Very small unruptured intracranial aneurysms (VSUIAs) measuring ≤ 3 mm represent a unique clinical challenge, balancing the low but non-negligible lifetime risk of rupture against the procedural risks of endovascular intervention. This study reports the safety, efficacy, and angiographic outcomes of endovascular coiling for VSUIAs from the ECOSA (Endovascular Coiling of Small Aneurysms) multicenter registry.

We performed a subgroup analysis of the ECOSA multicenter registry of patients with VSUIAs (maximum diameter ≤ 3 mm) who underwent endovascular coiling. Patient demographics, aneurysm characteristics, procedural details, periprocedural complications, clinical outcomes (modified Rankin Scale; mRS), and angiographic follow-up data were analyzed.

A total of 116 patients with 116 VSUIAs underwent endovascular coiling. The mean age was 52.3 years (SD 12.1), and the majority were female (75.0%). The mean aneurysm diameter was 2.66 mm (SD 0.44) and mean neck diameter was 2.1 mm (SD 0.87). Most aneurysms were discovered incidentally (78.4%). Balloon-assisted coiling was used in 14.7% and stent-assisted coiling in 23.3% of cases. The thromboembolic event (TEE) rate was 1.7%, with no symptomatic events. Intraprocedural rupture occurred in 0.9% of cases with no intraprocedural mortality. Among 98 patients with clinical follow-up (median 7.75 months), 93.9% of patients achieved good functional outcomes (mRS 0-2), and all-cause mortality rate was 1.0%. Among 80 patients with angiographic follow-up (median 6 months), adequate occlusion (RROC I-II) was achieved in 86.3%.

Endovascular coiling of VSUIAs ≤ 3 mm is feasible and associated with a low complication rate, high rates of good functional outcomes, and durable angiographic occlusion. These findings support the safety of elective intervention in carefully selected patients with high-risk morphological or clinical features. Larger prospective studies are needed to define optimal patient selection criteria for VSUIAs.

The timing of ischemic stroke and intracerebral hemorrhage (ICH) onsets follow distinct daily patterns, but it remains unclear whether these patterns influence ICH outcomes.

Consecutive data were obtained from the prospective stroke inpatient quality assurance registry of Hesse, Germany from 2015 to 2023. Patients with ICH were grouped according to the time of symptom onset: morning (5:00 AM to 10:59 AM), midday (11:00 AM to 4:59 PM), evening (5:00 PM to 10:59 PM), and night (11:00 PM to 4:59 AM). The primary outcome was global disability at discharge, analyzed using ordinal logistic regression. Secondary outcomes included mortality and complications during hospitalization. To account for potential confounding, the analysis incorporated both inverse probability weighting (IPW) and propensity score matching (PSM) based on baseline characteristics.

After exclusions, 5665 patients underwent final analysis. Peak ICH incidences occurred around 8:30 AM and 5:00 PM with a minimum at approximately midnight. Patients experiencing ICH during the evening and particularly at night had higher discharge disability, compared to those with symptom onset in the morning or midday. Unadjusted analyses found daily variations in mortality and in-hospital complications that were no longer significant after adjustment by PSM or IPW.

Our study confirms the daily pattern previously observed in ICH onset, with peak onset during daytime. Functional outcomes were worse in evening and night onset ICH patients. These findings underscore the potential for chronobiologically informed prevention and treatment strategies and the need for further research into time-dependent pathophysiology and care delivery.

The Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC) randomized controlled trial investigated the effects of a pharmacist-led intervention at a cardiology clinic on patient adherence and clinical outcomes. The results demonstrated that the intervention group had increased adherence to cholesterol-lowering medications and aspirin, as well as improved overall beliefs about medicines. However, the intervention did not lead to a higher proportion of patients reaching the target for low-density lipoprotein cholesterol (LDL-C) levels. This paper reports on the implementation of the intervention and explores potential mechanisms underlying these outcomes, focusing on the content of medication reviews, quality of prescribing, and changes in beliefs about medicines.

