Recent advances in suction catheter technology suggest that suction aspiration may prevent thrombus fragmentation during mechanical thrombectomy. We therefore hypothesize that the radiological outcomes of suction aspiration as a first-line treatment would not be inferior to those of the combination technique. This study aims to evaluate the radiological and clinical outcomes of first-line suction aspiration compared with those of the first-line combination technique for large artery occlusion amenable to both modalities.

The COMPETE trial is a prospective, randomized, multicenter, noninferiority, open-label trial. A total of 1,136 patients will be randomized at a 1:1 ratio to either the suction aspiration or combination technique groups.

The primary endpoints are successful recanalization (modified Thrombolysis in Cerebral Infarction scale score ≥ 2b) and a good clinical outcome (modified Rankin Scale score of 0-2) at 90 days after thrombectomy. The technical outcome is the switching rate from the combination technique to suction aspiration and from suction aspiration to the combination technique. The safety outcomes include procedural morbidity, nonprocedural morbidity, procedural mortality, and nonprocedural mortality.

The COMPETE trial is expected to determine whether the use of suction aspiration as a first-line approach in patients with acute ischemic stroke is noninferior to the combination technique in achieving successful radiological and good clinical outcomes.

ClinicalTrials.gov Identifier: NCT06254755; CRIS (KCT0007726).

Post-stroke depression (PSD) is a common neuropsychiatric complication in stroke survivors. However, gender differences in the prevalence and correlates of PSD are underexplored. This study examined gender differences in PSD prevalence and their demographic and clinical correlates among older stroke survivors.

Data from a large national survey conducted in China during 2017-2018 were analyzed. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale. Univariate and multivariate analyses examined the demographic and clinical correlates of PSD by gender.

A total of 1123 older stroke survivors (65 years of age or above), including 578 males (51.5%) and 545 females (48.5%), were included. The overall PSD prevalence was 34.28% (95% CI = 31.52%-37.15%), with significantly higher prevalence in females (38.71%; 95% CI: 34.62%-42.96%) compared to males (30.10%; 95% CI: 26.42%-34.05%). In males, engaging in recent physical exercise (OR: 0.604; 95% CI: 0.389-0.936; p = 0.024) was associated with a lower PSD risk, while more activity limitations (OR: 1.727; 95% CI: 1.131-2.639; p = 0.011) and severe anxiety (OR: 1.455; 95% CI: 1.334-1.586; p < 0.001) were associated with higher risk. In females, recent physical exercise (OR: 0.370; 95% CI: 0.235-0.581; p < 0.001) was linked to lower PSD risk, while heart disease (OR: 1.698; 95% CI: 1.136-2.539; p = 0.010) and severe anxiety (OR: 1.516; 95% CI: 1.372-1.674; p < 0.001) were associated with higher risk.

This study highlights the gender differences in PSD prevalence and correlates among older Chinese stroke survivors. Tailored interventions are needed to address PSD, with future research focusing on targeted screening and intervention.

Maintenance of tissue oxygenation in patients having surgery is important as tissue hypoxia is a major determinant of organ failure. Tissue oxygenation follows a stepwise physiological pathway involving the macrocirculation, the microcirculation, and the cellular oxygen metabolism. This narrative review endorsed by the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis outlines the physiology of tissue oxygenation, evaluates methods for intraoperative tissue oxygenation monitoring, and summarises therapeutic strategies to ensure adequate tissue oxygenation. In the macrocirculation, oxygen is delivered to peripheral organs by convection (through the bulk flow of oxygenated blood generated by cardiac output). Effective tissue perfusion requires both sufficient blood flow and perfusion pressure. Interventions targeting the macrocirculation include fluid therapy, blood transfusions, and targeted management of arterial pressure and cardiac output. Within the microcirculation, oxygen diffuses from capillaries into the surrounding tissues. The microcirculation distributes blood flow according to local metabolic demands. Most techniques for intraoperative microcirculation monitoring, such as handheld vital microscopy, near-infrared spectroscopy, laser Doppler, laser speckle imaging, fluorescence angiography, or the urethral perfusion index, are not implemented in clinical practice. The role of therapeutic interventions specifically targeting the microcirculation remains uncertain. At the cellular level, oxygen is consumed within the mitochondria, where it serves as the final electron acceptor in oxidative phosphorylation to generate adenosine triphosphate. Direct monitoring of cellular oxygen metabolism remains experimental and is not routinely available. Therapeutic strategies aiming to directly improve cellular oxygen metabolism are evolving. Future research is needed to better understand how to optimise tissue oxygenation during surgery to improve patient-centred outcomes.

