To examine whether early multidimensional mobility assessments discriminate independent ambulation and functional independence on discharge in subacute stroke inpatients with supervised walking ability.

Retrospective cohort study.

Fifty subacute stroke inpatients (≤ 5 months post-stroke).

Independent ambulation and functional independence were defined as Functional Ambulation Category ≥ 4 and Modified Barthel Index 75 on discharge, respectively. Discriminative ability of admission assessments was evaluated using univariate binary logistic regression and receiver operating characteristic curve analysis.

The Berg Balance Scale and the modified Four Square Step Test demonstrated the highest discriminative performance. For independent ambulation, the Berg Balance Scale (≥ 40.5) yielded an area under the curve of 0.74 (95% confidence interval: 0.60-0.88) with 82% accuracy, and the modified Four Square Step Test (≤ 31.52 s) yielded an area under the curve of 0.78 (0.64-0.91) with 80% accuracy. For functional independence, the Berg Balance Scale (≥ 42.5) yielded an area under the curve of 0.74 (0.60-0.88) with 74% accuracy, and the modified Four Square Step Test (≤ 32.88 s) yielded an area under the curve of 0.71 (0.57-0.86) with 70% accuracy.

Early balance and multidirectional stepping performance may be useful for screening to support goal-setting and discharge planning.

Portable air cleaners (PACs) can reduce blood pressure (BP) by decreasing fine particulate matter (PM_2.5) air pollution exposure. However, the effectiveness of a single PAC in a bedroom and the impact on self-measured home BPs over 4 weeks have not been evaluated. We conducted a randomized-order double-blind cross-over trial of active PAC (HEPA filter in-place) versus sham (no filter) intervention in the bedroom of older adults living in a senior residential facility from 1/11/2021-11/4/2024. Each study limb lasted 4 weeks with a 2-week washout period. Participants measured triplicate home BPs in the mornings and evenings during weeks 1 and 4. Bedroom PM_2.5 concentrations were continuously monitored, and 24-h personal exposures were determined during week 4. Results from 33 participants (74.9 ± 7.7 years old) completing the trial were analyzed. Active PAC intervention reduced bedroom PM_2.5 concentrations (1.3±1.5 vs. 8.3±12.8 µg/m³, p < 0.001) and 24-h personal exposures (5.1 ± 4.6 vs. 12.4±15.6 µg/m³, p < 0.001) versus sham. Average home systolic BP levels did not differ during active PAC versus sham intervention in the full study cohort (127.0 ± 16.2 vs. 126.5 ± 16.0 mm Hg, p = 0.59). However, having a larger body mass index plus higher baseline systolic BP, older age plus higher baseline systolic BP, and older age plus larger body mass index showed trends for modifying the benefits by active PAC. We showed for the first time that air filtration in the bedroom alone can successfully reduce PM_2.5 exposures. While systolic BPs were not lowered over 4 weeks in the entire cohort, some individuals may have benefited.

Alzheimer's disease and related dementias are influenced by genetic and environmental risk factors. We investigated the relationship between contextual exposures and cognitive outcomes, independent of and in interaction with polygenic risk.

Using the Multi-Ethnic Study of Atherosclerosis (N = 5687), we assessed the associations of contextual determinants representing the social, chemical, and built environment with incident dementia and late-life cognition using proportional hazards regression and generalized estimating equation models, then evaluated their joint effects stratified by genetic risk via Bayesian kernel machine regression.

Neighborhood disadvantage was associated with higher dementia risk and poorer cognitive scores after adjusting for genetic risk and other individual-level covariates. Joint analysis of all contextual determinants indicated that more deleterious mixtures of contextual determinants are associated with lower late-life cognition among apolipoprotein E ɛ4 non-carriers with intermediate polygenic risk.

Contextual determinants are associated with dementia and late-life cognition after adjusting for age, sex, education, and genetic risk.

Mortality among patients receiving chronic hemodialysis remains substantially higher than in the general population, with cardiovascular and infectious diseases as the leading causes of death. Data from rural, low-complexity community hospitals are limited. In geographically remote areas, factors such as long distances to higher-complexity referral centers and potential delays in access to specialized care may influence patient outcomes. This study aimed to determine the annual mortality rate and causes of death in a cohort of chronic hemodialysis patients treated at a rural community hospital in Chile.

We conducted a retrospective cohort study including all adult patients receiving maintenance chronic hemodialysis at our center between January 1, 2025, and January 31, 2026, corresponding to a 13-month observation period. Transient patients who were temporarily dialyzed at our unit for less than two months before returning to their original dialysis center were excluded. Total patient-years were calculated, and mortality was expressed as deaths per 100 patient-years with 95% confidence intervals.

A total of 59 patients were included (mean age 65 ± 14.7 years; 69.4% male). During follow-up, 13 patients died, accounting for 53.45 patient-years. The overall mortality rate was 24.3 deaths per 100 patient-years (95% CI: 13.0-41.6). Cardiovascular causes accounted for 61.5% of deaths, infectious causes for 30.7%, and traumatic causes for 7.6%. Six patients initiated dialysis during the study period; in this subgroup, the mortality rate was 56.5 deaths per 100 patient-years.

