To examine the implementation process, mechanisms of change and contextual influences of a stroke prevention intervention.

A process evaluation following the UK Medical Research Council's process evaluation framework was conducted alongside a randomised controlled trial (RCT).

The intervention was conducted in Swedish primary healthcare.

Persons at high risk of stroke participating in the Make My Day, a 10-week group-based intervention (n=122) and healthcare professionals delivering the intervention (n=10).

Quantitative data from logbooks, surveys and app registrations, and qualitative data from interviews, logbooks and reflexive fieldnotes were collected across five cohorts. Data were analysed separately and integrated using a convergent mixed-methods approach.

Fidelity varied; overall adherence to the study manual and programme content was good, while fidelity to specific session activities and session attendance varied, with a mean of 3.6 (SD 2.2) out of 6. Recruitment successfully reached individuals at high risk of stroke, but reaching a vulnerable population was challenging. Realistic, activity-focused goal setting emerged as the most perceived valued mechanism of change. Engaging everyday activities supported sustainable change when a sense of belonging was established. The group served as both a facilitator and a barrier to lifestyle change. The mobile app offered opportunities but faced usability challenges. Healthcare professionals' delivery of the intervention was expressed as central for the change.

This study demonstrates how fidelity, facilitation and contextual conditions shape the functioning of a complex lifestyle intervention. Supporting healthcare professionals with adequate preparation and pedagogical skills is critical to optimising the delivery and outcomes of stroke prevention interventions in primary healthcare.

NCT05279508.

Reduction of chronically herniated viscera and restoration of midline continuity in a large incisional hernia can raise intra-abdominal pressure (IAP), occasionally to the point of intra-abdominal hypertension. Component separation is intended to mitigate this by increasing the capacity and compliance of the abdominal wall, yet the perioperative pressure profile of endoscopic anterior component separation combined with intraperitoneal onlay mesh repair with fascial closure (IPOM-plus) has not been well characterized. We measured IAP and airway pressure across the perioperative period in patients undergoing this reconstruction.

Thirty consecutive adults with a midline incisional hernia of at least 6 cm width underwent bilateral endoscopic anterior component separation with primary fascial closure and IPOM-plus repair at a tertiary center. IAP was measured indirectly as intravesical pressure (IVP) at four predefined time points: preoperatively, immediately after induction of anesthesia, after completion of the reconstruction before anesthetic reversal, and 24 h postoperatively. Peak airway pressure (Paw) was recorded after induction and before reversal. Loss of domain was quantified on preoperative computed tomography using the Tanaka method. The primary outcome was the change in IVP from the preoperative measurement to 24 h. Repeated measures were compared using the Friedman test with post hoc Wilcoxon signed-rank tests and Bonferroni correction.

Mean IVP was 9.43 ± 1.01 mmHg preoperatively, 8.67 ± 0.84 mmHg after induction, 8.87 ± 0.82 mmHg before reversal and 9.93 ± 1.05 mmHg at 24 h, differing significantly overall (Friedman χ²(3) = 46.06, p < 0.001; Kendall W = 0.51). The primary outcome, the preoperative to 24-h change, was an increase of 0.50 ± 0.68 mmHg, which was statistically significant (adjusted p = 0.006) but clinically negligible. Two patients (6.7%) reached 12 mmHg and so met the threshold for Grade I intra-abdominal hypertension, and none developed organ dysfunction. IVP did not change significantly during the surgery itself (8.67-8.87 mmHg, adjusted p = 0.347). Paw was unchanged (19.60 ± 1.22 to 19.53 ± 1.11 cmH₂O, p = 0.564), as were FVC, FEV₁ and FEV₁/FVC. The Tanaka score (mean 25.7 ± 1.1%) was not associated with IVP at any time point or with the change in IVP. Fascial closure was achieved in all 30 patients, and 30-day morbidity comprised one seroma and one abdominal wall ecchymosis, both Clavien-Dindo Grade I.

