Aims/Background Patients with acute Stanford type A aortic dissection (ATAAD) face particularly high risks of prolonged mechanical ventilation and weaning failure due to the combined effects of surgical trauma, systemic inflammation, and multi-organ involvement. However, current weaning predictors are primarily derived from general cardiac surgery populations, leaving ATAAD-specific evidence limited. This study investigated the factors influencing postoperative mechanical ventilation weaning outcomes in ATAAD patients and constructed a prediction model. Methods We retrospectively analyzed 120 postoperative ATAAD patients requiring mechanical ventilation at Nanjing First Hospital between January 2020 and March 2022. Patients were categorized into a weaning success group (n = 79) and a weaning failure group (n = 41) based on their weaning outcomes. Clinical variables were compared between groups, and multivariate logistic regression analysis was performed to identify independent predictors of weaning failure. Multicollinearity was assessed using variance inflation factors (VIFs). A nomogram prediction model was developed, and its performance was evaluated using the C-index, receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). Results Multivariate logistic regression identified a history of chronic obstructive pulmonary disease (COPD) (p = 0.002), a history of kidney disease (p = 0.002), increased intraoperative blood loss (p = 0.037), elevated postoperative 24-hour serum creatinine (Scr) (p < 0.001), and elevated brain natriuretic peptide (BNP) levels (p = 0.009) as independent risk factors for weaning failure from mechanical ventilation in ATAAD patients. An increased respiratory rate (p = 0.003) was a protective factor. Multicollinearity testing revealed that VIF values for all six variables were <5 (1.018-1.050), indicating no significant collinearity. The nomogram model demonstrated good discrimination (C-index = 0.806, 95% confidence interval [CI]: 0.752-0.859; with an area under the curve [AUC] = 0.80 (95% CI: 0.72-0.88, p < 0.001), with a sensitivity of 92.13% and specificity of 67.86%. The calibration curve showed strong agreement with the ideal model. DCA indicated a significant net clinical benefit at thresholds above 0.2, confirming the clinical utility of the model. Conclusion Mechanical ventilation weaning failure is a frequent and clinically significant complication after ATAAD surgery. Its risk is associated with a history of COPD, a history of kidney disease, intraoperative blood loss, postoperative Scr, BNP, and respiratory rate. The constructed nomogram accurately predicts weaning outcomes, offering valuable support for individualized risk assessment and clinical decision-making in ATAAD patients.

Aims/Background Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation, pannus formation, and neovascularization. Reliable biomarkers for monitoring RA activity are needed to optimize treatment strategies. Periostin (POSTN) and vascular endothelial growth factor (VEGF) contribute to tissue remodeling and angiogenesis in various diseases, but their combined role and clinical significance in RA remain underexplored. This study aimed to evaluate serum POSTN and VEGF levels in RA patients and their correlation with disease activity. Methods Serum levels of POSTN and VEGF were quantified using enzyme-linked immunosorbent assay (ELISA) in 86 RA patients, 36 osteoarthritis (OA) patients, and 40 healthy volunteers (HV) enrolled between January 2022 and December 2024 at Jinhua Municipal Central Hospital. RA patients were categorized into active (Disease Activity Score-28 [DAS28] >2.6) and stable (DAS28 ≤2.6) subgroups. Serum POSTN and VEGF levels were compared across the three study groups and between RA activity subgroups. Correlations between these biomarkers and clinical/laboratory parameters, including DAS28, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were analyzed. Results Serum POSTN and VEGF levels were significantly higher in RA patients [(125.21 ± 35.17) ng/mL, (106.45 ± 29.54) pg/mL] compared to OA patients [(98.41 ± 30.09) ng/mL, (82.28 ± 23.18) pg/mL] and healthy controls [(75.86 ± 22.81) ng/mL, (71.24 ± 11.72) pg/mL] (all p < 0.001). Furthermore, POSTN and VEGF levels in the active RA group [(144.68 ± 29.98) ng/mL, (121.75 ± 27.49) pg/mL] were significantly higher than those in the inactive group [(100.62 ± 24.23) ng/mL, (87.33 ± 19.12) pg/mL] (all p < 0.001). Spearman's or Pearson's correlation analyses revealed a positive correlation between POSTN and VEGF in RA patients (r = 0.708, p < 0.001). Serum POSTN levels were positively correlated with DAS28, CRP, and ESR (r_DAS28 = 0.753, r_CRP = 0.623, r_ESR = 0.437, p < 0.001) so was VEGF (r_DAS28 = 0.720, r_CRP = 0.433, r_ESR = 0.623, all p < 0.001). Conclusion POSTN and VEGF levels are elevated in RA patients, correlate with disease activity markers, and may serve as complementary biomarkers for assessing RA activity.

Cardiovascular diseases (CVD) and depression frequently co-occur, yet the biological mechanisms underpinning this comorbidity remain poorly understood. This may reflect complex, non-linear associations across multiple biological pathways. We aimed to identify molecular biomarkers linking depressive symptoms and cardiovascular phenotypes using a network-based integrative approach.