The observed mortality rate was slightly higher than rates reported in large international registries. Although limited by the small number of patients in a single rural dialysis unit, these findings underscore the importance of continued outcome monitoring in rural dialysis units and suggest that structural and geographic factors may influence patient survival.

Hand-arm vibration syndrome (HAVS) is a chronic disease to vessels and nerves caused by vibrations. In Sweden, the medical check-up for vibrations (MCV) implements the EU surveillance system to detect early cases. No earlier research has shown participation in MCVs, nor why MCVs is avoided. We aimed to improve the understanding on avoidance of MCVs among vibration-exposed workers.

We used a mixed method. Participation was estimated from sales data registries from the three largest occupational health services (OHS) in Sweden, comprising 50% of the market share. Exposure figures for the quantitative estimates came from both public data and exposure-data from a meta-analysis. The qualitative aim was explored through strategic telephone interviews with 26 workers with known symptoms of HAVS using hermeneutical methods.

MCV-participation has increased five-fold from 2016-2022. In 2020-2022, 11,643 MCVs were performed in the three OHS, giving a national estimate of 22,000 MCVs. We estimated the number of exposed workers to be 218,000 by exposure, and 400,000 by statistical sources only. MCVs were mainly avoided because they are not offered by employers despite being mandatory, and due to fear of the socio-economic consequences of a HAVS diagnosis. Other reasons included bullying, inconvenience, perceived lack of necessity, and limited awareness.

Only 5%-10% of exposed Swedish workers attend an MCV despite its importance. A cohesive and transparent process is proposed to increase the low participation rate to avoid the common, chronic, and debilitating injuries from HAVS.

Immune checkpoint inhibitor-associated myocarditis (ICI-associated myocarditis) is a rare but fatal immune-related adverse event. Early identification of high-risk patients remains challenging. This study aimed to identify risk factors and develop models for predicting both the occurrence and severity of ICI-associated myocarditis.

This retrospective unmatched case-control study stratified patients receiving ICIs into ICI-associated myocarditis (stratified into mild and severe subgroups) and controls. Comparative analysis of baseline and onset-phase data was performed, with logistic regression used to identify risk factors for the development of ICI-associated myocarditis and the severe myocarditis.

In this cohort of 196 patients (98 myocarditis cases vs. 98 controls), a two-tiered risk stratification was established. Patients with myocarditis were further stratified into mild (n=71) and severe (n=27) subgroups. For predicting the occurrence of ICI-associated myocarditis, a baseline model incorporating elevated eosinophil ratio, reduced lymphocyte ratio, and elevated myoglobin demonstrated an area under the ROC curve (AUC) of 0.699 (95% CI, 0.626-0.772, P < 0.001). Upon onset, for predicting severe myocarditis, a model combining electrocardiographic abnormalities (T-wave changes, bundle branch blocks) and marked CK elevation (>10× ULN) achieved a higher AUC of 0.769 (95% CI, 0.655-0.882, P < 0.0001). Severe cases presented significantly earlier than mild cases (33 vs. 63 days, P = 0.043) and had higher rates of symptoms and concurrent immune-related adverse events.

A baseline profile of elevated eosinophil ratio, reduced lymphocyte ratio, and elevated myoglobin collectively may help identify patients at risk for ICI-associated myocarditis. At myocarditis onset, a combination of specific electrocardiographic abnormalities and marked CK elevation may predict severe cases. These findings suggest a two-stage approach for early risk stratification and targeted management.

This study aimed to investigate the independent and joint effects of two novel lipid-derived biomarkers-Remnant cholesterol (RC) and Cholesterol, high-density lipoprotein, and glucose (CHG) index-with hemorrhagic transformation (HT) and poor prognosis in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT).

In this dual-center retrospective cohort study, 4403 AIS patients undergoing IVT were analyzed. RC and the CHG index were calculated from routine baseline biochemical measurements. The primary outcome was HT, and the secondary outcome was poor prognosis at 90 days (modified Rankin Scale [mRS] score > 2). Multivariable logistic regression and restricted cubic spline (RCS) models were used to assess linear and non-linear associations. Subgroup and receiver operating characteristic (ROC) analyses were conducted to evaluate robustness and discriminative ability. Mediation analysis explored the potential mediating role of the systemic immune-inflammation index (SII).

Patients with HT or a poor prognosis had lower RC and CHG levels. Multivariate logistic regression analysis revealed that both RC and CHG were negatively associated with the risk of HT and with a poor prognosis. The joint effects showed that patients with higher levels of RC and CHG had a significantly lower risk of HT (OR = 0.18, 95% CI: 0.12-0.25) and poor prognosis (OR = 0.40, 95% CI: 0.32-0.49). Subgroup analyses confirmed the consistency of these negative associations across age, sex, baseline NIHSS, and vascular comorbidities. The RCS models showed a non-linear association between RC and poor prognosis (P for non-linearity < 0.05) but a linear trend with HT (P > 0.05). In contrast, CHG showed a U-shaped non-linear association with both outcomes (P < 0.05). Moreover, the combination of RC and CHG had better predictive efficacy for HT (AUC = 0.750, 95% CI: 0.727-0.773, P < 0.001) and poor prognosis (AUC = 0.721, 95% CI: 0.705-0.737, P < 0.001) than alone. Mediation analysis further showed that SII partially mediated these associations.

