A retrospective analysis was conducted on the baseline characteristics, clinical symptoms and signs, laboratory and imaging findings, and treatment prognosis of 10 PAVF patients from Northern Jiangsu People's Hospital from February 2013 to November 2024. The age of onset was between 16 and 79 years, with 3 cases in men and 7 cases in women. Among the 10 patients, 9 had pulmonary arteriovenous fistula and 1 bronchial artery-pulmonary vein fistula. Clinically, there were 4 cases of dyspnea and chest tightness, 3 cases of cough and sputum production, 1 case of chest pain, 2 cases of hemoptysis, 1 case of dizziness, 2 cases of nosebleeds, 1 case of multiple red nevi on the skin, 3 cases of asymptomatic findings upon physical examination, and 3 cases of acute cerebral infarction as the onset. Patients are mainly diagnosed with PAVF based on chest contrast-enhanced CT and/or pulmonary artery CT angiography (CTA). In terms of treatment, 6 cases underwent interventional embolization; 2 patients underwent surgical treatment: one underwent thoracotomy to remove the diseased lob, and one underwent video-assisted thoracoscopic lobectomy; 2 patients received conservative treatment. 10 patients improved and were discharged after treatment, with follow-up lasting 2.1-4.5 years. Among them, one complex PAVF patient was admitted one year after surgery for a second interventional treatment. During follow-up, 10 patients had stable conditions with no related complications, and no recurrence or signs of vascular embolization or recanalization were observed. Clinical manifestations of PAVF patients are diverse, diagnosis requires chest contrast-enhanced CT and pulmonary artery CTA, treatment methods include interventional embolization therapy and surgical treatment, follow-up is required after surgery to evaluate treatment effectiveness.

The use of agents to prevent and treat thromboembolism in pregnancy continues to increase, likely a reflection of greater burden of comorbid conditions in pregnant people, increased awareness of venous thromboembolism prevention efforts, and enhanced access to diagnostic testing. For this reason, obstetricians commonly find themselves involved in the management of patients who are receiving anticoagulation during pregnancy. Here, we summarize the features of anticoagulants used in pregnancy. Despite the advent of newer agents, the most common anticoagulant used in pregnancy remains heparin derivatives (primarily the low-molecular-weight forms).

Chronic limb-threatening ischemia is the most advanced stage of peripheral arterial disease and typically requires revascularization to prevent limb-loss. The choice of open surgical bypass versus endovascular therapy should be individualized based on patients' anatomy, operative risk, and conduit availability. Patients who are suitable candidates for both bypass and endovascular intervention and have an adequate single-segment great saphenous vein should undergo open surgical bypass based on level 1 evidence.

Macular disease is the leading cause of vision loss in the United Kingdom, affecting nearly 1.5 million people. Vascular endothelial growth factor (VEGF) has a major role in the onset and progression of vision-threatening macular conditions such as neovascular age-related macular degeneration, diabetic macular oedema and retinal vein occlusion. Anti-VEGF treatments, given by intravitreal injection, can prevent vision loss and may improve vision but must be started quickly before sight loss is irreversible. Informed by an observational study using Hospital Episode Statistics and the Emergency Care Data Set in England and a Costed Integrated Patient Scenario, we identify issues within the current pathway in England. Our key recommendations to optimise care and improve patient outcomes include: (1) increasing public awareness of macular disease to reduce late presentation; (2) ensuring the right patients are seen in the right place at the right time by improving quality and priority of optometrist referrals and by specialists directing patients with conditions such as diabetes and hypertension to community optometrists in the first instance; (3) planning for current and future demand and capacity using innovative solutions to manage expected increases in medical retina conditions and (4) ensuring patient-centred care. Our evidence should encourage National Health Service organisations at all levels to review macular disease pathways to address immediate issues and plan for the future. A shift in care delivery is needed, embracing scalable sustainable solutions, earlier diagnosis and treatment, improved access to more durable therapies, wider adoption of digital technologies and care closer to home.

Cerebral amyloid angiopathy (CAA) is associated with intracerebral hemorrhage, cognitive decline, and dementia. We examined (1) associations between CAA, cognitive impairment, and depressive symptoms; (2) whether depressive symptoms mediate the relationship between CAA and cognition; and (3) whether CAA neuroimaging markers predict depressive symptom severity.

