Peritoneal dialysis (PD)-related peritonitis is a common complication with high morbidity and mortality, and empirical antibiotic regimens vary across countries. Despite some research, inconsistent results and design limitations highlight the need to reassess the association between these regimens and outcomes.

This study was affiliated with the PD Telemedicine-assisted Platform (PDTAP) study. The primary outcome was peritonitis-associated death, and the secondary outcomes were peritonitis-associated hemodialysis transfer and subsequent peritonitis within 6 months. Propensity score matching and logistic regression were used to access the relationship between empirical antibiotic administration and outcomes.

Altogether, 1431 patients experienced a first episode of peritonitis from June 1, 2016, to April 30, 2019. Among them, 1203 patients were assigned to the cefazolin-based group (n = 637) or to the vancomycin-based group (n = 566) based on administration of empirical antibiotics against Gram-positive bacteria. Compared to the cefazolin-based group, patients in the vancomycin-based group were older, had a longer PD duration, and reported higher income, along with a greater prevalence of diabetes, cardiovascular disease, and peritonitis history (P < 0.05 for all). Both groups exhibited similar rates of peritonitis-associated death and subsequent peritonitis within 6 months (P > 0.05 for all), however, the vancomycin-based group was more prone to to hemodialysis transfer (11.00% vs 16.31%, P = 0.010, for total peritonitis; 2.62% vs 9.01%, P = 0.004, for Gram-positive bacterial peritonitis). After propensity score matching analyses, the rates of death, hemodialysis transfer and subsequent peritonitis remained similar between the two groups (P > 0.05 for all). Additionally, multivariate logistic regression, after adjusting for confounders, revealed no significant difference in the outcomes between the two groups (P > 0.05 for all). In the sensitivity analysis, excluding culture-negative patients, the results remained similar. In cases of Gram-negative bacterial peritonitis, the use of third-generation cephalosporins also had no association with better prognosis, irrespective of propensity score matching analysis (P > 0.05 for all).

Our study suggests that there is no significant difference in prognosis among different empirical antibiotic regimens for peritonitis.

The triglyceride-glucose (TyG) index has been identified as an independent predictor of stroke risk. However, the comprehensive impact of combined indices, integrating TyG with obesity indicators such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), on stroke risk remains insufficiently explored. Furthermore, there is a paucity of research on combined indices involving TyG and other obesity indicators like the weight-adjusted waist index (WWI), body roundness index (BRI), and a body shape index (ABSI). This study aimed to comprehensively evaluate the combined impact of TyG with various obesity indicators on stroke risk and to investigate their potential associations. This observational cohort study included 8,730 participants from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models, smooth curve fitting, and threshold effect analysis were employed to explore the potential relationships between the combined indices and stroke risk. The predictive value of TyG alone, obesity indicators, and the combined indices for stroke risk was compared using the area under the receiver operating characteristic (ROC) curve (AUC), and was validated by Delong test. Kaplan-Meier curves were used to illustrate the cumulative incidence of stroke events. Over a median follow-up of 7 years, 456 (5.20%) incident stroke cases were identified. After adjusting for confounding factors, non-linear relationships were observed between TyG-WC, TyG-WHtR, TyG-WWI, TyG-ABSI and stroke risk, demonstrating significant dose-response relationships (all P < 0.05 for the log-likelihood ratio test); conversely, TyG, TyG-BMI, and TyG-BRI exhibited linear relationships with stroke risk (The p values respectively: p < 0.001, p = 0.004, p = 0.019). The highest stroke risk incidence (7.55%) was observed in the Q4 group of TyG-WC. Furthermore, the combined indices showed higher AUC values for stroke risk compared to TyG or obesity indicators alone. Combined indices of TyG and obesity indicators are significantly associated with stroke risk. Combined obesity indicators with the TyG index may provide additional predictive utility for stroke risk compared to the TyG index alone. The combined assessment of the TyG index and obesity indicators could be considered in stroke risk assessment and primary prevention.