Endoscopic anterior component separation with fascial closure and IPOM-plus repair was not accompanied by a meaningful rise in intra-abdominal or airway pressure. The statistically significant 24-h increase of 0.5 mmHg is unlikely to be clinically relevant, and respiratory mechanics were preserved. Within the narrow range of loss of domain studied, the Tanaka score did not predict the perioperative pressure response.

Affecting ~1 in 4000 to 6000 live births, 22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion syndrome. It results from a 1.5 to 3 Mb heterozygous deletion at chromosome 22q11.2 and is associated with a broad spectrum of clinical manifestations, including cardiac defects, palatal abnormalities, thymic hypoplasia, developmental delays, and neuropsychiatric symptoms. Multiple techniques such as chromosomal microarray and sequencing techniques such as fluorescence in situ hybridization help in the diagnosis of 22q11.2DS. A multidisciplinary approach to management is required, involving cardiology, immunology, endocrinology, speech therapy, psychiatry, and genetics. Surveillance should include monitoring for immunodeficiency, hypocalcemia, thyroid dysfunction, hematologic complications, and psychiatric illness. Genetic counselling and prenatal testing are crucial components in guiding families and informing reproductive decision-making. Additionally, structured transition of care programs should be employed to ensure continued care into adulthood. Although 22q11.2DS has gained significant recognition in the past decades, educational gaps still persist for pediatricians, especially regarding when to suspect, genetic testing, and coordination of care. This review aims to provide insights into the epidemiology, pathogenesis, system-based clinical features, diagnosis, management, and surveillance of 22q11.2DS, highlighting practical strategies that can be employed by pediatricians to improve early detection and optimize long-term outcomes.

Hypertension control among Chinese older adults remains suboptimal, and the real-world effectiveness of individualized Dietary Approaches to Stop Hypertension (DASH)-based nutritional support delivered through community nursing is unclear. This study evaluated its association with 6-month blood pressure trajectories.

This retrospective cohort study used electronic health records to compare nurse-delivered individualized DASH-based nutritional support with standard care. Propensity score matching (1:1) was performed. The primary outcome was the 6-month systolic blood pressure (SBP) trajectory, analyzed using linear mixed-effects models with a Group × Time interaction. Secondary outcomes included diastolic blood pressure (DBP), blood pressure control (< 140/90 mmHg), body mass index (BMI), and hypotension.

Among 366 eligible patients, 210 were matched (105 per group), with all postmatching standardized mean differences < 0.10. SBP trajectories differed significantly between groups (p_interaction < 0.001). At 6 months, the between-group differences were -4.3 mmHg for SBP (95% CI, -6.6 to -2.0; p < 0.001) and -2.7 mmHg for DBP (p < 0.001). Blood pressure control was higher in the intervention group (61.9% vs. 40.0%; p = 0.003). The SBP difference was larger among patients with severe hypertension (-7.5 vs. -3.1 mmHg; p_interaction = 0.012). In the higher-contact subgroup (≥ 3 documented nutritional contacts), the SBP difference was -5.6 mmHg. BMI decreased by 1.2 kg/m² (p < 0.001). Hypotension was uncommon and comparable between groups (3.8% vs. 2.9%; p = 1.000).

Individualized community-based DASH nutritional support was associated with more favorable blood pressure trajectories and higher control rates without an observed increase in hypotension. Larger differences were observed among patients with severe baseline hypertension and those with greater documented intervention contact.