Metabolic syndrome (MetS) is a major risk factor for type 2 diabetes and cardiovascular disease. In recent years, telemedicine and digital health interventions have emerged as promising strategies to support lifestyle modification and the long-term management of cardiometabolic conditions. However, their clinical effectiveness in MetS remains heterogeneously reported.

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2019 and 2024. Eligible studies included adults with MetS or its components and evaluated telemedicine or technology-enabled interventions, including mobile health (mhealth) applications, remote monitoring, wearable devices, or telecommunication-based care. Outcomes of interest included waist circumference (WC), glycemic parameters, blood pressure, and lipid profile.

Twenty seven studies met inclusion criteria. Most interventions incorporated telemedicine components such as remote coaching, digital feedback, and continuous monitoring, frequently delivered through mobile platforms and wearable technologies. These interventions consistently resulted in reductions in WC, while modest but recurrent improvements were observed in glycemic control and blood pressure. Effects on lipid parameters were more variable, with more frequent improvements in high-density lipoprotein cholesterol than in low-density lipoprotein cholesterol. Higher intervention intensity and user engagement were associated with greater clinical benefits.

Telemedicine and digital health interventions represent effective adjuncts to conventional lifestyle management of MetS, particularly for central obesity and glycemic outcomes. Their ability to deliver scalable, personalized, and remotely supported care highlights their potential role in cardiometabolic prevention and management. Further research is needed to standardize intervention components and optimize long-term effectiveness.

Timely identification of hypertrophic cardiomyopathy (HCM) patients who may require a heart transplant (HT) in the future is crucial. Our study aimed to identify predictive factors associated with the need for HT in HCM patients.

All patients undergoing HT due to HCM in a tertiary HT hospital from 2003 to 2020 were included and compared - matched 1:4 for similar follow-up time since diagnosis - to a control HCM cohort. Patients' clinical and imaging characteristics at HCM diagnosis and longitudinal data were assessed.

85 patients, 17 who required a HT and 68 HCM control patients from the HCM clinic, were included. At HCM diagnosis, patients who would later require HT had higher NT-proBNP levels (880.5 vs. 86.2 pg/mL), larger left atrium (LA) dimensions (49 vs. 40 mm), and slightly reduced left ventricle (LV) ejection fraction (50 vs. 60%), and showed higher prevalence of atrial fibrillation (AF) (47 vs. 22%). During a median follow-up of 11.6 years, patients subsequently requiring HT developed further worsening functional class and higher incidence of hospital admission for HF and incidence of sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator (ICD) ther-apy (log-rank p < 0.001 in both). This was accompanied by significant LA dilatation (8 vs. 1 mm, p = 0.037) and worsening LV diastolic function.

Left atrium dilatation, AF, elevated NT-proBNP levels, and lower LV ejection fraction at HCM diagnosis should alert about the potential future need for HT. Progressive LA enlargement and worsening diastolic function during follow-up are warning signs that should prompt referral to a HT center.

Percutaneous coronary intervention (PCI) is a cornerstone treatment for coronary artery disease. As procedural volumes continue to rise, the associated radiation risk from angiography systems has drawn increasing concern. Thus, we developed a novel ultra-low-dose Noise-Free technology to optimize angiography systems. This study aims to investigate whether it effectively reduces radiation exposure in real-world coronary interventions.

