This bibliometric analysis evaluates health-related research in Public Health, Environmental Health, and Occupational Health (PHEOH) journals indexed in Scopus, categorized by Scimago quartiles (Q1-Q4) from 2016 to 2024. The study aims to identify trends, research productivity, and thematic priorities across these journals.

From 654 eligible journals, 100 (25 per quartile) were randomly selected. A total of 70,580 documents were retrieved from Scopus and analysed using Microsoft Excel and VOSviewer (v.1.6.20). Co-occurrence analysis of author and indexed keywords was performed separately for each quartile to identify research hotspots, thematic clusters, and trends over time.

Q1 journals contributed the highest proportion of publications (37.7%), followed by Q2 (25.4%), Q4 (22.1%), and Q3 (14.8%). The United States dominated output in Q1-Q3 journals, whereas Pakistan led in Q4. Across all quartiles, "COVID-19" was the most frequent and highly connected author keyword, followed by mental health, SARS-CoV-2, and child-related research. Indexed keyword analysis ranked "humans" highest in every quartile. Topics related to SARS-CoV-2 and mental health received the highest average citations.

The COVID-19 pandemic significantly influenced the research agenda of Public, Environmental, and Occupational Health journals between 2016 and 2024, particularly in higher-quartile outlets. The findings reveal persistent disparities in productivity across journal tiers and geographic regions.

Infective endocarditis (IE) remains a severe condition with high morbidity and mortality, often complicated by metastatic infections. Spinal involvement, particularly spondylodiscitis (SD) and epidural or paraspinal abscesses, is increasingly recognized but frequently underdiagnosed. We report two cases of mitral valve IE complicated by SD. A 77-year-old woman with culture-negative IE underwent urgent mitral valve replacement; subsequent magnetic resonance imaging revealed L3-L4 SD and a large right psoas abscess managed conservatively with prolonged antibiotics. A 73-year-old woman presented with cardioembolic stroke and severe mitral regurgitation; spinal MRI showed L4-L5 SD and a long-segment epidural abscess requiring urgent neurosurgical decompression, followed by valve replacement. Both cases highlight diagnostic challenges in culture-negative IE and underscore the need for early multimodality imaging, guideline-directed antimicrobial therapy, and multidisciplinary management. Timely recognition and intervention are essential to prevent irreversible neurological deficits and optimize outcomes.

The albumin-corrected anion gap (ACAG) has been associated with adverse outcomes in critically ill patients. However, its prognostic value in patients with acute heart failure (AHF) remains unclear. This study is aimed at investigating the association between ACAG levels and all-cause mortality in AHF patients.

This retrospective study included AHF patients admitted to the intensive care unit (ICU) for the first time, utilizing data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were stratified into tertiles (T1-T3) based on ACAG levels. The primary endpoints were 30- and 365-day all-cause mortality, whereas the secondary endpoints included 90- and 180-day all-cause mortality. Kaplan-Meier (K-M) survival analyses, Cox proportional hazards models, and restricted cubic spline (RCS) analyses were employed to assess the association between ACAG and all-cause mortality.

A total of 2754 patients were included, with a mean age of 74 years, and 56.5% of the participants were male. K-M curves demonstrated that elevated ACAG levels correlated with increased mortality at 30, 90, 180, and 365 days (all log-rank p < 0.001). Cox regression analysis indicated that T3 was associated with a higher risk of mortality compared with T1. RCS analysis revealed a nonlinear relationship between ACAG and all-cause mortality. Above certain thresholds, each 1-unit increase in ACAG was linked to a 9% increase in the risk of 30-day mortality (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.07-1.11) and an 8% increase in the risk of 365-day mortality (HR 1.08, 95% CI 1.06-1.09).

ACAG levels were associated with all-cause mortality in patients with AHF. Thus, ACAG may serve as a valuable prognostic marker for this patient population.

Psychotic disorders and use of antipsychotics prior to or after ischemic stroke (IS) may be associated with poor outcomes. However, data on antipsychotic use in young IS patients are limited. We aimed to characterize young patients purchasing antipsychotics prior to IS or de novo post-stroke, and to examine their association with long-term outcomes.

We analyzed data from the Helsinki Young Stroke Registry, including 1008 consecutive patients aged 15-49 with first-ever IS 1994-2007. We considered patients without antipsychotic purchases as non-users, those with at least one purchase any time before IS as prior users, and those who had purchases at any time after IS (but not before) as de novo users. Cox regression models assessed the association of antipsychotic purchases with any recurrent vascular event or all-cause mortality.

Of 966 included IS survivors (62.6% male, median age 44), 55 (5.7%) purchased antipsychotics before and 67 (6.9%) after index IS. Compared with de novo or non-users, prior users more often had other/unknown socioeconomic status, a history of psychiatric hospitalization, drug abuse, smoking, heavy drinking, more severe stroke symptoms on admission, and limb paresis at discharge. Antipsychotics purchased before IS were associated with a heightened hazard of endpoint events when adjusted for sociodemographics and cardiovascular comorbidities. The association was not found for de novo users.

