Basilar artery aneurysms (BAA), though relatively rare, are critical lesions due to their location and potential for catastrophic outcomes if ruptured. The Level 3 pretemporal transcavernous approach has emerged as a valuable surgical technique for the clipping of BAA, especially those that are low-lying. In this video, we present a case of a ruptured low-lying basilar tip aneurysm which was clipped using a Level 3 pretemporal transcavernous approach. A 60-year-old woman presented with modified Hunt and Hess grade IV subarachnoid hemorrhage. Computed tomography angiography showed a low-lying basilar tip aneurysm. The patient underwent a frontotemporal craniotomy, Level 3 pretemporal transcavernous approach, and clipping of the aneurysms. The patient had an uneventful recovery and was independent functionally at 3-month follow-up. Level 3 pretemporal transcavernous approach is a valuable surgical technique for clipping of low-lying basilar tip aneurysms.

Despite major advances in temporary mechanical circulatory support (tMCS), cardiogenic shock remains associated with high mortality. Early management strategies were dominated by the intra-aortic balloon pump (IABP), widely adopted on physiological grounds despite limited randomized evidence and later declining use due to downgraded guideline recommendations. Subsequent shifts toward more potent tMCS devices, including transaortic micro-axial flow pumps and venoarterial extracorporeal membrane oxygenation (VA ECMO), were driven by the pursuit of improving systemic perfusion and ventricular unloading. However, enhanced hemodynamic support has not consistently translated into superior clinical outcomes and is frequently accompanied by substantial device-related complications. Increasing recognition of the complex and patient-specific physiology of cardiogenic shock has fueled a transition from device-centred to patient-centred strategies, emphasizing tailored support configurations, multimodal monitoring, and physiology-driven decision-making. Adjunct left ventricular unloading during VA ECMO has emerged as a promising yet controversial approach, with ongoing trials expected to clarify its clinical role. Recent evidence, including the DanGer Shock trial, suggests that timely initiation of appropriately selected tMCS may improve longer-term outcomes in selected populations. Parallel advances in biomedical engineering have enabled physiology-based cardiovascular simulators that allow systematic comparison of tMCS strategies, pharmacological support, and device hemocompatibility under controlled conditions. When extended to virtual populations, these in silico approaches can complement clinical evidence through virtual clinical trials, potentially reducing the size and cost of traditional studies. Together, these developments highlight a new era of patient-centred critical care and biomedical innovation in cardiogenic shock.

To investigate and compare the associations of the systemic immune-inflammation index (SII), the systemic inflammation response index (SIRI), the platelet-to-lymphocyte ratio (PLR), and the neutrophil-to-lymphocyte ratio (NLR) with 90-day functional outcomes in AIS patients treated with IV rt-PA., with particular attention to their nonlinear relationships and threshold effects.

Note that 503 AIS patients who received intravenous thrombolysis with alteplase (rt-PA) were consecutively enrolled, and clinical information along with laboratory data were collected. ROC curve analysis was conducted to determine the optimal cut-off value of SII, PLR, NLR, and SIRI. Multivariate analysis was included for variables with p < 0.05 in univariate analysis. The restricted cubic spline (RCS) curve illustrates the nonlinear relationship between SII, PLR, NLR, SIRI, and the 90-day unfavorable outcomes.

A total of 503 patients were included. According to multivariate logistic regression analysis, admission NIHSS scores (OR = 1.156, 95% CI: 1.049-1.274), albumin (OR = 0.875, 95% CI: 0.774-0.989), and SII (OR = 1.004, 95% CI: 1.001-1.006) were independent indicators of unfavorable outcomes at 90 day after intravenous thrombolysis (p < 0.05). The ROC analysis showed that an SII cutoff value of 1268.00 could predict poor 90-day outcomes with a sensitivity of 61.58% and a specificity of 92.02%. The AUC was 0.764 (95% CI 0.677-0.852, p < 0.05). Pairwise comparison using the DeLong test revealed that SII and NLR demonstrated comparable discriminative ability (p = 0.392), and both significantly outperformed PLR (SII vs. PLR: p = 0.001; NLR vs. PLR: p = 0.006). No significant difference was detected between SII and SIRI (p = 0.709) or between NLR and SIRI (p = 0.211). SII showed the most consistent independent association in multivariable analysis (OR = 1.004, 95% CI: 1.001-1.006). The RCS curve illustrates the nonlinear relationship between SII, PLR, NLR, SIRI, and the 90-day unfavorable outcomes.

Among the inflammatory indices studied, SII showed the strongest association with 90-day unfavorable outcomes in this cohort. Our findings suggest a potential role of systemic inflammation in patient prognosis post-thrombolysis, warranting further prospective validation.

Stomach contractions are coordinated in part by bioelectric slow waves (SW). Dysfunctional SWs are associated with motility disorders. Electrical pacing is a potential strategy for managing motility disorders but remains poorly understood with inconsistent efficacy.

