Next-generation bone marrow cell (BMC) therapies are evolving to address longstanding translational challenges in regenerative cardiology by shifting from conventional cell transplantation toward precision-engineered repair systems. Although early approaches using bone marrow-derived mononuclear cells and mesenchymal stem cells demonstrated safety, clinical efficacy remained limited, with modest improvements in left ventricular ejection fraction and inconsistent long-term outcomes. These clinical limitations are largely attributed to poor cell retention, reduced survival within the ischemic microenvironment, and diminished potency of autologous cells. To overcome these barriers, current research focuses on genetic enhancement of BMCs. Key targets include the SDF-1/CXCR4 axis to improve homing and Akt signaling to enhance resistance to apoptosis, utilizing advanced tools such as modified mRNA and CRISPR/Cas9 to enable precise modulation of regenerative pathways. While ongoing clinical studies highlight the translational potential of these approaches, overcoming limited clinical efficacy remains the primary benchmark for the field. CLINICAL RELEVANCE STATEMENT: By combining gene therapy and bioengineering, this next-generation approach overcomes the critical hurdles of poor cell survival and low retention that have historically limited the success of standard bone marrow cell therapies in ischemic hearts. Clinically, this integrated strategy offers a more potent, disease-modifying treatment capable of driving robust cardiac regeneration, reducing infarct size, and ultimately preventing the progression of end-stage heart failure.

Real-world gait assessment has gained momentum in populations with walking impairments, offering insights beyond standardized tests and supporting the integration of remote monitoring into clinical care. However, its potential remains limited by the lack of validated population- and context-specific digital biomarkers.

The primary objective was to summarize and critically evaluate the current state of real-world gait assessment using wearable sensors in Parkinson disease (PD) and stroke, addressing methodological approaches, sensor configurations, validation strategies, and outcome reporting. The secondary objective was to quantify methodological heterogeneity by reporting pooled means with 95% confidence intervals (CIs) and prediction intervals (PIs) of commonly reported gait parameters.

PubMed, Scopus, Web of Science, and Embase were searched for English-language studies published up to April 20, 2026. Eligible studies used wearable sensors to assess gait quality parameters in real-world settings in at least 5 individuals with PD or poststroke. Laboratory- or rehabilitation-only studies, non-peer-reviewed articles, abstracts, and studies before 2014 were excluded. Methodological quality was assessed with a checklist adapted from Hubble et al. Gait features available in at least 5 reports were included in a meta-analysis using a random-effects model with Hartung-Knapp-Sidik-Jonkman adjustment, deriving 95% CIs and PIs to characterize the pooled estimate and its dispersion.

Of 2489 records, 43 reports were included: 37 on PD (2774 participants; mean age 67.89, SD 8.68 years) and 6 on stroke (217 participants; mean age 63.83, SD 11.84 years). Methodological quality was high, but external validity was consistently the weakest domain in both populations. Sensor configurations most commonly consisted of a lower back accelerometer. In total, 13 distinct walking bout definitions were identified, whereas 17 reports provided none, indicating substantial terminological heterogeneity. In PD, 4 gait parameters met the meta-analysis threshold, each showing a PI far wider than its CI, precluding generalization to future settings. For example, gait speed pooled at 0.84 m/s (95% CI 0.77-0.91; 95% PI 0.56-1.12), and number of steps per day at 7202 (95% CI 3975-10,429), the latter with a PI extending below zero, a mathematically impossible range reflecting extreme dispersion. No stroke parameter was reported consistently enough to permit meta-analysis, underscoring a critically underdeveloped evidence base.

Unlike previous reviews focusing on single diseases or specific hardware, this review contrasts PD and stroke to highlight shared methodological challenges. Real-world gait assessment in PD is advancing but fragmented, whereas the stroke evidence base remains sparse. The observed variance is compounded by procedural and algorithmic inconsistencies that cannot currently be separated from genuine clinical differences. The methodological groundwork established in PD offers a foundation for early adoption of standardized terminology, validation procedures, and core outcomes, essential for transitioning wearable sensors from exploratory tools to reliable clinical and remote-monitoring instruments.