Around 6% of young IS patients had a history of antipsychotic use, while a similar proportion initiated antipsychotics post-stroke. Pre-stroke antipsychotic use was associated with recurrent vascular events and mortality.

The aim of this paper, which includes a meta-analysis, is to elucidate the effects of cranberry consumption on systolic and diastolic blood pressure based on all relevant randomized controlled trials (RCTs).

A systematic literature search was performed across the ISI Web of Science, PubMed, Embase, the Cochrane Library, and Google Scholar databases, encompassing trials published until December 2024. Weighted mean differences (WMD) were calculated using random or fixed-effects models. Between-study heterogeneity was evaluated using Cochrane's test and the I² index. This study's registration number in PROSPERO is CRD420251028424.

A total of 1204 publications were reviewed, leading to the inclusion of 12 trials for qualitative synthesis and meta-analysis. The pooled effect size indicated statistically nonsignificant reductions of 1.31 mmHg for systolic blood pressure (SBP) (p = 0.19) and 1.31 mmHg for diastolic blood pressure (DBP) (p = 0.12). Stratified analysis showed that the reduction in SBP was statistically significant in studies where cranberry was provided in juice form, with a duration of 8 weeks or less, involving participants with a mean age of < 50 years, and predominantly in females. Furthermore, subgroup analysis indicated a significant reduction in DBP in studies that involved both genders, lasted more than 8 weeks, included participants with a normal body mass index, and had a mean age below 50 years.

This systematic review and meta-analysis suggest that cranberry consumption was not effective in managing SBP and DBP.

The prognostic relevance of perioperative myocardial injury/infarction (PMI) in older patients undergoing major noncardiac surgery remains unclear, as high comorbidity burden may lessen its impact.

Older patients (defined as age ≥70 years with ≥3 comorbidities, or ≥80 years) enrolled in a multicentre, prospective study of patients at increased cardiovascular risk undergoing major noncardiac surgery were analysed. The primary endpoint, all-cause mortality at 1 year, was analysed using Cox proportional hazards regression. Secondary endpoints included major adverse cardiac events (MACE) (cardiovascular death, acute myocardial infarction, life-threatening arrhythmia and acute heart failure), analysed using Fine-Grey hazard regression. All models were adjusted for prespecified confounders with PMI as a time-varying exposure.

Amongst 4634 older patients (median age 80 years; 42.9% women), PMI occurred in 892 patients (19.2%), which was higher than in younger patients (P < .0001). The distribution of PMI aetiologies was comparable between groups. At 1 year, all-cause mortality was 26.2% in patients with PMI and 13.2% in patients without PMI, and MACE occurred in 30% versus 13%, respectively. After multivariable adjustment, the hazard ratio of PMI was highest on postoperative day 1 (all-cause mortality: 10.5 [95% CI 4.5-24.5]; MACE: 4.4 [95% CI 3.2-5.9]), declined by day 90 (1.4 [95% CI 1.0-1.9] and 2.2 [95% CI 1.7-2.7], respectively), and persisted through 1 year.

PMI was very common amongst older patients and associated with substantially higher 1-year risks of all-cause mortality and MACE, with greatest vulnerability observed during the initial 90 postoperative days.

Device-related thrombus (DRT) remains a concern after left atrial appendage closure (LAAC), particularly when the device is deeply implanted. However, the mechanistic links between implantation depth, flow dynamics, and DRT risk are not well understood.

We therefore aimed to evaluate the impact of LAAC device implantation depth on local flow characteristics and its association with DRT using patient-specific computational fluid dynamics (CFD).

The study included 285 patients undergoing LAAC with either Amplatzer Amulet or WATCHMAN devices at 10 centres. Patient-specific CFD simulations were performed using postprocedural computed tomography and echocardiography-derived boundary conditions to assess blood flow dynamics. The primary endpoint was the comparison of CFD-derived flow indices - device surface velocity index (DSVI), endothelial cell activation potential (ECAP), and the presence of eddies/stagnated flow - between proximal and distal device implantation groups. Secondary analyses explored the relationship between these flow features and DRT.

Proximal implants (57.2%) showed more favourable flow patterns: higher DSVI (0.11 m/s vs 0.09 m/s; p=0.002), lower ECAP (0.75 vs 0.90; p=0.003), and fewer recirculating zones (40.5% vs 74.6%; p<0.001). DRT incidence increased with greater implantation depth, paralleled by worsening flow indices. A composite CFD-based DRT risk score, incorporating ECAP, implantation depth, and flow complexity, demonstrated good discrimination (area under the receiver operating characteristic curve [AUC] 0.81), outperforming anatomical depth alone (AUC 0.71).

Deeper LAAC device implantation is associated with adverse flow profiles and a higher risk of DRT. CFD-based flow characterisation may enhance risk stratification beyond anatomical criteria alone. Further studies incorporating clinical variables are warranted to validate these methods.