To determine whether heart rate variability (HRV) indices derived from 24-hour ambulatory electrocardiography provide complementary prognostic information in machine-learning prognostic models using conventional clinical variables in patients with heart failure, particularly with regard to calibration and threshold-based performance.We analyzed 353 patients with heart failure. The primary endpoint was cardiovascular death or hospitalization for worsening heart failure. Patients were randomly divided into training and test cohorts in a 3:2 ratio. Two gradient boosting models were developed: one using clinical variables and HRV indices, and the other incorporating clinical variables only. To ensure a fair comparison and limit model complexity, the number of selected predictors was restricted to five in both models.The primary endpoint occurred in 49 patients (14%) during a median follow-up of 740 days (interquartile range 566-870 days). In the independent test cohort (n = 141), discrimination (AUC) was similar between the two models (0.77 versus 0.71; DeLong P = 0.263). However, the HRV model showed higher threshold-based classification performance (higher F1 score and accuracy) and a calibration slope closer to 1.0 (slope 1.01 versus 0.73).In machine-learning-based prognostic modeling for heart failure, Holter-derived HRV indices may be associated with clinically relevant classification performance and a calibration slope closer to 1.0, although the improvement in discrimination as assessed by AUC was not statistically significant. These findings suggest that heart rate variability may provide complementary prognostic information not fully captured by standard clinical variables alone.

Fish gallbladder ingestion remains a traditional folk remedy in several Asian countries but may result in severe hepatorenal toxicity. We report three patients admitted to the Poison Control Center, Bach Mai Hospital, Hanoi, Vietnam, following ingestion of grass carp (Ctenopharyngodon idella) gallbladders. A 44-year-old man developed severe hepatocellular injury (peak AST 4442 U/L, ALT 5115 U/L), moderate acute kidney injury (AKI), and prolonged severe hypertension requiring intravenous nicardipine infusion for 88 hr. A 48-year-old man presented with severe AKI (peak creatinine 749 µmol/L) and toxic hepatitis and underwent intermittent hemodialysis because of rapidly progressive renal dysfunction despite preserved urine output. A 73-year-old woman developed severe acute hepatocellular injury with AST and ALT levels exceeding 7000 U/L and ferritin of 40,000 ng/mL but without clinically significant AKI. Peak total bilirubin concentrations were 83.6, 102, and 99 µmol/L in Cases 1, 2, and 3, respectively. Viral hepatitis investigations were negative in all patients. Despite variable clinical phenotypes, all patients recovered with supportive treatment. These cases further illustrate the variable patterns of hepatorenal involvement following grass carp gallbladder ingestion, ranging from dialysis-requiring acute kidney injury to predominant hepatocellular injury with preserved renal function. Because toxin exposure could not be quantified, the observed variability may reflect differences in ingested toxin dose, host susceptibility, or both. These findings highlight interindividual variability in patterns of hepatorenal involvement following grass carp gallbladder ingestion.

Fruquintinib (FRU) is a vascular endothelial growth factor receptor (VEGFR)-1, 2, 3 tyrosine kinase inhibitor (TKI) approved for metastatic colorectal cancer. While hypertension, fatigue, and hand-foot syndrome are common adverse events, severe proteinuria and nephrotic syndrome are rare and has not been reported in clinical trials. A woman in her 60s with recurrent rectal cancer began fruquintinib at 5 mg/d as a 4th-line treatment. She had a history of hypertension and was taking amlodipine. On day 8 of the first cycle, she developed hypertension (grade 2) . On day 22, proteinuria (grade 3) was detected and hypertension had worsened (grade 3) . Since these changes occurred during the off-treatment period, observation was selected. However, on day 23, the patient presented with fatigue, generalized edema, and dyspnea. Laboratory tests revealed a urine protein/creatinine ratio of 10.3 g/gCr and elevated serum creatinine (grade 1), leading to hospitalization. Post-admission, hypermagnesemia (grade 3) was also noted. loxoprofen and magnesium oxide were discontinued and furosemide was initiated. By day 6 of hospitalization, 24-h urine protein quantification had decreased to 2.1 g/d. By day 9, edema and hypertension had both improved, and the patient was discharged. The Naranjo score were 7 for fruquintinib, 6 for loxoprofen and bevacizumab, and 5 for trifluridine/tipiracil hydrochloride, suggesting probable adverse drug reaction. VEGFR-TKIs are presumed to impair glomerular structure and function, leading to proteinuria. Although renal biopsy was not performed, thrombocytopenia and elevated lactate dehydrogenase suggested thrombotic microangiopathy. Earlier monitoring could have enabled faster detection and prevention of severe symptoms.

