Headache is a common complaint in children and may indicate early hypertension (HT), an emerging concern in pediatrics. Children with primary headache (PH) may exhibit elevated blood pressure (BP) load or impaired nocturnal dipping despite normal office BP. This study aimed to evaluate the utility of ambulatory blood pressure monitoring (ABPM) in children with PH.

A case-control study was conducted including 37 children aged 8-17 years diagnosed with PH according to the International Classification of Headache Disorders (ICHD-3) criteria, all with office BP below the 95th percentile. Thirty-seven age- and sex-matched healthy subjects served as controls. Demographic, office BP, and ABPM parameters were compared between groups.

Of the PH group, 81% (n = 30) had migraines and 19% (n = 7) had tension-type headache. No significant differences were found between groups regarding age, BMI SDS, or office systolic BP SDS. However, ABPM revealed significantly higher total, daytime, and nocturnal systolic BP, and increased nocturnal systolic and diastolic BP loads in the PH group (all p < 0.05). No differences were noted between headache subtypes.

Children with PH may exhibit increased BP loads and disrupted BP patterns despite normal office measurements. ABPM appears to be a useful tool for accurately detecting subtle BP alterations in this population.

Inflammation and thrombosis influence short-term outcomes after primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). The platelet-to-lymphocyte ratio (PLR) is an inexpensive marker that may support bedside risk stratification.

To assess whether pre-PCI and post-PCI PLR predict in-hospital outcomes and 90-day all-cause mortality in STEMI patients undergoing primary PCI in Palestine.

This retrospective cohort study included STEMI patients referred for primary PCI at An-Najah National University Hospital. Of 413 eligible patients, 118 were excluded for incomplete records, leaving 295 patients for analysis. PLR was measured before and after PCI and dichotomized using ROC-derived cutoffs: pre-PCI PLR < 21.68 versus ≥ 21.68 and post-PCI PLR < 14.85 versus ≥ 14.85. Outcomes were compared between groups, and multivariable logistic regression was used to assess independent associations.

Elevated pre-PCI PLR was associated with greater in-hospital clinical instability and remained independently associated with the composite in-hospital clinical endpoint, both per 10-unit increase (OR 1.41, 95% CI 1.13-1.74; p = 0.002) and using the cutoff ≥ 21.68 (OR 2.90, 95% CI 1.55-5.44; p < 0.001). However, pre-PCI PLR was not independently associated with heart failure or 90-day mortality. Post-PCI PLR showed stronger prognostic value and was independently associated with composite in-hospital events, heart failure, and 90-day mortality, both as a continuous variable and using the cutoff ≥ 14.85.

Post-PCI PLR demonstrated stronger prognostic value than pre-PCI PLR and may serve as a simple, low-cost adjunctive marker for short-term risk stratification after primary PCI in STEMI patients.

Early diagnosis of acute myocarditis (AMC) is crucial due to its rapid progression and high mortality rate. Initial symptoms such as fever, abdominal pain, and vomiting are nonspecific and pose challenges for clinicians in distinguishing AMC from acute gastroenteritis (AGE).

We retrospectively reviewed the clinical characteristics of seven patients with AMC who were hospitalized at our institution between April 2011 and March 2022. We compared these findings with those of 19 patients with AGE.

The common initial symptoms of patients with AMC included fever, vomiting, abdominal pain, appetite loss, nausea, and fatigue, which did not differ significantly from those in patients with AGE. However, the percentage of diarrhea was significantly lower, whereas the detection rates of tachypnea, tachycardia, gallop rhythms, or cardiomegaly on radiography were higher in the patients with AMC than in those with AGE, respectively. Additionally, patients with AMC exhibited significantly higher serum lactate dehydrogenase (LDH) levels than those with AGE (p = 0.006). LDH demonstrated 71% sensitivity and 100% specificity (area under the curve, 0.857) for predicting AMC when a cutoff value of 459 U/L was used.