Data were obtained from the Young Finns Study (N = 1,686; mean age = 37.7 years; 58.3% female), including 21 depressive symptoms (Beck Depression Inventory), 17 CVD-related indicators, 6 risk factors, 228 metabolomic, and 437 lipidomic variables. Mutual information was used to capture both linear and non-linear associations among variables. A multipartite projection network was constructed to quantify how depressive symptoms and cardiovascular phenotypes are biologically connected via shared metabolites and lipids. Biomarkers were ranked by their contribution to these projected associations. Results were validated in an independent cohort from the UK Biobank.

Specific depressive symptoms - crying, appetite changes, and loss of interest in sex - showed strong projected associations with diastolic blood pressure, systolic blood pressure, and cardiovascular health scores. Key mediators included creatinine, valine, leucine, phospholipids in very large HDL, triglycerides in small LDL, and apolipoprotein B. Important lipid mediators included sphingomyelins, phosphatidylcholines, triacylglycerols, and diacylglycerols. Replication analysis in the UK Biobank identified many overlaps in metabolite profiles, supporting generalizability.

This network-based analysis revealed symptom-specific biological pathways linking CVD and depression. The identified biomarkers may offer insights into shared mechanisms and support future prevention and treatment strategies for cardiometabolic-psychiatric comorbidity.

The aim of this study was to evaluate the changes in platelet indices (PLT) provided by the ADVIA 2120 hematology analyzer (Siemens Hematology System) in the early stages of onset of infections and acute coronary syndromes (ACSs).

Samples were selected from 40 patients admitted to the intensive care unit with suspected uncomplicated sepsis at presentation, from 40 patients with a biochemical diagnosis of ACS at presentation and from 40 apparently healthy subjects. These samples were tested for PLT and PLT indices [mean platelet volume (MPV); mean platelet mass (MPM); mean platelet component (MPC); immature platelets (RtcPlts)] obtained by automation with the ADVIA 2120 and specific biomarkers for sepsis [white blood cells (WBCs); neutrophil granulocytes (NGs); presepsin (PSP); procalcitonin (Pct); C-reactive protein (CRP)] and for SCA (hs cTnI).

Platelet indices (RtcPlts, MPV, MPM) were significantly altered (p > 0.005) in patients with suspected sepsis and patients with ACS compared to control subjects; however, no statistically significant difference was observed between the two groups of patients with disease. Cutoff values (ROC curves) were obtained for platelet indices that best discriminated healthy subjects from subjects with severe infection or ACS.

Our data show that, in subjects with suspected sepsis and ACS at disease onset, a state of early platelet activation exists that is not disease-specific. Immature platelets (RtcPlts) and the platelet indices MPM and MPV, provided by the ADVIA 2120 hematology analyzer, showed high sensitivity in subjects with suspected sepsis or ACS at disease onset.

Background: Sarcopenia is linked with high rates of adverse surgical outcomes, and computed tomography angiography (CTA)-based psoas measurements are used as imaging sarcopenia surrogates. Their prognostic value in patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization remains uncertain. Objectives: To evaluate whether CTA-derived psoas muscle indices predict complications and mortality after lower-limb revascularization for CLTI. Methods: We performed a retrospective cohort study of consecutive adults who underwent open, hybrid, or endovascular revascularization for CLTI at a single tertiary center (March 2018-December 2021). Psoas muscle area (PMA) and density (PMD) were measured preoperatively on CTA at the mid-L3 vertebral level. Psoas muscle index (PMI) was calculated as PMA/height². Patients were stratified by tertiles for each index (lowest tertile = "sarcopenic" vs. upper two tertiles). Outcomes included early in-hospital complications, late complications, overall complications, late mortality, and overall mortality. Group comparisons used χ²/Fisher tests with false discovery rate (FDR) adjustment; multivariable logistic regression with AIC-guided selection assessed independent predictors. Results: A total of 234 patients were included (median age 68 years; 65.4% men). Early complications occurred in 15.8%; late complications in 70.3%; overall mortality during follow-up was 26.6% (38/143 within follow-up data). In tertile analyses, none of the psoas-derived measures were significantly associated with early complications, late complications, overall complications, or mortality after FDR correction. Lower PMD showed consistent but non-significant trends toward higher late complications (84% vs. 64%), overall complications (87% vs. 72%), overall mortality (38% vs. 21%), and late mortality (37% vs. 20%) (all p < 0.05 unadjusted; all p_adj ≥ 0.139). In multivariable models, PMA, PMD, and PMI were not independent predictors of any outcome. Conclusions: In this retrospective cohort study, preoperative CTA-derived psoas indices were not independent predictors of early, late, or overall complications, nor of in-hospital or follow-up mortality after revascularization for chronic limb-threatening ischemia. Although lower psoas muscle density showed consistent trends toward higher risk, these associations did not reach statistical significance after adjustment. Taken together, our findings suggest that psoas-based measures have limited prognostic value in this setting and should be interpreted cautiously, while their potential role warrants confirmation in larger, prospective studies.

