Pulmonary arterial hypertension (PAH) is a serious complication of congenital heart disease (CHD) with a left-to-right shunt, particularly ventricular septal defect (VSD). In patients presenting with severe PAH, therapeutic decision-making remains challenging because precise and individualized assessment criteria are lacking. In current clinical practice, treatment strategies are often based mainly on isolated hemodynamic parameters obtained by right heart catheterization (RHC), which may not fully reflect disease severity or reversibility.

This study aimed to explore an individualized treatment strategy for patients with severe VSD-PAH by analyzing the relationships among peripheral arterial oxygen saturation (SaO₂), pulmonary vascular resistance (PVR), pulmonary-to-systemic blood flow ratio (Qp/Qs), and pulmonary-to-systemic pressure ratio (Pp/Pa).

We retrospectively analyzed 121 patients with isolated VSD and severe PAH admitted to our center between 2010 and 2020. All patients underwent RHC. Correlations between SaO₂ and PVR, Qp/Qs, and Pp/Pa were assessed using Spearman correlation analysis. Patients were stratified according to SaO₂ levels, and treatment strategies were compared across different hemodynamic profiles using Fisher's exact test. Based on these findings, we established a scoring system integrating SaO₂, PVR, Qp/Qs, and Pp/Pa, and categorized total scores to examine their association with actual treatment strategies.

The distribution of treatment strategies differed significantly across combinations of SaO₂ and PVR, whereas Qp/Qs and Pp/Pa provided limited additional discrimination when SaO₂ exceeded 93%. The proposed scoring system was associated with observed treatment patterns: patients with total scores ≥ 60 were predominantly managed surgically (with or without preoperative medical therapy), whereas those with scores <40 were mainly treated with medical therapy alone (93.7%). Intermediate score ranges were associated with mixed treatment patterns.

Combining SaO₂ with RHC-derived parameters provides a more comprehensive and individualized assessment of disease severity in VSD-PAH than hemodynamics alone. The proposed multidimensional scoring system may provide a hypothesis-generating framework for cardiovascular specialists.

Digital technologies increasingly shape responses to acute respiratory infection (ARI) symptoms through information seeking, consultation, medication purchase, monitoring, and access to diagnostic products or services. However, how digital health engagement overlaps with in-person facility attendance and whether digital and other out-of-facility behaviors provide complementary signals for episodes that are less visible in routine facility-based surveillance remain unclear.

This study estimates the distribution of ARI episodes by in-person facility attendance and digital health engagement, describes digital and nondigital out-of-facility actions and the reported ordering of these actions, and examines subgroup differences.

We conducted a population-based cross-sectional survey in 11 Chinese cities using multistage stratified random sampling. Participants reported ARI symptoms within the preceding 14 days and subsequent health-related actions. The primary digital composite included online health information seeking, AI-assisted consultation, telemedicine, online medication purchase, wearable device-based self-monitoring, digitally accessed self-administered rapid antigen testing, and at-home pathogen specimen collection. Participants were cross-classified by in-person facility attendance and digital health engagement. Weighted descriptive proportions were estimated using poststratification weights, with 95% CIs calculated using Wilson score intervals based on the Kish effective sample size. Behavioral sequences were descriptively reconstructed from retrospectively reported timing of actions using 1 representative action per reported day, with adjacent-transition CIs estimated by participant-level bootstrap resampling. Modified Poisson regression with individual-level robust variance estimation was used to estimate adjusted associations with in-person facility attendance, expressed as adjusted prevalence ratios (aPRs).

Among 247,530 participants, 68,650 reported ARI symptoms. Among symptomatic participants, 19.18% (95% CI 18.87%-19.48%) reported in-person facility attendance, and 18.94% (95% CI 18.64%-19.24%) reported at least one digital health behavior. Digital health engagement without in-person facility attendance comprised 11.20% (95% CI 10.95%-11.44%) of ARI episodes, while 7.74% (95% CI 7.54%-7.95%) involved both dimensions. Digital health engagement was positively associated with in-person facility attendance during the same episode (aPR 2.12, 95% CI 2.05-2.20). Compared with participants reporting 2 or fewer symptoms, the aPRs were 3.31 (95% CI 3.16-3.46) for 3 symptoms and 4.69 (95% CI 4.51-4.88) for 4 or more symptoms. Among participants with nonempty sequences, the most common sequence beginning with an out-of-facility action was offline medication purchase followed by no subsequent reported action (6058/26,494, 22.87%). Digital health engagement was lowest among adults aged 60 years or older.

