Selecting appropriate outcomes is crucial for enhancing the comparability and relevance of clinical trials, yet uptake of core outcome sets (COS) remains low. This study aims to develop a framework to improve the quality and value of choosing outcomes in cardiovascular disease research (FAVOUR), so that the uptake of COS may be improved.

The mixed-methods will be used to develop a framework: (1) a systematic review will be conducted to identify current rationales, values and preferences of different stakeholders of outcome selection in clinical trials; (2) semi-structured interviews with patients and healthcare professionals will be used to identify the evidence, values and preferences of different stakeholders in outcome selection and measurement; (3) two rounds of Delphi survey will be conducted to prioritise items for the framework; and (4) a consensus meeting will be carried out to finalise the framework.

This study has been approved by the ethics committee of Dongzhimen Hospital, Beijing University of Chinese Medicine (Approval No.: 2025DZMEC-148-02). The results will be disseminated through peer-reviewed journals and conference presentations.

This research has been registered in the Core Outcome Measures in Effectiveness Trial database (https://www.comet-initiative.org/Studies/Details/3723).

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is known for higher adverse event rates compared with non-CTO PCI. Comparative outcomes with respect to bleeding events remain limited.

To evaluate bleeding events in patients undergoing CTO PCI compared with non-CTO PCI and to identify patient and procedural characteristics associated with bleeding events.

Prospective multicentre study of ongoing collected data registered within the South-East Netherlands Heart Registry (Zuid-Oost Nederland Hart Registratie, ZON-HR).

All consecutive patients with coronary artery disease undergoing clinically indicated PCI are included in the ZON-HR since November 2020.

At the time of analyses, the ZON-HR consisted of 8264 included patients with 30-day follow-up between November 2020 and December 2023. A total of 8162 patients were included once in the registry. CTO PCI was performed in 410 (5.0%) patients and non-CTO PCI in 7854 (95.0%) patients. Bleeding events occurred more frequently in patients undergoing CTO PCI compared with non-CTO PCI (9.0% vs 5.4%, p<0.01), driven by a significantly higher rate of access-site bleeding events (7.6% vs 3.2%, p<0.01). After multivariable analysis, CTO was not significantly associated with the occurrence of access-site bleeding events (adjusted HR (aHR) 1.39 (95% CI 0.92 to 2.11)). Access-site bleeding events were associated with female sex (aHR 1.71 (95% CI 1.34 to 2.18)), peripheral artery disease (aHR 1.39 (95% CI 1.02 to 1.89)), oral anticoagulation use (aHR 1.34 (95% CI 1.00 to 1.78)), femoral artery access (aHR 2.90 (95% CI 2.08 to 4.05)) and left main PCI (aHR 1.50 (95% CI 1.04 to 2.14)).

The incidence of bleeding events is higher in patients undergoing CTO PCI and particularly driven by access-site bleeding events. The apparent correlation is attributed to non-modifiable and modifiable patient-related and procedure-related characteristics rather than the CTO PCI itself.

NCT06512493.

The automatic estimation of left ventricular ejection fraction (LVEF) from echocardiograms is crucial for the diagnosis of cardiovascular diseases. However, constrained by the inherent speckle noise of ultrasound imaging, the complex temporal dynamics of the cardiac cycle, and the continuous distribution characteristics of physiological indicators, current methods often struggle to extract feature representations that exhibit both robustness and semantic continuity. To address this challenge, we propose a unified structural contrastive learning framework for LVEF applications, designed to seamlessly integrate two complementary structural constraints into the feature learning process through a unifying mathematical formulation. The framework dynamically redefines the sampling strategy for positive and negative pairs. Specifically, it incorporates (1) a temporal consistency constraint via key region masking and (2) reconstruction-based denoising during the self-supervised pre-training phase to capture noise-resistant and stable anatomical structures. During the fine-tuning phase, we further introduce an EF-aware continuous constraint to guide the feature space along the LVEF gradient to form an ordered continuous manifold. Extensive experiments on the EchoNet-Dynamic dataset demonstrate that with only 36 input frames, our method achieves a mean absolute error (MAE) of 3.84, a root mean square error (RMSE) of 5.12, and an R² of 0.82. Furthermore, evaluating its clinical utility using an automated medical report generation pipeline shows that our module improves downstream diagnosis accuracy to 88.21% and enhances report reliability, particularly near critical diagnostic thresholds. Without relying on large-scale external data for pre-training, the proposed method achieves highly competitive performance compared to current state-of-the-art approaches, providing a promising tool for precise cardiac function assessment in clinical settings.

