In Norway, helicopter emergency medical services (HEMS) are dispatched for suspected cerebral stroke if intravenous thrombolysis may be administered within 4.5 hours of symptom onset, and it reduces time of transport by ≥30 minutes compared with basic emergency medical services (EMS). However, cerebral stroke presents with heterogeneous symptoms; therefore, identification by emergency dispatchers can be difficult. The primary outcome was the positive predictive value for stroke among patients with suspected stroke for whom HEMS was dispatched. Secondary outcomes included rates of prehospital interventions, quality indicator fulfillment, and rates of selected in-hospital interventions within time limits.

We conducted a retrospective cohort study using aggregated prehospital and in-hospital data from an electronic patient journal. It included 161 primary missions from the HEMS base in Trondheim, where HEMS was deployed on the index criterion of cerebral stroke set by the Emergency Medical Coordination Center between 2022 and 2024.

Of all primary missions, 14% (n = 162) were because of suspected stroke. A total of 75 patients (47%) were diagnosed with having stroke, whereas 12 (7%) were diagnosed with having transient ischemic attack. In 7% of cases, an advanced intervention that requires a physician was performed. A total of 40 patients (25%) received intravenous thrombolysis and/or endovascular thrombectomy.

Stroke was confirmed in 47% of HEMS dispatches for suspected stroke. HEMS likely reduced transport time by ≥30 minutes for most patients, whereas prehospital advanced interventions were rarely performed. Further studies on index use and comparative studies of HEMS and EMS dispatches could help strengthen patient selection and optimize resource utilization.

Decreased time to cardiac catheterization improves survival and limits cardiac tissue damage in ST Elevation myocardial infarction (STEMI). Emergency medical services delays account for half of treatment delays in STEMI. Helicopter air ambulance (HAA) can reduce the time to percutaneous intervention (PCI), and therefore may reduce mortality. The impact of physical distance between the PCI hospital helipad and the PCI laboratory on the door-to-door-to-balloon time (DDBT) for cardiac intervention in STEMI patients transported through HAA from remote community hospitals to PCI facilities was assessed.

This was a retrospective chart review of interfacility STEMI patients where HAA was activated to reduce DDBT from January 1, 2020, to January 1, 2023. The HAA agency under review transports STEMI patients to 2 PCI centers. There is a significant difference in the distance between the helipad and the PCI laboratory at the 2 hospitals. Descriptive statistics were used to compare DDBT as well as the time from HAA arrival at the PCI hospital helipad to the cardiac catheterization laboratory.

Data were available for 91 STEMI cases. The median time for DDBT was 89.9 minutes with a median time of 10.5 minutes from helipad arrival to catheterization laboratory (Table 1). Of the 91 cases, 69 (76%) were from hospital A and 22 (24%) were from hospital B. There was no detectable difference in the distribution of DDBT times between hospitals (P = .47). Helipad arrival times to cardiac catheterization laboratory were significantly longer for hospital A than hospital B (P < .001). The median time for hospital A was 11.0 minutes (interquartile range, 9.2-14.0) compared with hospital B, which had a median of 5.4 minutes (5.0-7.3).

The physical distance a PCI laboratory is located from the helipad can be a significant addition to ischemic time for STEMI patients.

Plasma inflammatory biomarkers linked to cardiovascular risk have been associated with asymptomatic apical periodontitis. However, it remains unclear whether endodontic treatment can reverse these alterations. This review evaluated the effect of endodontic treatment on inflammatory markers in individuals with asymptomatic apical periodontitis.

A comprehensive search was conducted in PubMed/Medline, Embase, Web of Science, Scopus, VHL, gray literature, and reference lists between October and November 2022, with an update in September 2025. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence using the GRADE approach. Random-effects meta-analysis estimated pooled mean differences (MD) and 95% confidence intervals (95%CI) for serum inflammatory markers concentrations between treated individuals and controls (α = 5%).

The search identified 6,295 records; sixteen studies were assessed and eight included in the quantitative synthesis. All studies showed moderate risk of bias, and evidence certainty was very low. Meta-analysis suggested possible reductions in C-reactive protein (CRP) [MD = 0.76 (95% CI: - 0.15, 1.67)] , interleukin-6 (IL-6) [MD = 0.81 (95% CI:-0.27, 1.90)], and tumor necrosis factor-alpha (TNF-α) [MD = 1.04 (95% CI:-0.38, 2.46)] after endodontic treatment, with levels similar to control groups.

Evidence, although limited, suggests endodontic treatment may lower serum CRP, IL-6, and TNF-α levels in asymptomatic apical periodontitis patients.

Endodontic treatment of asymptomatic apical periodontitis may help reduce systemic inflammatory biomarkers associated with cardiovascular risk, reinforcing its potential role beyond local infection control.