The current standard regimen for antithrombotic therapy after percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) recommends long-term use of antiplatelet agents. However, this recommendation is not supported by sufficient clinical evidence. Since LAAC is a treatment option for managing patients at high risk of bleeding, it is necessary to clarify whether long-term antiplatelet therapy is truly required after LAAC. The Non-Antithrombotic Versus. Single antiPlatelet Therapy Following Left Atrial Appendage Closure (NAPT-LAAC) trial, a prospective, randomised, controlled, open-label, blinded-endpoint multicentre study, will be conducted in Japan. It was designed to evaluate whether non-antithrombotic therapy is non-inferior to antiplatelet monotherapy after 45 days of oral anticoagulant (OAC) monotherapy following LAAC, with respect to the incidence of thrombotic and bleeding composite events in patients with NVAF and high bleeding risk. Patients with NVAF with a CHA₂DS₂-VA score ≥2 and who successfully undergo LAAC are eligible for inclusion. A total of 500 patients undergoing LAAC will be randomised (1:1) to aspirin monotherapy versus non-antithrombotic therapy for the 45 days following OAC monotherapy. The primary outcome is a composite of all-cause mortality, myocardial infarction, stroke, systemic embolism, major bleeding, and clinically relevant non-fatal bleeding during a maximum of 4 years of follow-up. Major bleeding or clinically relevant non-fatal bleeding is defined as Type 2, 3, or 5 bleeding, according to the Bleeding Academic Research Consortium definition. The NAPT-LAAC trial will determine the probable non-inferiority of long-term non-antithrombotic therapy to aspirin monotherapy in patients with NVAF who undergo LAAC. (ClinicalTrials.gov: NCT07125417; jRCTs031250110).

Renal function is a critical factor of ischaemic and bleeding risks in patients with atrial fibrillation (AF) receiving antithrombotic therapy.

This study aimed to evaluate the impact of renal dysfunction in patients with AF and stable coronary artery disease (CAD) undergoing antithrombotic therapy.

The Edoxaban Versus Edoxaban With antiPlatelet Agent In Patients With Atrial Fibrillation and Chronic Stable Coronary Artery Disease (EPIC-CAD) trial randomised patients to edoxaban monotherapy or dual antithrombotic therapy (edoxaban plus a single antiplatelet agent). In this prespecified analysis, patients were stratified by creatinine clearance into low (<50 mL/min) or high (≥50 mL/min) groups according to edoxaban dose-reduction criteria. The primary endpoint was net adverse clinical events (NACE: death from any cause, myocardial infarction, stroke, systemic embolism, urgent revascularisation, or major/clinically relevant non-major bleeding) at 12 months.

Of 1,040 randomised patients, 252 (24.2%) had low creatinine clearance; these patients were older and had more comorbidities compared with the 788 patients (75.8%) with high creatinine clearance. Patients with low creatinine clearance experienced higher risks of NACE (hazard ratio [HR] 1.72, 95% confidence interval [CI]: 1.19-2.49; p=0.004), ischaemic events (HR 2.70, 95% CI: 1.09-6.70; p=0.032), and bleeding (HR 1.54, 95% CI: 1.01-2.34; p=0.046). At 12 months, edoxaban monotherapy reduced NACE compared with dual therapy in both the low (12.1% vs 21.7%, HR 0.52, 95% CI: 0.28-0.98; p=0.042) and high creatinine clearance groups (5.2% vs 14.5%, HR 0.40, 95% CI: 0.25-0.65; p<0.001), with no interaction (p for interaction=0.53).

In patients with AF and stable CAD, edoxaban monotherapy led to a lower risk of primary NACE than dual antithrombotic therapy, regardless of renal function. (ClinicalTrials.gov: NCT03718559).

Recurrent tricuspid valve regurgitation (TVR) after tricuspid transcatheter edge-to-edge repair (T-TEER) poses a significant challenge, particularly when centrally positioned clips impede subsequent transcatheter tricuspid valve replacement (TTVR). Electrosurgical laceration and stabilisation of T-TEER (ELASTA-T) has been developed to facilitate TTVR by enabling controlled single leaflet device attachment (SLDA). The aim of this manuscript is to provide a step-by-step standardised description of the ELASTA-T strategy, outlining essential procedural principles, the required equipment, and technical steps. ELASTA-T involves intentional detachment of the most centrally placed tricuspid clip using electrosurgical leaflet laceration. A modified coronary guidewire shaped into a "flying V" - based on Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) and Laceration of the Anterior Mitral leaflet to Prevent Outflow ObstructioN (LAMPOON) principles - is positioned across the target leaflet using bilateral femoral vein access, deflectable guiding sheaths, microcatheters, and a snare-assisted venovenous rail. Laceration is performed under fluoroscopic and transoesophageal echocardiographic guidance, with preventive haemodynamic support on standby because of the risk of transient severe TVR. After laceration, the clip is mobilised towards the septal leaflet to avoid interference with valve deployment, followed by immediate implantation of a dedicated transcatheter tricuspid valve (TTV). ELASTA-T allows safe and reproducible SLDA, creating adequate central space for accurate positioning and full expansion of a TTV. Detachment can be reliably confirmed by fluoroscopy and transoesophageal echocardiography. By removing any mechanical obstruction from centrally placed clips, the technique facilitates secure TTVR anchoring and may reduce paravalvular regurgitation. This step-by-step framework may support procedural standardisation and broader adoption, ultimately improving outcomes in this high-risk population.