To prospectively evaluate the diagnostic efficacy of combining head and neck computed tomography angiography (CTA) with the ABCD2 score (Age, Blood pressure, Clinical features, Duration, Diabetes score) for detecting carotid artery stenosis in patients with transient ischemic attacks (TIAs) over an extended follow-up period. In this single-center prospective cohort study, 416 TIA patients (January 2020-January 2025) were stratified into high-risk (ABCD2 ≥4, n = 200, 48.08%) and low-risk (ABCD2 <4, n = 216, 51.92%) groups. High-risk patients underwent head-neck CTA within 2 hours of symptom onset, followed by digital subtraction angiography (DSA) within 48 hours if CTA revealed ≥50% stenosis. Low-risk patients received CTA within 24 hours, with DSA escalation for clinical deterioration. Diagnostic confirmation required combined ABCD2 ≥4 and CTA ≥50% stenosis in high-risk patients. DSA served as the reference standard. Diagnostic accuracy, sensitivity, and specificity were analyzed using chi-square tests. Among 416 patients, 231 underwent both CTA and DSA. CTA detected cerebrovascular stenosis/occlusion in 169 cases (70.13%), showing significant discordance with DSA (χ² = 14.785, P = 0.005). ABCD2 scores ≥4 were observed in 157/231 patients (67.97%), significantly correlating with cerebrovascular disease risk (χ² = 14.351, P < 0.001). The combined approach of CTA and ABCD2 score demonstrated a diagnostic accuracy of 88.74%, sensitivity of 91.15%, and specificity of 76.92% for post-TIA cerebrovascular stenosis. These values showed statistically significant improvements compared to either method alone (all P < 0.05), while no significant difference was observed versus the reference standard DSA (χ² = 0.914, P = 0.339). Head and neck CTA combined with the ABCD2 score offers significant advantages in the early diagnosis of carotid artery stenosis in TIA patients.

Omega-3 fatty acids (omega-3) are widely recognized for their potential benefits in promoting cardiovascular health. However, the precise relationship between dietary omega-3 fatty acid intake and mortality outcomes in participants with established cardiovascular disease (CVD) remains a subject of ongoing debate and considerable uncertainty. Clinical trials have yielded conflicting results, creating a need for further clarification. To address these uncertainties, we undertook a prospective study to examine the long-term associations between omega-3 fatty acids, including their specific subtypes, and both all-cause and cardiovascular-specific mortality in participants with CVD. This study aimed to explore the possible link between dietary intake of omega-3 fatty acids and both all-cause mortality and CVD-specific mortality in patients with cardiovascular conditions. Utilizing publicly accessible National Health and Nutrition Examination Survey linked mortality files up to December 31, 2019, we identified mortality rates and specific causes of death related to heart disease. To determine the association between omega-3 fatty acid consumption and mortality risk, we employed multivariable Cox regression analyses, generating hazard ratios (HRs) and 95% confidence intervals (CIs) while adjusting for a variety of demographic characteristics, lifestyle factors, and comorbid conditions. Moreover, we utilized Kaplan-Meier survival curves and conducted subgroup analyses to further examine these associations. To assess how varying levels of dietary Omega-3 fatty acids influence the risk of mortality in patients with CVD, we employed restricted cubic spline models under various conditions. A total of 3,826 participants with CVD completed the final cohort, averaging 7.59 years of follow up. Following adjustments for multiple variables, a pronounced inverse association was noted for participants in the highest quintile of total Omega-3 consumption and overall mortality, indicated by the HR of 0.77 (95% CI: 0.60-0.99). Likewise, increased total Omega-3 consumption was correlated with a reduction in CVD-specific mortality, with the HR of 0.63 (95% CI: 0.42-0.95), which was confirmed statistical significance by trend tests (P for Trend < 0.05). In the separate analysis of individual subtypes of the omega-3 fatty acid family, the consumption of alpha-linolenic acid (ALA) was obviously inverse-associated with CVD-specific mortality (HR of 0.64, 95% CI: 0.44-0.95). Nonetheless, the consumption of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and docosapentaenoic acid (DPA) did not show a significant association with mortality risk (P > 0.05). In the dose-response relationship analysis, total omega-3 fatty acid intake and ALA intake were observed to have an "L"-shaped nonlinear relationship with cardiovascular mortality, with the inflection points at 2.12 (g/day) and 2.03 (g/day), respectively. In summary, our research indicates that both total omega-3 fatty acids and ALA are inversely linked to the risk of all-cause mortality and cardiovascular mortality in patients with CVD. We recommend a daily intake of 2.12 g of total omega-3 fatty acids, with an optimal intake of 2.03 g/day for ALA for CVD patients.

