Severe pneumonia-induced septic shock is one of the most representative complex syndromes in pulmonary critical care medicine. Its pathophysiology results from the combined effects of alveolar-capillary barrier injury, infection-associated vasodilation, microcirculatory perfusion abnormalities, cardiopulmonary interactions related to mechanical ventilation, and multiple organ dysfunction. Therefore, fluid management should emphasize a dynamic balance between lung injury, circulatory benefit, and etiological control. In recent years, international guidelines and clinical studies have indicated that the focus of treatment for severe pneumonia-induced septic shock has shifted from conventional fluid resuscitation to precision resuscitation based on dynamic fluid responsiveness, fluid tolerance, and phase-specific goals. In the setting of acute respiratory distress syndrome (ARDS) or at high risk of ARDS, the importance of early vasopressor administration and negative fluid balance management has further increased. Meanwhile, advances in artificial intelligence-including the identification of ARDS subphenotypes, early prediction of sepsis-associated ARDS, sepsis early warning systems have provided a foundation for identifying "fluid-intolerant" subpopulations, optimizing the timing of negative fluid balance, and constructing multimodal closed-loop decision-support systems. This article reviews the hemodynamic characteristics of severe pneumonia-induced septic shock, phenotype identification, etiological control, and an integrated closed-loop pathway combining ventilator waveforms, hemodynamics, ultrasonography, and artificial intelligence. It aims to provide a reference for clinical practice and future research.

Social media use has the potential to promote misperceptions, but evidence is mixed. Despite social media characteristics that include homophilous social networks, algorithms that can reinforce biases, and social bots that promote falsehoods, there is no evidence of a strong association between social media use and misperceptions. This project offers the strongest empirical test of this relation to date, providing additional evidence of the minimal effects of social media use on misperceptions. Data come from two independent large-N panel studies, each paired with online tracking data, one focused on the 2020 election and the other on the COVID-19 pandemic. Within-between regression models show that social media use was not associated with a statistically significant decline in Americans' ability to discriminate between true and false claims on any of the four platforms examined-Facebook, Twitter, YouTube, and Instagram.

Cell fixation on a microscope glass slide is a standard technique for evaluating cellular morphology in a wide range of biosamples. Cytofunnels are used in a cytocentrifuge to direct cells onto the glass slide and generate a "cytospin". Commercial cytofunnels have a fixed design with limited cytospin areas, being mostly single-use and are costly. The goal of this study was to design and manufacture a 3D-printed, customized cytofunnel that is cost-efficient, reusable and generates a larger cytospin area. We used an iterative design process using computer-aided design (CAD) software and stereolithography (SLA) printing with biocompatible resin. The funnel prototypes were subjected to a technical evaluation using two independent human pleural effusion specimens, as well as through repeated exposure to two commonly used disinfectants.

The 3D-printed cytospin funnel featured larger outlet diameters, increasing the cytospin area approximately threefold with a total manufacturing time of 24 h. The presented reusable funnel design enabled enlarged cytospin areas and increased practical cell-loading capacities under the tested conditions and may support future digital cytology and high-throughput analysis workflows. The published STL file may provide an accessible, sustainable alternative for laboratories, especially in resource-limited settings and may serve as a basis for further customization.

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with symptoms resolving within 24 hours and without evidence of acute infarction. This study aims to investigate patterns of sick leave before and after TIA in working-age adults compared with matched general population controls.

This register-based cohort study included all individuals aged ≤66 years treated for TIA in Gothenburg, Sweden, between 2014 and 2019, and age- and sex-matched general population controls (4:1). Data from national registers were used to assess sick leave the year before and after the index event. Logistic regression was used to model associations of sick leave after TIA.

347 individuals with TIA (median age 59 years; 40.6% women) and 1,388 controls were included. Individuals with TIA had more days on sick leave than controls during the year before the event (mean 26 [SD 78] vs. 14 [SD 55], p < 0.001), and increased by 39 days during the year after TIA compared with the year before (95% CI 28-50 days, p < 0.001). The number of individuals on sick leave peaked 14 days after TIA (35.7% vs. 3.4% controls) and remained elevated at 1 year (11.5% vs. 3.8%). The most common registered sick-leave diagnoses 14 days after the event were TIA (43%), stroke (12%), and mental health conditions (13%). Higher income (middle tertile: adjusted OR 2.54, 95% CI 1.22-5.29; highest: 2.11, 1.03-4.34) and employment (adjusted OR 3.11, 1.23-7.88) were associated with sick leave at 14 days.

Over one-third of working-age adults were on sick leave 2 weeks after TIA, and one in ten remained on benefit after one year. Individuals with TIA also tend to have more days on sick leave the year before TIA compared to the general population.

Wearable monitoring of sedentary behavior is increasingly used in digital cardiovascular care, but the validity of consumer-grade wrist-worn trackers in older patients with cardiac issues is unclear.

