An ideal microneedle array for promoting wound healing should possess mechanical strength, antibacterial, anti-inflammatory, and angiogenic properties. In this study, we developed a microneedle array with a PVA-Alginate-Maltose (PAM) matrix, within which Cu@ZIF-8 metal-organic framework nanoparticles were encapsulated for enhanced wound healing. We fabricated microneedle arrays containing 0%, 1%, and 3% w/w Cu@ZIF-8 (CZ), as well as a control group with 3% ZIF-8. The physical and chemical characteristics of both the nanoparticles and the microneedle arrays were analyzed using FESEM, XRD, FTIR, and EDS. The addition of maltose in the polymer matrix resulted in an increase in compressive force from 0.03 N/needle to 0.143 N/needle; by adding 3% Cu@ZIF-8, this value further increased to 0.156 N/needle, achieving a tip sharpness of 5.1 μm. In vitro studies demonstrated that the microneedles exhibited significant antibacterial activity, good biocompatibility, and an effective release rate of zinc and copper ions proved beneficial for wound closure. In vivo tests using immunohistochemical and histopathological analyses demonstrated that PAMCZ3% microneedles facilitated the highest levels of wound healing, epithelial layer regeneration, angiogenesis, and reduced scar formation. These findings suggest that the proposed PAMCZ3% microneedles could be applicable in clinical wound healing treatments.

Despite advancements in management strategies, patients with refractory cardiogenic shock (CS) have high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized as temporary mechanical support in these patients. Current predictive models for mortality suffer from practical limitations, including complexity and the extensive variables required.

We aimed to develop a simplified, practical predictive model, the Extracorporeal Life Support Outcome score (ELSO-Score), using readily available pre-ECMO variables to predict in-hospital mortality among VA-ECMO patients.

This retrospective study utilized data from 8495 VA-ECMO patients collected by the Extracorporeal Life Support Organization (ELSO) registry between January 2017 and December 2022. We developed a simple neural predictive model, validated on training, validation, and test cohorts.

The training cohort comprised 6029 analyzed cases, with an overall in-hospital mortality rate of 55.5%. Significant predictors of mortality were elevated lactate levels, age, bilirubinemia, acute kidney injury, and the requirement for renal replacement therapy at the time of ECMO cannulation. The predictive model demonstrated moderate discriminatory performance, achieving area under the ROC curve values of 0.70, 0.69, and 0.68, 95% CI [0.63-0.73], in the training, validation, and test cohorts, respectively.

Our study demonstrates that the ELSO-Score may be a practical and effective predictive tool facilitating informed clinical decision-making and resource allocation for patients considered for VA-ECMO therapy.

The aim of the study was to compare the effectiveness and safety of daptomycin versus vancomycin treatment for left-sided infective endocarditis (IE) caused by methicillin-resistant staphylococci (MRS). We specifically aimed to explore the effectiveness of different daptomycin-based regimens.

Prospective, multicenter cohort including consecutive patients with definite left-sided MRS-IE from January 2008 to December 2023. Patients were in two groups whether they received daptomycin or vancomycin as main antibiotic. Those patients in whom neither antibiotic could be considered the main antibiotic were excluded. The primary endpoint was in-hospital mortality. Multivariable logistic regression was used for adjusted in-hospital mortality and Cox regression for 1-year mortality RESULTS: A total of 617 patients were included: 421 (68.2%) received daptomycin-based and 196 (31.8%) received vancomycin-based regimens. In the adjusted analysis, daptomycin showed with similar in-hospital mortality compared to vancomycin (adjusted odds ratio [aOR] 0.79 [95% CI 0.48-1.28]). Daptomycin was associated with a significantly lower rate of adverse drug reactions (14.5% [61/421] vs 26.0% [51/196], p=0.001), mainly driven by less acute kidney injury (8.7% [36/421] vs 16.8% [32/196], p=0.003). In subgroup analyses, high-dose daptomycin (HDD, ≥8 mg/kg) in combination was associated with lower in-hospital mortality than other daptomycin regimens (aOR 0.55, 95% CI 0.31-0.98) without more adverse reactions (14.5% [34/234] vs 14.4% [27/187], p=1.000). Compared to vancomycin, HDD-based combination strategy was not associated with statistically significant difference in in-hospital mortality (aOR 0.66, 95%CI 0.38-1.09) but was associated with lower one-year mortality (adjusted hazard ratio 0.55; 95% CI 0.31-0.98). and lower rate of adverse reactions (14.5% [34/234] vs 26.0% [51/19], p=0.003).