The evolution of decentralized clinical trials, driven by advanced digital technologies, is transforming traditional clinical research. It introduces innovative methods for informed consent, remote patient monitoring, and data analysis, enhancing study efficiency, validity, and participation while reducing patient burden. Some clinical procedures can be conducted remotely, increasing trial accessibility and reducing population selection biases, particularly for cardiovascular patients. However, this also presents complex regulatory and ethical challenges. The article explores how digital platforms and emerging technologies like block chain, AI, and advanced cryptography can promote traceability, security, and transparency throughout the trial process, ensuring participant identification and documentation of each procedural step. Clear, legally compliant informed consent, often managed through electronic systems, both for research participation and data management in line with GDPR, is essential. Ethical considerations include ensuring participants understand trial information, with adaptations such as simplified language, visual aids, and multilingual support. The transnational nature of decentralized trials highlights the need for coordinated regulatory standards to overcome jurisdictional barriers and reinforce accountability. This framework promotes trust, shared responsibility, and the protection of participants rights while upholding high ethical standards in scientific research.

Cardiac allograft vasculopathy (CAV) remains a prevalent and serious long-term complication following orthotopic heart transplantation (OHT), contributing substantially to graft failure and patient mortality. Given the adverse prognostic impact of extensive coronary artery involvement, this study investigates whether myocardial work (MW) indices can serve as a non-invasive tool to detect OHT recipients with a high burden of coronary disease.

In this prospective study, 55 OHT recipients underwent paired evaluations with coronary computed tomography angiography (CCTA) and transthoracic echocardiography (TTE) during routine follow-up. From the echocardiograms, global longitudinal strain (GLS) of the left ventricle (LV) and myocardial work (MW) indices were derived. Patients were classified into two groups according to CCTA findings: those without extensive coronary artery disease (disease affecting fewer than four coronary segments or none, OHT < 4) and those with extensive disease (disease of four or more coronary artery segments, OHT ≥ 4).

CCTA revealed extensive coronary disease in 38 OHT recipients, while 17 had involvement of fewer than four segments or none. Between-group comparisons showed significant differences in global wasted work (GWW, energy expended without generating forward flow) and global work efficiency (GWE, the percentage of constructive work relative to total work). Using the Youden Index, the optimal thresholds for identifying extensive disease were GWW > 88 mmHg% and GWE < 94%. Patients exceeding these thresholds had a markedly higher probability of having ≥ 4 affected segments, with ORs of 4.61 for pathological GWW and 3.68 for pathological GWE compared to those with normal values.

GWW and GWE demonstrated the strongest performance for identifying OHT recipients with extensive coronary disease. If confirmed in larger cohorts, these indices could offer a practical, non-invasive approach for detecting extensive CAV.

Right heart failure (RHF) remains an under-recognized yet devastating condition in critically ill and chronic patients, frequently complicating cardiac surgery, pulmonary embolism, advanced heart failure, sepsis and left ventricular assist device (LVAD) implantation. Despite growing awareness, clinical decision making is still hampered by the complex pathophysiology, limitations in diagnosis and a fragmented therapeutic landscape. In recent years, progress in hemodynamic phenotyping, advanced echocardiographic and biomarker-based assessment, and the development of mechanical circulatory support (MCS) systems, including percutaneous and surgical right ventricle assist devices (RVAD), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), Impella RP (right percutaneous) or BiPella (Impella CP/5.0/5.5 + Impella RP) has expanded the armamentarium for managing RHF. This review synthetizes current evidences on the anatomical, physiological and molecular underpinnings of RHF, delineates the distinction and continuum between acute and chronic forms and provides a comparative analysis of diagnostic tools and MCS strategies. By integrating mechanistic insights with emerging clinical frameworks, the review aims to support earlier recognition, tailored management and innovative therapeutic approaches for this high-risk population.

Systemic capillary leak syndrome is a rare disorder, first described in 1960, characterized by recurrent episodes of shock, hemoconcentration, and hypoalbuminemia. Diagnosis is primarily clinical, and management includes supportive care and immunoglobulin therapy. Given its potentially life-threatening course, early recognition and timely treatment are essential to improving outcomes. We report the case of a 48-year-old man with recurrent episodes of shock, hemoconcentration, and hypoalbuminemia, initially misdiagnosed as sepsis. He required intensive care management and underwent fasciotomies of all four extremities due to compartment syndrome. During the second hospitalization, he was correctly diagnosed with systemic capillary leak syndrome. Treatment with intravenous immunoglobulins, theophylline, and salbutamol was initiated, leading to a sustained favorable clinical response to date.

Behçet's syndrome (BS) is a variable-vessel vasculitis with multiorgan involvement and heterogeneous clinical manifestations. A list of studies were published on BS last year including studies that explore the epidemiology of BS in different parts of the world, role of potential immunological biomarkers in major organ involvement phenotypes, genome wide association studies, studies on micro RNAs, toll like receptors, neutrophil function and epigenetics that added to our understanding of the pathogenesis, studies on imaging and clinical findings that aim to improve diagnosis, differential diagnosis, and monitoring of each organ involvement, as well as studies on management, especially focusing on the role of TNF inhibitors compared to conventional immunosuppressives. The aim of this review is to provide a critical digest of the studies on BS published during 2024.