This study aimed to evaluate the agreement between sedentary time measured by a consumer-grade wrist-worn tracker (Fitbit Inspire 3; Fitbit LLC) and a research-grade waist-worn accelerometer (ActiveStyle Pro HJA-750C; Omron Healthcare Co, Ltd) used as the comparator, in Japanese outpatients with cardiac issues under free-living conditions.

Fifty-one outpatients with heart failure (28/51, 55%) or ischemic heart disease (23/51, 45%; mean age 78.4, SD 9.0 years; 25/51, 49% male) simultaneously wore both devices for 7 consecutive days. Sedentary time was assessed within a standardized 12-hour daytime window (9 AM to 9 PM) at 1-minute epochs. Agreement was examined using Pearson correlation, Bland-Altman analysis (after confirming normality of the paired differences), Lin concordance correlation coefficient (CCC), and Cohen kappa for distribution-based tertile classification. A constant bias correction was applied, with leave-one-out cross-validation (LOOCV) used as an internal-consistency check on the stability of the sample mean bias. Moderators of the bias were explored using multivariable regression.

Mean sedentary time within the 12-hour window was 497.9 (SD 86.5) minutes for the comparator and 559.9 (SD 84.3) minutes for the Fitbit. The devices were strongly correlated (r=0.905, 95% CI 0.838-0.945; P<.001). The Fitbit showed a significant fixed bias of 62.0 minutes (95% CI 51.5-72.5; P<.001) with no proportional bias (slope -0.03; P=.67); the 95% limits of agreement were wide (-11.3 to 135.2 minutes). Uncorrected concordance was moderate (CCC=0.71, 95% CI 0.57-0.80) and improved to high after subtracting the 62-minute bias (CCC=0.904, 95% CI 0.84-0.94); LOOCV indicated that this in-sample improvement was internally stable (out-of-sample CCC=0.90). No candidate factor (sex, age, diagnosis, and musculoskeletal disorder) significantly moderated the bias (model P=.12). Tertile classification showed moderate agreement (κ=0.588, 95% CI 0.405-0.772; 37/51, 72.5% agreement), with all misclassifications between adjacent categories.

In older Japanese outpatients with cardiac issues, a consumer-grade wrist-worn tracker overestimated sedentary time by approximately 62 minutes within a standardized 12-hour daytime window compared with a waist-worn comparator, with fixed but no proportional bias. A simple constant correction markedly improved group-level concordance (cross-validated CCC≈0.90), supporting calibrated use of consumer wearables for scalable monitoring in ambulatory cardiac care. However, wide limits of agreement constrain individual-level precision, and the population-specific correction factor requires independent validation before transfer to other settings.

Recurrent cardiac health care utilization (HCU) is common in patients with nonobstructive coronary artery disease (NOCAD), yet long-term mental health, personality, and health status contributing to repeated emergency department visits (ED) and diagnostic testing remain unclear. This study examined 10-year patterns and predictors of recurrent cardiac HCU in patients with NOCAD.

In total 546 patients (52% women) were followed with ED visits or repeat diagnostic tests. Baseline assessments included anxiety, depressive symptoms, type D personality, fatigue, health status, and disease-specific quality of life. Negative binomial regression evaluated associations between baseline mental health and health status and total HCU, with adjustment for age, sex, education, obesity, diabetes, and major adverse cardiac events (MACE). Sex-stratified and MACE-stratified analyses were explored.

During follow-up, 24% of the patients experienced a single, and 26% multiple HCU. Higher anxiety, fatigue, poorer physical health, more frequent angina, and lower quality of life were associated with greater HCU, in age and sex-adjusted models. After full adjustment, lower baseline quality of life, diabetes, and subsequent MACE remained independent predictors. Sex-stratified analyses showed that baseline angina frequency and lower quality of life predicted HCU in women. Most patients with recurrent HCU did not develop MACE, suggesting that subjective symptom burden, rather than disease progression, was the main driver of long-term HCU.

Recurrent HCU is frequent in NOCAD and is strongly influenced by baseline quality of life and cardiometabolic risk. These findings highlight the need to address symptom burden in NOCAD to reduce recurrent testing and improve long-term outcomes.

ClinicalTrials.gov (NCT01788241) https://clinicaltrials.gov/study/NCT01788241.

Obesity has become a global health epidemic, contributing significantly to numerous chronic diseases, including metabolic disorders, cardiovascular diseases, and certain cancers. This study aimed to assess the prevalence of overweight, obesity, and abdominal obesity and the associated factors in Duhok City, Kurdistan Region of Iraq.

A population-based cross-sectional study was conducted in Duhok City, Iraq, including 490 participants aged 18 years and older. A multistage sampling technique was used, and data were collected via structured questionnaires covering sociodemographic and clinical characteristics. Anthropometric measurements were used to classify participants according to their body mass index (BMI) and waist circumference.