Atherosclerosis is a complex and progressive vascular disease characterized by lipid accumulation and inflammation. In recent years, the purinergic signaling system, particularly the P2X7 receptor, has been suggested to play a role in atherosclerosis pathogenesis through the regulation of inflammatory responses. The present study aimed to evaluate the association between P2RX7 rs1718119 (G > A) and rs2393799 (C > T) polymorphisms and the angiographic severity of coronary artery stenosis in a Turkish atherosclerosis population. Patients with angiographically confirmed atherosclerosis were enrolled and stratified according to the degree of coronary artery stenosis. Genotyping of the P2RX7 rs1718119 and rs2393799 polymorphisms was performed using real-time polymerase chain reaction-based fluorescence melting curve analysis (FMCA). No significant associations were observed between the genotype or allele distributions of either polymorphism and the angiographic severity of coronary artery stenosis. The investigated variants were not associated with angiographic stenosis severity. Associations with selected hematological and biochemical parameters should be regarded as exploratory and require further validation. These findings provide additional data on P2RX7 genetic variation in patients with atherosclerosis and highlight the need for further functional studies.

Lipoprotein(a) [Lp(a)] levels are associated with increased cardiovascular risk, possibly linked to its oxidized phospholipid content that may accelerate lipoprotein oxidation. Attenuating this process could reduce Lp(a) atherogenicity. Atorvastatin is metabolized into 2 hydroxylated metabolites, which account for low-density lipoprotein reduction and potential antioxidant activity. We compared these metabolites' effects to other active statins on oxidation of plasma samples enriched with various levels of Lp(a) or other apolipoprotein B particles, as well as lipid membranes enriched with cholesterol. Lp(a) oxidized more rapidly than other apolipoprotein B particles and accelerated in a nonlinear fashion at levels associated with cardiovascular risk. The metabolites inhibited oxidation of each fraction in contrast to other statins and consistent with cholesterol-enriched membranes. The metabolites' unique phenoxy group facilitated membrane partitioning, leading to free radical scavenging activity as compared with other statins. The antioxidant actions of atorvastatin metabolites may reduce the atherogenicity of Lp(a) in patients independent of their levels.

Borderline personality disorder (BPD) is a severe and prevalent mental illness. Longitudinal research consistently demonstrates that people diagnosed with BPD experience persistent functional impairment despite current psychotherapeutic treatment. Functional impairment is typically defined in terms of performance in vocational and relational domains. However, functional recovery across multiple domains of functioning should also be considered, such as leisure, self-care, health and household management. This study aimed to describe the daily living functioning of people diagnosed with BPD from multistakeholder perspectives.

This qualitative descriptive study used semi-structured interviews with 22 participants, including consumers (n = 4), carers (n = 5) and clinicians (n = 13). Data were analysed using reflexive thematic analysis.

Consumer, carer and clinician consultants reviewed a draft of the interview guide and provided feedback on the terminology, question ordering and provision of practical examples. Their feedback was incorporated and amendments were made prior to data collection.

Five themes were generated: (1) structured routines, (2) extremes of doing, (3) a lot of energy required to manage in daily life, (4) doing when disconnected from values and identity and (5) doing through others. People diagnosed with BPD experienced challenges establishing and maintaining structured routines, engaged in boom-and-bust activity patterns, expended considerable energy managing emotions and interpersonal interactions, struggled to identify values to derive meaning from daily activities and relied on others to initiate and complete daily activities.

Functional recovery outcomes are important for people diagnosed with BPD. Occupational therapists are well positioned to support functional recovery for this population, which could involve exploring daily living functioning beyond a psychotherapeutic framework, including the structure of routines, sleep patterns, activity pacing, energy conservation, values identification, and the extent of carer involvement in daily activities.