Most reported ARI episodes did not involve in-person facility attendance and may be underrepresented in routine facility-based surveillance. Digital health behaviors identified potential complementary signals for some episodes, while common pathways involving offline medication purchase suggest that pharmacy-derived data may provide additional information. These data sources require direct validation, and lower digital health engagement among older adults indicates that digital signals may not represent all population groups equally.

Hoarseness and postoperative sore throat (POST) are common complications of endotracheal intubation during robotic-assisted gynecological surgery. Despite the increasing prevalence of robotic procedures, studies focusing on airway symptom management in this context are limited. This study aimed to evaluate the effects of intraoperative endotracheal tube (ETT) cuff pressure adjustment on hoarseness, POST, and oral comfort. Additionally, the study sought to inform nursing interventions to enhance postoperative care.

This study employed an assessor-blinded, quasi-experimental design at a single institution.

A total of 60 patients undergoing robotic-assisted gynecological surgery were allocated in equal numbers to the experimental group (n = 30) and the control group (n = 30) using an alternating sequence based on the order of entry into the operating room waiting area (odd/even assignment). In the experimental group, ETT cuff pressure was monitored and adjusted to 22-cmH₂O every 10 minutes. In the control group, cuff pressure was monitored but not adjusted. Hoarseness, POST, and oral comfort were assessed preoperatively and at 1, 6, and 24 hours postoperatively. Statistical analyses included t tests, χ² tests, and nonparametric methods.

The experimental group exhibited significantly lower POST and hoarseness scores and higher oral comfort scores at all postoperative time points compared with the control group (P < .001).

Regular intraoperative ETT cuff pressure adjustments effectively reduced POST and hoarseness while improving oral comfort in patients who underwent robotic-assisted gynecological surgery. Implementing clinical guidelines for optimal cuff pressure management may enhance postoperative symptom management and improve patient outcomes.

Echocardiography is widely used for non-invasive measurements of stroke volume and cardiac output, while Ultrasonic Cardiac Output Monitor (USCOM) offers an alternative Doppler-based approach. Whether these two modalities can be used interchangeably in clinical practice remains unclear. This study aims to evaluate the correlation and agreement between echocardiography and USCOM for hemodynamic assessment.

A total of 44 pediatric patients underwent hemodynamic assessment using echocardiography and sequential USCOM measurement during the same evaluation. Spearman's rank correlation was used to assess the relationship between methods. Agreement was evaluated using Bland-Altman analysis.

Strong correlations were found for stroke volume (SV; r = 0.97), cardiac output (CO; r = 0.95), cardiac index (CI; r = 0.91), stroke volume index (SVI; r = 0.90), and aortic valve (AV) diameter (r = 0.91; p < 0.001), with a moderate correlation for left ventricular outflow tract (LVOT) velocity (r = 0.64, p < 0.001). Bland-Altman analysis revealed echocardiography produced lower values of all parameters compared to USCOM. Significant proportional bias was identified for SV, SVI, CO, and CI (all p ≤ 0.006), indicating that two methods increased disagreement with higher measured values. AV diameter and LVOT velocity showed no significant proportional bias and narrower limits of agreement.

Although echocardiography and USCOM correlate strongly for hemodynamic parameters, clinically meaningful systematic bias and proportional error limit their interchangeability for volumetric flow measurements. These devices should not be used interchangeably for quantitative hemodynamic monitoring, particularly in high-output states.

Left ventricular hypertrophy (LVH) constitutes Stage B heart failure and marks elevated risk for atrial fibrillation, stroke, and death. Unlike body mass index, body roundness index (BRI), derived from waist circumference and height, more accurately reflects visceral adiposity. Because existing BRI-LVH evidence is usually cross-sectional, we investigated whether the BRI trajectory can predict incident LVH.