A comparative study on a single-center, real-world, observational cohort. The primary end point was an intergroup comparison of procedural radiation exposure, including dose area product, air kerma, and dose rate, stratified by exposure mode (fluoroscopy or cine) and procedure type (diagnostic coronary angiography, single-vessel PCI, or chronic total occlusion PCI). The secondary end point included an expert semi-quantitative assessment and a quantitative contrast-to-noise ratio for image quality.

A total of 380 procedures (102 coronary angiography, 78 single-vessel PCI, and 200 chronic total occlusion PCI) were performed in 380 patients using 4 different angiography systems. There was no significant difference in baseline patient characteristics, procedural time, or operator experience. In coronary angiography procedures, the ultra-low-dose technique demonstrated a total air kerma of 60.3 (38.5-74.1) mGy, total dose area product of 4.0 (2.9-5.2) Gy·cm², fluoroscopy dose rate of 7.9 (6.0-9.6) mGy/min, and cine dose rate of 51.7 (37.4-64.9) mGy/min, corresponding to 40% to 70%, 37% to 66%, 16% to 62%, and 25% to 79% reductions than others, respectively. Similar radiation reductions were observed for single-vessel PCI. For chronic total occlusion PCI, the corresponding percentages of radiation reduction in total air kerma, total dose area product, fluoroscopy dose rate, and cine dose rate were 59% to 73%, 54% to 69%, 22% to 64%, and 60% to 79%, respectively, relative to the other 3 systems. The semi-quantitative assessment and contrast-to-noise ratio analysis showed comparable image quality between the 4 systems.

The Noise-Free technique reduced radiation exposure across cumulative and rate metrics while preserving diagnostic image quality, with the greatest reduction observed in complex cases. These findings support its clinical utility for lowering radiation risk.

In the field of cardiovascular diseases, chronic heart failure(CHF), as an increasingly serious health challenge, is often intertwined with anxiety disorders, forming a complex clinical comorbidity. The incidence of anxiety gradually increases with the progression of heart failure, significantly reducing patients' quality of life and aggravating the overall disease burden. Modern medicine not only focuses on the pathophysiological mechanisms of CHF but has also gradually emphasized the bidirectional relationship between CHF and psychological states. The TCM theory of heart-Yin deficiency provides a distinctive theoretical perspective for elucidating the complex associations underlying such mind-body comorbidity and offers unique advantages in the treatment of CHF with comorbid anxiety. Based on the theory of heart-Yin deficiency, this article systematically explores the intrinsic pathological mechanisms by which CHF induces anxiety symptoms, as well as corresponding TCM treatment strategies. A pathogenic model is proposed in which heart-Yin deficiency leads to &quot;failure to control deficiency fire, scorching the collaterals and disturbing the spirit&quot;, &quot;blood stasis with collateral damage, resulting in insufficient nourishment of the spirit and vessels&quot;, and &quot;aggregation of phlegm, stasis, and toxins, causing concurrent impairment of the heart and spirit&quot;. This model elucidates the intrinsic associations with modern medical mechanisms such as neuroendocrine dysregulation, inflammatory and oxidative stress, and gut microbiota imbalance, highlighting the central role of heart-Yin deficiency in disease progression. With respect to treatment, guided by the principle of &quot;nourishing Yin and calming the spirit&quot;, this article systematically analyzes the multiple effects of Chinese herbal compound prescriptions and acupuncture and moxibustion therapies in improving cardiac function and alleviating anxiety symptoms, aiming to provide a theoretical basis and practical guidance for the clinical management of anxiety in patients with CHF.

High menstrual bleeding (HMB) is a common issue affecting women's health, often leading to significant physical and psychological distress. While several medical treatments are available, many women face treatment failures or undesirable side effects, prompting interest in natural remedies. This systematic review aims to evaluate the therapeutic effects of Plantago major on women with high menstrual bleeding, focusing on randomized clinical trials.

A comprehensive literature search was conducted in various databases such as, PubMed, ScienceDirect, Cochrane Library, and Google Scholar to identify relevant randomized clinical trials assessing the efficacy of Plantago major in reducing menstrual bleeding until July 2024. Various preparations of P. major were utilized in the included studies.

