Early identification of heart failure with preserved ejection fraction (HFpEF) in hypertensive patients remains challenging using conventional parameters alone. This retrospective study aimed to assess whether combining left atrial (LA) reservoir strain (εs) with left ventricular (LV) longitudinal strain improves the discrimination of HFpEF among hypertensive patients. We included 50 hypertensive patients with HFpEF (HTN-HFpEF), 56 hypertensive patients without HFpEF, and 50 healthy controls. Cardiac magnetic resonance feature tracking (CMR-FT) was used to measure LV global longitudinal strain (LVGPLS) and strain rates, as well as LA εs, conduit (εe), and booster (εa) strains. Parameters were compared across the three groups. Binary logistic regression was performed to identify predictors of HTN-HFpEF, and receiver operating characteristic (ROC) curves were generated to calculate the area under the curve (AUC). From controls to HTN to HTN-HFpEF, LVGPLS and strain rate showed progressive impairment, while LAVImax and LAVImin progressively increased (all p < 0.001). Compared to the HTN group and healthy controls, the HTN-HFpEF group demonstrated significant impairment in LA functional and strain parameters (all p < 0.001). Binary logistic regression analyses revealed that LVMI, LAVImin, LAεs, and LVGPLS remained independently associated with HFpEF. LAεs alone showed the highest diagnostic performance (AUC = 0.790), and the combination of LAεs and LVGPLS further improved the AUC to 0.841. In conclusion, CMR-FT-derived LA strain demonstrates high discriminative ability for HFpEF in hypertensive patients. The combination of LAεs and LVGPLS offers optimal diagnostic value and may serve as a sensitive non-invasive biomarker for identifying HFpEF in this population.

Autoimmune hypothyroidism (Hashimoto's thyroiditis) is common and has a strong genetic component. Here we performed multi-ancestry genome-wide association meta-analyses encompassing 48,694 Hashimoto's thyroiditis cases, using a precise case definition, and 1,044,134 controls. We identified 155 significant (P < 5 × 10^-8) independent genetic associations, of which 45 variants and 19 loci were not previously associated with hypothyroidism. Six loci were specific for individuals of European ancestry reference populations. Functional enrichment analyses of Hashimoto's thyroiditis-associated genes highlighted immune cells and the spleen, underpinning the importance of T cells in Hashimoto's thyroiditis development. This observation was further supported by 161 significant colocalizations with expression quantitative trait loci in immune cells and 40 in thyroid tissue (for example, TG, VAV3, IRF5), highlighting the interplay between the immune system and the thyroid. Mendelian randomization indicated causal effects of Hashimoto's thyroiditis on cardiovascular traits and expected associations with thyroid hormone levels.

In the osteoarthritic joint, activated macrophages release pro-inflammatory factors that promote cartilage degeneration. The CD200:CD200R immune checkpoint pathway is a promising therapeutic target that inhibits classical macrophage activation. We hypothesized that the presentation of CD200 to macrophages would shift their cytokine profile from pro-inflammatory to pro-regenerative, thereby reducing chondrocyte catabolism. CD200 encapsulated in poly(lactide-co-glycolide) microparticles (MPs) were incubated with murine bone marrow-derived macrophages. CD200 MP treatment reduced protein and gene expression of pro-inflammatory mediators in M1 macrophages and increased protein and gene expression of anti-inflammatory mediators in M2 and M1/2 macrophages. Conditioned media from CD200 MP-treated M1 macrophages reduced the expression of catabolic enzyme genes in chondrocytes. This study is the first to demonstrate that delivery of CD200 alters the inflammatory cascade and paracrine signaling to chondrocytes. There is significant potential for the CD200:CD200R inhibitory signaling pathway to be leveraged as an intra-articular treatment of OA.

Aortic aneurysm and dissection (AA/AD) are life-threatening vascular diseases with high mortality, yet no effective drugs to delay progression. Lipoprotein(a) [Lp(a)] is genetically determined and associated with atherosclerotic disease, but high-quality evidence on its causal role in AA/AD remains limited.

To investigate the association between Lp(a) and AA/AD and assess potential causal relationships with major aortic disease subtypes.

A prospective cohort of 312,332 UK Biobank participants was analyzed. Kaplan-Meier curves, Cox regression, and Fine-Gray competing-risk models assessed associations between Lp(a) and incident AA/AD. Two-sample Mendelian randomization (MR) analyses evaluated the potential causal effects of Lp(a) on AA, abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), and AD.

During a median follow-up of 16.5 years, 3122 AA/AD events occurred. Elevated Lp(a) independently predicted AA/AD with a dose-response relationship (hazard ratio [HR] = 1.40 for >180 vs <50 nmol/L; HR = 1.15 per 75 nmol/L increment). Competing-risk analyses yielded consistent results. MR analyses supported a causal association between Lp(a) and AA (odds ratio [OR] = 1.31, 95% CI: 1.08-1.62) and AAA (OR = 1.80, 95% CI: 1.37-2.37), whereas MR analyses did not provide sufficient evidence for causal associations with TAA or AD.

Lp(a) may serve as a promising biomarker for risk assessment and stratification in aortic disease. However, the MR analysis for AD was limited by low statistical power, and the clinical utility of Lp(a) measurement requires further investigation.

This study assessed whether China's workday-rescheduling policy is associated with short-term and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI), particularly in occupational groups more likely to be affected by rescheduling.