Medical artificial intelligence (AI) benchmarks are increasingly used to assess the readiness of large language models for health-related tasks, but aggregate performance scores can obscure clinically meaningful variation across domains. HealthBench, an open benchmark of 5000 multi-turn health conversations, represents a salient example: the score is difficult to interpret for decisions about specific clinical use cases, including those with mental health needs. Conversations involving suicidality, psychosis, eating disorders, trauma or relational dependence require recognising ambiguous disclosures, responding safely under uncertainty, avoiding reinforcement of harmful beliefs or over-reliance and knowing when to escalate to human-based crisis support. We propose that HealthBench and similar benchmarks report domain-specific results. To demonstrate feasibility and utility, we adopted OpenAI's classified dataset to identify 332 mental health conversations, validated against human review (sensitivity 0.980, specificity 1.000, positive predictive value 1.000, negative predictive value 0.980, F1 0.990, inter-rater agreement 99.0%). We analysed mental health domain performance separately from overall HealthBench performance using a stratified random sample of 500 conversations. Across deployments, mental health point estimates differed from overall estimates by -0.034 to +0.047. Mental health domain composition was also uneven: for example, postpartum depression represented 26.8% of mental health conversations compared with 4.5% for suicidal crisis, 0.9% for psychosis and 1.5% for eating disorders. The findings suggest benchmark averages can mask domain-specific insights relevant to clinical safety. We argue that interpretable medical AI evaluation requires transparent domain composition; subgroup and failure mode reporting; calibration against clinically meaningful anchors, including human expert performance; and reproducible versioned analyses as models, grader systems and deployment contexts evolve.

The Psychosis Polyrisk Score (PPS) was developed to characterise exposure to environmental and developmental risk factors for psychosis. In previous studies, the PPS showed promise particularly in discriminating between individuals at clinical high risk for psychosis (CHR-P) and community controls (CC).

This study aimed to (1) perform an external validation of the PPS model in a large independent sample and (2) refine the model using expanded predictor data.

Participants were recruited through the AMP SCZ program: n=1642 CHR-P, n=519 CC. We performed a formal external validation of the PPS original model. The model was then refined incorporating expanded predictor data (perceived loneliness, neighbourhood quality) and increasing the granularity of existing predictors (ethnicity, childhood trauma, parental severe mental illness). Next, we evaluated the refined model through repeated nested cross-validation and compared it to the original model retrained in the new dataset. Discrimination (Harrell's C-index) and calibration (intercept and slope) were used to assess model performance.

The externally validated PPS original model showed good discrimination (C=0.777, 95% CI 0.756 to 0.797) between CHR-P and CC and good calibration (intercept=0; slope=1.003) after recalibration. The refined PPS model exhibited higher internally cross-validated discrimination than the retrained original model (C=0.876, 95% CI 0.860 to 0.891 vs C=0.796, 95% CI 0.775 to 0.816), as well as good calibration performance (intercept=-0.008; slope=1.031).

The PPS showed good generalisability to a large, independent sample, and performance improved after model refinement.

The PPS represents a potential scalable tool within stepped assessment frameworks for identifying individuals who warrant further CHR-P assessment.

NCT05905003.

The co-occurrence of a psychiatric disorder and a substance use disorder affects many patients in adult psychiatry, with significant clinical and social repercussions. The fragmentation of healthcare systems hinders continuity of care. A survey of 147 nurses at two psychiatric facilities explored existing practices regarding dual diagnosis and defined the roles of advanced practice nurses. These nurses contribute to improving care and reducing disruptions in the care pathway.

To explore the influence of vision impairment (VI) on mental wellbeing in children and young people (CYP) with inherited macular disease and experiences perceived to enhance and limit their wellbeing.

Qualitative semi-structured interviews with children and young people with vision impairment and parents/carers of young people with VI. Interviews were recorded, transcribed and analysed by two researchers, working independently, using reflexive thematic analysis.

Low vision and ophthalmology clinics in England.

Six young people aged 13-18 years with VI caused by inherited macular disease and 12 parents of young people with VI caused by inherited macular disease.

Four overarching themes were developed: (1) Living in the aftermath of diagnosis, capturing participants' internal experience of living with vision impairment from the time of diagnosis onward, including the psychological impact of negotiating the loss of vision and the challenge of accepting VI; (2) Fighting the system, reflecting how parents and CYP navigate both formal and informal support systems, highlighting the barriers they face; (3) Being seen and being misunderstood, encapsulating how VI influences the way that participants experience relationships, develop a sense of self and navigate their place within society; and (4) Building a life with vision impairment, centring on how participants function in everyday contexts while living with VI, alongside their aspirations for building their lives and living well in adulthood.

Vision impairment has emotional, social and systemic consequences. Experiences perceived to influence mental wellbeing included acceptance of vision loss, functional adaptation, self-efficacy and effects of social stigma and discrimination.