Preliminary findings suggest that LDH may serve as a trigger for suspicion of AMC in the pediatric population. Furthermore, combining LDH results with physical examination and chest radiographic findings could be useful for early diagnosis.

To evaluate the effect of 12-week Mavacamten on left ventricular function in obstructive hypertrophic cardiomyopathy (oHCM) using myocardial work analysis, and explore its role in myocardial energy metabolism.

Thirty-five oHCM patients and 35 matched healthy controls were enroled. Patients received Mavacamten for 12 weeks. At baseline and post-treatment, we measured LVOT gradient, LVEF, GLS, myocardial work parameters [GWI, GCW, GWW, GWE], mitral regurgitation severity, and SAM.

Myocardial work parameters showed good reproducibility (ICCs > 0.75). After 12 weeks, resting and provoked LVOT gradients significantly decreased (both p < 0.001). Proportions of moderate/severe mitral regurgitation and SAM reduced. GWI, GCW, and GWW decreased (p < 0.001), while GWE increased (p < 0.001). NT-proBNP decreased and NYHA functional class improved (p < 0.001). LVEF, GLS, and left atrial diameter showed no significant changes. Compared with controls, baseline oHCM patients had lower GWI, GCW, GWE and higher GWW (all p < 0.001). After treatment, GWE remained lower than controls (p < 0.001), and GWW remained higher (p < 0.001).

Twelve-week Mavacamten reduces LVOT obstruction in oHCM, accompanied by decreased GWI and increased GWE, while preserving systolic function and improving symptoms. Myocardial work parameters may serve as novel non-invasive references for treatment evaluation.

Complete atrioventricular block after mechanical tricuspid valve replacement represents a challenging pacing scenario because transvalvular right ventricular lead placement is contraindicated. We report a 51-year-old woman with mechanical mitral and tricuspid valves who presented with syncope and complete AV block due to late epicardial lead dysfunction. Transient restoration of capture during transthoracic echocardiography suggested dynamic lead-myocardial contact or intermittent lead continuity. Coronary sinus pacing was attempted but abandoned because of intolerable diaphragmatic stimulation. The patient later deteriorated and died from septic shock. This case highlights the limitations of available pacing strategies after mechanical tricuspid valve replacement.

The incidence of distal femur fractures (DFF) has shown a continuous annual increase. Preoperative deep vein thrombosis (DVT) of the lower limbs in DFF patients is associated with unfavorable clinical outcomes. Inflammation has been recognized as an essential contributor to thrombus formation, drawing increasing research attention in recent years.

This study aimed to construct a predictive model utilizing inflammatory blood indicators to estimate the preoperative risk of DVT in patients with DFF.

A retrospective analysis was performed on 493 eligible patients treated for DFF, admitted to a single-center, between January 2022 and September 2025. Clinical baseline characteristics and laboratory parameters were collected. Independent risk factors for preoperative lower limb DVT were identified through univariate and multivariate binary logistic regression analyses. The predictive model was established using R 4.2.0, with patients randomly allocated to training and validation cohorts in a 7:3 ratio. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were computed for internal validation. Model performance was further assessed using calibration curves (CC) and decision curve analysis (DCA) in both cohorts.

A total of 493 eligible patients were analyzed, comprising 205 cases with DVT and 288 without DVT. Univariate and multivariate binary logistic regression identified neutrophil- to-lymphocyte (NLR) (OR = 0.86, 95% confidence interval (CI) [0.774-0.95], P = 0.004), lymphocyte-to-monocyte ratio (LMR) (OR = 1.545, 95% CI [1.3-1.851], P = 0.000), white blood cell count (OR = 1.245, 95% CI [1.152-1.353], P = 0.000), neutrophil count (OR = 1.563, 95% CI [1.398-1.766], P = 0.000), lymphocyte count (OR = 0.151, 95% CI [0.077-0.285], P = 0.000), and eosinophil count (OR = 2.343, 95% CI [0.657-8.447], P = 0.19) as independent variables associated with preoperative lower limb DVT in DFF patients. Incorporating age with these indicators, a predictive model was developed. The ROC analysis demonstrated AUC values of 0.926 and 0.939 in the training and validation cohorts, respectively.