Administration of P. major leaf and seed extract significantly reduced both the duration and severity of bleeding. These extracts also led to a decrease in hemoglobin (Hb) and hematocrit (HTC) levels in the intervention group compared to the control group. The rectal suppository of P. major seed extract significantly decreased bleeding during the first 4 hours postpartum compared to the control group. Additionally, vaginal suppositories of P. major leaf extract notably reduced the mean in the pictorial blood loss assessment chart (PBAC) and improved the duration of bleeding in the intervention group.

The extracts of P. major seeds and leaves may enhance hematological parameters and reduce both the mean and severity of menstrual bleeding; however, the clinical significance of these findings necessitates further assessment in future trials.

A nutritionally balanced, age-appropriate diet is crucial for child development. The randomized Special Turku Coronary Risk Factor Intervention Project (STRIP) was a 20-year dietary intervention starting at 7 months of age. It aimed at improving fat quality and promoting healthy foods to prevent cardiovascular diseases. We examined whether the intervention was associated with university enrollment and difficulties in school-related tasks in a post hoc setting.

Participants (n = 1062) were recruited at the age of 5 months between December 1, 1989, and May 30, 1992, from child health clinics in Turku, Finland, and were randomly assigned to either the intervention (n = 541) or control group (n = 521) at the age of 7 months. Children in the intervention group received personalized dietary counseling through age 20, without a fixed diet. We used linear probability models estimated by ordinary least squares (OLS) to investigate whether being in the intervention group was associated with university enrollment by age 26, and OLS regressions to examine its association with difficulties in school-related tasks at age 10. The study is reported in accordance with the CONSORT guidelines.

In total, 639 participants provided university enrollment data. Among males from low-education families, being in the intervention group was associated with a 32 percentage point higher likelihood of enrollment (b = 0.324, p = 0.004, 95% confidence interval (CI): 0.103, 0.546). Among all males the association was 11 percentage points (b = 0.107, p = 0.07, 95% CI: -0.007, 0.220), and among females -3 percentage points (b = -0.033, p = 0.53, 95% CI: -0.137, 0.071). The results also suggested that diet, rather than cardiovascular health, may serve as a mediator.

Long-term dietary counseling is associated with increased educational attainment among males from low-education families. The study is registered at ClinicalTrials.gov (#NCT00223600).

To externally validate previously published prognostic models developed exclusively from pre-extracorporeal cardiopulmonary resuscitation (ECPR) variables in a contemporary ECPR cohort.

We conducted a bicenter retrospective external validation of four published pre-ECPR prognostic models (Lee, RESCUE-IHCA, CHIU-S1, and CHIU-S2) in adult patients treated with ECPR between January 2015 and December 2024. Model performance was evaluated for in-hospital survival and favorable neurological outcome (FNO; Cerebral Performance Category 1-2) in the overall cohort, in-hospital cardiac arrest (IHCA), and cardiac-origin cardiac arrest (Cardio_CA) subgroups. Discrimination (the area under the receiver operating characteristic curve, AUROC), calibration, overall model fit (Brier score), and decision curve analysis (DCA) were assessed. For point-based CHIU scores, validation focused on observed outcome rates across predefined risk strata.

Among 214 patients, 79.0% (169/214) had IHCA; survival to discharge was 45.8% and FNO occurred in 24.8%. Discrimination for survival was modest across models (overall ECPR AUROC 0.608-0.709; IHCA 0.586-0.672; Cardio_CA 0.591-0.689) but was higher for FNO (overall ECPR 0.709-0.764; IHCA 0.696-0.744; Cardio_CA 0.698-0.718). The Lee model showed poor calibration with slopes far below 1, whereas RESCUE-IHCA model underestimated survival but demonstrated better calibration (slopes close to 1), higher overall accuracy (lower Brier scores) and broader clinical utility (wider net-benefit ranges in DCA). CHIU models provided limited risk separation between adjacent strata.

In this external validation, pre-ECPR models showed modest performance, with better discrimination for neurological outcome than for survival. RESCUE-IHCA showed the most favorable overall performance. Future studies should develop and validate more robust, transportable tools.