In this large, real-world cohort, daptomycin demonstrated comparable effectiveness to vancomycin. However, it was associated with lower adverse reactions. High-daptomycin dose-based combinations with a second agent could be associated with improved outcomes. This strategy could be considered as a therapeutic option for MRS-IE.

The five cardiovascular diseases (CVDs): Coronary artery disease (CAD), stroke, heart failure (HF), peripheral arterial disease (PAD), and atrial fibrillation(Afib) often co-occur. Most polygenic risk scores (PRSs) are developed for individual CVDs, limiting their clinical utility across multiple CVDs. We investigated associations between five PRSs and (1) their CVDs, (2) cross-disease associations for pleiotropy, and (3) across multimorbidity clusters.

We calculated restricted PRSs using genome-wide significant variants from published genome-wide association studies and validated them in 484,154 UK Biobank participants. For the time-to-onset and sequence analysis, we included 34,394 individuals with a CAD diagnosis. We used logistic regression, Cox regression, and accelerated failure time analysis; p ≤ 0.05 was considered significant.

All PRSs were significantly associated with their respective CVDs (ORs 1.08-1.60 per 1-SD). The odds of CAD increased by 55% per 1-SD increase in PRS_CAD (OR 1.55, 95% CI: 1.53-1.57). In cross-disease associations, all 25 PRS-CVD pairs were significant. For some CVDs, PRS from other CVDs showed a stronger association than their own. For instance, HF was more strongly associated with PRS_Afib than PRS_HF (OR 1.21 vs 1.17). In CAD patients, those in the top 10% of PRS_CAD had a 2.66-fold higher PAD risk (HR 2.66, 95% CI: 1.06-6.71) and developed PAD 5.6 years earlier than those in the bottom 10% (time ratio 0.40, 95% CI: 0.17-0.93).

PRSs reveal shared polygenic risk across CVDs and provide insight into CVD multimorbidity trajectories, such as timing and sequence of events.

Despite advances in acute care, stroke remains a leading cause of death and long-term disability worldwide, with limited treatment options to improve recovery after stroke. Traditionally, the management of ischemic stroke has mostly focused on early reperfusion, yet growing evidence highlights a central role for inflammation in both acute and long-term pathophysiology of stroke. The inflammatory response post-stroke is complex and dynamic, beginning with early intravascular activation of platelets and neutrophils (thrombo-inflammation), followed by microglial activation and the subsequent infiltration of peripheral immune cells, which together paradoxically contribute to tissue repair but can also worsen tissue injury. Importantly, this evolving understanding opens new therapeutic opportunities. However, efforts to target inflammation in stroke have yielded limited clinical success, as many strategies that showed promise in preclinical studies have failed to translate into beneficial outcomes. Here, we systematically review the role of inflammatory responses in stroke, integrating insights from both experimental and clinical studies. We highlight the roles of key immune cell populations and signaling pathways in mediating tissue injury and repair, also discussing the progress and limitations of inflammation-targeting clinical trials. We further address translational challenges, including optimal timing of intervention, mechanistic target validity, and the relevance of preclinical models. Finally, we explore emerging approaches, including targeting thrombo-inflammation, modulation of the gut-brain axis, reverse translation, and adaptive data-driven trial designs as potential strategies to refine therapy development to improve stroke outcomes. These insights provide a foundation for advancing the long-elusive goal of clinically translating immune therapy into effective stroke recovery treatments.