The rising prevalence of cardiometabolic multimorbidity (CMM), characterized by the coexistence of two or more cardiometabolic disorders, poses a significant public health challenge in aging populations. While ambient air pollution is a recognized environmental risk factor, its long-term impact on CMM remains underexplored, particularly in China. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS, 2015 wave), we analyzed 9,830 participants aged ≥ 45 years. CMM was defined as the concurrent presence of two or more conditions: diabetes/hyperglycemia, cardiovascular diseases (myocardial infarction, angina pectoris, coronary artery disease, or heart failure, or stroke. Annual pollutant exposures were estimated using a machine learning-based spatiotemporal model (space-time extremely randomized trees) based on residential addresses. Generalized linear models adjusted for sociodemographic, lifestyle, and meteorological covariates were employed to assess odds ratios (ORs) per interquartile range (IQR) increase in pollutants. Chronic exposure to particulate matter (PM) 10 demonstrated a consistent positive association with CMM prevalence across models. In fully adjusted analyses, each IQR increase in PM10 was associated with elevated CMM risk (OR = 1.01, 95% CI: 1.00-1.02, P = 0.039). Sensitivity analyses, including alternative exposure windows and adjustments for regional variations, reinforced PM10's robust association with CMM. Other pollutants (PM2.5, and sulfur dioxide) showed weaker or inconsistent associations. Long-term exposure to ambient particulate matter, particularly PM10, is significantly linked to increased CMM prevalence in China's aging population. The findings of this study provide epidemiological evidence, laying the foundation for future cohort studies and mechanistic investigations.

White matter hyperintensity, a key imaging biomarker for brain health, has prognostic implications for stroke. Using a multicenter MRI dataset of 9179 stroke patients plus the UK Biobank (n = 36,210 low/high risk controls), we employ Subtype and Stage Inference modeling and identify three distinct white matter hyperintensity progression subtypes: fronto-parietal, radial, and temporo-occipital. Longitudinal validation confirms classification stability. The fronto-parietal subtype shows delayed onset and more hypertension, while the temporo-occipital subtype has more atrial fibrillation and coronary heart disease. The fronto-parietal and radial subtypes are linked to small vessel stroke, while the temporo-occipital subtype is linked to cardioembolism. The fronto-parietal subtype has higher 1-year ischemic stroke recurrence, while the temporo-occipital subtype shows a higher incidence of early neurological deterioration by symptomatic hemorrhagic transformation and worse 3-month outcomes. Beyond capturing progression, demographics, and vascular risks, and improving post-stroke outcome prediction, this subtyping-staging model also holds potential for stroke prediction.

Dilated cardiomyopathy (DCM) is a complex disease characterized by cardiomyopathic hypokinesis and left ventricular interior hypertrophy. Cardiac rehabilitation (CR) is an established treatment for some cardiovascular diseases; however, the outcomes of early CR for patients with DCM remain underexplored. This study aimed to investigate the association between early CR and 90-day mortality in patients with DCM and symptomatic heart failure, using a national inpatient database in Japan from July 1, 2010, to March 31, 2020. We applied multiple imputation to the missing data and propensity score matching analysis. Early CR was defined as that initiated within 3 days of admission. The study included 30,296 eligible patients, including those with early CR (n = 3,130) and delayed or no CR (n = 27,166). The early CR group showed significantly lower 90-day mortality compared to the delayed or no CR group (odds ratio, 0.70, 95% confidence interval, 0.53-0.93; P = 0.01). Compared to the delayed or no CR group, the early CR group exhibited a higher activities of daily living score at discharge, but there was no significant difference in length of stay between the groups.