Among the preoperative inflammatory indicators evaluated, NLR, LMR, white blood cell count, neutrophil count, lymphocyte count, and eosinophil count were identified as independent determinants of preoperative lower limb DVT in patients with DFF. The predictive model constructed based on independent risk factors has excellent predictive efficacy and clinical application value.

Ischemic heart disease (IHD) remains a leading cause of mortality and disability worldwide. Using Global Burden of Disease (GBD) 2021 estimates, this study provides an integrated assessment of IHD burden across the Middle East and North Africa (MENA) region from 1990 to 2021, highlighting temporal trends, inter-country heterogeneity, sociodemographic index (SDI)-related patterns, and attributable risk factors by sex and age.

We conducted a secondary analysis of GBD 2021 estimates for the 21 countries and territories in MENA. We assessed prevalence, deaths, and disability-adjusted life years (DALYs), reporting counts and age-standardized rates per 100,000 population with 95% uncertainty intervals (UIs). This framework allowed direct comparison of temporal change, cross-country variation, development-related gradients, and modifiable risk attribution within a single regional analysis.

In 2021, the age-standardized prevalence of IHD in MENA was 6404.8 per 100,000 (95% UI: 5872.0-7041.1), with an age-standardized mortality rate of 202.8 (95% UI: 180.6-223.7) and DALY rate of 4023.2 (95% UI: 3581.7-4507.5). Although age-standardized death and DALY rates declined from 1990 to 2021, the burden remained substantial and unevenly distributed. Kuwait had the highest age-standardized prevalence [7806.4 (95% UI: 7141.6-8556.3)] and Turkey the lowest [5365.9 (95% UI: 4895.5-5874.7)]. Saudi Arabia had the largest increase in age-standardized prevalence [17.1% (95% UI: 11.4-23.0)], whereas Turkey had the largest decrease [-11.9% (95% UI: -17.3 to -6.9)]. DALY rates increased progressively with age for both sexes, and IHD burden showed an inverse, non-linear relationship with SDI. The leading contributors to IHD DALYs were elevated systolic blood pressure [49.6%], elevated LDL cholesterol [39.6%], and exposure to ambient particulate matter pollution [28.2%].

Despite reductions in age-standardized mortality and DALY rates, IHD remains a major public health challenge in MENA, with substantial cross-country variation and a large contribution from modifiable risks. By integrating temporal trends, inter-country heterogeneity, SDI-related patterns, and attributable risk factors, this study provides novel evidence for prioritizing prevention efforts across the region. These findings support context-specific prevention strategies prioritizing hypertension control, lipid management, and improved access to cardiovascular prevention and treatment, alongside action to reduce air pollution exposure; implementation should be tailored to national risk profiles, disease trends, and health-system capacity.

Cardiovascular-kidney-metabolic (CKM) Stage 4 is defined by established cardiovascular disease in the setting of kidney and/or metabolic dysfunction. Despite the high risk carried by this condition, simple tools for refining prognosis are limited. The neutrophil-to-lymphocyte ratio (NLR), derived from routine differential blood counts, has been linked to outcomes in cardiovascular, renal, and critically ill populations. Whether it is prognostically informative in critically ill adults with CKM Stage 4 is not established. We investigated the relationship between NLR and all-cause mortality in this population.

Using the Medical Information Mart for Intensive Care IV (MIMIC-IV), we assembled a retrospective cohort of adults who met CKM Stage 4 criteria. For patients with multiple intensive care unit (ICU) admissions, analysis was restricted to the earliest stay. Admission NLR was derived from the first valid paired neutrophil and lymphocyte measurements recorded within 24 h. Patients were classified by NLR quartile. The prespecified primary endpoints were 30-day and 365-day all-cause mortality, with 90-day and 180-day mortality as secondary endpoints. Associations were examined using multivariable Cox regression, restricted cubic splines, subgroup analyses, sensitivity analyses, and mediation analysis.