BACKGROUND Type A aortic dissection during pregnancy, a rare and fatal clinical emergency, is highly challenging to the survival of both the mother and her fetus. In the obstetrical context, synchronous surgical repair of type A aortic dissection is both more critical and more difficult in clinical practice; therefore, multidisciplinary treatment is necessary. In our report, the treatment of acute type A aortic dissection during pregnancy is presented, with the aim to share clinical experience and provide clinical insights. CASE REPORT A 37-year-old pregnant patient (G3P1), admitted with a complaint of sudden severe pain in both chest and back for 2 hours, was diagnosed as having type A aortic dissection based on findings from imaging. After a comprehensive preoperative assessment, the patient underwent a combination emergent surgical procedure of cesarean section and repair of type A aortic dissection. During the emergent surgical procedure, the infant was safe and vital signs were stable throughout the cesarean section. Also, the repair of the aortic dissection was completed smoothly. Postoperatively, the outcomes for both mother and her baby were satisfactory as expected. CONCLUSIONS The case report mainly emphasizes the clinical significance of reliable and feasible treatment for acute type A aortic dissection during pregnancy. In view of higher mortality and incidence of perioperative complications in pregnant patients, an individual strategy based on preoperative assessment, intraoperative coordination, and postoperative management-- involving both obstetricians and cardiovascular surgeons-- can play a crucial role in successful intervention for this kind of complicated obstetric event during pregnancy.

The term myocardial edema refers to abnormal myocardial fluid accumulation due to impaired fluid homeostasis, triggered by a complex interplay of cellular, molecular, and hemodynamic factors. It is a multifaceted pathologic phenomenon with diverse clinical manifestations and plays a pivotal role in the pathophysiology of various cardiovascular conditions, such as ischemic, inflammatory, infiltrative, toxic, infectious, and autoimmune diseases. Detection of myocardial edema presents some challenges, necessitating familiarity with imaging strategies and potential artifacts, differential diagnoses of myocardial edema-associated conditions, and the clinical implications for risk stratification. Cardiac MRI is a key tool in evaluation of myocardial edema, often providing critical insights into underlying disease processes and aiding in clinical decision making. It is not only useful for detailed tissue characterization but also plays a significant role in monitoring diseases. T2-weighted imaging and T2 mapping are essential for identifying myocardial edema, while other techniques such as cine imaging, T1 mapping, and late gadolinium enhancement imaging can provide complementary characterization. Although cardiac MRI is indispensable for edema evaluation, understanding its capabilities and limitations is essential for accurate assessment. Recognizing different edema patterns and integrating findings with the clinical context are fundamental to the diagnostic process. The authors examine the diagnostic utility of cardiac MRI in characterizing myocardial edema through various case examples and a comprehensive review of the existing literature. By addressing the role of myocardial edema in a range of cardiovascular conditions, they provide a systematic framework outlining key aspects of edema imaging. ^©RSNA, 2026 Supplemental material is available for this article.

Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2 or the presence of clinical, imaging, or histopathological features of kidney injury over a 3-month period, has been linked to several comorbidities including cardiovascular diseases, such as myocardial infarction, cerebrovascular diseases, renal artery stenosis and peripheral artery disease. A pro-inflammatory and pro-fibrotic state, together with the accumulation of uremic toxins and impaired calcium-phosphorus homeostasis leading to mineral and bone disorders, appear to constitute the underlying pathophysiology of peripheral artery disease in CKD patients. Despite such association and the deleterious effects of peripheral artery disease, the association between CKD and peripheral artery disease is generally underestimated in clinical practice, with physicians being less likely to initiate pharmacotherapy or offer interventional treatments to patients with CKD. Many therapeutic options, including lifestyle modifications, methods for cardiovascular risk reduction such as anti-platelet or lipid-lowering drugs, targeted pharmacotherapies, and endovascular or surgical interventions are available for the management of peripheral artery disease. However, the diagnostic and/or therapeutic process in CKD patients is not as straightforward as it is in the general population, with misleading outcomes and higher treatment-related complications. Aim of this narrative review was to discuss the epidemiology, risk factors, underlying pathophysiology, and diagnostic and therapeutic approaches toward peripheral artery disease in CKD patients.