Cellular senescence is a state where cells permanently exit the cell cycle after a finite number of divisions, while maintaining metabolic activity. This phenomenon, initially described by Leonard Hayflick, plays a pivotal role in aging, contributing to the progressive decline in physiological function by promoting tissue dysfunction and restricting regenerative capacity. It is regulated by an array of factors, including DNA damage, telomere shortening, oxidative stress, mitochondrial dysfunction, and epigenetic modifications. Nesprins, a family of transmembrane proteins embedded in the nuclear envelope, are integral components of the LINC (Linker of Nucleoskeleton and Cytoskeleton) complex, which connects the nucleus to the cytoskeleton, thus preserving structural integrity and facilitating mechanotransduction. Lamin proteins, which form the nuclear lamina beneath the inner nuclear membrane, provide support to nuclear envelope architecture, organize chromatin, and modulate gene expression. Lamin proteins also interact with nesprins to collectively sustain nuclear mechanics and maintain morphological stability. Understanding the molecular mechanisms by which nesprins and lamins influence cellular senescence provides valuable insights into the biology of aging and may offer novel therapeutic avenues to address age-related diseases. This review examines the interactions between nesprin and lamin proteins and their potential contributions to cellular senescence.

The life-long exposure of the left heart chambers to systemic blood pressures may be important to changes in left atrial (LA) function with age, but long-term follow-up studies are scarce. We aimed to assess the impact of blood pressure in mid-life on LA function assessed by echocardiographic reservoir (LASr) and contractile (LASct) strain two decades later, in men and women.

Echocardiography was performed at ages 62-65 in 3706 participants born in 1950 of the prospective observational Akershus Cardiac Examination (ACE) 1950 Study. Data was linked with blood pressure measurements from the Age 40 Programme, a national health survey performed when the participants were 40-43 years of age. Participants were categorised into three groups representing normal blood pressure, elevated blood pressure and hypertension, based on measurements at ages 40-43. Linear regression models were used to assess associations between blood pressure and echocardiographic LA strain analysis.

A total of 2399 participants (51.6% women) had available LA strain analysis from the ACE 1950 Study (mean age 63.9±0.6 years) and blood pressure data from the Age 40 Programme (mean age 40.1±0.3 years). At ages 62-65, mean LASr was 35.1±9.2% and LASct was 17.7±5.6%. Adjusted regression models showed a significant association between blood pressure category increase at ages 40-43 and LASct (adjusted β 1.03% (95% CI 0.37% to 1.69%), p=0.002) at ages 62-65, but not with LASr. In women, no associations were evident between blood pressure at ages 40-43 and LA strain two decades later.

Increased blood pressure in the early 40s was associated with higher LA contractile strain two decades later in men, but not in women.

Since the 1960s, beta blockers have been used to treat hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder causing abnormal heart muscle thickening. This systematic review evaluates their efficacy across clinical outcomes.

Registered on PROSPERO (CRD42022344255), searches were performed in June 2022 and updated in September 2025 across MEDLINE, Embase, CINAHL and PubMed. Two reviewers independently screened studies. Meta-analysis was undertaken when ≥3 comparable datasets were available; otherwise, narrative synthesis was used.

21 studies including 775 adults met inclusion criteria. Beta blockers significantly reduced left ventricular outflow tract (LVOT) gradient (Standardised mean difference (SMD) -1.57; 95% CI -2.07 to -1.07) and heart rate (SMD -1.19; 95% CI -2.24 to -0.14). Sensitivity analyses confirmed the robustness of the LVOT effect, while heart rate effects remained heterogeneous. Improvements in New York Heart Association class, exercise tolerance and symptom burden were consistently reported, although data were subjective and small in scale. Mortality evidence was limited to two retrospective cohorts with divergent findings.

Beta blockers provide consistent haemodynamic and symptomatic benefits in HOCM, but most evidence derives from small, older studies with high risk of bias and limited survival data. Contemporary, adequately powered randomised controlled trials are required to define optimal agent selection, dosing and long-term outcomes.

CRD42022344255.