We used a newly-developed optical mapping method to image gastric pacing in 4 pigs (35.0 ± 1.3 kg). The method imaged transmembrane potential, primarily from the circular smooth muscle layer, with high spatiotemporal resolution. We delivered unipolar pacing pulses to the serosal surface or to the luminal side of the circular muscle layer. Pulses were 100 ms in duration with 4 or 8 mA amplitude.

Pacing elicited transmembrane potential polarization patterns consistent with bidomain theory: For cathodal pacing, there was an elongated depolarized region (virtual cathode) oriented orthogonally to the smooth muscle fibers and centered on the electrode. It was flanked on either side by hyperpolarized virtual anodes. For anodal pacing, virtual electrode polarity was reversed. Of 175 pulses, 18% induced SWs that activated the entire mapping region. The remaining pulses failed completely (38%) or induced SWs that only partially activated the mapping region (43%). All SWs initiated from virtual cathode sites approximately 1 cm from the pacing electrode and not from the electrode site itself.

These results suggest that close to the electrode, pacing pulses inhibited the network of interstitial cells of Cajal (ICC) that propagates SW. SWs may have initiated when the ICC network was activated by depolarized smooth muscle in the virtual cathodes remote from the electrode.

Stroke is a leading cause of epilepsy, especially in older adults. The SeLECT score remains the standard among post-stroke epilepsy (PSE) prediction tools. However, its broader validation is limited by the need to manually extract neuroimaging predictors (cortical and middle cerebral artery [MCA] involvement). Unlike the CAVE score, SeLECT did not evaluate acute stroke volume, which can now be quantified automatically. We aimed to determine whether stroke volume independently predicts PSE and compare its predictive contribution to SeLECT's neuroimaging variables.

SeLECT variables were manually extracted. Diffusion-weighted imaging volume was quantified using a validated convolutional neural network. Cox proportional hazards models for time to PSE were built by adding stroke volume (per 10 mL) and then removing cortical and/or MCA involvement. For each model, we analyzed variable significance, discrimination, and calibration.

Among 221 patients, 35 (15.8%) developed PSE. In our cohort, the original SeLECT score and the refit model had a C-index of 0.669 and 0.642, respectively. Adding stroke volume resulted in a C-index of 0.656. Retaining volume while removing cortical and MCA involvement resulted in C-indices of 0.664 and 0.668, respectively. Keeping stroke volume and removing both variables increased the C-index to 0.679. Calibration was good for all models. Stroke volume in crease by 10 mL was an independent predictor of 12% increased PSE risk across all models.

Acute stroke volume is an independent PSE predictor. Stroke volume offered comparable discrimination to the neuroimaging components of the SeLECT score, supporting its use as a scalable and automated alternative.

Late adverse events after percutaneous coronary intervention continue to occur beyond the first year with last-generation drug-eluting stents (DES). The coronary bioadaptor marks a new approach with an uncaging beginning at approximately 6 months after implantation. We conducted a pairwise meta-analysis of bioadaptor versus DES in randomised trials with complementary single-arm 6-12 and 6-24 landmark analyses.

The systematic review and meta-analysis was conducted according to PRISMA 2020 Guidelines. PubMed, Embase, CENTRAL and Google Scholar were searched for studies reporting clinical outcomes after bioadaptor implantation. The primary outcome was target-lesion failure (TLF), a composite of cardiac death, target-vessel myocardial infarction and target-lesion revascularisation at 1 year. Secondary outcomes were TLF and individual components at landmark intervals 6-12 and 6-24 months. Single-arm pooled event rates and pairwise comparisons were estimated using generalised linear mixed-effects models.

Three randomised trials (n = 2892; 1448 bioadaptor, 1444 DES) were included in pairwise analyses. 1-year TLF showed no significant difference between bioadaptor and DES (OR 0.81, 95% CI 0.51-1.31, I² = 0.0%, p = 0.3943). Likewise, individual components of TLF and device thrombosis did not differ between groups. Ten studies (1753 patients; 1900 lesions) were included in single-arm analyses. Landmark TLF was 0.57% (95% CI 0.07-4.29; I² = 4.6%) from 6 to 12 months and 2.01% (95% CI 0.81-4.92; I² = 74.2%) from 6 to 24 months. Event rates for other endpoints were generally low.

No significant differences in safety and efficacy outcomes were observed between bioadaptor and DES. Complementary single-arm landmark analyses suggested low late event rates, but these findings should be interpreted as exploratory. Further randomised trials are warranted.

Sex-related disparities affect diagnosis, referral, and prognosis of aortic valvular diseases. Contemporary US data on transcatheter aortic valve implantation (TAVI) by sex are limited.

To characterize 10-year trends in TAVI use, periprocedural complications, and long-term outcomes among Medicare beneficiaries, stratified by sex.

This nationwide, retrospective, population-based cohort study used US Medicare claims data from fee-for-service beneficiaries discharged after TAVI from January 1, 2013, to December 31, 2022. The median follow-up time was 2.19 (IQR, 0.94-3.79) years. Exclusions included patients who had concomitant valve surgery, infective endocarditis, valve-in-valve TAVI, transapical TAVI, TAVI for pure aortic insufficiency, or later conversion to Medicare Advantage. Analyses were conducted between October 1, 2024, and April 1, 2025.