Recruitment occurred through memory and stroke prevention clinics across 2 sites. Cross-sectional data from probable CAA and controls were analyzed. Neuropsychological tests were grouped into episodic memory, executive function, and processing speed domains. Scores ≥5 on the Geriatric Depression Scale: Short Form (GDS-15) defined "possible depression." Regression and mediation analyses examined associations among CAA status, cognition, and depressive symptoms, and in CAA, associations between neuroimaging biomarkers and GDS-15.

In 85 CAA (mean age 73.5; 35.3% female) and 83 controls (mean age 68.8; 62.7% female), CAA status was associated with poorer performance across cognitive domains. Higher GDS-15 scores were associated with poorer performance across domains. CAA participants had higher odds of "possible depression" (odds ratio 15.71; 95% CI 4.26-80.05, p < 0.001) and scored 2.71 times higher on the GDS-15 than controls (95% CI 2.10-3.51, p < 0.001). In mediation, "possible depression" accounted for significant proportions of the effect of CAA on episodic memory (11%; β = -0.14, 95% CI -0.30 to -0.03, p = 0.014) and executive function (9%; β = -0.14, 95% CI -0.30 to -0.02, p = 0.016), but not processing speed (2%; β = -0.04, 95% CI -0.18 to 0.08, p = 0.56). In 81 CAA participants, higher GDS-15 scores were associated with lower mean cortical thickness (count ratio [CR] 1.33 per SD decrease in thickness, 95% CI 1.09-1.62, p = 0.005), presence of cortical superficial siderosis (CR 2.04, 95% CI 1.35-3.09, p < 0.001), and higher CAA small vessel disease total score (CR 1.16, 95% CI 1.00-1.35, p = 0.047).

CAA participants exhibited greater depressive symptoms and poorer cognition than controls. Depressive symptoms mediated a small portion of the association between CAA and cognition. Cerebral cortex damage may underlie some depressive symptoms. Interventions targeting CAA-related neurodegeneration and treatment of depressive symptoms may support cognitive health in CAA.

Background and objectives A considerable proportion of the older populations have been suffering from stroke multimorbidity. Post-stroke complications often affect the overall well-being of individuals. This study assesses the trends, patterns, and determinants of stroke multimorbidity. Methods We used data from three waves of the World Health Organization study on global ageing and adult health (WHO-SAGE) and analysed individuals aged 50 and above years (Wave I, 7,150 individuals, Wave II, 6,823 individuals, and Wave III, 6,719 individuals) who reported a physician diagnosis of stroke. We analysed trends and patterns of stroke multimorbidity across three waves of WHO-SAGE. Stroke multimorbidity was also analysed with respect to the socioeconomic characteristics of study participants. Results We found a significant increase in the prevalence of stroke multimorbidity over one and a half decade (1,050 per 100,000 to 2,410 per 100,000). The burden of stroke multimorbidity increased steadily, mainly among individuals suffering from two or more long-term conditions. Prevalence of stroke multimorbidity was much higher among older people aged 80 yr and above in wave 3 as compared with wave 1, a relative increase of around 200%. An older individual with no formal education showed an increased prevalence of stroke multimorbidity, a relative change of 102% in last one and a half decade. Interpretation and conclusions This study demonstrated a significant increase in the prevalence of stroke multimorbidity over the last one and a half decade (2007-2020), which considerably varied by age group, sex, place of residence, education, and wealth quintile.

The presence of a patent foramen ovale (PFO) in the heart is a risk factor for stroke due to the potential for paradoxical embolism. Given the implication of the heart in PFO-associated stroke and transcatheter closure, there may be unique factors that prevent patients from returning to physical activity.

To elicit patient perceptions of physical activity after PFO-associated stroke and transcatheter closure.

A purposive sample of 48 individuals who had a PFO-associated stroke participated in this study. Data were collected using semi-structured interviews and data were analyzed using Braun and Clarke's thematic analysis methodology. NVivo software was used to manage data, code, and generate themes.

Participants were on average 47.7 years of age (SD = 8.2). All participants were diagnosed with ischemic stroke or transient ischemic attack and 44 participants received transcatheter PFO closure. The main themes (and sub themes) related to perceptions of physical activity after stroke and closure were: (1) psychological barriers (fear and anxiety, and closure device apprehension); (2) variability in fitness performance (subjective fitness improvement and decline in physical activity compared to before their stroke); and (3) variability in physical recovery (lingering fatigue/neuro-fatigue, residual physical symptoms, and cardiac irregularities after closure).

PFO-associated stroke survivors reported several significant and unique barriers (e.g., cardiac irregularities) to engaging in physical activity after PFO-associated stroke and closure. Some participants also reported improved fitness after their closure procedure. These findings highlight the need for further research to better support patient recovery and reduce uncertainty surrounding return-to-activity recommendations.

