Basic cardiac life support and automated external defibrillation refer to the skills required for resuscitation of a cardiac arrest casualty. On recognising cardiac arrest, the rescuer should call '995' for an ambulance and start cardiopulmonary resuscitation. High-quality chest compressions are performed with the arms extended, elbows locked, shoulders directly perpendicular over the casualty's chest and the heel of the palm placed on the lower half of the sternum. The rescuer compresses to a depth of 4-6 cm for adults, at a rate of 100-120 compressions per minute, allowing complete chest recoil after each compression. Two quick ventilations of 400-600 mL each are delivered via a bag-valve-mask (or mouth-to-mouth or mouth-to-mask if trained and able) after 30 chest compressions (or 15 chest compressions for casualties under 12 years of age). Cardiopulmonary resuscitation should be stopped when the casualty regains consciousness, the emergency team takes over care, or when an automated external defibrillator analyses the heart rhythm or delivers a shock.

To evaluate the efficacy and safety of early aspirin discontinuation followed by P2Y12 inhibitor monotherapy versus standard dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

This systematic review and meta-analysis followed PRISMA 2020 guidelines and a prespecified protocol registered in PROSPERO (CRD420261293472). MEDLINE, Embase, Scopus, and CENTRAL were searched through December 2025 for randomized controlled trials comparing early aspirin discontinuation (≤ 3 months) with standard DAPT in ACS patients undergoing PCI with drug-eluting stents. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment (Cochrane RoB 2.0). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model.

Seven trials including 20,501 patients (10,246 early discontinuation; 10,255 standard DAPT) were analyzed. Early aspirin discontinuation significantly reduced bleeding (RR, 0.46; 95% CI, 0.36-0.60; p < 0.001; I²=21.9%). There was no significant difference in major adverse cardiovascular events (RR, 0.98; 95% CI, 0.77-1.26) or in myocardial infarction, stroke, repeat revascularization, or all-cause mortality. However, early aspirin discontinuation was associated with an increased risk of stent thrombosis (RR, 1.72; 95% CI, 1.07-2.78). In trials with aspirin discontinuation within 1 month, bleeding reduction remained substantial, with numerically higher but nonsignificant ischemic outcomes.

In ACS patients undergoing PCI, early aspirin discontinuation reduces bleeding without a statistically significant increase in overall ischemic events; however, a significant increase in stent thrombosis was observed. These results support individualized decision-making, particularly favoring patients at high bleeding risk and low thrombotic risk treated with potent P2Y12 inhibitors. Further adequately powered studies focused on rare ischemic outcomes, including stent thrombosis, are warranted.

Orthopedic diseases impose heterogeneous therapeutic demands, ranging from symptomatic control of inflammation and pain to intra-articular drug delivery, cartilage repair, bone regeneration, and prevention of implant-associated infection. Although hydrogels are widely investigated as tunable biomaterials for these applications, their translational potential is often discussed primarily in terms of polymer composition or crosslinking chemistry. This review argues that delivery modality provides a clinically useful framework for evaluating orthopedic hydrogel systems, but translational success depends on the combined influence of material properties, mechanical requirements, degradation behavior, biological integration, manufacturability, and regulatory feasibility. Hydrogel patches, injectable hydrogels, and implantable hydrogels differ in tissue access, mechanical competence, payload capacity, residence time, invasiveness, and regulatory feasibility. Here, we critically compare these three delivery paradigms across major orthopedic indications. Hydrogel patches are best positioned for localized analgesic and anti-inflammatory therapy but remain poorly suited for deep regenerative delivery because of skin-barrier limitations. Injectable hydrogels can offer a strong balance between minimally invasive administration and localized therapeutic control, particularly for intra-articular disease and irregular defects, but require improved retention, mechanical stability, and predictable gelation. Implantable hydrogels can provide architectural and mechanical control for focal bone and osteochondral repair when designed as structural or composite systems, yet their clinical adoption is constrained by surgical burden, manufacturing complexity, and long-term durability requirements. By shifting the discussion from material cataloguing to indication- and delivery-modality-driven design, this review provides a balanced framework for evaluating orthopedic hydrogel technologies and identifies practical translational priorities related to tissue access, mechanical durability, biological response, manufacturing, and clinical feasibility.

