Chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation, immune dysregulation, and increased susceptibility to infections. Obesity may influence these processes and has been proposed as a potential contributor to the so-called "obesity paradox", although its effects on immune competence, viral burden, and survival are not yet fully understood. Seventy patients with severe to very severe COPD (GOLD stage 3-4) were stratified according to BMI (<30 vs. ≥30 kg/m²). Clinical and functional parameters were assessed together with biomarkers of oxidative stress, DNA damage, systemic inflammation, and T-cell subsets. A comprehensive viral panel, including Torque Teno virus (TTV), was also analyzed. Five-year survival was evaluated using Kaplan-Meier curves and Cox regression models. Patients with BMI ≥ 30 showed higher lymphocyte counts and increased CD4⁺ and CD8⁺ T-cell levels, accompanied by lower systemic inflammatory indices. No significant differences were observed in oxidative stress or DNA damage markers. In addition, TTV viremia (≥4 log₁₀ copies/mL) was more frequently observed among patients with lower BMI. Despite these differences, five-year survival did not significantly differ between the two groups. These findings suggest that BMI alone may have limited value as a predictor of outcomes in patients with advanced COPD. Conversely, immune-inflammatory indices and viral burden, particularly TTV viremia, could provide complementary information for risk assessment and may deserve further investigation as potential tools for personalized patient stratification.

To evaluate associations between polymorphisms in CYP3A4 (*1B, *22), CYP3A5 (*3), CYP2J2 (*7, rs11572325), ABCB1 (c.1236C>T, c.2677G>T/A, c.3435C>T, rs4148738) and ABCG2 (c.421C>A) and the occurrence of bleeding or occlusive events in patients receiving rivaroxaban in real-world clinical practice.

A nested case-control study, divided into two substudies (bleeding and thromboembolic events), was conducted within a prospective cohort of 385 adults receiving rivaroxaban at University Hospital Centre Zagreb (September 2021-September 2024). Bleeding events were classified per ISTH criteria, and genotyping was performed using TaqMan real-time PCR. Cases and controls were balanced using entropy balancing, and associations were estimated with Bayesian logistic regression under a skeptical prior N(0, 0.355); LASSO regression was used to identify clinical and genetic predictors of outcomes.

In total, 71 patients (18.4%) experienced bleeding events, most frequently gastrointestinal (47.9%), while 314 patients served as controls. No pharmacogenomic variant showed a clear association with bleeding risk (raw and balanced odds ratios 0.80-1.35; 95% credible intervals crossing 1.0). LASSO regression identified age (OR 2.00 per decade), gastrointestinal comorbidity (OR 8.77), and eGFR as the dominant predictors of bleeding. Twenty-one patients experienced occlusive events (15 venous, 6 arterial); however, the low event count precluded meaningful pharmacogenomic analysis.

Individual pharmacogenomic variants in CYP3A4, CYP3A5, CYP2J2, ABCB1, and ABCG2 together with pharmacogenetic-based phenotypes were not associated with clinically relevant bleeding in rivaroxaban-treated patients. Traditional clinical risk factors, particularly advanced age and gastrointestinal comorbidity, remain the dominant determinants of adverse outcomes. Routine pharmacogenomic testing to guide rivaroxaban dosing is not currently supported.

Vascular stents are crucial devices in the treatment of cardiovascular diseases, and their structural design and function critically affect therapeutic efficacy and patient prognosis. Conventional stents can effectively restore vascular patency by providing mechanical support to blood vessels. However, they still face significant challenges including restenosis, thrombosis, and limited adaptability to complex patient-specific lesion characteristics. To address these limitations, drug delivery offers an important strategy to modulate the pathological microenvironment, enhance long-term vascular healing, and reduce systemic side effects. Meanwhile, advances in computational simulations have provided powerful tools for optimizing stent design through structural mechanics, hemodynamics, and drug release modeling. Computational approaches enable the rational design of stent architectures with improved mechanical stability, vascular compatibility, and therapeutic regulation. Consequently, the development of vascular stents is evolving toward the synergistic integration of drug delivery, structural optimization, and intelligent design. This review summarizes the latest advances in functional vascular stents, clinical applications and computational design. This work aims to provide valuable insights for the engineering of efficient, precise, and intelligent vascular stents for cardiovascular therapies.