Medication reviews were evaluated by classification of identified drug-related problems (DRPs), actions taken to address these problems, and the outcomes of those actions, utilizing data from electronic health records (EHR). The Medication Assessment Tool for secondary prevention of Coronary Heart Disease (MAT-CHDsp) was applied to EHR data to evaluate prescribing quality. Beliefs about medicines were evaluated using the Beliefs about Medicines Questionnaire specific (BMQ-S), completed by participants at baseline and follow-up. Descriptive and comparative statistics were used to analyze the data.

Medication reviews were conducted for 144 of the 159 patients in the intervention group, with a mean of 4.3 DRPs per patient. Pharmacists identified 500 DRPs and managed 245 of these with patients alone, while 196 required discussions with physicians. The resulting status of 218 DRPs was known, and for 194 of these, the issue was solved or improved. No differences in prescribing quality were observed between groups at six months post-discharge. The mean concern score on the BMQ-S decreased more in the intervention group, and 52.8% of intervention patients vs. 31.0% of control patients (p = 0.051) shifted from an ambivalent to an accepting attitudinal category.

This process evaluation demonstrates that clinical pharmacists were effective in identifying and managing DRPs through collaboration with patients and physicians, leading to the resolution or improvement of a substantial number of DRPs. The intervention did not impact prescription quality. Patients in the intervention group reported reduced concerns about their medications, which explains the improved medication adherence.

This study is based on data from a randomized controlled trial (RCT) registered at ClinicalTrials.gov (NCT02102503; registered 03/04/2014).

Incidental vegetation-like findings on echocardiography prompt extensive diagnostic evaluation for infective endocarditis (IE), even in patients with low clinical suspicion. Given the association between IE and renal involvement, we evaluated whether routine urinalysis could serve as a simple adjunctive tool to aid early clinical assessment in this setting.

We retrospectively analyzed adults with vegetation-like echocardiographic findings at a tertiary center between 2010 and 2024. Patients were classified as those with confirmed IE [IE (+)] and those in whom IE was ultimately excluded [IE (-)]. Urinalysis parameters at presentation were analyzed, and a simple additive score was constructed.

A total of 459 patients were included, comprising 202 with IE (+) and 257 with IE (-). Proteinuria, hematuria, and pyuria were more frequent in IE (+) and remained independently associated with IE in multivariable analysis. An additive score incorporating these variables (1 point each; range 0-3) demonstrated acceptable discriminatory ability (area under the curve, 0.77; 95% CI, 0.72-0.81). A score of 0 showed a relatively high sensitivity (78%) with acceptable specificity (67%).

The absence of hematuria, proteinuria, and pyuria on routine urinalysis may serve as a supportive adjunct-not a rule-out test-for early clinical assessment.

The development of Bruton's tyrosine kinase (BTK) inhibitors has revolutionized the management of B-cell malignancies and holds potential in autoimmune diseases. However, safety concerns remain regarding treatment-associated adverse events: first-generation ibrutinib has been associated with off-target adverse event profiles, second-generation agents (acalabrutinib and zanubrutinib) require further validation of long-term safety patterns, and the real-world safety characteristics of third-generation pirtobrutinib continue to be evaluated. This study aims to characterize differences in adverse event (AE) disproportionality reporting signal patterns among four BTK inhibitors using data from the FDA Adverse Event Reporting System (FAERS).

This study analyzed AE reports for four BTK inhibitors from the FAERS database via disproportionality analysis with four distinct algorithms, complemented by a clinical prioritization scoring system. Disproportionality reporting signal patterns were characterized across System Organ Class (SOC), Preferred Term (PT), and temporal distribution dimensions. A standardized 2-year observation window was applied for sensitivity analysis, and AE-mortality associations were evaluated.

