Prehospital delay remains a major barrier to timely reperfusion therapy in acute ischemic stroke (AIS). We externally validated eight prediction algorithms and examined whether complex machine-learning models added value beyond logistic regression.

This retrospective cohort study included consecutive patients with AIS from two hospitals in Kashgar, China (January 2019-December 2024). Hospital 1 (n = 1,377) was the development cohort and Hospital 2 (n = 1,015) the independent validation cohort. Prehospital delay was defined as onset-to-door time >4.5 h. LASSO selection and tuning were restricted to Hospital 1. Sensitivity analyses used all 36 encoded candidate features and repeated all models without SMOTE. Evaluation included discrimination, calibration, post-hoc recalibration, and decision curves.

Delay occurred in 80.9 and 83.2% of the two cohorts. In the prespecified LASSO-plus-SMOTE analysis, XGBoost had the highest validation AUC (0.771; 95% CI, 0.734-0.807), but did not significantly outperform logistic regression (difference, 0.015; 95% CI, -0.003 to 0.034; p = 0.107). Full-feature modeling produced no consistent gain. Omitting SMOTE improved calibration and often discrimination; logistic regression without SMOTE achieved AUC 0.774 and Brier score 0.122, versus 0.756 and 0.180 with SMOTE. The original SMOTE-trained logistic model underestimated absolute risk. Rural residence, non-emergency-channel presentation, referral, and non-ambulance transport were associated with absolute risk differences of 15.8, 21.5, 9.2, and 36.3 percentage points in Hospital 2.

Complex algorithms did not show a clear advantage over logistic regression. Because several predictors are available only after arrival, the framework is intended for retrospective health-system profiling and quality-improvement planning, not individual pre-arrival prediction. Universal interventions remain warranted given the high prevalence of delay.

Extended thromboprophylaxis after medical hospitalization has not consistently shown benefit, largely due to increased bleeding events. Accurate prediction of postdischarge (PD) venous thromboembolism (VTE) and bleeding risk is therefore essential. The Intermountain Risk Scores (IMRSs) were developed to predict 90-day risks of these outcomes following discharge.

To assess the predictive performance and external validity of the IMRSs in an independent cohort.

We retrospectively identified adults discharged alive from medical hospitalizations at an academic medical center between 2010 and 2019. PD VTE and bleeding events were identified using validated computable phenotypes. IMRSs were calculated using data at discharge, with missing data addressed via multiple imputation. We determined the observed risks of VTE and bleeding in our cohort for low- and high-risk patients and compared these with the corresponding risks reported in the original cohort and evaluated model discrimination by estimating the time-dependent area under the receiver operating characteristic curve.

Among 14,556 discharges, 108 PD VTE and 373 PD bleeding events occurred within 90 days. The observed risk for high-risk and low-risk categories was 0.9% and 0.5% for VTE (hazard ratio 1.51; 95% CI, 0.88-2.59) and 4.2% and 1.8% for bleeding (hazard ratio 2.51; 95% CI, 2.04-3.08), respectively. Discrimination was poor for both outcomes (area under the receiver operating characteristic curve 0.55 for VTE; 0.60 for bleeding).

The IMRSs demonstrated limited discrimination in this external cohort. These findings suggest that the IMRSs may not be generalizable to all medical populations and highlight the need for more robust risk-stratification tools.

To evaluate the efficacy and safety of endovascular treatment (EVT) versus standard medical therapy (SMT) in patients with progressive large vessel occlusion (LVO) presenting 24-72 h after onset.

We retrospectively analyzed patients with progressive LVO and perfusion mismatch (tissue window) between 24 and 72 h after onset. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days. Secondary outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH).

A total of 164 patients were included (EVT, n = 48; SMT, n = 116). The EVT group showed significantly better 90-day functional outcomes (median mRS: 3 [IQR 2-4] vs. 4 [IQR 3-6]; OR 1.86, 95% CI 1.13-5.25; p = 0.018) and higher functional independence rates (43.8% vs. 12.9%; OR 5.24, 95% CI 2.73-10.05; p < 0.001) compared with the SMT group. EVT was also associated with reduced severe disability or death (18.8% vs. 47.4%; OR 0.26, 95% CI 0.12-0.56; p < 0.001) and lower all-cause mortality (12.5% vs. 37.9%; OR 0.23, 95% CI 0.09-0.51; p = 0.001). The incidence of sICH did not differ significantly between groups (10.4% vs. 6.0%; OR 1.81, 95% CI 0.65-5.08; p = 0.409). These findings remained consistent after PSM and in sensitivity analyses excluding non-witnessed strokes. Subgroup analysis indicated that good collateral circulation (Tan 2-3) significantly predicted functional independence (73.1% vs. 9.1%; OR 27.14, 95% CI 4.83-152.45; p < 0.001).