Inflammation contributes to atherosclerosis and vascular remodeling, but the immune pathways associated with distinct carotid ultrasound phenotypes, including carotid intima-media thickness (cIMT), maximal plaque thickness (MPT), and arterial stiffness remain incompletely characterized. We investigated associations between circulating immune biomarkers and carotid ultrasound measures in a stroke-free, multi-ethnic cohort. We analyzed data from 1,134 stroke-free participants (mean age 70 ± 9 years, 59% women, 66% Hispanic) in the Northern Manhattan Study (NOMAS) who underwent high-resolution B-mode carotid ultrasound. cIMT and MPT were measured using automated edge-detection software, while arterial stiffness was assessed via systolic and diastolic diameter measurements, strain, and β-stiffness. Plasma levels of 60 immune biomarkers were quantified using a multiplex immunoassay. Biomarker selection was performed using LASSO, Random Forest, and XGBoost; markers selected by ≥ 2 methods were prioritized. Associations were tested using multivariable linear regression adjusted for age, sex, race/ethnicity, and cardiovascular risk factors (hypertension, hyperlipidemia, diabetes, and smoking). Machine-learning analyses identified partially distinct candidate biomarker profiles for cIMT, MPT, and arterial stiffness. In fully adjusted regression models, greater cIMT was associated with higher IL-4 and leptin levels and lower IL-10, VCAM-1, and SerpinE1 levels. None of the machine-learning-selected biomarkers was independently associated with MPT at the conventional p < 0.05 threshold. Greater arterial stiffness was associated with higher SCF levels, while CXCL10 demonstrated a nonsignificant inverse trend. Models incorporating the selected biomarkers had modestly higher adjusted R² values than models containing clinical covariates alone (cIMT, 0.072 versus 0.109; MPT, 0.134 versus 0.147; arterial stiffness, 0.063 versus 0.075). In a stroke-free, multiethnic cohort, machine-learning analyses identified distinct and overlapping candidate immune biomarker profiles across cIMT, plaque thickness, and arterial stiffness. However, only a subset of selected biomarkers demonstrated independent associations in fully adjusted regression models. These findings support a hypothesis-generating role for inflammatory and immunometabolic pathways in subclinical carotid disease and vascular aging and require validation in longitudinal studies.

ObjectiveSystemic lupus erythematosus is associated with increased cardiovascular morbidity, even in the absence of overt clinical disease. Sestrin-1 is a stress-responsive antioxidant protein implicated in oxidative homeostasis and cardiovascular protection. This study aimed to evaluate serum Sestrin-1 levels in patients with systemic lupus erythematosus and examine their relationship with subclinical cardiovascular findings.MethodsIn this controlled cross-sectional study, 60 patients with systemic lupus erythematosus and 60 age-matched healthy controls underwent clinical assessment, laboratory testing, 12-lead electrocardiography, transthoracic echocardiography, and carotid intima-media thickness measurement. Serum Sestrin-1 was measured by enzyme-linked immunosorbent assay (ELISA). Between-group comparisons used parametric or nonparametric tests according to data distribution. Within the systemic lupus erythematosus cohort, correlations between Sestrin-1 and disease activity (Systemic Lupus Erythematosus Disease Activity Index), as well as cardiovascular parameters, were assessed. An exploratory multivariable logistic regression model including Sestrin-1, left atrial diameter, corrected QT interval, age, and sex was constructed to identify variables associated with case status.ResultsSerum Sestrin-1 levels were significantly lower in patients with systemic lupus erythematosus than in controls (9.99 ± 2.01 vs. 17.79 ± 5.11 ng/mL; p < 0.001). Patients with systemic lupus erythematosus had a significantly longer corrected QT interval (429.65 ± 32.42 vs. 376.26 ± 33.41 ms; p < 0.001). In the exploratory multivariable logistic regression analysis, lower Sestrin-1 (per 1ng/mL increase, odds ratio 0.63; 95% confidence interval: 0.54-0.75; p < 0.001), larger left atrial diameter (per 1 mm increase, odds ratio 1.13; 95% confidence interval: 1.06-1.22; p < 0.001)), and longer corrected QT interval (per 1ms increase, odds ratio 1.03; 95% confidence interval: 1.02-1.05; p < 0.001) were independently associated with systemic lupus erythematosus status.ConclusionPatients with systemic lupus erythematosus exhibit markedly reduced serum Sestrin-1 levels together with subclinical cardiovascular abnormalities. The inverse relationship between Sestrin-1 and left atrial diameter suggests a possible link between reduced antioxidant defense and early atrial remodeling in systemic lupus erythematosus. Sestrin-1 may represent a promising candidate biomarker for subclinical cardiovascular involvement in patients with systemic lupus erythematosus; however, prospective studies are needed to confirm its clinical utility.

Older Aboriginal and Torres Strait Islander Australians are central to their communities, providing cultural leadership and care. However, colonisation and systemic inequities have led to significant health disparities, with chronic diseases and dementia disproportionately affecting those aged over the age of 55 years. This study aimed to develop a strengths-based framework to support healthy ageing in the Torres Strait and Northern Peninsula Area.