A total of 77,014 AE reports were included in this study. The four BTK inhibitors showed positive disproportionality reporting signals in blood and lymphatic system disorders, cardiac disorders, and infections and infestations. However, distinct disproportionality signal patterns were observed at the PT level. Ibrutinib showed prominent cardiovascular-related disproportionality reporting signals, particularly for atrial fibrillation (ROR = 9.8). Acalabrutinib was characterized by a distinct headache signal. Zanubrutinib showed prominent signals for myelosuppression (ROR = 16.24) and haemorrhage subcutaneous (ROR = 146.81). Pirtobrutinib demonstrated the strongest signal for increased white blood cell count (ROR = 54.28). Descriptive analysis of reported time-to-onset distributions showed that pneumonia reports for ibrutinib represented a larger proportion among cases reported after longer treatment durations, whereas haemorrhage and decreased white blood cell count reports were more frequently observed within earlier reporting intervals. In terms of fatal outcomes, multiple PTs associated with ibrutinib showed statistically significant associations with reported death outcomes within the FAERS dataset.

This descriptive pharmacovigilance study identified distinct disproportionality reporting signal patterns for four BTK inhibitors based on FAERS data, providing potential signals for post-marketing safety surveillance. These findings should be interpreted as differences in reporting patterns.

Digital approaches that capture dietary behavior repeatedly in real-world settings may improve the monitoring of long-term lifestyle interventions while reducing participant burden and supporting self-awareness. This study developed and evaluated a low-burden dietary ecological momentary assessment (EMA) protocol to monitor Mediterranean diet adherence during the 12-month PENSA multimodal lifestyle trial in older adults at increased risk of cognitive decline.

A total of 104 participants aged 60-80 years with subjective cognitive decline and APOE-ε4 carrier status were included. Daily mobile EMA prompts assessed key Mediterranean diet food groups through a rotating schedule, and participants received personalized feedback every 4 weeks. EMA-derived adherence indicators were evaluated against the Mediterranean Diet Adherence Screener, 3-day food diaries, nutrient profiles, usability data, and cardiometabolic and dementia-risk markers.

Mediterranean diet adherence improved over the intervention, with EMA scores increasing from 73.6 to 82.3% and capturing dynamic changes in dietary quality across the year. EMA-derived indicators showed increasing convergence with the Mediterranean Diet Adherence Screener over time (ρ = 0.36 at 6 months and ρ = 0.46 at 12 months; both p < 0.001) and were associated with expected nutrient patterns, including higher fiber and monounsaturated fat intake and lower free sugar, saturated fat, and sodium intake. Higher EMA-based adherence was also associated with lower body mass index, visceral adiposity, body fat percentage, insulin resistance, glycated hemoglobin, triglyceride-glucose index, and lifestyle-based dementia risk. The protocol showed high feasibility, with sustained completion rates and positive participant evaluations, although engagement declined modestly over time.

These findings support dietary EMA as a feasible, scalable, and behaviorally meaningful approach for monitoring and promoting Mediterranean diet adherence in real-world lifestyle interventions, with potential value both as an assessment tool and as an active component to reinforce dietary change. The PENSA trial is registered at ClinicalTrials.gov (NCT03978052).

Post-Stroke Cognitive Impairment (PSCI) is a common complication after stroke, significantly affecting patients' quality of life and long-term prognosis. Although PSCI has been extensively studied, most research combines ischemic and hemorrhagic strokes. Whether the distinct inflammatory mechanisms and vascular injury underlying ischemic stroke-specific cognitive dysfunction (ISCD) have followed an independent research trajectory remains unknown from a bibliometric perspective.

Using the Web of Science Core Collection (2004-2024), our study identified 1,062 articles focused on ISCD for bibliometric analyses. Following cross-validation with PubMed confirming complete literature concordance, bibliometric tools (CiteSpace, VOSviewer, the R-based bibliometrix package) were employed to analyze publication trends, contributions and collaborations among countries, institutions, journals, and authors. Subgroup analyses quantified trends in inflammatory biomarkers, assessment tools and prediction models.

Annual publication peaked in 2022 (n = 133), followed by a decline in 2023 and 2024. China dominated in productivity (31.4%), while the United States exhibited the highest collaborative centrality (0.30). Keyword bursts identified ischemic-specific hotspots, including "model" (2021, burst strength = 4.66), "validation" (2022, burst strength = 4.96), and "inflammation" (2021, burst strength = 3.83). Inflammatory biomarkers and assessment tools have consistently been research hotspots in ISCD, recent efforts are shifting toward the development of prediction models for cognitive outcomes following acute ischemic stroke.