Ventriculoperitoneal shunting (VPS) helps reduce intracranial pressure and alleviate clinical symptoms caused by hydrocephalus in hemorrhagic Moyamoya disease (MMD). To date, no literature describes the occurrence of subdural fluid collection (SDFC) in hemorrhagic MMD patients undergoing VPS prior to cerebral revascularization. This report aims to explore the potential pathological mechanisms underlying SDFC following cerebral revascularization after prior VPS, and to provide effective strategies for future prevention. Clinical data of hemorrhagic MMD patients undergoing VPS prior to bypass admitted to our hospital from 2021 January and 2024 December were selected. Medical records were reviewed to analyze patient characteristics and the entire disease course. Among the 7 patients (9 cases), postoperative SDFC occurred in 7 cases (7/9, 77.8%), located contralateral to the shunt in 6 cases (6/7, 85.7%) and ipsilateral to the surgical side in 1 case (1/7, 14.3%), with onset mostly within 1 day after surgery. Among these 7 patients, 2 underwent subdural drilling and drainage due to significant mass effect caused by the effusion. One of these patients developed herniation with decreased consciousness and notable midline shift, and symptoms gradually improved after subdural drainage. Durin-g short-term clinical follow-up (postoperative period < 12 months), recurrent hemorrhage occurred in 1 out of 9 cases, while no cases of cerebral infarction or seizures were observed. CT angiography (CTA) revealed occlusion of the bypass graft in 2 out of 6 direct bypass cases. Through the findings of this study and literature review, we observe that cerebral revascularization performed during the late phase of VPS may induce SDFC complications through multiple mechanisms. Future implementation of early intervention may effectively reduce the risk of adverse events and improve surgical outcomes.

The Reprieve System is designed to overcome barriers limiting safe and rapid decongestion with individualized automated diuretic titration, real-time diuretic response monitoring, and individualized sodium chloride replacement to prevent cardio-renal dysfunction.

This study aims to establish proof-of-concept that the Reprieve System can facilitate rapid and safe decongestion.

FASTR (Fluid Management of Acute Decompensated Heart Failure Subjects Treated With Reprieve Decongestion Management System [DMS]) was a randomized pilot trial comparing the Reprieve System vs a control strategy of optimal diuretic therapy (ODT) in hospitalized patients with acute heart failure. The primary efficacy endpoint was 24-hour natriuresis, and the primary safety endpoint was a composite of dialysis or doubling of creatinine levels, severe electrolyte abnormalities, hypotension, or hypertensive emergency.

A total of 100 patients were enrolled, with 96 receiving randomized treatment (Reprieve, n = 52; ODT, n = 44). At baseline, the median estimated glomerular filtration rate was 49 mL/min/1.73 m² (Q1-Q3: 36-78 mL/min/1.73 m²) with estimated excess fluid volume of 20 lbs (Q1-Q3: 15-35 lbs). Twenty-four-hour natriuresis was significantly greater with the Reprieve System (1,082 ± 487 mmol) vs ODT (423 ± 290 mmol; P < 0.001). The safety endpoint occurred in 31% of the Reprieve group vs 39% of the ODT group (P = 0.42). Intravenous diuretic therapy duration was shorter with Reprieve [46 hours [Q1-Q3: 29-80 hours]) vs ODT (88 hours [Q1-Q3: 44-143 hours]; P = 0.014). The rate of weight loss (P = 0.002), net fluid loss (P = 0.03), and net natriuresis (P < 0.001) were significantly faster with Reprieve. Change in serum creatinine levels did not differ between the Reprieve (0.19 ± 0.24 mg/dL) and ODT (0.31 ± 0.39 mg/dL; P = 0.07) groups.

In this pilot trial, the Reprieve System safely produced significantly faster decongestion compared with ODT. Confirmation of these findings in the ongoing pivotal trial is required. (Fluid Management of Acute Decompensated Heart Failure Subjects Treated With Reprieve Decongestion Management System [DMS] [FASTR]; NCT05174312).