Although historically discouraged due to the risk of arrhythmias and sudden cardiac death (SCD), physical exercise (PE) may be safe and beneficial for individuals with hypertrophic cardiomyopathy (HCM).

To evaluate the association between PE and the incidence of mortality and arrhythmic events in adults with HCM, stratifying the analysis according to different types and intensities of exercise.

Systematic review of randomized clinical trials (RCTs) and observational studies identified in PubMed, Embase, and the Cochrane Library through December 2024. Studies including individuals exposed to different intensities of PE were eligible. Risk of bias was assessed using the RoB 2 and ROBINS-I tools, and certainty of evidence using GRADE. Recommendations were developed by an expert panel of the Brazilian Society of Cardiology.

Eight studies (four RCTs and four observational studies; 9,744 participants) were included. None reported an increased risk of mortality or severe arrhythmic events associated with PE, even at moderate or vigorous intensities. Syncope was rare. Additionally, a Korean observational study involving more than 7,000 participants (mean age: 59 years) demonstrated reduced all-cause mortality with higher physical activity intensity (dose-response curve). In low-risk athletes, competitive sports were not associated with severe adverse events. The quality of evidence ranged from moderate to very low.

PE in HCM should be encouraged based on individualized assessment. In patients without high-risk criteria for SCD, benefits appear to outweigh risks. For higher-risk subgroups, recommendations are more cautious and based on expert consensus.

Intravascular lithotripsy (IVL) has emerged as a groundbreaking technology for treating calcified coronary lesions.

To assess whether case selection and interventional performance with IVL have evolved over time after its incorporation into daily practice.

We prospectively included 104 consecutive patients with 127 calcified coronary lesions treated with IVL. The cohort was divided into two temporal groups (52 patients each) based on the order of patient inclusion. Clinical data and procedural performance were compared between the groups. All statistical tests were two-sided, with a significance level of 0.05.

The mean age was 73.2 ± 10.2 years, and 62.5% of patients presented with acute coronary syndromes. Severe calcification and type B2/C lesions were identified in 73.2% and 98.4%, respectively. Upfront IVL was performed in 92.9% of lesions, intravascular imaging was used in 78%, rotational atherectomy in 6.3%, and angiographic success was achieved in 96.0%. Compared with the first cohort, the latter cohort had more bifurcation lesions (60.0% vs. 41.9%; p = 0.04), more interventions in the circumflex artery (24.6% vs. 8.1%; p = 0.02), and a lower use of 4.0-mm diameter balloons (4.6% vs. 18.5%; p = 0.02). The latter cohort spanned a longer inclusion period (168 ± 90.8 vs. 120 ± 72.8 days; p = 0.004) and had fewer angiographic complications (1.5% vs. 14.5%; p = 0.01), whereas in-hospital major adverse cardiac events did not differ (3.8% vs. 5.8%; p = 1.0).

IVL is an effective modality for coronary calcium modification. Temporal changes in case selection and interventional performance may reflect a learning-adaptation curve.

Venous thromboembolism prophylaxis remains a complex and controversial issue in orthopedic practice, with persistent variability in recommendations even among experts. With the growing use of online platforms and artificial intelligence, the aim of this study was to evaluate the quality and clinical adequacy of artificial intelligence-generated recommendations regarding venous thromboembolism.

Thirty-three guideline-based questions derived from International Consensus Meeting, National Institute for Health and Care Excellence, American College of Chest Physicians, and American Academy of Orthopaedic Surgeons recommendations were independently submitted to ChatGPT (Generative Pre-trained Transformer [GPT]-4.0) by two orthopedic surgeons, resulting in 66 generated responses for analysis. Responses were assessed using the DISCERN instrument, Journal of the American Medical Association benchmark criteria, and a novel clinically oriented scale, the Thromboembolism Digital Knowledge Level. Inter-rater reliability was evaluated using intraclass correlation coefficients.

