Objective: To evaluate the efficacy and clinical outcomes of transcatheter closure of intracristal ventricular septal defect (VSD) using an eccentric occluder. Methods: In this case series study, 39 children with intracristal VSD who underwent attempted transcatheter closure using an eccentric occluder at the Second Affiliated Hospital of Wenzhou Medical University from January 2011 to December 2021 were included. All children were regularly followed up at 1, 3, 6, 12, 24 and 36 months after the procedure. Echocardiography, electrocardiography and treadmill exercise testing were used for postoperative follow-up evaluation. The main outcomes included occlude morphology and position, residual shunt, valvular regurgitation, cardiac function, arrhythmia and postoperative exercise capacity. Comparisons among different follow-up time points were performed using the paired t-test or repeated-measures analysis of variance, Friedman test or Wilcoxon signed-rank test. Results: Device implantation was successful in 38 of 39 children (97%). One child underwent surgical repair because the aortic valve prolapse protruded into the VSD shunt orifice, making transcatheter closure unsuitable. No severe complications occurred after the procedure. Follow-up showed that residual shunt was observed in 7 children (18%) after the procedure and disappeared within 24 months of follow-up. Valvular regurgitation occurred in 9 children (24%) and did not worsen during follow-up; in 7children, valvular regurgitation disappeared within 36 months. Arrhythmia occurred in 6 children (16%), including incomplete right bundle branch block in 2 children and premature ventricular contractions in 4 children. Five children resolved within 12 months, and the remaining 1 child resolved by 36 months of follow-up. Compared with baseline, the Z scores of left ventricular end-diastolic diameters and left atrial diameters showed a progressive decrease during the first 1 to 6 months after transcatheter closure (both P<0.05), and remained stable after 24 months. Right ventricular diameter and left ventricular ejection fraction showed no significant changes before and after the procedure (all P>0.05). A total of 20 children underwent treadmill exercise testing 1 year after the procedure, and 19 children (95%) had negative results. Conclusion: Transcatheter closure of intracristal VSD using an eccentric occluder is effective and feasible, with favorable safety and efficacy during short-and mid-term follow-up.

Objective: To investigate the risk factors of vascular function damage in children with primary hypertension and establish a risk prediction model. Methods: In this retrospective case-control study, a total of 117 children aged 6-17 years with primary hypertension, hospitalized at Capital Center for Children's Health, Capital Medical University, between February 2024 and October 2025 were included. Flow mediated dilation (FMD) and carotid-femoral pulse wave velocity (cfPWV) were used as indicators of vascular function impairment. The children were divided into a vascular function damage group and a normal vascular function group according to the presence or absence of vascular function damage. Independent samples t-test or Mann-Whitney U test was used for intergroup comparison of measurement data, χ² test or Fisher's exact test was used for enumeration data. Differences in clinical, laboratory and vascular function-related indicators were compared between the two groups. Multivariate Logistic regression was employed to identify independent risk factors, based on which a nomogram was constructed. The predictive performance was verified by the receiver operating characteristic (ROC) curve. Results: Among 117 hypertensive children, there were 92 (78.6%) males and 25 (21.4%) females, with the age of (13.0±2.1) years at admission. There was 58 (49.6%) with vascular function damage. The body fat percentage, 24 h mean systolic blood pressure, daytime systolic blood pressure, nocturnal systolic blood pressure, low-density lipoprotein, total cholesterol, triglycerides, homocysteine, folic acid, fasting insulin, uric acid and cfPWV levels in the vascular function damage group (58 cases) were significantly higher than those in the normal group (59 cases), while the FMD level in the vascular function damage group was significantly lower than that in the normal group (all P<0.05). Multivariate Logistic regression identified that: nocturnal systolic blood pressure (SBP) (OR=1.06, 95%CI 1.01-1.10, P=0.019), serum low-density lipoprotein (LDL) (OR=5.51,95%CI 2.41-12.58,P<0.001), and homocysteine (OR=1.11,95%CI 1.03-1.19,P=0.005) were independent risk factors for vascular function damage. A nomogram prediction model was constructed accordingly, and the Logistic regression equation was: Logit(P)=-10.73+0.05×nocturnal systolic blood pressure+1.71×low-density lipoprotein+0.10×homocysteine. The ROC curve for the nomogram showed an area under curve of 0.82 (95%CI 0.74-0.89, P<0.001), with a sensitivity of 0.76 and a specificity of 0.71. Conclusion: Nocturnal systolic blood pressure, low-density lipoprotein and homocysteine are independent risk factors for vascular function damage in children with primary hypertension.