A participatory action research approach was conducted across five communities, involving yarning circles with 45 community members, clinical audits of 1128 residents using the Healthy Ageing Audit Tool (HAAT) and continuous quality improvement (CQI) initiatives. Findings informed the co-design of an Ageing Well Framework, refined through stakeholder workshops and community feedback.

The HAAT audit revealed high rates of chronic disease and multimorbidity among adults aged over 55 years, alongside gaps in preventive care, including low rates of cardiovascular risk and dementia screening and limited follow-up for abnormal findings. Continuous Quality Improvement (CQI) activities highlighted opportunities to improve culturally appropriate care, such as increased use of Indigenous Health Workers, validated screening tools and comprehensive health assessments. The co-designed Ageing Well Framework outlined strategies at community, primary health care and individual levels to promote cultural and social connectedness, independence and ageing in place.

The Ageing Well Framework provides a culturally responsive, evidence-based guide to improving health and well-being for older Aboriginal and Torres Strait Islander Peoples. It fosters collaboration across sectors and prioritises cultural determinants of health, supporting holistic care and addressing health inequities in the Torres Strait and Northern Peninsula Area (NPA).

Introduction: Acute subdural hematoma (aSDH) represents one of the most lethal and debilitating forms of traumatic brain injury (TBI) encountered in neurosurgical emergency settings, carrying high mortality rates and severe long-term functional deficits. Historically, the timing of surgical decompression has been considered a critical modifiable prognostic factor. However, contemporary evidence regarding the relationship between time to surgery and clinical outcomes remains inconsistent. This systematic review and meta-analysis evaluates the impact of surgical timing on mortality and functional status in adult patients undergoing evacuation for acute subdural hematoma. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines and registered in PROSPERO. A database search was performed across PubMed, Scopus, Embase and Web of Science for relevant studies published between 2009 and 2026. Peer-reviewed cohort studies and clinical trials including adults (>18 years) with CT- or MRI-confirmed aSDH were included. Data extraction focused on baseline characteristics, surgical timing thresholds, and primary outcomes of mortality and functional status assessed using the Glasgow Outcome Scale (GOS). Methodological quality was assessed using the Newcastle-Ottawa Scale. Relative risks (RR) and risk differences (RD) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: The search identified 1815 records, of which six studies, including 926 patients, met the inclusion criteria. Meta-analysis found no statistically significant association between time to surgery and mortality (RR 1.01, 95% CI [0.69, 1.48], p = 0.96; RD -0.02, 95% CI [-0.19, 0.15]). High statistical heterogeneity was observed (I² = 80%) across the included cohorts. Most studies indicated that patients who underwent rapid neurosurgical intervention frequently presented with significantly worse baseline neurological status, which acts as a primary confounding factor and drives poorer prognostic trends. Conclusions: While historical paradigms emphasize a 4h period for subdural hematoma evacuation, our meta-analysis indicates that a straightforward linear relationship between time to intervention and improved survival or functional outcome is absent in contemporary clinical studies. Surgical timing thresholds must be interpreted cautiously, as the decision-making process is heavily guided by clinical triage bias, where rapidly deteriorating patients are prioritized for urgent decompression. Crude timing thresholds do not reflect a lack of causal benefit of early intervention but rather highlight the profound confounding by indication embedded in contemporary neurotrauma literature. Future multicenter investigations adjusting for admission severity, pupillary reactivity, associated intracranial pathology and other confounding factors are crucial to isolate the true prognostic value of surgical timing in aSDH.

Background: Neonatal open-heart surgery induces profound oxidative stress, yet its perioperative dynamics remain incompletely characterized. This study quantified urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane as markers of oxidative damage, and plasma α₁-microglobulin (A1M) as an endogenous antioxidant, while exploring the influence of pre- and intraoperative factors. Methods: In a prospective cohort of 40 term neonates with critical congenital heart defects undergoing open-heart surgery, serial urinary and plasma samples were collected perioperatively. Biomarker concentrations were analyzed using mixed-effects regression models to assess associations with postnatal age, sex, preoperative oxygenation, oxygen surge at bypass initiation, and cell-free hemoglobin in the prime solution. Results: Urinary 8-OHdG and 8-isoprostane increased following bypass separation; 8-OHdG remained elevated through postoperative days 0-2, while 8-isoprostane returned toward baseline by day 1. Plasma A1M declined at bypass initiation, recovered to preoperative levels at separation, and rose thereafter. Females exhibited higher A1M concentrations throughout. Longer time to surgery was associated with greater preoperative oxidative stress, and lower preoperative arterial pO₂ correlated with increased 8-isoprostane at bypass separation. No statistically significant associations were identified between intraoperative variables and biomarker levels, although the study was designed to be a hypothesis generating study and not powered to detect modest intraoperative effects. Conclusions: This exploratory study delineates distinct perioperative trajectories of oxidative stress and antioxidant response in neonates undergoing open-heart surgery, with surgical timing, preoperative hypoxemia, and sex emerging as relevant associations. No statistically significant associations were identified between intraoperative variables and biomarker levels; however, the study was hypothesis-generating in design and not powered to detect modest intraoperative effects.