Of a total of 2,578 subjects who underwent echocardiographic examinations, we studied 1,764 participants who were free of LVH on echocardiography at baseline (2007-2008, wave 4). BRI trajectory was determined from BRI values measured at four biennial examinations (2001-2008). The outcome was incident LVH on echocardiography during the follow-up (2009-2016, wave 5-8).

The mean age was 53.2±6.3 years, and 828 (46.9%) were women. Latent class mixed models identified 3 sex-specific BRI trajectory classes: stable-low (Class 1), stable-moderate (Class 2), and variable-high BRI (Class 3). Among men, 225 (24.0%), 615 (65.7%), and 96 (10.3%) were classified into these classes, respectively; among women, 319 (38.5%), 356 (43.0%), and 153 (18.5%). Incident LVH, defined as LVH on echocardiography at any of the 4 follow-up examinations conducted during 2009-2016 (wave 5-8), developed in 249 of 936 men (26.6%) and 196 of 828 women (23.7%), and incidence increased across trajectory classes in both sexes (in men, 5.8%, 30.6%, and 50.0%; in women, 7.5%, 32.3%, and 37.3%; both P < 0.001). In the fully adjusted model, compared with Class 1, OR of incident LVH were increased for Class 2 (men; 4.75 [95% CI, 2.33-9.66]; women, 4.53 [2.67-7.68]; both P < 0.001) and for Class 3 (men, 9.28 [3.91-22.02]; women, 4.60 [2.50-8.48]; both P < 0.001).

In a community-based Korean cohort, sex-specific BRI trajectories characterized by stable-moderate (Class 2) or variable-high (Class 3) BRI trajectory groups were associated with a substantially increased risk of incident LVH in both men and women.

Intramuscular fat (IMF), also known as myosteatosis, refers to the accumulation of lipids within and around skeletal muscle fibres. Excess IMF is increasingly recognised as a sign of poor muscle quality, linked to reductions in strength, power and mobility, and associated with adverse outcomes in metabolic disease, osteoarthritis, cardiovascular diseases and cancer. It is important to note that an increase in intramuscular fat is not always pathological. These associations and the ongoing uncertainty have sparked growing interest in IMF as a biomarker of muscle health beyond muscle mass and cross-sectional area. This narrative review synthesises current evidence on IMF as a biomarker of muscle health, critically evaluating its definition, measurement, biological variability, responsiveness to intervention and ongoing challenges for clinical application. We first clarify terminology, distinguishing intramyocellular lipids, extramyocellular lipids, intermuscular adipose tissue and subcutaneous adipose tissue. Advances in imaging techniques are assessed: Magnetic resonance imaging and spectroscopy provide accurate compartmental lipid quantification; computed tomography offers practical, reproducible estimates of muscle density; and ultrasound presents an accessible, though operator-dependent, alternative. Across populations, IMF shows considerable variability: Levels increase with age, differ by sex and ethnicity and have strong associations with adiposity and activity. Normative values are emerging but are lacking standardisation and population-specific reference ranges. Interventional studies show that IMF is modifiable. Acute endurance exercise reduces intramyocellular lipid stores, while long-term aerobic and resistance training prevent or lower fat infiltration but increase levels of intramyocellular lipids. Dietary restriction and bariatric surgery reliably decrease IMF but may also cause loss of lean mass without sufficient resistance training or protein intake. Pharmacological therapies, particularly glucagon-like peptide-1 receptor agonists such as liraglutide and semaglutide, have recently been shown to lower IMF while enhancing muscle quality, despite some overall muscle reduction. These findings support IMF as a flexible biomarker that indicates intervention success and correlates with functional outcomes including strength, gait speed and insulin sensitivity. Key barriers remain: lack of standardised imaging protocols, no universally defined pathological thresholds and the complex challenge of interpreting IMF across different age groups, sexes and ethnicities. Overcoming these obstacles through consensus definitions, prospective multi-ethnic research and the integration of advanced imaging with functional outcomes will be vital. If achieved, IMF could become a clinically important biomarker, complementing mass and strength-based measures to guide treatments, assess risk and track muscle health throughout life.