Objective: To explore age-adapted left ventricular ejection fraction (LVEF) diagnostic thresholds for heart failure with preserved ejection fraction (HFpEF) in children. Methods: In this multicenter retrospective cohort study, children with chronic heart failure were selected from 3 546 hospitalized pediatric heart failure patients across 30 medical centers in 20 provinces, autonomous regions and municipalities in China from January 2013 to December 2022. Children were divided into 3 groups based on LVEF:<50%, 50%-<55%, and ≥55%. Age-stratified analyses were performed using cutoffs at 9, 10, 11, 12, and 13 years of age. Intergroup comparisons were conducted using the chi-square test or Fisher's exact test, Wilcoxon rank-sum test or Kruskal-Wallis test. Multivariable linear regression was used to analyze the independent association between LVEF categories and cardiac structural parameters. Results: A total of 1 018 pediatric patients were included in the analysis. Among them, 527 (51.8%) were male and 491 (48.2%) were female, with an age of 1.2 (0.4, 7.1) years. There were 447 children in LVEF <50% group, 62 children in 50%-<55% group, and 509 children in ≥55% group. Statistical differences in baseline clinical characteristics were observed among the 3 groups, including age, heart rate, respiratory symptoms, systemic congestion symptoms, congenital heart disease, cardiomyopathy cardiovascular events, growth retardation (all P<0.05). Age-stratified analysis showed that when using 9, 10 and 11 years of age as cutoffs, left ventricular end-systolic diameter (LVESD) differed between the LVEF <50% and 50%-<55% groups in children aged at or above the respective cutoff (all P<0.05). When using 12 and 13 years of age as the cutoff, left atrial diameter differed between the LVEF 50%-<55% and ≥55% groups in children below 12 and 13 years of age (both P<0.05). After adjustment for covariates using multivariable linear regression, when using 10 and 11 years of age as the cut-offs, LVEF were correlated with LVESD in both children aged ≥10 years and those aged ≥11 years (β=11.62 and 10.94,95%CI 2.38-20.85 and 1.32-20.56, P=0.018 and 0.029). And when using 12 years of age as the cut-offs, LVEF was correlated with left atrial diameter in children aged <12 years of age (β=-1.82,95%CI -3.29--0.35,P=0.015). Conclusion: Age-related heterogeneity may exist in the LVEF thresholds for pediatric HFpEF, an LVEF threshold of 55% is recommended for children younger than 12 years, whereas 50% consistent with adult criteria, may be considered for those aged 12 years or older.

Orbital venolymphatic malformations (OVLM) are rare congenital vascular anomalies that may cause progressive proptosis, visual loss, facial disfigurement and marked psychosocial burden. Management is challenging especially when the disease is multifocal, diffuse and with limited response to conventional therapies. We describe a school-aged child with a right eye refractory extensive orbital venolymphatic malformation leading to marked visual impairment and disfigurement despite multiple prior sclerotherapy sessions. After multidisciplinary evaluation, oral sirolimus was initiated with written informed consent from the parents in a refractory setting. After 9 months of treatment, visual acuity improved from counting fingers at 3 metres to 6/12, proptosis reduced substantially, conjunctival chemosis resolved completely, ocular motility became full with minimal residual hypotropia and the palatal lesion resolved, with mild residual lip hypertrophy. At 19 months of follow-up after initiation of therapy, visual acuity had further improved to 6/9-2, MRI demonstrated near-complete radiological regression of the lesion, no clinically significant adverse effects or recurrence. The child resumed normal activities. This case highlights the potential role of systemic mechanistic target of rapamycin (mTOR) inhibition in complex, refractory orbital venolymphatic malformations and highlights careful patient selection and long-term follow-up.