Venous leg ulcers (VLUs) are often accompanied by chronic pain, which is frequently managed through pharmacological treatments, including opioids, which can have undesirable effects and complications. Recent evidence advocates for the integration of non-pharmacological therapies to improve pain management and patient outcomes.

This study reviewed the literature for non-pharmacological interventions to manage chronic pain in individuals affected by VLUs.

An integrative literature review enabled inclusion and integration of diverse study methodologies. Studies were critically appraised.

16 studies met the eligibility criteria; eight were appraised as methodologically moderate, two as strong and six as weak. Non-pharmacological interventions included electrical stimulation therapy, compression therapy, social and peer support, virtual reality, light therapy, music therapy, aromatherapy and traditional Chinese medicine.

Effective non-pharmacological therapies for managing chronic pain in VLUs exist and these can improve quality of life and overall wellbeing. Compression bandaging, electrical stimulation and virtual reality are the most effective and feasible for implementation. Research that adopts complex study methodologies would be most appropriate to evaluate the complexity of VLU care and provide a higher quality evidence base on which to expand and better support a holistic approach to VLU pain management.

Ethnic disparities in stroke incidence and recurrence are well-known but there is conflicting evidence regarding post-stroke care and recovery. In the UK, stroke-survivors are recommended a six-month specialist review but fewer than half receive this review, potentially exacerbating health inequities. Using data from the Sentinel Stroke National Audit Programme (SSNAP) from inception to August 2023 across four regions in England with varying ethnicity profiles we conducted a retrospective descriptive analysis to assess ethnic differences in six-month care and outcomes for stroke-survivors. A total of 80,413 (26.2%) stroke-survivors attended their 6-month review (whites: 26.5%, Black patients: 27.9%; Asian patients: 26.1%; Mixed patient: 27.6%; other: 23.5% other; unknown: 23.1%) with a higher proportion of reviews taking place via telephone for Black and Asian patients (X = 955.7, p = 0.001). After adjustment, non-White patients were significantly more likely to be followed up at 6 months (Black patients OR 1.29 (95%CI 1.21-1.38), Asian patients OR 1.10 (95% CI: 1.04-1.15). The odds of having a further stroke (Black OR 1.49 (95% CI: 1.21-1.84), Asian OR 1.25 (95% CI 1.03-1.52)) or other illness requiring hospital readmission (Black OR 1.25 (95% CI: 1.12-1.40), Asian OR 1.15 (1.05-1.27)) were significantly higher in Black and Asian patients following adjustment for age and stroke severity. At six months lipid therapy was significantly lower in Black patients (OR 0.79 (95% CI: 0.72-0.87)). Black and Asian stroke-survivors experience worse outcomes and lower use of secondary prevention despite similar clinic attendance. Culturally sensitive interventions are needed to reduce post-stroke complications.

Left ventricular (LV) global longitudinal strain (GLS) and left atrial reservoir strain (LASr) are established predictors of adverse outcomes in heart failure with reduced ejection fraction (HFrEF), but the prognostic value of their combined assessment has not been fully elucidated.

This retrospective study included 341 patients hospitalized with decompensated HFrEF who underwent speckle-tracking echocardiography for assessment of LV GLS and LASr. Receiver operating characteristic (ROC) analysis with Youden index optimization was applied to determine optimal strain cutoff values and develop a combined strain classification model. Cox proportional hazards models were used to identify parameters associated with all-cause mortality. LV GLS was analyzed using absolute values.

During a median follow-up of 59 months, 238 patients (70%) died. In univariable analysis, both LV GLS and LASr were associated with mortality. After multivariable adjustment, both remained independently associated with mortality (GLS: adjusted HR 0.945, 95% CI 0.902-0.991, p = 0.019; LASr: adjusted HR 0.972, 95% CI 0.953-0.992, p = 0.006). ROC analysis identified optimal cutoff values of 7.3% for LV GLS and 9.0% for LASr. Patients with concomitant marked impairment of both strain parameters exhibited the highest mortality risk, whereas those with the least impaired ventricular and atrial strain had the most favorable outcomes. Patients with pronounced impairment of either parameter alone demonstrated intermediate survival.

In patients hospitalized with HFrEF, both LV GLS and LASr were independently associated with all-cause mortality. Their combined assessment may identify distinct risk phenotypes and provide enhanced risk stratification beyond either parameter alone.