Infective endocarditis (i.e.) results from the combined effects of multiple factors, such as frequent vascular access procedures and impaired immune system function, and is relatively common among patients with uremia undergoing long-term hemodialysis. Myocardial infarction with nonobstructive coronary arteries (MINOCA) may present as an atypical clinical presentation, especially in patients with multiple comorbidities.

We report a rare case of a 52-year-old male who underwent regular hemodialysis using a tunneled-cuffed catheter and presented with persistent acute chest distress and pain for 4 hours.

Immediately after defecation, the patient developed persistent severe chest pain, shortness of breath, and profound sweating. ST-segment depression and T-wave alterations in the inferior leads (II, III, and aVF) on the initial ECG, together with elevated troponin I levels, raised suspicion of acute myocardial infarction (AMI). Emergency coronary angiography showed an irregular aortic valve, no significant stenosis of the left main coronary artery, 20-30% stenosis of the middle segment of the anterior descending artery, 30-40% stenosis of the circumflex artery, and no significant stenosis of the right coronary artery. Laboratory results revealed an increased percentage of white blood cells, neutrophils, and C-reactive proteins (CRP). Cardiac ultrasonography revealed hyperechogenicity of the aortic valve, suggesting the presence of vegetation. Considering the patient's history of uremia, long-term hemodialysis, and the absence of obstructive coronary arteries, MINOCA secondary to IE was suspected.

Treatment with broad-spectrum antibiotics was initiated. Given the echocardiographic findings of massive and moderate aortic valve regurgitation, the patient underwent aortic valve replacement with cardiopulmonary bypass.

The patient's inflammatory markers and white blood cells significantly decreased, serum troponin decreased, and ST-T changes in the ECG significantly recovered. After mechanical aortic valve replacement, the patient was discharged with anti-infection therapy, cardiac strengthening, blood purification, and nutritional support.

The clinical presentation of infective endocarditis is atypical in patients undergoing dialysis, especially in the presence of other life-threatening conditions. Early multimodal imaging and multidisciplinary collaboration are essential for the timely diagnosis and management of MINOCA and IE.

This study aimed to evaluate the clinical performance of artificial intelligence (AI)-assisted measurement of thoracic aortic diameter on non-contrast computed tomography (NCCT). This single-center prospective study included 79 patients (mean age = 70 ± 13 standard deviation; 46 men) who underwent NCCT and arterial phase contrast-enhanced computed tomography (CECT) for evaluating aortic diseases between 2021 and 2022. Maximum diameters of 9 American Heart Association landmarks and the maximum ascending/descending aorta were measured. Upper limits of the 95% confidence interval (CI) for the absolute difference in aortic diameter between the AI-assisted/manual method on NCCT and the manual method on CECT (DiffAI-assisted/Diffmanual) were calculated and compared using a predefined cutoff of 1.5 mm. Evaluation times were also compared. No significant difference was found between per-patient DiffAI-assisted and Diffmanual (1.10 mm; 95% CI = 1.03-1.18 vs 1.03 mm; 95% CI = 0.95-1.11, P = .058); the upper limit of the 95% CI was <1.5 mm. The upper limit of the 95% CI of the geometric mean DiffAI-assisted and Diffmanual was also <1.5 mm at each landmark. The median evaluation time of the AI-assisted method was shorter than that of the manual method (expert radiologist = 272 seconds [interquartile range (IQR) = 229-313] vs 496 seconds [IQR = 438-550]; P < .001, training radiologist: 304 seconds [IQR = 257-404] vs 710 seconds [IQR = 563-855]; P < .001). AI-assisted thoracic aortic diameter measurement on NCCT was as accurate as manual measurement on CECT; its evaluation time was shorter than that of manual measurement on NCCT.