TAVI.

The primary outcome was all-cause mortality. Secondary outcomes included periprocedural mortality, vascular complications, acute kidney injury, major or life-threatening bleeding, stroke, acute myocardial infarction (AMI), permanent pacemaker implantation (PPI), and hospitalization for heart failure (HF). Adjusted odds ratios (AORs) and hazard ratios (AHRs) with 95% CIs were estimated.

The study included 314 123 patients (141 233 women [45.0%] and 172 890 men [55.0%]). Women were older than men (mean [SD] age, female: 80.3 [7.8] years; male: 79.4 [7.7] years; standardized mean difference, 12%). The proportion of female patients who underwent TAVI declined from 47.6% in 2013 to 43.6% in 2022 (P < .001). Compared with men, women had higher periprocedural mortality (2.5% vs 2.2%; AOR, 1.20 [95% CI, 1.14-1.26]), vascular complications (5.8% vs 3.6%; AOR, 1.65 [95% CI, 1.60-1.71]), and bleeding (10.4% vs 6.8%; AOR, 1.67 [95% CI, 1.62-1.71]) but less PPI (16.9% vs 20.0%; AOR, 0.81 [95% CI, 0.79-0.82]). Long-term mortality was lower in female patients (AHR, 0.92; 95% CI, 0.91-0.93), although their risks of HF hospitalization, AMI, stroke, and bleeding were higher.

Among Medicare beneficiaries, women constituted a progressively declining proportion of patients treated with TAVI, experienced more periprocedural complications, and demonstrated modestly better long-term survival compared with men. Further work is needed to understand factors influencing these trends and to refine sex-specific strategies for optimal outcomes.

Ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (DCM) shared common structural alterations with a high mortality from sudden cardiac death (SCD) and pump failure. Implantable cardioverter-defibrillator (ICD) has been confirmed both beneficial and cost-effective for primary prevention of SCD in patients with ischemic or non-ischemic heart diseases. The management of heart failure has improved due to the of implantation of ICD and cardiac resynchronization therapy-defibrillator (CRT-D). It remains unclear whether there is a difference in clinical effectiveness of primary prophylactic ICD implantation between patients with ICM and DCM.

We conducted a retrospective, single-center study, which enrolled 53 DCM patients and 25 ICM patients with guideline indications for primary prophylactic ICD or CRT-D treatment. Primary endpoint was all-cause mortality and secondary outcomes included cardiovascular death.

During a median follow-up of 38.5 months, all-cause death occurred in 8 patients (32%) in the ICM group and 5 patients (9.43%) in the DCM group (P = 0.012). Cardiovascular death occurred in 5 patients (20%) in the ICM group and 3 patients (5.66%) in the DCM group (P = 0.052). Multivariable Cox regression analysis showed that cardiogenic mortality in the ICM group is higher than that in the DCM group (hazard ratio [HR] 0.119, 95% confidence interval (CI) 0.016 to 0.860, P = 0.035).

Among patients who received ICD implantation for the primary prevention of SCD, there is no statistical difference in benefits between DCM and ICM patients. However, compared with DCM patients, ICM patients have a higher cardiovascular mortality, due to more exposure to risk factors.

Over the past decade, the global burden of depression has increased and remains higher in women than in men. Emerging evidence suggests that low testosterone is linked to depressive symptoms in both sexes, raising important questions about its causal role and potential as a therapeutic target.

To provide a narrative review of the literature on the relationship between testosterone and depression across both sexes, examine underlying neurobiological mechanisms, and assess the efficacy and risks of testosterone replacement therapy (TRT) as a treatment for depressive symptoms.

We conducted a narrative review of PubMed, Medline, and Google Scholar for articles published between 1980 and 2024. Eligible sources included primary research articles, systematic reviews, meta-analyses, and narrative reviews that examined the relationship between testosterone levels, depression, and the effects of TRT on mood regulation. Search terms include low testosterone, hypogonadism, depression, mood disorders, androgen deficiency, TRT, neurotransmitters, and mental health.

Low testosterone is associated with depressive symptoms, particularly in hypogonadal men. Testosterone modulates serotonergic, dopaminergic, and GABAergic systems and acts on brain regions involved in mood regulation, including the prefrontal cortex, amygdala, and hippocampus. TRT improves mood, energy, and libido in hypogonadal men, though evidence in eugonadal men and women is mixed. Ethnic and genetic factors, such as androgen receptor Cytosine, Adenine, Guanine (CAG) repeat length, may influence susceptibility and treatment response. Risks of TRT include erythrocytosis, prostate-specific antigen elevation, cardiovascular events, and metabolic changes.

Testosterone may play a significant role in mood regulation, and its deficiency may contribute to depressive symptoms. TRT is a promising treatment option for select patients, though it must be personalized and closely monitored to balance therapeutic benefits with potential risks.