According to DISCERN, 62.1% of responses were classified as good quality, whereas Thromboembolism Digital Knowledge Level evaluation demonstrated that only 45.45% of responses were clinically adequate, with no responses classified as excellent. The same responses were systematically categorized into higher quality levels by DISCERN compared to Thromboembolism Digital Knowledge Level. All scoring systems demonstrated excellent inter-rater reliability (Intraclass Correlation Coefficient range: 0.897-0.961). Although differences between scoring systems were statistically significant, the effect size was moderate (r=0.39). Strong correlations were observed between evaluators across all scales (p<0.001).

ChatGPT-generated responses demonstrated good structural quality but limited clinical adequacy for thromboembolic prophylaxis after arthroplasty. These findings suggest that artificial intelligence systems should be used cautiously and may not be sufficient as standalone clinical decision-support tools.

To investigate the protective effects of green tea extract on ovarian ischemia-reperfusion injury in a rat model using histopathological and immunohistochemical analyses.

Twenty-one female Wistar-Albino rats were randomly divided into three groups (n = 7 each): sham, saline-treated ischemia-reperfusion, and green tea extract-treated ischemia-reperfusion. Ovarian torsion was induced by 720° clockwise rotation of the adnexa for three hours, followed by three hours of reperfusion. Green tea extract (200 mg/kg) or saline was administered intraperitoneally immediately before reperfusion. Ovarian tissues were evaluated histopathologically for congestion, hemorrhage, edema, polymorphonuclear leukocyte infiltration, and follicular degeneration. Bax and caspase-3 expression levels were assessed immunohistochemically.

The saline group demonstrated significantly increased congestion, edema, follicular degeneration, and total injury scores compared with the sham group. Green tea extract administration significantly reduced congestion, edema, and follicular degeneration compared with the saline group, indicating partial histopathological protection against ovarian ischemia-reperfusion injury. However, Bax and caspase immunoreactivity remained elevated in the treatment group.

Green tea extract attenuated histopathological ovarian damage following ischemia-reperfusion injury, suggesting a protective effect against ovarian tissue injury. Although treatment was associated with increased expression of apoptotic markers, the overall findings support the potential of green tea-derived antioxidants as a therapeutic strategy for ovarian ischemia-reperfusion injury.

Behçet's disease (BD) can affect the urogenital system in men, leading to conditions such as epididymitis, urethritis, cystitis, and dorsal penile vein thrombosis. A high incidence of erectile dysfunction (ED) in BD patients has been previously reported; however, the role of vascular involvement in ED is unclear.

To investigate the effect of vascular involvement on ED in male patients with BD.

Ninety-seven patients diagnosed with BD (mean age, 40.4 ± 10.7 years; disease duration, 12.5 ± 9.6 years) were included in the study and divided into the vascular and non-vascular groups. The presence and severity of ED were assessed using the International Index of Erectile Function-5 (IIEF-5), with a score of ≤21 indicating the presence of ED. Patients with ED underwent corpus cavernosum electromyography and penile color Doppler ultrasonography to diagnose ED.

Half of all patients with BD (n = 49, 50.5%) were found to have ED. No significant difference in the presence of ED was observed between the two groups (vascular group: n = 24, 49% vs. non-vascular group: n = 25, 52.1%; p = 0.76). The proportion of patients with peak systolic velocities of less than 30 cm/s was significantly higher in the vascular group than in the non-vascular group (n = 12, 80% vs. n = 2, 22.2%; p = 0.01). No significant between-group difference was found in corpus cavernosum electromyography results (p > 0.05).

ED is common in patients with BD, and arterial ED is more prevalent among those with vascular involvement. Sexual dysfunction, which is less frequently screened for in patients with BD, should be thoroughly monitored; early intervention is recommended.

Right ventricular (RV) pacing can alter ventricular mechanics and may lead to ventricular dysfunction, even in patients with preserved baseline left ventricular ejection fraction (LVEF) and structurally normal hearts.

This study examines the hemodynamic effects of right ventricular pacing on left ventricular function and volume, and identifies early variables associated with pacemaker-induced left ventricular dysfunction and cardiomyopathy in patients with dual-chamber RV pacemakers.