Natural products derived from plants, animals, and microorganisms have long been used as nutritional supplements and are increasingly recognized for their potential role in preventing and managing human diseases. This narrative review aims to summarize current evidence on the therapeutic relevance of natural products as dietary supplements across major disease categories and to highlight their mechanisms of action, clinical efficacy, and safety considerations.

A narrative literature review was conducted using peer-reviewed articles, systematic reviews, and clinical studies focusing on natural products used as nutritional supplements in disease management. Relevant data were analyzed thematically, with emphasis on bioactive compounds, mechanisms of action, and evidence from preclinical and clinical research.

Natural products, particularly plant-derived polyphenols, flavonoids, terpenoids, omega-3 fatty acids, and probiotic-derived metabolites, exhibit diverse biological activities, including antioxidant, anti-inflammatory, immunomodulatory, and antimicrobial effects. Evidence suggests potential benefits in cardiovascular diseases, metabolic disorders such as diabetes and obesity, neurodegenerative conditions, certain cancers, gastrointestinal disorders, and infectious diseases. However, clinical efficacy varies depending on compound type, dosage, and formulation. Key limitations include low bioavailability, variability in composition, and insufficient large-scale clinical trials. Safety concerns such as herb-drug interactions and lack of standardization remain significant challenges.

Natural products as nutritional supplements represent a promising adjunct strategy in the prevention and management of various human diseases. While preclinical and early clinical evidence is encouraging, stronger clinical validation, improved standardization, and clearer regulatory frameworks are required to fully integrate these agents into evidence-based medical practice.

Background and Objectives: Hyperphosphatemia is a key component of chronic kidney disease-mineral and bone disorder and is associated with higher rates of cardiovascular events and mortality in patients undergoing dialysis. Phosphate binders are essential for phosphorus reduction, and their evaluation relies on several factors, such as chemical composition, binding capacity, and safety profile. Unfortunately, long-term management is hindered by high pill burden and poor adherence. Magnesium phosphate binders have proven effectiveness in reducing phosphate levels. Nevertheless, despite their efficacy, they are not widely used in clinical settings because of concerns related to their use. This study assessed the efficacy of low-dose magnesium carbonate as a phosphate binder in patients undergoing chronic dialysis, focusing on its biochemical control, tolerability, and cost-effectiveness. Materials and Methods: A prospective observational study was conducted on 54 hemodialysis patients with end-stage renal disease at a single dialysis center. Patients were taking either 250 mg magnesium carbonate or 2400 mg sevelamer carbonate for 3 months. Results: Both groups showed decreased phosphorus levels, with a 14.2% significant reduction in the magnesium carbonate group (p < 0.001) and a 5.1% reduction in the sevelamer carbonate group. At the end of the study, no significant differences were observed between the groups (p = 0.682). In the magnesium carbonate group at month 3, compared to baseline, no significant differences were detected in other laboratory parameters reflecting calcium-phosphorus metabolism (Ca-p = 0.681, PTH-p = 0.126). Simultaneously, good compliance without clinically relevant gastrointestinal side effects was observed, including the absence of clinically significant hypermagnesemia. Conclusions: The phosphorus-lowering potential of low-dose magnesium carbonate is non-inferior to that of low-dose sevelamer carbonate. However, its favorable safety profile, low incidence of adverse effects, and cost-effectiveness make it a promising option in clinical practice, further highlighting the need for better recognition by physicians.

Takotsubo syndrome (TTS) is an acute disorder characterized by transient left ventricular dysfunction with typical regional wall motion abnormalities, most commonly apical ballooning. It accounts for 1-3% of all suspected acute coronary syndromes and up to 5-6% in women presenting with ST-segment elevation myocardial infarction requiring coronary angiography to exclude obstructive coronary artery disease. The pathophysiology of TTS is complex and not fully elucidated, with sympathetic hyperactivation playing a central role through calcium dysregulation, oxidative stress, and metabolic alterations. Both clinical and experimental data demonstrate the importance of inflammation, with cell infiltration and persistent immune activation exceeding the acute phase. Increasing evidence highlights the impact of coronary microvascular disfunction (CMVD) as a secondary phenomenon, with some findings that support its role as a causative substrate. Beyond well-known predisposing conditions such as female sex, postmenopausal age, and neurological and psychiatric disorders with the trigger of a physical or psychological event, numerous case reports associate the syndrome with chronic autoimmune diseases, even if clear experimental evidence remains poor and worthy of further study. Echocardiography and advanced imaging techniques, including cardiac magnetic resonance and positron emission tomography, have provided insights into transient CMVD, reversible myocardial edema, and metabolic impairment, strengthening our knowledge of the syndrome as a dynamic process. It is also of growing interest to perform invasive hemodynamic assessment to explain the increase in microvascular resistance. This review offers a comprehensive and up-to-date overview of these techniques in the context of TTS. Since clinically, TTS may be associated with significant morbidity and mortality, with some unexplained cases of long-term myocardial disfunction or even recurrence, a deeper understanding of the interplay between catecholamines, inflammation, immune substrate, and CMVD may improve risk stratification and lead to the development of targeted therapeutic strategies.