Stanford type A acute aortic dissection(AAAD)is a life-threatening cardiovascular emergency, Early surgical repair is essential to prevent fatal outcomes, According to the 2023 Annual Report of the Japanese Association for Thoracic Surgery, AAAD cases increased by 4.4% in 2022, with an in-hospital mortality of 10% for AAAD, Although surgical outcomes have improved with advances in cerebral protection techniques, patients with cerebral malperfusion remain at high risk of poor neurological outcomes and mortality, with postoperative death rates reported between 15~30%, Antegrade selective cerebral perfusion(ASCP)is the standard method for cerebral protection during circulatory arrest, However, in AAAD patients with carotid artery occlusion or severe stenosis, conventional ASCP may result in uneven cerebral perfusion, risking ischemia in the affected hemisphere, To address this, we introduced a two-roller pump technique, in which each carotid artery(affected and non-affected)is perfused independently using separate ASCP circuits, Cerebral perfusion was monitored with transcranial Doppler and regional cerebral oxygen saturation(rSO2), The common carotid artery(CCA)was exposed via median sternotomy without additional neck incision, and direct cannulation was performed to establish targeted perfusion, The two-roller pump technique allowed independent regulation of flow and pressure for each carotid artery, Intraoperative monitoring confirmed stable perfusion to all cerebral vessels, including the previously occluded CCA, The two-pump technique prevented uneven blood distribution, reduced cerebral ischemia time, and was associated with improved immediate neurological outcomes, It enables immediate, controlled reperfusion of the affected hemisphere, potentially improving neurological outcomes, and offers a practical option for urgent surgical management of severe cerebral malperfusion in AAAD.

Timely and adequate bereavement support is associated with better mental health and psychosocial outcomes for bereaved individuals. There is limited research focusing on how the pre- and post-death process in the hospital setting influences family caregivers' perceptions and support needs before and after bereavement. The aim of this study is to explore the pre-and post-bereavement experiences and support needs of family caregivers in hospital settings in Türkiye.

A qualitative exploratory study using semi-structured in-depth interviews analysed thematically was conducted to provide a detailed understanding of the bereavement experience in the context of bereaved family caregivers' in hospital settings. Purposive sampling was used to recruit bereaved family caregivers (n = 21) who had experienced caring for an adult patient with life-threatening conditions in hospital.

Twenty-one bereaved family caregivers participated, over half of the participants (62%) were female and, participant age ranged between 20 and 52 years, with the average age being 39.8 years. Four themes were generated: (1) Pre-bereavement process, (2) Communication during the dying stages, (3) Post-bereavement process and, (4) Bereavement support needs of family caregivers. Many caregivers reported that the lack of information about the disease process of their close person, unfinished business, and cultural barriers to the discussion of death made the bereavement process more difficult. Social support, culturally specific coping strategies, support from psychiatric consultation liaison nurses and empathetic communication were identified as facilitators of the bereavement process for family caregivers.

We recommend a culturally sensitive family-centered approach, compassionate and empathetic communication, and the integration of psychiatric consultation liaison nurses into hospital bereavement care systems to provide dignified and culturally adapted bereavement support care in hospitals. The insights gained from the perspective of family caregivers may be utilised by mental health professionals and policy makers to improve hospital-based bereavement care. By exploring the perspectives of family carers in a middle-income country, our research contributes to a more inclusive understanding of bereavement support needs globally, particularly in culturally diverse contexts where research has been limited.