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.

To evaluate the efficacy and safety of Chinese herbal acupoint application for post-stroke sleep disorders, particularly insomnia and poor sleep quality, and to provide evidence for sleep management during post-stroke rehabilitation.

This systematic review and meta-analysis followed the PRISMA 2020 reporting guideline and was registered in PROSPERO (CRD420261358357). China National Knowledge Infrastructure, Wanfang Data, VIP Database, Chinese Biomedical Literature Database (SinoMed), PubMed, the Cochrane Library, Embase, and Web of Science were searched from inception to April 1, 2026. Randomized controlled trials comparing acupoint application plus a comparator intervention with the same comparator intervention alone were included. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1), certainty of evidence was evaluated using GRADE, and meta-analyses were performed in RevMan 5.4.1.

Seven randomized controlled trials involving 608 participants were included. Compared with the matched comparator intervention alone, adjunctive acupoint application was associated with a higher trial-defined clinical response rate [odds ratio (OR) = 3.50, 95% confidence interval (CI) 2.05-5.97; p < 0.00001] and lower Pittsburgh Sleep Quality Index scores [mean difference (MD) = -2.69, 95% CI - 3.84 to -1.55; p < 0.00001], Hamilton Anxiety Rating Scale scores (MD = -9.38, 95% CI - 10.09 to -8.68; p < 0.00001), and Hamilton Depression Rating Scale scores (MD = -7.58, 95% CI - 9.08 to -6.08; p < 0.00001). Only two studies reported adverse events, and no study reported post-treatment follow-up. The certainty of evidence was low for trial-defined clinical response and very low for the other outcomes.

Low- to very-low-certainty evidence suggests that adjunctive Chinese herbal acupoint application may improve subjective sleep quality and emotional symptoms after stroke. However, the true effects may differ substantially from the pooled estimates. Current evidence is insufficient to establish safety or sustained benefit; larger, multicenter, rigorously designed trials are required.

https://www.crd.york.ac.uk/prospero/, CRD420261358357.

Deep vein thrombosis (DVT) is a major complication in patients with traumatic fractures. Although clinical guidelines recommend risk stratification and appropriate thromboprophylaxis, the burden of in-hospital detected DVT remains high.

To evaluate in-hospital DVT detection, the discriminative ability of the modified Caprini score, and thromboprophylaxis guideline adherence in hospitalized patients with traumatic fractures.

This retrospective real-world study included 13,990 patients with traumatic fractures admitted to the Second Affiliated Hospital of Chongqing Medical University from January 2019 to October 2024. Demographic characteristics, comorbidities, fracture characteristics, and clinical data were extracted from electronic medical records. Patients were stratified into very-low-risk, low-risk, moderate-risk, and high-risk groups according to the modified, retrospectively reconstructed Caprini Risk Assessment Model, and thromboprophylaxis practice across risk categories was analyzed.

Among 13,990 hospitalized patients with traumatic fractures, DVT was detected during hospitalization in 1765 patients (12.62%). In the operational guideline-adherence analysis, restricted to patients for whom routine thromboprophylaxis was recommended and excluding patients whose prophylaxis was initiated only after DVT detection, 13,156 patients were included; 8121 (61.73%) received recorded pharmacological or mechanical thromboprophylaxis, and 6065 (46.10%) received guideline-concordant prophylaxis. Thromboprophylaxis use increased with higher risk categories, whereas overall guideline adherence remained suboptimal. The modified Caprini score showed moderate discrimination for in-hospital detected DVT.

Approximately one in 8 hospitalized patients with traumatic fractures had DVT detected during hospitalization. Significant gaps in thromboprophylaxis practice and guideline adherence persist in real-world clinical settings. Improved risk assessment and optimized implementation of guideline-based thromboprophylaxis may help improve real-world VTE prevention practice in patients with traumatic fractures.