High RC and CHG levels were associated with a lower risk of HT and poor prognosis in AIS patients undergoing IVT. Integrating these biomarkers enhances predictive performance, supporting their potential utility in pre-thrombolysis risk stratification and personalized treatment decision-making.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a prevalent metabolic disorder with rising global incidence and substantial clinical implications. The atherogenic index of plasma (AIP), a novel marker of lipid metabolism, has shown potential in predicting metabolic diseases, but its longitudinal association with MASLD remains unclear.

This longitudinal study included 1,894 participants from the health examination database of the First Affiliated Hospital of Xi'an Jiaotong University (2020-2024). Group-based trajectory modeling (GBTM) identified three AIP trajectory patterns: low-stable, moderate-stable, and high-stable. Cox proportional hazards models were used to assess the association between AIP trajectories and incident MASLD, adjusting for demographic, lifestyle, and metabolic factors. Subgroup and sensitivity analyses were conducted to assess effect modification and robustness.

Three AIP trajectory patterns were identified: low-stable (33.7%), moderate-stable (49.1%), and high-stable (17.3%). Over a median follow-up of 2.97 years, the high-stable group exhibited a 2.23-fold increased risk of incident MASLD (adjusted HR = 2.23, 95% CI: 1.51-3.30; P < 0.001) compared with the low-stable group, even after adjusting for metabolic mediators including BMI and fasting glucose. The moderate-stable group also showed an increased risk (HR = 1.42, 95% CI: 1.02-1.98; P = 0.038). Subgroup analyses demonstrated consistent associations, with more pronounced effects among non-diabetic and non-hypertensive individuals. Sensitivity analyses further confirmed the robustness of these findings.

Sustained high AIP levels are independently associated with an increased risk of MASLD. AIP trajectory monitoring may offer a valuable tool for early identification and targeted prevention of MASLD.

There is mounting evidence that conventional replacement strategies with calcium and vitamin D are insufficient to fully prevent complications of chronic hypoparathyroidism (HypoPT) in all patients.

To investigate the disease burden of chronic HypoPT, we performed a survey in 205 HypoPT patients (159 females; median age 55 years; median disease duration 16 years). Patients received a disease-specific questionnaire asking for subjective health status, comorbidities, disease-related emergencies and interference of HypoPT with daily and work life. Patients were further assessed by the SF-36 questionnaire. Data was compared to sex- and age-matched subjects from the Study of Health in Pomerania SHIP-START, the German Health Interview and Examination Survey for Adults (DEGS1) and to 214 patients with adrenal insufficiency.

Clinical symptoms associated with HypoPT during the past 12 months were reported by 92% of patients, requiring medical intervention in 32%. Since primary diagnosis of HypoPT, 36% of patients had presented at least once at an emergency department due to severe hypocalcemia (14.7 events per 100 patient years). Trigger factors for hypocalcemic symptoms were reported by 76% of patients (e.g. physical activity, infections, hot weather). In comparison to population-based controls, patients with HypoPT showed a higher prevalence of renal insufficiency (11% vs. 2%, p<0.001) and more frequently received antihypertensive (44% vs. 34%; p=0.003) and antiepileptic drugs (5% vs. 2%, p=0.01). Lifetime prevalence of both depression (22% vs. 15%, p=0.003) and anxiety (21% vs. 6%, p<0.001) were increased in HypoPT. SF-36 values indicated significantly reduced subjective health status in HypoPT patients compared to controls as well as patients with adrenal insufficiency.

Despite established treatment, chronic HypoPT is associated with a variety of symptoms with a significant impact on daily life and work life.

https://ClinicalTrials.gov/NCT03437174.

The aim of this study is to report our experience with a complication that occurred during a single-branch aortic arch endograft deployment for a symptomatic aortic aneurysm exclusion. An 85-year-old patient was diagnosed with an aortic arch and descending aortic aneurysm associated with chest pain and dyspnea. After a multidisciplinary discussion, we selected an endovascular approach using an off-the-shelf device for the arch (Nexus™ endograft; Endospan) with a single branch for the brachiocephalic trunk (BCT). Supra-aortic trunks debranching (right common carotid-left subclavian bypass and left common carotid artery reimplantation) was planned in the same procedure. After an uneventful main module deployment, the release of the ascending graft was followed by the sudden occlusion of the endograft branch. Suspecting the branch coverage by the ascending module, a relining of the branch using the through-and-through guide wire was performed restoring brain perfusion. The post-operative course was uneventful as well during the follow-up (6 months). In our experience, the Nexus™ endograft (Endospan) presents peculiar technical features that provide great main module deployment stability and allow for rapid bailout maneuvers if complications occur.