Cardiogenic shock (CS) is a life-threatening syndrome characterized by severe pump failure and systemic hypoperfusion, with persistently high mortality. Red blood cell distribution width (RDW) has been associated with adverse outcomes in several cardiovascular conditions, but its prognostic role in CS, particularly for long-term mortality and machine learning-based risk stratification, remains incompletely defined. We aimed to investigate the association between RDW and mortality in patients with CS and to evaluate its value in interpretable machine learning models for 1-year mortality prediction.We identified 2,014 patients with CS from the MIMIC-IV database (2008-2019). Associations between RDW and in-hospital mortality were assessed using logistic regression, and associations with 1-year mortality were evaluated using Cox regression. RDW was analyzed both as a continuous variable and by tertiles (T1 ≤ 14.40%, T2 14.40-16.27%, T3 > 16.27%). Kaplan-Meier curves and restricted cubic splines (RCS) were used to examine survival patterns and dose-response relationships. Patients were randomly divided into training and test cohorts (8:2). Feature selection was performed using Boruta and random forest-derived importance metrics. Six machine learning models (LR, DT, RF, SVM, XGBoost, and TabPFN) were developed for 1-year mortality prediction and evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, F1 score, and decision curve analysis (DCA). Model interpretability was assessed using SHapley Additive exPlanations (SHAP).Among 2,014 patients with CS, 1-year mortality was 53.2%. Higher RDW was independently associated with increased 1-year mortality after multivariable adjustment (HR = 1.043, 95% CI: 1.015-1.071). For in-hospital mortality, the association remained significant in fully adjusted analysis but was attenuated (OR = 1.055, 95% CI: 1.001-1.112). Compared with T1, patients in T3 had a significantly higher risk of 1-year mortality (HR = 1.626, 95% CI: 1.376-1.921; P for trend = 0.004). RCS analysis showed a significant overall association between RDW and 1-year mortality, with risk increasing above approximately 14.4%, although the test for nonlinearity was not statistically significant. Among the evaluated models, TabPFN achieved the highest observed AUC for 1-year mortality prediction (AUC = 0.861), with sensitivity of 0.80 and specificity of 0.72, and showed the most favorable net benefit on DCA. SHAP analysis indicated that model predictions were driven by multiple clinically meaningful domains, including treatment-related variables, shock severity, metabolic disturbance, cardiovascular substrate, and RDW.Elevated RDW is an independent predictor of 1-year mortality in patients with CS. An RDW level above approximately 14.4% may serve as a practical marker of increased risk. Integrating RDW into interpretable machine learning-based risk assessment, particularly with TabPFN, may improve early prognostic stratification in CS. Prospective external validation is warranted.

An 85-year-old bedridden woman (modified Rankin Scale 5) presented with a contained rupture of an acute retrograde aortic dissection (Type B0,7). Because open surgery was prohibitive due to severe frailty, an emergent total endovascular repair was performed using single-branch, retrograde in situ branched stent grafting (RIBS). Two conformable GORE TAG devices established a Zone 1 seal, and the left common carotid artery was preserved by in situ needle fenestration using a percutaneous transhepatic gallbladder drainage needle and bridged with a VIABAHN VBX stent. To limit embolic risk, cerebral blood flow was transiently interrupted by manual right carotid compression, direct left carotid clamping, and left subclavian balloon occlusion. Operative time was 114 minutes, and the postoperative course was uneventful without neurological deficits. One-year computed tomography showed favorable aortic remodeling and no endoleak. Single-branch RIBS may offer an immediate, off-the-shelf salvage option for high-risk patients when open repair is not feasible.

Obesity accelerates the progression of chronic kidney disease (CKD) and often limits access to kidney transplantation. Although metabolic and bariatric surgery (MBS) has been associated with improvements in kidney function and cardiometabolic outcomes, evidence regarding long-term kidney failure, dialysis, transplantation, cardiovascular, and survival outcomes among patients with established CKD remains heterogeneous.