For progressive LVO patients presenting 24-72 h after onset with favorable perfusion imaging, EVT was associated with improved functional outcomes and lower mortality, without a significant increase in hemorrhage risk. Furthermore, good collateral circulation is a statistically significant factor associated with EVT benefit.

Myocardial infarction (MI) is an acute, life-threatening cardiovascular disease, and high-quality, accessible public health education is vital for emergency management. This study systematically evaluates the quality, transparency, clinical accuracy, patient safety, and readability of information generated by different large language models (LLMs) in responding to MI-related public inquiries.

Twenty-five representative MI patient education questions were submitted to Gemini 3.5 Flash, Claude Opus 4.8, and ChatGPT 5.5. The generated information was independently evaluated by two cardiologists using four validated tools (DISCERN, EQIP, GQS, and JAMA) alongside a strict clinical safety assessment. Text readability was concurrently assessed utilizing six established metrics (FRES, ARI, GFI, CLI, FKGL, and SMOG).

Significant variations were observed in the quality, transparency and readability of information generated by the evaluated LLMs. Regarding quality and transparency, significant overall differences were noted among models in DISCERN (p < 0.001) and EQIP (p < 0.001) scores, whereas no significant differences were found in GQS and JAMA benchmarks. For DISCERN, Claude achieved significantly higher scores than both Gemini and ChatGPT. In the EQIP assessment of completeness and clarity, Claude and Gemini scored significantly higher than ChatGPT, though all models attained a "good" rating. Additionally, all models exhibited poor performance on the JAMA benchmark, indicating critical deficits in information transparency. Notably, LLMs sometimes generated incomplete, incorrect, or even potentially harmful information. Regarding readability, although Claude generated relatively more comprehensible text, all models failed to meet the recommended sixth-grade reading benchmark, indicating high reading difficulty.

While LLMs can generate structurally clear and logically coherent foundational content for MI-related queries, they occasionally produce clinically inappropriate directives. Furthermore, the texts generated by these models are overly complex, creating substantial reading barriers for the general public. Consequently, under zero-shot and English-language testing conditions, the current LLMs are not yet capable as standalone health education tools for MI.

Cardiovascular diseases (CVDs) represent the leading global cause of disability and premature mortality, imposing an immense burden on global public health and medical systems. Notwithstanding the availability of multiple clinical drugs, controlling the incidence and mortality of CVDs remains a formidable challenge. Pyroptosis, a specialized pro-inflammatory programmed cell death marked by membrane pore formation, is involved in the pathogenic mechanisms of several CVDs. Phytomedicines, encompassing plant-derived metabolites and multi-botanical botanical formulations, can inhibit pyroptosis by regulating related pathways, thereby exerting cardiovascular protective effects. This review elaborates on the core molecular characteristics, morphological changes, and canonical/non-canonical activation mechanisms of pyroptosis. Systematically delineate the pivotal function of pyroptosis in the pathogenic advancement of predominant CVDs. Additionally, analyze the regulatory impacts and fundamental molecular processes of natural products and multi-botanical botanical formulations on pyroptosis in various CVDs. Collectively, this research positions the manuscript as a systematic preclinical review focused on pyroptosis-targeted natural therapeutic candidates, systematically outlines pyroptosis-mediated pathological cascades in CVDs, and highlights the translational potential of natural agents that block pyroptosis. Nearly all supporting evidence summarized herein remains pre-clinical; well-designed human studies are urgently required before any real-world clinical application can be considered.

Cardiometabolic multimorbidity (CMM) may accompany changes in cognition and everyday function in later life. We reassessed these associations across international ageing cohorts while addressing outcome structure, unequal threshold severity, measurement precision, repeated observations, mortality and non-death attrition.

We harmonised repeated observations from HRS, ELSA, CHARLS, KLoSA, MHAS and SHARE. Within-interval change in a complete four-condition CMM count (hypertension, diabetes, heart disease and stroke) was used in continuous analyses, whereas transition analyses used interval-baseline CMM4. Fixed-reference, non-overlapping cognitive and functional composites were constructed by cohort. Continuous outcomes were paired cognitive and functional worsening, analysed with participant-clustered Gaussian GEE and a CMM-by-domain interaction. Binary outcomes were any cognitive and any functional transition using cohort-wave-specific thresholds targeting 20% occupancy; sensitivity analyses included 15, 25%, historical -0.43/+0.43, stricter -0.67/+0.67 and persistent-state definitions. Logistic GEE estimates were pooled using REML with Hartung-Knapp confidence intervals.