The study enrolled patients undergoing dual-chamber RV pacemaker implantation without any structural abnormality of the heart. Data on biventricular functions, LV volumes, and global longitudinal strain (GLS) were collected with 2D, speckle tracking, and 3D echocardiography. Paired continuous variables were compared using two-sided tests with a significance level of 0.05.

Out of 75 patients, 20 experienced LV systolic dysfunction, 15 developed PIVD, and five developed PICM. In comparison to the control group, patients with PICM had lower GLS (17.02 vs. 19.27; p<0.05), wider QRS width (139.57 vs. 102.75; p < 0.05), and greater ventricular pacing percentage (VP%; 94.32 vs. 84.03; p = 0.06).

RV pacing resulted in a substantial decline in LV systolic function in the short and long term. Concurrently, RV functions declined over the long term (six months). Diminished GLS at seven days, a broader pre-implantation QRS complex, and an elevation in VP% are early indicators of PIVD and PICM. Routine patient monitoring for these indicators can be beneficial for timely intervention on a case-by-case basis.

Routine platelet indices have been linked to blood pressure and vascular risk. However, longitudinal evidence on the association between platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) and incident hypertension remains limited, and it is unclear whether these associations differ according to adiposity. We aimed to examine associations of PLT, MPV, PCT, and PDW with incident hypertension and assess whether these associations vary by body mass index (BMI).

We analysed 51,191 hypertension-free adults aged ≥18 years from the 2006 baseline examination of the Kailuan Study, with follow-up through 31 December 2023. We measured PLT, MPV, PCT, and PDW from routine full blood counts. We used weighted Cox regression to estimate overall hazard ratios (HRs) and by Chinese BMI categories, adjusting for age, sex, fasting blood glucose, physical activity, and smoking. Restricted cubic splines assessed dose-response relationships.

During a median follow-up of 8.2 years, 29,491 participants developed hypertension (incidence rate = 70.67 per 1000 person-years). Higher PLT (HR = 1.07; 95% confidence interval (CI) = 1.05-1.09) and PDW (HR = 1.03; 95% CI = 1.01-1.04) were associated with greater hypertension risk, whereas MPV showed a modest inverse association (HR = 0.98; 95% CI = 0.96-1.00) and PCT was not significantly associated (HR = 0.99; 95% CI = 0.98-1.01). Absolute incidence rates increased across Chinese BMI categories from 33.59 to 105.13 per 1000 person-years. BMI-stratified analyses suggested heterogeneous patterns, particularly for MPV and PDW. Splines indicated approximately linear positive associations for PLT and PDW, a mild inverse/flat pattern for MPV, and nonlinear associations for PCT.

Routine platelet indices showed modest associations with incident hypertension, with heterogeneous patterns across BMI categories. These findings suggest that platelet-related haematological traits may reflect BMI-dependent differences in hypertension risk, but external validation and formal prediction analyses are needed before clinical use.

Sleep deprivation represents a growing global public health concern, driven by the widespread use of digital devices and by socio-environmental changes that increasingly disrupt the alignment between biological and social rhythms. Reduced sleep duration, quality, and regularity are associated with an increased cardiovascular and cardiometabolic risk, identifying sleep as a modifiable determinant of health. This review examines the principal pathophysiological mechanisms linking sleep deprivation to cardiovascular disease, with particular emphasis on autonomic dysregulation, endothelial dysfunction, systemic inflammatory activation, and neuroendocrine-metabolic alterations, through which insufficient sleep promotes hypertension, insulin resistance, visceral obesity, type 2 diabetes, and atherosclerosis. An emerging role is attributed to circadian misalignment, a condition associated with increased cardiometabolic risk independently of sleep duration alone. Compensatory mechanisms such as weekend sleep recovery and daytime napping appear to exert partial protective effects under specific conditions but cannot be considered equivalent to regular sleep. Overall, current evidence suggests that sleep duration, quality, continuity, and circadian synchronization should be regarded as essential components of clinical assessment and cardiovascular prevention, highlighting the need for further prospective research into therapeutic and preventive strategies aimed at improving sleep health.