The gut microbiome supports digestion, immunity, and metabolism; its imbalance (dysbiosis) drives inflammation and metabolic dysfunction, contributing to chronic diseases such as diabetes, cardiovascular disease, inflammatory bowel disease, and autoimmune disorders. Medicinal plants provide a wide range of phytochemicals (such as polyphenols, flavonoids, alkaloids, saponins), which reach the colon and undergo two-sided interactions with microbes in the gut, acting as potential microbiome modulators and substrates of biotransformation into bioactive metabolites. This structured narrative review synthesises evidence from peer-reviewed studies indexed in PubMed, Scopus, and Web of Science over the last 10 years on the role of medicinal plants in microbiome-mediated chronic disease modulation. This literature is organised into three mechanistic axes: (i) perturbations, defined here as measurable shifts in microbial diversity or taxonomic composition relative to a baseline or healthy reference state, together with beneficial taxa enrichment; (ii) alterations in microbial metabolite output, especially short-chain fatty acids (SCFAs) and other immunometabolic mediators; and (iii) downstream host metabolic and immune signalling. Rather than broad descriptive summaries, the literature is organised using an axis-based mechanistic framework, highlighting key translational constraints such as botanical heterogeneity, dose/formulation variability, and inconsistent microbiome endpoint standardisation, that must be addressed to strengthen human evidence and clinical relevance. Illustrative microbiome-mediated processes involve botanicals such as turmeric (curcumin), ginseng (ginsenosides), and green tea (catechins), though evidence strength varies by study design. Future progress requires standardised phytochemical characterisation, microbiome-stratified trials, and integration of multi-omics with artificial intelligence analytics to enhance mechanistic insight, identify responders, and enable personalised plant-based microbiome therapies.

Children born small for gestational age (SGA) face elevated risks of metabolic, cardiovascular, respiratory, and neurodevelopmental disorders, as well as premature mortality, yet the underlying mechanisms remain only partly understood. We analyze blood proteomic data from multiple birth cohorts to identify molecular pathways linked to SGA and to later-life lung function. We find that approximately one-third of SGA children exhibit a distinct molecular endotype marked by dysregulation of axon-guidance proteins in cord blood. In peripheral blood collected later in life, these proteins are inversely associated with contemporaneous spirometric restriction. Using GWAS data and an experimental sheep model, we obtain convergent evidence that axon-guidance genes are associated with spirometric indices (FEV₁/FVC) at genome-wide significance and are broadly expressed during fetal development across multiple organs. These findings offer new insight into the developmental origins of chronic disease and highlight axon-guidance pathways as promising targets for investigating multiorgan morbidity.

Centenarian patients constitute a rapidly growing yet understudied population in emergency medicine. Evidence regarding prognostic factors and one-year outcomes in individuals aged 100 years and older presenting to the emergency department remains limited.

This retrospective observational study was conducted in the emergency department of Giresun Training and Research Hospital and included centenarian patients presenting between 2010 and 2023. A total of 160 emergency department visits from 83 unique patients were evaluated. Demographic characteristics, clinical variables, comorbidities, frailty indices, and laboratory parameters obtained at admission were recorded. Frailty was assessed using a modified frailty index excluding functional dependence (mFI-4) and the Clinical Frailty Scale (CFS). The primary outcome was one-year all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were performed at the patient level using the index emergency department visit.

In the descriptive visit-level analysis, non-survivor visits showed higher hospitalization frequency and less favorable inflammatory and renal function marker profiles than survivor visits, while pulmonary diseases were more frequent among non-survivors and cardiovascular diseases were more common among survivors. Modified frailty index scores did not differ significantly between groups. Higher CFS categories were associated with shorter median survival times, although Kaplan-Meier analysis showed no statistically significant separation between frailty categories. In Cox regression analysis, hospitalization at the index emergency department visit and higher blood urea nitrogen levels remained independently associated with one-year mortality.

In centenarian patients presenting to the emergency department, traditional comorbidity-based frailty indices show limited discriminatory value for one-year mortality. Acute clinical presentation and laboratory parameters reflecting inflammatory burden, renal function, and physiological reserve appear to be more closely associated with outcomes.

The study is not registered in a clinical trial registry.

People living with HIV (PLWH) face an increased CardioVascular (CV) risk due to the interaction between risk factors, chronic inflammation and AntiRetroviral Therapies (ART) metabolic effects. However, standard risk models often underestimate this burden. Our study aims to evaluate: (i) the CV risk category and the relative LDL-C targets; (ii) the achievement of these targets; and (iii) factors associated with target achievement and HIV-related variables.

A retrospective analysis was conducted on 246 PLWH, aged ≥40, on ART followed at the Niguarda Hospital. Clinical and laboratory data were extracted from the hospital's electronic registries and ten-year CV risk was assessed using SCORE2. Only 27.2% of the analyzed cohort achieved the recommended LDL-C targets with further lower prevalence in patients in the "high" or "very high" risk categories. Patients who achieved their LDL-C target had a more favorable cardiovascular risk profile (LDL-C: 75.8 ± 18.1 vs 121.1 ± 33.4 mg/dL, p < 0.001; systolic blood pressure: 116.9 ± 12.4 vs 123.4 ± 15.7 mmHg, p = 0.001), and CV risk categories, being less frequently classified as high and very-high risk (20.8 vs 52.4%, p < 0.0001). No significant relation was found between LDL-C target achievement and HIV-specific variables.

LDL-C target achievement remains suboptimal and may not reflect adequate cardiovascular risk control in PLWH, supporting the need for more aggressive and HIV-tailored prevention strategies.