The data included 236,088 people, 172,518 with at least two waves, and 523,570 scheduled-wave or terminal-death intervals. In 361,562 paired intervals across six cohorts, each additional CMM condition accumulated was associated with cognitive worsening (β = 0.0459, 95% CI 0.0243 to 0.0675; I ² = 74.3%) and functional worsening (β = 0.0960, 0.0809 to 0.1111; I ² = 41.8%). The functional-minus-cognitive contrast was 0.0534 (0.0325 to 0.0742; I ² = 51.6%). Among 266,127 intervals beginning in the distribution-defined unimpaired state, each additional baseline CMM condition was associated with any functional transition (OR = 1.33, 95% CI 1.27 to 1.40; I ² = 64.9%) but not with a common any-cognitive transition effect (OR = 1.01, 0.95 to 1.07; I ² = 81.8%). The functional-to-cognitive ratio of odds ratios was 1.32 (1.23 to 1.42). Persistent any-functional transition was associated with CMM (OR = 1.39, 1.33 to 1.45; I ² = 0%), whereas persistent any-cognitive transition did not (OR = 0.99, 0.89 to 1.10; I ² = 77.0%). Fixed reference-wave thresholds, disease-restricted exposures, cohort exclusions, KLoSA ADL-only scoring and inverse-probability weighting preserved the functional contrast.

CMM was associated with worsening in both continuous domains, with a larger functional coefficient, and with more consistent distribution-defined functional than cognitive transitions. Associations were mainly synchronous, although a smaller delayed cognitive association was observed. Binary states are not diagnoses of mild cognitive impairment, dementia or clinical dependence; findings do not establish causality or a validated screening rule.

H Hypertension is the most significant modifiable risk factor for cardiovascular disease. This study aimed to determine attitudes toward hypertension prevention, examine their relationship with the propensity to achieve a healthy lifestyle, and identify sociodemographic and health-related predictors in young and middle-aged adults.

This descriptive, cross-sectional study included 351 adults without diagnosed hypertension who had at least one chronic condition associated with increased hypertension risk. Data were collected via an online survey between February and August 2025 using a validated self-report survey comprising the Demographic Information Form, the Attitudes Scale towards Prevention of Hypertension, and the Propensity to Achieve Healthy Lifestyle Scale. Descriptive statistics, Pearson correlation, and hierarchical multiple linear regression were used to analyze relationships and correlates, with significance set at p < 0.05.

The mean age was 30.73 ± 11.20 years; 67.8% were female. The mean Attitudes Scale towards Prevention of Hypertension score was 106.37 ± 12.31 (range 26-130), indicating a positive attitude, while the mean Propensity to Achieve Healthy Lifestyle scale score was 18.93 ± 4.96, a moderate level. A significant, low-level positive correlation was found between the two scales (r = 0.186; p < 0.001). Three variables were independently associated with preventive attitudes, explaining 17.5% of the variance (all p < 0.05): elementary education (β = -0.280), no previous hypertension education (β = -0.175), and higher propensity to achieve a healthy lifestyle (β = 0.153). The propensity to achieve a healthy lifestyle accounted for a small but significant increment over sociodemographic and health variables alone (ΔR ² = 0.022, p = 0.003).

Although preventive attitudes were generally positive in this at-risk, normotensive sample, perceived readiness and self-efficacy for lifestyle change remained only moderate, indicating a discordance between attitude and readiness rather than a demonstrated attitude-behavior gap, since behavior itself was not measured. Educational level and structured hypertension education showed the strongest associations with preventive attitudes, underscoring the importance of early preventive interventions prioritizing groups with lower educational levels. As the design was cross-sectional, these associations should not be interpreted causally.

Even after technically successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), patients face persistent excess cardiovascular risk. The hemoglobin glycation index (HGI), a marker of interindividual glycation heterogeneity, has not been studied in this setting.

We enrolled 1, 513 patients who had undergone successful CTO-PCI between 2011 and 2023 at Guangdong Provincial People's Hospital. HGI was computed as the difference between the measured HbA1c and the value predicted from fasting plasma glucose using a cohort-derived linear equation. The primary composite outcome included cardiovascular death, non-fatal myocardial infarction, and stroke (cardiovascular events, CVEs). Secondary outcomes were all-cause and cardiovascular death. Multivariable Cox regression and restricted cubic splines were applied to assess associations.