A prospective cohort study was conducted using data from the China Acute Myocardial Infarction registry between January 2013 and September 2014. A total of 15 854 STEMI patients were included. Since individual adherence to workday rescheduling is not directly measured in the registry, occupational category was used as a proxy to define groups more likely versus less likely to be affected by the workday-rescheduling policy. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) and 2 year all-cause mortality. Multivariable logistic and Cox regression models were used for analysis.

Using occupational category as a proxy for the likelihood of exposure to workday rescheduling, we stratified patients into a rescheduling-likely group (n=3141) and a rescheduling-unlikely group (n=12 713). Among patients in the rescheduling-likely occupational group, in-hospital mortality was significantly higher during abnormal workdays than conventional weekdays (7.8% vs 3.44%; adjusted OR=3.01; 95% CI 1.40 to 6.45). Two-year mortality was also higher (adjusted HR=1.99; 95% CI 1.20 to 3.30). Among 12 713 patients in the rescheduling-unlikely occupational group, no significant mortality differences were observed across temporal groups. Within the rescheduling-likely group, baseline characteristics and care quality indicators were generally comparable across the four temporal groups.

Workday-rescheduling-induced abnormal work cycles are associated with higher in-hospital and 2 year adverse events in affected ST-segment elevation myocardial infarction patients. These findings should be interpreted as heterogeneity in the association between abnormal workdays and mortality by occupational likelihood of rescheduling exposure rather than as a direct individual-level causal effect of rescheduling.

A previously healthy surfer apprentice in his late 30s presented to our emergency department with acute paraplegia and loss of sensation in the lower limbs following sudden back pain during his third surfing lesson. The patient reported a hyperextension movement of the back while trying to stand up on the surfboard. On examination, he was classified as grade A on the American Spinal Injury Association (ASIA) Impairment Scale, with a sensory level at T10, hypotonic paraplegia, urinary retention and constipation. T2-weighted MRI revealed hyperintensity in the central spinal cord between T7 and T10 and a T11 focus of restricted diffusion compatible with spinal cord ischaemia. CT angiography of the thoracic and lumbar spine showed stenosis and occlusion of segmental arteries at the T11-T12, T12-L1 and L1-L2 levels. After extensive work-up, a diagnosis of surfer's myelopathy was made. The patient underwent antiplatelet treatment, high-dose methylprednisolone and early rehabilitation, but no major improvement was noted in the first 3 weeks. After 8 weeks of rehabilitation, the patient was able to dorsiflex and plantarflex the feet, as well as flex the legs, but remained unable to walk. Bilateral hypoaesthesia persisted and he had not regained anal or urinary sphincter control. He is now classified as ASIA D, and the MRI demonstrated complete resolution of the signal abnormalities after 8 weeks. Our case describes this non-traumatic entity with angiographic documentation of multiple vascular occlusions, which has rarely been reported in the literature and is thought to be secondary to arterial wall dissection and/or in situ thrombosis due to hyperextension and sudden movement of the back.

Buerger's disease, or thromboangiitis obliterans, is a rare vascular disorder closely linked to smoking. It can cause severe ischemic pain, trophic disorders, and a high risk of amputation. Its management requires a specialized, multidisciplinary, and patient-centered approach. Drawing on the testimony of Nicolas Robin, a patient receiving vascular care, this article highlights the clinical, functional, psychological, and social consequences of this condition, as well as the challenges involved in the care pathway.

Vascular diseases represent a major public health challenge due to their high prevalence and their functional and skin-related complications. Their management relies on a comprehensive approach that combines medication, appropriate physical activity, and lifestyle changes, with diet playing a central role. Tailored nutritional support is therefore a key therapeutic tool for promoting wound healing, preventing complications, and improving patients' quality of life. Nurses play an essential role in identifying at-risk situations, providing nutritional monitoring, and coordinating care throughout the patient's treatment journey.

In sarcoidosis, personalised strategies that consider the various phenotypes and endotypes of the disease have the potential to improve patient care. The 'treatable traits' (TT) approach offers a promising strategy that has already been proposed and implemented in several other chronic pulmonary diseases. In this review, we propose five distinct TT categories for patients with sarcoidosis: aetiological, lifestyle, pulmonary, extrapulmonary (systemic) and comorbidities.Despite the potential of this strategy, several challenges hinder its implementation. In addition, much of the knowledge on the definition and prevalence of TTs comes from single-centre studies. Creating international registries will enhance our understanding and provide more accurate data on these traits.TTs are dynamic and require continuous evaluation to effectively respond to changes caused by disease progression or treatment response. A multidisciplinary management approach is therefore crucial as sarcoidosis can impact multiple organs. Integrating primary care physicians into the management framework will improve overall patient care.Incorporating patient preferences into the TT strategy is vital for improving adherence to treatment. Additionally, using patient-reported outcome measures will provide valuable insights into the impact of treatment.While the TT approach is feasible in developed healthcare systems, challenges exist in resource-limited settings. Advancing patient-centred care towards 5P medicine involves addressing key TTs that meet the unique patient needs.Therefore, randomised controlled trials focused on TTs are needed. Our proposed TT strategy aims to enhance quality of life and outcomes for patients with sarcoidosis while increasing awareness of the importance of TTs among healthcare providers and advocacy groups.