The risk of rehospitalization in patients with heart failure (HF) has initiated various efforts to prevent and simultaneously improve quality of life. Self-monitoring at home is one option, and technology is increasingly being used for this purpose.

This pilot study aimed to evaluate the feasibility and preliminary effects of a digital home monitoring intervention on patient-reported outcomes and 30-day readmissions among patients with HF in Indonesia.

A mixed methods pilot study was conducted, combining qualitative system development and quantitative evaluation. Patients were assigned to an intervention group (digital monitoring) or control group (standard care). Readmission rates were compared using chi-square tests and odds ratios. Changes in Kansas City Cardiomyopathy Questionnaire scores were analyzed using linear mixed-effects models.

A total of 60 patients were included (n=30, 50% in the intervention group; n=30, 50% in the control group). Readmission occurred in 20% (6/30) of patients in the intervention group and 43.3% (13/30) of patients in the control group (odds ratio 0.33, 95% CI 0.10-1.09; P=.10). Linear mixed-effects analysis showed greater improvement in Kansas City Cardiomyopathy Questionnaire overall summary score in the intervention group (P=.02). Improvements were observed in the physical limitation, symptom frequency, symptom burden, quality of life, and social limitation domains. During follow-up, 3.3% (1/30) of the patients in the intervention group died of non-HF-related causes, and 10% (3/30) of the patients in the control group died due to HF.

This pilot study suggests that digital home monitoring is feasible and associated with improvements in patient-reported outcomes, with a potential signal toward reduced readmission. Larger studies are needed to confirm effectiveness.

Central retinal artery occlusion (CRAO) is an ophthalmic emergency analogous to acute ischemic stroke, presenting with sudden painless vision loss and carrying a poor visual prognosis. The use of thrombolysis in managing CRAO remains controversial; recent randomized trials have not demonstrated statistically significant improvement in visual outcomes, though authors acknowledge potential underpowering to detect a clinically meaningful effect, with larger trials ongoing. Observational data suggest time-dependent treatment effects within a 4.5-hour window. Regardless of treatment efficacy, rapid recognition and evaluation within this narrow therapeutic window are essential for time-sensitive intervention. This study evaluated CRAO incidence and barriers to timely diagnosis within a regional healthcare system.

Retrospective chart review of patients diagnosed with CRAO across Avera Health facilities (June 2018-September 2025). Cases were identified using ICD-10 codes and confirmed through medical record review. Thrombolysis rates were used as a process measure to identify workflow inefficiencies. Data included presentation site, referral pathways, time from symptom onset to presentation, and thrombolysis eligibility and administration.

Of 107 patients identified, 67 had complete documentation. Initial presentation occurred across multiple settings: 36 (53.7%) to the emergency department, 31 (46.3%) to ophthalmology/optometry/outpatient settings. Forty-three patients (64.2%) presented >4.5 hours after symptom onset. Among 24 presenting within the window, 7 (29%) received thrombolysis, 4 (16.7%) had contraindications to thrombolysis, and 13 (54.2%) either presented to or were referred to ophthalmology for evaluation, all of whom were diagnosed outside the treatment window.

Timely CRAO evaluation remains uncommon due to delayed presentation and diagnostic delays awaiting ophthalmologic consultation. Among patients presenting within the treatment window, just 45.8% received time-sensitive treatment options. Referral for ophthalmologic evaluation prior to emergency department diagnosis was the most common barrier (54.2%). Streamlined triage pathways, emergency department education, and remote retinal imaging may facilitate earlier diagnosis and preserve treatment opportunities.