As the primary active constituent of the traditional Chinese medicinal herb Ligusticum chuanxiong, Tetramethylpyrazine (TMP) has demonstrated broad therapeutic potential across multiple disease areas. Its clinical applications span cardiovascular and cerebrovascular disorders, oncology, hepatorenal protection, and respiratory diseases. The mechanisms of action involve antiplatelet aggregation, anti-inflammatory, antioxidant, and anti-apoptotic effects, as well as modulation of autophagy and multiple signaling pathways. Despite its pleiotropic efficacy, the clinical utility of TMP is constrained by unfavorable pharmacokinetic properties, including rapid metabolism and limited oral bioavailability. To overcome these limitations, researchers have developed various TMP derivatives, which exhibit significantly improved metabolic stability and enhanced pharmacological activity. This review summarizes recent advances in TMP and its derivatives over the past five years, aiming to provide insights for the future development of novel TMP-based therapeutics.

Background: Hyperlipidemia represents a pivotal risk factor for multiple cardiovascular and metabolic diseases, creating an urgent demand for safe, effective novel therapeutic interventions. Resveratrol (RES), a natural plant polyphenol, has exhibited great potential as a hypolipidemic agent for hyperlipidemia treatment. Methods: In this work, we established a high-fat diet (HFD)-induced hyperlipidemic mouse model to systematically investigate the lipid-regulating efficacy of RES. Results: Oral administration of RES significantly decreased serum levels of total cholesterol and low-density lipoprotein cholesterol, while markedly increasing high-density lipoprotein cholesterol concentrations. Histopathological analyses further demonstrated that RES alleviated HFD-induced hepatic and ileal injury. Moreover, RES significantly decreased the circulating levels of several bile acids (BAs), including taurodeoxycholic acid, taurolithocholic acid, lithocholic acid, and tauro-(α + β)-muricholic acid. RES also ameliorated HFD-induced gut microbial dysbiosis, as evidenced by a reduction in the Firmicutes/Bacteroidetes ratio, increased relative abundances of non_f_Muribaculaceae, Lactobacillus, Ileibacterium, and Bacteroides, and decreased abundances of Lachnospiraceae_NK4A136_group and unclassified f_Lachnospiraceae. Spearman correlation analysis revealed significant associations between gut microbial taxa and BA profiles, suggesting that coordinated regulation of the gut microbiota and BA metabolism contributes to the hypolipidemic effects of RES. Conclusions: Collectively, RES alleviates HFD-induced hyperlipidemia by remodeling gut microbiota composition and restoring bile acid metabolic homeostasis.

Suicide remains a major public health challenge worldwide, particularly among socially vulnerable populations who experience disproportionate exposure to social determinants associated with suicide risk and barriers to mental healthcare. Primary health care (PHC) is often the first point of contact with healthcare services and therefore plays a critical role in suicide prevention.

This narrative review was conducted according to the SANRA guidelines. A structured literature search of PubMed/MEDLINE, Scopus, and Web of Science was performed to identify evidence on suicide prevention interventions implemented in PHC and their applicability to socially vulnerable populations. The review focused on intervention characteristics, implementation approaches, reported outcomes, and challenges relevant to PHC practice.