Among 13,602 eligible patients, mortality rose progressively across NLR quartiles at all assessed time points. After full adjustment, the hazard ratio (HR) for Q4 compared with Q1 was 2.142 (95% confidence interval [CI], 1.858-2.469) for 30-day mortality. The corresponding 365-day HR was 1.708 (95% CI, 1.543-1.891). Associations at 90 and 180 days were similar. Restricted cubic splines indicated nonlinear relationships. Results were generally stable in subgroup and sensitivity analyses. Adding NLR improved established ICU severity scores, and blood urea nitrogen (BUN) partially mediated the observed association.

Admission NLR was independently related to higher all-cause mortality during both short- and long-term follow-up in critically ill adults with CKM Stage 4. Because it is routinely available, NLR may provide complementary information for risk stratification in this population.

Pregnancy is regarded as a crucial window period for the assessment and management of cardiovascular health (CVH). This study investigated the relationship between the gestational CVH metrics of Chinese women and adverse pregnancy outcomes.

Six separate CVH metrics (smoking status, body mass index, blood pressure, total cholesterol, fasting blood glucose, and sleep health) were measured at 24-28 gestational weeks and categorized as ideal (2 points), intermediate (1 point), or poor (0 point) to generate a gestational CVH score. Total gestational CVH was categorized as high (all ideal metrics), moderate (no poor metrics), or low (one or more poor metric). Associations between gestational CVH and adverse pregnancy outcomes were evaluated using Poisson regression.

Among the 2,775 pregnant women included, 36.07%, 36.11%, and 27.82% had high, moderate, and low CVH, respectively. Each one-point increase in the CVH score was significantly associated with 7% and 4% lower risk of adverse maternal and neonatal outcomes (relative risk [RR], 0.93 and 0.96; 95% confidence interval [CI], 0.90-0.95 and 0.93-0.98). Compared with low CVH, high CVH was associated with 21% and 12% lower risk of adverse maternal and neonatal outcomes (RR, 0.79 and 0.88; 95% CI, 0.72-0.87 and 0.80-0.96). Individual CVH metrics also showed associations with adverse pregnancy outcomes, in which ideal body mass index, fasting blood glucose and sleep health were particularly important.

High gestational CVH was significantly associated with a considerably lower risk of adverse pregnancy outcomes, but approximately two-thirds of pregnant Chinese women do not achieve a high level of CVH.

Objective: To understand the potential parent-of-origin effect (POE) of imprinted gene KCNQ1 on the risk for hypertension by using a family-based design. Methods: Probands and their relatives in 9 rural areas in Fangshan District, Beijing, were included in this study. Mixed-effects model was used to evaluate the association between single nucleotide polymorphisms (SNPs) in the KCNQ1 gene and hypertension. The POE effects were evaluated by adopting log-linear model, and the interactions between POE and environmental factors, including smoking, alcohol consumption, were analyzed by using Wald χ² test. The POE was assessed by the ratio of maternal relative risk to paternal relative risk (RR_m/RR_f). Results: A total of 195 SNPs in the KCNQ1 gene were included in the analysis after quality control. The association analysis in 1 261 study participants identified 13 loci in the KCNQ1 gene associated with hypertension (all P<0.05). POE analysis, involving 167 study participants from 54 core families, identified 6 loci that showed possible POE with hypertension (all P<0.05). The most significant locus was rs231879, with an RR_m/RR_f of 3.46 (95%CI: 1.36-8.57, P=0.009), indicating that the relative risk of inheriting the risk allele from mother was 3.46 times higher than that from father. Analysis on the interactions between POE and environmental exposure revealed that sleep duration might potentially modify the POE of rs170786 (interaction for P=0.023). Conclusion: The imprinted gene KCNQ1 might be associated with the risk for hypertension through POE.