ObjectiveThe monocyte-to-high-density lipoprotein cholesterol ratio (MHR) integrates inflammatory burden with anti-inflammatory lipid status, yet its prognostic value for long-term outcomes in critically ill patients with coronary heart disease (CHD) remains unclear. This study aimed to evaluate the association between MHR and 1-year all-cause mortality in this high-risk population.MethodsWe conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care (MIMIC)-III and IV databases (2001-2019). Adult patients (≥18 years) with CHD were included, excluding those with ICU stay <24 hours or missing monocyte count/HDL-C data, yielding 3,004 patients. MHR was calculated as monocyte count (×10⁹/L) divided by HDL-C (mmol/L). The primary outcome was 1-year all-cause mortality. Kaplan-Meier analysis and log-rank tests compared survival across MHR tertiles. Restricted cubic splines assessed dose-response relationships. Multivariable Cox proportional hazards regression with progressive adjustment evaluated MHR-mortality associations. Subgroup analyses examined effect modification across predefined clinical characteristics.ResultsThe cohort had a mean age of 73.5 years, with 65.8% males. Patients in the highest MHR tertile (T3) demonstrated greater disease severity, higher comorbidity burden, and more intensive treatment requirements. Kaplan-Meier analysis revealed significantly lower 1-year survival in T3 versus T1 (68% vs. 80%, log-rank P<0.001). Restricted cubic spline analysis showed a linear relationship (P for non-linearity=0.441). After adjustment for demographics, vital signs, comorbidities, laboratory parameters, and treatments, each 1-unit increase in MHR conferred a HR of 1.33 (95% CI: 1.18-1.51), per-SD HR = 1.10, 95% CI: 1.03-1.17. Tertile analysis demonstrated a dose-response pattern, with T3 showing HR=1.25 (95% CI: 1.04-1.51) compared with T1 (P for trend<0.05). Subgroup analyses revealed consistent associations across most strata.ConclusionsElevated MHR is associated with increased 1-year mortality in critically ill CHD patients. As a readily available composite marker, MHR may have supplementary prognostic relevance, but its clinical utility requires prospective validation.

Excess sugar intake in early life may affect long-term brain health, but evidence for dementia is limited. We used the abrupt end of UK sugar rationing in September 1953 as a natural experiment to test whether exposure to sugar rationing during different windows within the first 1,000 days from conception was associated with adult risk of all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD).

We analyzed UK Biobank participants born around the end of UK sugar rationing. Exposure was classified as rationing in utero only, in utero plus the first year of life, in utero plus 1-2 years of life, or no exposure. Incident dementia was identified from linked ICD-10 records. MRI of the brain and cognitive function were assessed in the imaging subcohort. Adjusted Cox and Gompertz models estimated HRs and 95% CIs, Fine-Gray models accounted for competing risk, and mediation analyses evaluated type 2 diabetes and hypertension.

Among 64,737 participants included in the analysis, the mean age at recruitment was 54.6 years, and 56.4% were women; 40,963 were exposed to sugar rationing during fetal and/or early-childhood life, and 23,774 were unexposed. Compared with unexposed individuals, sugar rationing in utero plus the first year of life was associated with lower hazards of all-cause dementia (HR, 0.79; 95% CI 0.66-0.94) and AD (HR, 0.77; 95% CI 0.59-1.00). Similar or slightly stronger associations were observed for exposure in utero plus 1-2 years (all-cause dementia: HR, 0.77; 95% CI 0.63-0.95; AD: HR, 0.72; 95% CI 0.53-0.98). Exposure in utero plus 1-2 years was associated with delayed onset of all-cause dementia by 2.55 years, AD by 2.87 years, and VaD by 2.49 years. Early-life sugar rationing was also associated with higher total gray matter volume (β, 3.27; 95% CI 0.46-6.07), lower white matter hyperintensity volume (β, -0.64; 95% CI -0.97 to -0.31), and better performance in processing speed and reasoning. Incident type 2 diabetes and hypertension jointly mediated 25.5% of the association.