Thyrotoxicosis in high-risk patients is a severe condition requiring prompt management, although conventional therapeutic approaches often present limitations. Therapeutic plasmapheresis has emerged as a potential option to achieve rapid clinical stabilization and facilitate a safe transition to definitive treatment by effectively reducing circulating thyroid hormone levels. The objective of this study was to evaluate the safety and efficacy profile of plasmapheresis in patients with high-risk thyrotoxicosis.

We conducted a retrospective multicenter study with a cohort of 13 patients with high-risk thyrotoxicosis who underwent plasmapheresis due to clinical instability, adverse effects related to antithyroid drugs, or significant cardiovascular comorbidities. Therapeutic success was assessed based on objective clinical improvement and restoration of euthyroidism, determined by hormonal measurements. Adverse events were systematically recorded to evaluate the procedural safety profile.

The median age was 50 years, and 84.6% of patients were women. The median number of plasmapheresis sessions was 3. Normalization of T3 and free T4 levels was achieved in 92.3% of patients. Mild adverse events occurred in 30.8% of cases, none of which required treatment discontinuation. Definitive therapy following plasmapheresis was performed in 76.9% of patients, most commonly total thyroidectomy.

Plasmapheresis appears to be a safe and effective therapeutic option in patients with high-risk thyrotoxicosis, particularly in those with absolute contraindications to conventional treatments or severe cardiovascular comorbidities, facilitating stabilization and transition to definitive therapy.

This study investigated the effects of therapeutic play on angiography in children aged 4-10.

Our study was conducted as a randomised controlled experimental trial with 70 (experimental: 35, control: 35) children undergoing angiography at the paediatric cardiology clinic of a university hospital between 1 January 2022 and 31 August 2022. The "Child Information Form", "Wong-Baker Faces Pain Rating Scale", "Children's Fear Scale", "Children's Anxiety Meter-State" and "Doll Model" were used for data collection. Percentage, mean, pearson correlation, ANOVA were used in the evaluation of the data.

It was found that 57.1% of the children who participated in our study were female, their mean age was 6.48±2.36 years, 45.7% had the diagnosis of Atrial Septal Defect (ASD), 78.6% had not undergone any surgery before and 60% were hospitalised for follow-up. It was found that the difference between pain, fear and anxiety scores of the children after the therapeutic play programme was statistically significant (p ˂ 0.05).

Our study found that therapeutic play programmes can reduce pain, fear and anxiety in children. These findings demonstrate that negative experiences during invasive procedures affect children not only physiologically, but also psychologically and behaviourally. Therapeutic play can therefore be a powerful supportive intervention. Therefore, we recommend integrating therapeutic play into nursing clinical guidelines and care protocols, and providing paediatric nurses with training in this area.

Atrial standstill (AS) is the complete absence of atrial electrical and mechanical activity caused by diffuse atrial myocardial disease, distinct from sinus node dysfunction. First documented in 1897 and often misdiagnosed as atrial fibrillation, it arises from SCN5A loss-of-function, NPPA, or EMD/LMNA mutations, muscular dystrophies, and infiltrative or idiopathic fibrotic processes. Diagnosis requires absent P waves, absent atrial electrograms, and failure of atrial capture at maximal pacing output, with late gadolinium enhancement MRI and electroanatomic mapping demonstrating diffuse fibrosis. Thromboembolism complicates 30-54% of cases. Management comprises permanent pacing, anticoagulation, and gene-specific risk stratification for defibrillator eligibility. AS is best understood as the end-stage of fibrotic atrial cardiomyopathy (EHRAS Class II-III); absence of trials, unvalidated risk tools, and incomplete genotype-phenotype correlation warrant a multicenter registry.