was performed using R software, incorporating consistency or inconsistency models (based on Deviance Information Criterion differences), random-effects models, and I² statistics to assess heterogeneity. Sources of heterogeneity were analyzed through sensitivity analyses, subgroup analyses, and meta-regression. Intervention efficacy was ranked using Surface Under the Cumulative Ranking Curve (SUCRA) values. Robustness and consistency were validated via Egger test, sensitivity analyses, and node-splitting methods. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

A total of 2128 articles were retrieved, with 27 meeting the inclusion criteria. Compared to conventional rehabilitation or care (C), CACT demonstrated significant superiority in MoCA scores (mean difference [MD]=3.03, 95% CI 1.69 to 4.38; SUCRA=91.53%); while cognitive training (CCT) demonstrated no statistical difference (MD=0.70, 95% CI -0.88 to 2.28). The ordering is CACT>VR>RAT>CCT. For MMSE scores, RAT ranked highest in efficacy (MD=5.99, 95% CI 3.20 to 8.79; SUCRA=99.44%); whereas both VR (MD=1.34, 95% CI -0.94 to 3.62) and CCT (MD=1.12, 95% CI -1.46 to 3.69) showed no significant improvement. The ordering is RAT>CACT>CCT>VR.

Digital therapies are effective in improving cognitive functioning in patients post stroke. CACT showed superior efficacy on the MoCA (emphasizing executive functioning), while RAT had the highest efficacy in the MMSE (focusing on basic cognition), suggesting different domain-specific effects. However, caution is warranted due to the heterogeneity of the included studies, risk of bias, and limited sample sizes in some studies. Future research should focus on optimizing intervention protocols, integrating neuromodulation or traditional rehabilitation techniques, and exploring cost-effective clinical implementation strategies.