This ischemic-specific bibliometric analysis confirms that inflammatory biomarkers, assessment tools, and prediction models are persistent hotspots in ISCD, with a clear ongoing shift from descriptive studies toward predictive model development and validation. These findings provide a quantitative literature-based rationale for guiding future research directions.

Osteoporosis is a major global public health challenge, with lifestyle as a key modifiable factor. This study aimed to examine associations between lifestyle patterns and bone mineral density (BMD) in Chinese adults.

In this cross-sectional, multi-center study, 5,324 adults from Beijing (2016-2020) with complete lifestyle questionnaires were analyzed (lumbar spine BMD available for 4,028; hip BMD available for 4,654). Each of eight lifestyle variables was residualized on age and sex before k-means clustering (k = 3) categorized participants into three groups: office/mental-labor workers with low leisure-time activity (OL), physical-labor workers (PL), and office/mental-labor workers with an active leisure-time lifestyle (OA). Differences in lumbar spine and hip BMD among clusters were examined using multivariable-adjusted models (age modeled via restricted cubic spline, sex, body mass index [BMI], hospital fixed effects), with stratification by sex, age group, and BMI group, alongside full-cohort dose-response and cluster × exposure interaction analyses.

After adjustment, the OA cluster showed higher lumbar spine BMD than the OL cluster (adjusted difference = 0.024 g/cm², 95% CI 0.012-0.036, P < 0.001). The PL cluster showed lower hip BMD than both the OL cluster (adjusted difference = -0.041 g/cm², 95% CI -0.056 to -0.027, P < 0.001) and the OA cluster (adjusted difference = 0.028 g/cm², 95% CI 0.011-0.044, P = 0.002), despite the occupational physical activity inherent to manual labor. These associations were broadly consistent across sex, age, and BMI strata, though attenuated among participants aged ≥70 years and those with obesity. In dose-response analyses, exercise and sun exposure showed non-linear associations with BMD at both sites, while calcium supplementation frequency showed a consistent negative linear association that did not vary by cluster.

A lifestyle pattern combining active leisure-time behavior with office-based occupation was associated with higher lumbar spine BMD, while an occupationally physical-labor lifestyle was associated with lower hip BMD relative to both other clusters. These associations exhibited site-specific patterns and were generally consistent across demographic subgroups. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects; prospective studies are needed to clarify their causal structure and clinical significance.

Depression and suicidal ideation are common among men who have sex with men (MSM) and transgender women (TGW). Pre-exposure prophylaxis (PrEP) has become an important component of HIV prevention, but its relationship with mental health remains incompletely understood. This study compared depression and suicidal ideation/risk between PrEP users and non-users among MSM and TGW attending HIV prevention services, and identified factors associated with depression.

A cross-sectional study was conducted among 150 MSM and TGW (75 PrEP users and 75 non-users) recruited from two HIV prevention clinics in Chiang Mai, Thailand Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and suicidal ideation/risk was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS). Group differences were compared using χ ² tests, Fisher's exact test, or independent-samples t-tests as appropriate. Multivariable linear regression was performed to identify factors associated with depression.

PrEP users had significantly lower mean depression scores than non-users (3.80±3.46 vs. 5.96±3.76; mean difference 2.16, 95% CI: 0.99-3.33; p <0.001). Suicidal ideation/risk was reported by 5 (6.7%) PrEP users and three (4.0%) non-users, with no significant difference between groups (Fisher's exact test, p = 0.719). In the adjusted linear regression model, PrEP use was independently associated with lower depression scores (B = -1.77, 95% CI: -3.07 to -0.47; p = 0.008), whereas experience of discrimination was independently associated with higher depression scores (B = -1.32, 95% CI: -2.59 to -0.06; p = 0.040).

Among MSM and TGW attending HIV prevention services in Chiang Mai, PrEP use was independently associated with lower depression scores, whereas suicidal ideation/risk did not differ significantly between PrEP users and non-users. Experience of discrimination was associated with higher depression scores. Although causal inferences cannot be made, the findings highlight the importance of considering mental health alongside HIV prevention services for key populations.