The overall prevalence of overweight, obesity, and abdominal obesity was 38.4%, 24.3%, and 72.9%, respectively. Factors significantly associated with overweight in multivariate logistic regression included age group 30-44 (adjusted odds ratio [aOR]: 2.356, p = 0.018), married individuals (aOR: 2.040, p = 0.038), and smokers (aOR: 0.562, p = 0.045). Obesity was associated with age group 30-44 (aOR: 2.769, p = 0.030) and age group 45-59 (aOR: 5.384, p = 0.002). Abdominal obesity was significantly associated with gender, where males had lower odds compared to females (aOR: 0.248, p = <0.001), age group 30-44 (aOR: 2.630, p = 0.011), age group 45-59 (aOR: 4.793, p = 0.002), married individuals (aOR: 3.313, p = 0.001), and sleep disturbance (aOR: 1.790, p = 0.025).

The findings indicate a high prevalence of overweight, obesity, and abdominal obesity in Duhok City, with various associated factors. Public health initiatives targeting these associated factors are essential to address the growing obesity epidemic in the region. Further studies with broader geographic coverage and larger sample sizes are needed to reinforce these results and inform policy interventions.

The recommendation of free sugar reduction in dental practice is mostly given with regard to caries prevention but has also further health impacts. This umbrella review aimed to comprehensively display the shared health consequences of sugar consumption in both oral and general health.

Within an umbrella review, two independent reviewers identified and analysed systematic reviews examining free sugar consumption alone or as a part of dietary patterns and its association to described diseases in three databases (Epistemonikos, Pubmed, Cochrane Library). Electronic databases were searched up to March 2026, findings were synthesised narratively. Risk of bias was assessed using AMSTAR-2.

The literature search identified 10,593 articles, of which 633 were further assessed for eligibility. Finally, 228 articles were included after full-text analysis. Results showed that sugar intake was consistently associated with increased risks of 18 generalised negative health outcomes. Strongest evidence was found for type 2 diabetes, obesity, cardiovascular and all-cause mortality, oral diseases, irritable bowel syndrome, and cognitive disorders. Furthermore, a positive association was found between excessive sugar consumption and cancer, non-alcoholic fatty liver disease, kidney disease, gout, asthma, poor sleep, reduced bone density, mood disorders, telomere shortening, and fertility impairments. AMSTAR-2 showed that most reviews had low or critically low methodological quality, while about one third demonstrated moderate to high confidence. Most studies (68%) investigated sugar in form of sugar-sweetened beverages.

Within the limitations of this umbrella review, available evidence indicates that avoiding free sugar intake contributes to both reduced chronic disease burden and improved oral health. Against this background, avoiding free sugar, as recommended by dentists, is a key shared health factor that should be emphasized in the context of caries, periodontal disease, and in terms of general primary prevention.

Dental advised and assisted sugar reduction is an important preventive measure not only for oral health but also for several general health outcomes. After synthesizing and evaluating the available systematic reviews, this study highlights the crucial need to reduce sugar consumption as an important factor in improving both systemic and oral health.

The systematic review was registered in the international register for systematic reviews Prospero. Systematic review registration CRD42023380458.

This is a protocol for a Cochrane review (intervention). The objectives are as follows: To assess the benefits and harms of oral anticoagulant monotherapy compared with oral anticoagulant plus antiplatelet therapy in adults with stable coronary artery disease requiring long-term anticoagulation.

High body-mass index (BMI) is the second largest contributor to stroke burden and the fastest-growing risk factor for stroke globally. Given China's rapidly aging population and the increasing obesity epidemic, understanding the long-term trends and drivers of stroke burden is critical.

High BMI is a chief risk factor for stroke. We aim to evaluate the long-term trends and population risk on stroke mortality burden caused by high BMI in Chinese population between 1990 and 2023.

The decomposition analysis and linear regression were utilized to determine the contribution of population aging and other risk factors to the changing trends in the mortality and disability-adjusted life year (DALYs) of stroke caused by high BMI.

In China, the mortality rate of stroke caused by high BMI increased by 1.640/100,000 during the study period of 1990-2023. The increase was decomposed as 1.180/100,000 due to population aging and 0.460/100,000 due to other risk factors, with population aging contributing 72% and other risk factors contributing 28%. The DALYs rate increased by 52.228/100,000, of which 32.999/100,000 was due to population aging and 19.229/100,000 was due to other risk factors. Notably, population aging contributed 63% of the increase. These findings confirm that population aging was the dominant driver of the increased stroke burden attributable to high BMI, whether measured by mortality or DALY.

Population aging is the dominant driver of the increasing stroke burden attributable to high BMI in China. Effective burden reduction will require integrated prevention strategies targeting both the elderly population and modifiable metabolic risk factors.