Background: Asymptomatic atrial fibrillation (AF) represents a substantial proportion of diagnosed AF cases; however, its prognostic implications remain controversial. This study aimed to compare clinical characteristics, treatment strategies, and outcomes between asymptomatic and symptomatic AF patients in a contemporary real-world registry. Methods: This observational subanalysis included 997 patients from the prospective multicenter REGUEIFA registry with 2-year follow-up. Patients were classified as asymptomatic if they had a baseline European Heart Rhythm Association (EHRA) score of I. Clinical characteristics, therapeutic strategies, and the incidence of a composite endpoint including cardiovascular death, stroke, major bleeding, or worsening heart failure were analyzed. Results: Overall, 33.7% of patients were asymptomatic. Compared with symptomatic patients, asymptomatic patients had a lower prevalence of heart failure, hypertension, and cardiomyopathy, lower CHA₂DS₂-VASc scores, and a higher prevalence of preserved left ventricular ejection fraction. Rhythm control strategies were less frequently used in asymptomatic patients (58.33% vs. 65.96%; p = 0.018), despite similar arrhythmia recurrence rates after treatment (p = 0.490). The incidence of the composite endpoint was lower in asymptomatic patients (8.39 [6.53-10.78] vs. 12.12 [10.43-14.09] per 100 person-years; p = 0.013), mainly driven by lower cardiovascular mortality. No significant differences were observed in stroke, major bleeding, worsening heart failure, or all-cause mortality. In multivariable analysis adjusted for clinically relevant covariates, symptomatic patients exhibited a higher incidence of the composite endpoint. Conclusions: In this contemporary real-world registry, asymptomatic AF patients exhibited a lower burden of cardiovascular comorbidities and lower cardiovascular mortality than symptomatic patients, while rates of stroke, heart failure worsening, major bleeding, and arrhythmia recurrence were similar. These findings suggest that prognosis is influenced predominantly by baseline comorbidity burden, and the independent contribution of symptom status itself, although statistically significant, appears modest and should be interpreted with caution given the observational design.

Background/Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) is a major cause of neurodevelopmental diseases. In a previous retrospective study, we revealed that the levels of the soluble form of lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) are linked to HIE severity. We conducted a prospective investigation to evaluate the association between sLOX-1 levels and HIE severity using the Sarnat staging system, as well as a multicenter study to assess neurodevelopmental sequelae in the short term. Methods: A total of 193 infants were enrolled in the study between April 2018 and March 2021. We divided the infants into groups as follows: infants without HIE were assigned to a normal control group, and those with HIE to mild, moderate, and severe HIE groups. We measured 191 samples, excluding three participants. The distribution of 191 participants was as follows: 88 normal samples of 50 umbilical cord (UC) arteries and 38 venous blood samples (control; CTL), as well as 103 HIE samples of 34 mild, 55 moderate, and 14 severe HIE samples. All the plasma samples were collected until 6 h after birth. Results: The mean sLOX-1 value in the CTL group was 613 pg/mL (IQR: 474-925 pg/mL) and that in the UC group was 497 pg/mL (IQR: 337-693 pg/mL), with no significant difference (p = 0.136). The mean sLOX-1 value in the mild HIE group was 1030 pg/mL (IQR: 658-1547 pg/mL), 1026 pg/mL (IQR: 710-2051 pg/mL) in the moderate HIE group, and 1444 pg/mL (IQR: 766-3927 pg/mL) in the severe HIE group. There were significant differences between the CTL and HIE groups (p = 0.006) and between the CTL and mild HIE groups (p < 0.05), but not between the mild HIE and the moderate and severe HIE groups (p = 0.088). The other blood markers exhibited no correlation with Sarnat severity. Interestingly, blood sLOX-1 levels increased with Sarnat severity. Conclusions: The results of this study indicated that sLOX-1 level was correlated with Sarnat severity. Moreover, early assessment of sLOX-1 level may be useful for deciding whether to induce therapeutic hypothermia and/or other treatments, and sLOX-1 may serve as a short-term outcome biomarker of HIE.