To evaluate the association between MBS and long-term renal, cardiovascular, and transplant outcomes, and all-cause mortality, in patients with obesity and CKD using a large, propensity score-matched real-world cohort.

Analysis of TriNetX Global Collaborative Network, a de-identified real-world database from over 140 health care organizations.

Adults (≥18 years) with severe obesity and CKD who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2010 and 2020. Patients were propensity score-matched 1:1 to those without MBS based on demographics, comorbidities, baseline kidney function, and medication use. Outcomes were assessed over 5years. Primary endpoints included incidence of end-stage renal disease (ESRD), dialysis initiation, kidney transplantation, cardiovascular events, and all-cause mortality. A subgroup analysis comparing SG and RYGB was performed using propensity score matching.

A total of 4481 MBS patients were matched to 4481 non-MBS patients, with well-balanced baseline characteristics. Compared to the non-MBS group, MBS was associated with significantly lower risks of ESRD (5.9% versus 11.9%; odds ratio [OR] .47, 95% confidence interval [CI] .40-.55), dialysis dependence (4.1% versus 9.0%; OR .43, 95% CI .36-.52), and composite cardiovascular events (15.5% versus 27.7%; OR .48, 95% CI .42-.54). Interestingly, kidney transplant rates were more than twice as high in the MBS group (4.6% versus 2.2%; OR 2.13, 95% CI 1.67-2.72), and all-cause mortality was markedly lower (5.0% versus 16.3%; OR .27, 95% CI .23-.32). In subgroup analyses, outcomes were comparable between SG and RYGB, although SG was associated with higher kidney transplantation rates.

In this large TriNetX cohort of patients with obesity and CKD, MBS was associated with lower observed rates of ESRD, dialysis dependence, cardiovascular events, and all-cause mortality and with a higher rate of kidney transplantation. Similar renal, cardiovascular, and survival outcomes were observed after SG and RYGB. Because of residual differences in baseline kidney function, unmeasured treatment-selection factors, and limitations in the geographic and institutional characterization of the TriNetX network, these findings should be interpreted as associations within the study cohort rather than causal effects or population-level estimates. Further prospective and population-based studies are needed to confirm these associations.

The epigenetic factors underlying varicocele and idiopathic infertility are still poorly understood, despite established pathophysiological mechanisms.

This study assessed sperm miR-574 expression in infertile males with or without varicocele and fertile controls, evaluating its relationship with semen parameters and chromatin condensation.

Thirty-eight participants were included, comprising idiopathic infertile men (n = 14), varicocele patients (n = 9), and fertile controls (n = 15). Aniline blue staining evaluated chromatin condensation; quantitative RT-PCR determined miR-574 expression. In silico analysis predicted target genes.

Idiopathic infertile men exhibited significantly lower expression of sperm miR-574, indicated by significantly higher ΔCq levels, than fertile controls (P = 0.031). The idiopathic group also showed a significantly higher ratio of aniline blue-positive, histone-rich spermatozoa than the controls (P = 0.002). Across the entire study cohort, a significant negative correlation was established between miR-574 ΔCq levels and the proportion of spermatozoa with normal morphology (ρ = -0.465, P = 0.022). In silico analysis predicted that miR-574 targets key genes involved in chromatin regulation (H1FNT, CHD7), mitochondrial function (MRPS23, MARC2), and spermatogenesis (DAZL, SOHLH2).

These findings suggest a potential biological association where miR-574 downregulation may be a feature of idiopathic male infertility, potentially influencing gene networks involved in sperm formation and nuclear organization. Its precise regulatory mechanisms in male infertility subgroups warrant further large-scale validation.

Sperm miR-574 targets critical spermatogenesis and mitochondrial genes, representing a potential epigenetic factor involved in germ cell differentiation. Although its direct utility as a diagnostic biomarker requires further validation, it provides a valuable conceptual framework for understanding the molecular complexity of idiopathic male factor infertility.