Aortic stenosis is a common valvular heart disease associated with substantial morbidity and mortality if left untreated. Surgical aortic valve replacement (SAVR), transcatheter aortic valve implantation (TAVI), and autologous pericardial aortic valve reconstruction (Ozaki procedure) represent alternative interventional strategies, but direct real-world comparisons remain limited. This study evaluated early clinical and 6-month hemodynamic outcomes following these 3 treatment approaches. This retrospective single-center observational study included 153 consecutive patients with severe aortic stenosis treated between December 2020 and March 2022 (SAVR, n = 67; Ozaki, n = 31; TAVI, n = 55). Early mortality was the primary clinical outcome, and 6-month mean transvalvular gradient was the primary echocardiographic outcome. Other clinical and echocardiographic outcomes were considered secondary or exploratory. Multivariable regression, analysis of covariance, and separate pairwise propensity-score matching models were used to account for baseline differences. Propensity scores were estimated using age, sex, EuroSCORE II, chronic kidney disease, and coronary artery disease. TAVI patients were older and had higher operative risk. No statistically significant differences were detected among the groups in early mortality, stroke, or postoperative dialysis. Permanent pacemaker implantation was more frequent after TAVI, while prolonged intensive care unit stay also differed among treatment groups. At 6 months, the Ozaki group showed favorable hemodynamic parameters, including lower mean transvalvular gradients and maximum transvalvular velocity. However, 6-month echocardiographic follow-up was incomplete, and these findings should be considered exploratory given the small Ozaki cohort, baseline differences, and observational study design. SAVR, Ozaki neocuspidization, and TAVI showed distinct early clinical and hemodynamic profiles in this real-world observational cohort. No statistically significant differences were detected in several major early clinical outcomes, although the study was not sufficiently powered to establish equivalent safety or exclude clinically meaningful differences. The favorable short-term hemodynamic findings observed with the Ozaki procedure should be considered hypothesis-generating. Larger prospective studies with longer follow-up are needed to further evaluate comparative clinical outcomes, hemodynamic performance, and durability.

Older adults with cardiovascular disease or hypertension have an elevated risk of depressive symptoms, which may adversely affect prognosis and quality of life. A practical prediction model could support early risk stratification and targeted screening. Data were obtained from the China Health and Retirement Longitudinal Study from 2011 to 2020. A time-based design was used for model development and temporal validation. The development cohort included 548 participants followed from 2011 to 2015, and the nonoverlapping temporal validation cohort included 523 participants followed from 2015 to 2020. The Boruta algorithm was used for predictor selection, 7 machine learning algorithms were compared, and Shapley additive explanations were used to interpret the selected model. Missing values were imputed using a random forest algorithm. Seven predictors were selected. Logistic regression showed the best overall performance, with an area under the receiver operating characteristic curve of 0.844 (95% confidence interval, 0.773-0.915) in the development cohort and 0.840 (95% confidence interval, 0.799-0.881) in the temporal validation cohort. The logistic regression model demonstrated good discrimination and calibration for predicting long-term depressive symptoms among older adults with cardiovascular disease or hypertension. Further independent and prospective validation is required before routine clinical implementation.

Chronic hepatitis B virus (HBV) infection is associated with both hepatic and extrahepatic complications. While liver-related outcomes are well characterized, the burden, demographic patterns, and survival associated with extrahepatic manifestations (EHMs) remain incompletely defined. This study aimed to evaluate the spectrum, incidence, and survival impact of EHMs in a large, geographically diverse cohort of patients with chronic HBV infection. We conducted a retrospective cohort study using the TriNetX Global Research Network, including 2,32,820 patients aged 0 to 90 years with chronic HBV infection. Demographic variables included age, sex, race, ethnicity, and geographic region. EHMs assessed comprised renal (glomerulonephritis), vasculitic (polyarteritis nodosa), musculoskeletal (arthralgia), hematologic (aplastic anemia), immunologic (cryoglobulinemia), and neurologic (polyneuropathy) conditions. Incidence proportions and incidence rates per person-day were calculated and stratified by demographic characteristics. Survival probabilities were estimated for each manifestation. The mean age of the cohort was 60 ± 14 years, and 56.9% were male. Racial distribution included Asian (34.4%), White (15.4%), Black or African American (12.1%), and unknown race (34.4%). Most patients were non-Hispanic (53.6%), with 44.1% reporting unknown ethnicity. Patients were represented across all US regions and internationally. Glomerulonephritis occurred in 1.26% of patients, with higher incidence in older adults, males, and Native Hawaiian/Other Pacific Islander and Hispanic/Latino populations. Polyarteritis nodosa was rare (0.04%) and predominated in older individuals, American Indian/Alaska Native, and Hispanic/Latino patients. Arthralgia was the most frequent EHM (13.76%), increasing with age and more common among females and Black or African American individuals. Cryoglobulinemia (0.10%) and aplastic anemia (0.12%) were uncommon. Polyneuropathy affected 3.27% of patients, with higher prevalence among older adults and males. Chronic HBV infection is associated with a wide spectrum of extrahepatic manifestations, with substantial variation by demographic factors. These findings underscore the need for comprehensive multisystem surveillance and targeted risk stratification in patients with chronic HBV infection.