The reviewed literature indicates that suicide prevention in PHC relies on multiple complementary strategies, including suicide risk screening, collaborative care models, safety planning interventions, brief psychological interventions, telehealth approaches, continuity-of-care programs, and provider training. Evidence suggests that multicomponent and integrated approaches are generally more effective than isolated interventions. Socially vulnerable populations, including people experiencing homelessness, poverty, unemployment, migration, domestic violence, substance use disorders, social isolation, disability, and social marginalization, face additional barriers to accessing mental healthcare and suicide prevention services. Effective interventions frequently combine clinical care with community, social, and support services to address both mental health needs and underlying social determinants of suicide risk.

Suicide prevention in PHC requires integrated, multidisciplinary, and person-centered approaches that extend beyond risk identification alone. Strengthening service integration, continuity of care, provider capacity, and intersectoral collaboration may improve suicide prevention efforts, particularly among socially vulnerable populations. Further research is needed to evaluate implementation strategies and intervention effectiveness in diverse healthcare settings, especially in low- and middle-income countries.

Burnout is prevalent among nurses, particularly in Intensive Care Units (ICUs), where work is characterized by high intensity, high risk, and heavy workloads. This condition not only directly impairs nurses' physical and mental health and reduces their occupational retention rate but may also threaten the safety of ICU patients due to potential declines in the quality of nursing care. Given these implications, effective alleviation of burnout among ICU nurses is essential for promoting their well-being, stabilizing the nursing workforce, and improving patient satisfaction. Previous studies have explored various variables related to burnout among ICU nurses, such as psychological capital, social support, work-family conflict, and moral distress. However, these findings remain inconsistent and fragmented across studies. To date, a comprehensive quantitative synthesis of the correlations between these variables and burnout among ICU nurses is lacking. Therefore, this study conducted a meta-analysis based on Pearson correlation coefficients to examine the correlates of burnout among ICU nurses, aiming to provide more reliable evidence for the development of targeted intervention strategies for this population.

Databases including CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database (CBM), PubMed, Web of Science, Embase, CINAHL, and Cochrane Library were systematically searched. The search used terms for intensive care units, nurses, burnout, and China in both Chinese and English. The search was conducted from the inception of the database to September 2025. Two researchers with expertise in evidence-based practice performed the literature search, independently screened studies based on the inclusion and exclusion criteria, assessed the quality of the included studies using the Agency for Healthcare Research and Quality (AHRQ)'s quality assessment criteria for observational studies, and extracted relevant data. A meta-analysis was conducted using RevMan 5.4 software, with Pearson correlation coefficients (r values) as the outcome indicator.

A total of 31 studies were included, with a combined sample size of 8,219 participants, and the overall methodological quality of the included studies was moderate. The pooled analysis indicated that burnout was significantly negatively correlated with psychological capital (r = -0.43, 95% CI: -0.53 to -0.33, I ² = 81%), research competence (r = -0.21, 95% CI: -0.30 to -0.11, I ² = 0%), and social support (r = -0.40, 95% CI: -0.49 to -0.28, I ² = 82%) (p < 0.01). Burnout was positively correlated with work-family conflict (r = 0.49, 95% CI: 0.41-0.57, I ² = 69%), presenteeism (r = 0.33, 95% CI: 0.24-0.41, I ² = 0%), moral distress (r = 0.32, 95% CI: 0.16-0.46, I ² = 53%), turnover intention (r = 0.48, 95% CI: 0.24-0.66, I ² = 96%), and alarm fatigue (r = 0.55, 95% CI: 0.26-0.75, I ² = 95%) (p < 0.01). Substantial heterogeneity was observed in several pooled estimates, particularly for turnover intention and alarm fatigue.

This meta-analysis suggests that burnout among ICU nurses is associated with multiple occupational and psychosocial factors, including work-family conflict, turnover intention, presenteeism, social support, and psychological capital. These findings highlight the importance of work-related stressors and psychological resources in relation to burnout among nurses. However, given the heterogeneity across studies and the cross-sectional nature of the included evidence, these associations should be interpreted with caution. The results provide a synthesized overview of the factors related to burnout among ICU nurses and may help inform future research and the development of strategies aimed at supporting nurses' occupational well-being.

This study was registered in the PROSPERO database (registration number: CRD420251146719). The protocol predefined the research objectives, inclusion and exclusion criteria, and main analytical methods. This study was conducted in accordance with the registered protocol. If minor adjustments were made during the study due to data availability, they were clearly described and justified in the Methods section to improve transparency and reproducibility.