Sugar restriction in the first 1,000 days was associated with lower dementia hazards, delayed onset, and more favorable brain-health profiles. These results support early-life sugar reduction as a potential strategy for dementia prevention.

Cardiovascular disease arises from interactions between inherited risk, molecular programmes, and tissue-scale remodelling that are observed clinically through imaging. Cardiac MRI (CMR), computed tomography (CT), and echocardiography are integral to routine cardiovascular care, while bulk RNA sequencing, single-cell RNA sequencing, and spatial transcriptomics are providing increasingly detailed molecular characterization of cardiac tissue. Yet, these imaging and molecular data are still analysed in largely separate pipelines. This review examines joint representations that link cardiac imaging phenotypes to transcriptomic and spatially resolved molecular states. An imaging-anchored perspective is adopted in which echocardiography, CMR, and CT define a spatial phenotype of the heart, and bulk, single-cell and spatial transcriptomics provide cell-type- and location-specific molecular context. We define the representation requirements of each modality, compare multimodal fusion strategies, and synthesize integrative pipelines for radiogenomics, spatial alignment, and image-based gene-expression prediction, together with their validation requirements, limitations, and failure modes. Spatial multiomic maps of human myocardium and atherosclerotic plaque, together with single-cell, spatial, and multimodal medical foundation models, are advancing imaging-anchored multiomics; however, cost, scalability, and tissue availability remain substantial barriers to large-scale cardiovascular translation.

Occupational hearing loss is a prevalent occupational disease with potential systemic health implications, including cardiovascular disease (CVD). This cross-sectional study investigated the association between hearing loss and 10-year CVD risk among middle-aged industrial workers in Tehran.

A total of 988 workers (83.7% male, mean age 46.8 ± 5.9 years) underwent routine occupational health examinations, including pure-tone audiometry and cardiovascular risk assessment using the WHO/ISH prediction chart. Hearing-loss phenotypes included low-frequency hearing loss (LFHL), high-frequency hearing loss (HFHL), overall hearing loss (HL), and noise-induced hearing loss (NIHL). Ear-specific hearing loss was first assessed separately for the left and right ears; participant-level hearing-loss variables were then defined based on the presence of hearing loss in either ear. The WHO/ISH 10-year CVD risk score was reported descriptively. To avoid conceptual overlap between the composite WHO/ISH score and its component variables, the composite CVD-risk variable was not entered into multivariable logistic regression models. Instead, multivariable logistic regression was used to identify demographic, occupational, and clinical factors associated with each hearing-loss phenotype.

The prevalence of NIHL was 19.9%. Ear-specific HFHL was observed in 27.2% of left ears and 25.5% of right ears, while LFHL was observed in 17.0% of left ears and 18.0% of right ears. In multivariable logistic regression models, sex and age were the most consistent independent factors associated with hearing loss. Female sex was associated with lower odds of LFHL, HFHL, overall HL, and NIHL compared with male sex. Older age was independently associated with LFHL, HFHL, and overall HL. Smoking was independently associated with HFHL and NIHL, while work experience was independently associated with NIHL. Job type and diabetes were not consistent independent predictors in the adjusted models. The composite WHO/ISH CVD-risk score was not included in the adjusted models to avoid conceptual overlap with its component variables.

These findings highlight the importance of demographic, behavioral, and occupational factors, particularly sex, age, smoking, and work experience, in occupational hearing loss among middle-aged industrial workers. Although predicted 10-year CVD risk was described in this occupational cohort, the composite WHO/ISH risk score was not included in multivariable models together with its component variables. Hearing conservation programs should integrate noise control, regular audiometric screening, smoking cessation, and cardiovascular risk assessment as complementary components of occupational health surveillance.