To conduct a bibliometric analysis of stroke center-related research fields, both domestically and internationally, using CiteSpace, and to explore the current research status, hot topics, and development trends.

Using the China National Knowledge Infrastructure (CNKI), Wanfang, VIP, PubMed, and the Web of Science Core Collection (WOSCC) as data sources, we performed visual analysis of annual publication volume, authors/institutions, and high-frequency keywords through CiteSpace.

A total of 3730 literature pieces were retrieved, including 3044 English articles and 686 Chinese articles. The overall research enthusiasm for stroke centers presents an upward trend. Current research hotspots mainly focus on Intravenous Thrombolysis (IVT), endovascular therapy, emergency green channels, and prognosis. The developmental frontiers chiefly involve machine learning (ML) and information system construction.

This study conducted cluster analysis on literature concerning stroke centers using CiteSpace software. It aims to explore hot topics and evolutionary trends within the field of stroke center research, broaden relevant research perspectives, and provide strategic references for clinical nursing practice and scholarly research.

Cardiovascular disease remains the leading cause of death in the United States, with heart failure (HF) and hyperlipidemia substantially contributing to mortality. This study aimed to examine national trends in HF-related mortality with coexisting hyperlipidemia from 1999 to 2024 and project future mortality patterns through 2035. Mortality data were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Deaths were identified when heart failure and hyperlipidemia were listed on death certificates using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population and were stratified by sex, race/ethnicity, census region, and urbanization level. Temporal trends were evaluated using joinpoint regression analysis. Forecasts for 2025-2035 were generated using machine learning-based Seasonal Autoregressive Integrated Moving Average (SARIMA) time-series models. From 1999 to 2024, 283,161 deaths involving HF with hyperlipidemia were recorded on death certificates. The AAMR increased from 0.7 to 6.8 per 100,000 population, with a notable increase after 2018. Mortality rates were higher among men than women and were elevated in the non-Hispanic Black and American Indian/Alaska Native populations. Higher rates were also observed in nonmetropolitan counties and in the Midwest and West regions of the United States. Mortality involving HF with hyperlipidemia has increased over the past two decades, with persistent demographic and geographic differences. These findings highlight the importance of continued surveillance and targeted prevention strategies to address the cardiovascular health disparities in the United States.

Employees with hypertension face challenging job pressures that have a negative impact on their health, leading to ineffective and unsatisfactory work. Additionally, this can affect an organization's overall level of productivity. This study aimed to examine the effects of rational emotive behavior therapy (REBT) on stress among lecturers in tourism and hospitality management, educational scientists, and home economics and hospitality from state and federal universities who have hypertension, with a focus on the health and well-being of individual workers in specific university faculties.

A randomized controlled study was conducted, involving 93 staff members from private, state, and federal universities. Two dependent measures were assessed at Times 1, 2, and 3. A repeated measures statistical analysis was used to evaluate the participants' responses.

Participants' stress levels and illogical beliefs significantly decreased as a result of the REBT intervention. Before and after the REBT session, the participants' reactions to stress and irrational beliefs differed significantly. The follow-up study's findings confirm the long-lasting benefits of REBT and show the intervention's long-term influence.

The REBT intervention helps educators cultivate a positive mindset, decrease stress, and eliminate irrational beliefs.

ObjectiveModels of youth mental health help-seeking emphasize parents' central role in recognizing concerns, deciding to seek help, and accessing services. However, many parents who perceive a need for care do not access services. This study investigated whether parents' characteristics were related to parents' status in the youth mental health help-seeking pathway.MethodParents (N = 186; 25.8% Black or African American, 25.3% Hispanic or Latino, 15.6% Asian) completed online self-report questionnaires assessing sociodemographic characteristics and mental health-related knowledge, attitudes, and beliefs. Based on their responses to service use history and intentions to seek treatment, parents were classified as need perceivers, treatment intenders, or treatment utilizers.ResultsWhite parents were more likely than Black/African American and Asian parents to be treatment intenders or treatment utilizers rather than need perceivers. Parents were more likely to be treatment utilizers than need perceivers as parental self-efficacy increased and perceived irrelevance of treatment decreased.DiscussionFindings highlight potential parent-level and systemic factors relevant to youth mental health service use. Efforts to support access may benefit from addressing parents' confidence in seeking care, misconceptions about treatment relevance, and racial and ethnic inequities in the youth mental health help-seeking process.