During a median 810-day follow-up, 83 (5.5%) all-cause deaths, 53 (3.5%) cardiovascular deaths, and 73 (4.8%) CVEs occurred. After full adjustment, Each 1-standard deviation increment in HGI conferred an independent hazard of 1.34 (95% CI 1.14-1.58) for all-cause mortality, 1.52 (95% CI 1.25-1.83) for cardiovascular mortality, and 1.42 (95% CI 1.15-1.61) for CVEs. Compared with the lowest tertile, patients in the highest HGI tertile exhibited a 2.41-fold (95% CI 1.37-4.25, P = 0.002), 4.13-fold (95% CI 1.91-8.94, P<0.001), and 2.73-fold (95% CI 1.47-5.07, P = 0.001) higher risk of all-cause mortality, cardiovascular mortality, and CVEs, respectively. RCS analysis revealed a linear dose-response relationship, with a secondary exploratory threshold effect identified at HGI = -0.15 for CVEs (HR 2.05, 95% CI 1.22-3.44).

In this retrospective cohort study, elevated HGI was independently and linearly associated with heightened long-term adverse clinical outcomes after successful CTO-PCI. These findings suggest that HGI may have potential as a prognostic marker for risk stratification in this population; however, prospective validation is required before clinical application.

Both the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and collateral status are well-established predictors of clinical outcomes in patients with large ischemic stroke undergoing endovascular therapy (EVT); however, they have traditionally been assessed independently. This study aimed to evaluate the prognostic value of a combined imaging score, the AS-TCIS score, which integrates ASPECTS and collateral status into a unified framework.

This study is a subanalysis of a prospective multicenter cohort including patients with ASPECTS ≤5 enrolled between November 2021 and February 2023. The AS-TCIS score was constructed by integrating the 5-point ASPECTS with collateral status, including the 3-point Tan score and the 8-point comprehensive venous outflow (CVO) score, yielding a 16-point composite scale. The primary outcomes were 90-day functional outcome (modified Rankin Scale [mRS] 0-3) and mortality.

Of 750 patients, 287 were eligible (median age 67 years; 58.5% male; median AS-TCIS score 8). In multivariable models, each 1-point increase in AS-TCIS was associated with higher odds of mRS 0-3 (OR 1.38; 95% CI 1.24-1.56) and mRS 0-2 (OR 1.30; 95% CI 1.17-1.47), and lower odds of mortality (OR 0.74; 95% CI 0.66-0.82), with no significant association with symptomatic intracranial hemorrhage (OR 0.92; 95% CI 0.82-1.03). AS-TCIS also demonstrated a linear association with functional outcome and mortality. Compared with ASPECTS, Tan score, and their combination, AS-TCIS showed consistently higher AUCs and improved model fit across all outcomes.

The AS-TCIS score, a composite of ASPECTS and collateral status, was independently associated with 90-day outcomes in patients with large ischemic stroke undergoing EVT. It may provide incremental value for risk stratification and outcome prediction in acute stroke imaging assessment.

Microembolic signals (MES) detected by transcranial Doppler ultrasonography (TCD) reflect ongoing cerebral embolization and may serve as a marker of stroke instability. However, the association between MES and functional outcomes in patients with acute ischemic stroke (AIS) remains uncertain. This meta-analysis aimed to evaluate the prognostic significance of MES for poor functional outcomes after AIS.

PubMed, Embase, Web of Science, Wanfang Data, and CNKI databases were searched for cohort studies comparing functional outcomes between AIS patients with and without MES. The primary outcome was poor functional outcome, defined as a modified Rankin Scale score of 3-6 during follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random-effects model accounting for the influence of potential heterogeneity.

Thirteen cohort studies involving 1,777 patients with AIS were included, of whom 361 (20.3%) had detectable MES. Overall, MES was associated with a significantly increased risk of poor functional outcome (OR: 2.85, 95% CI: 2.16-3.75; p < 0.001) with no significant heterogeneity (I ² = 0%). Subgroup analyses demonstrated consistent results across prospective and retrospective studies, and the observed association was not significantly influenced by patient age, sex distribution, endovascular treatment status, TCD monitoring duration, analytical model, or study quality (all p for subgroup difference > 0.05). MES was associated with poor functional outcomes at discharge (OR: 3.60), 14 days (OR: 2.69), and 90 days (OR: 3.15).

MES detected by TCD are associated with an increased risk of poor functional outcome in patients with AIS. However, their independent and incremental prognostic value beyond established clinical and imaging predictors requires further confirmation.

The review protocol was prospectively registered in PROSPERO (CRD420261425262).