Multifocal atherosclerosis (MFA) is one of the common diseases in elderly patients. Currently, there is no single approach to treating patients with MFA. The active implementation of endovascular surgery has significantly expanded the treatment options for comorbid elderly patients with MFA.

Of the study: to evaluate the effectiveness and safety of various methods of surgical revascularization in geriatric patients with multifocal atherosclerosis.

This single-center observational cohort study was conducted in the Department of Cardiovascular Surgery at the Research and Clinical Center of the Russian National Research Medical University named after N.I. Pirogov. The study included 44 elderly patients with arterial diseases of various localizations. Two groups of patients were identified depending on the chosen treatment method: a group of patients undergoing endovascular treatment (n=30), and a group after open surgical procedures (n=14). Endovascular interventions: balloon angioplasty and/or stenting (carotid, iliac-femoral, popliteal-tibial, etc.), aortic endoprosthetic replacement (EVAR/TEVAR), endovascular reconstructions of visceral/renal arteries. Open surgeries: carotid endarterectomy, aortic prosthetic replacement/grafting/shunting, peripheral shunting, thromboendarterectomy, etc. All operations were performed as part of the routine schedule from June 2024 to June 2025. The choice of revascularization method was made by a multidisciplinary team.

An analysis of in-hospital complications was performed in 44 patients; no fatal cases were recorded during hospitalization. Postoperative delirium developed in 3 patients (2 in the endovascular treatment group and 1 in the open surgery group, p>0.05). Despite the less favorable initial geriatric and functional profile of patients undergoing endovascular surgery, early postoperative outcomes are comparable to the results in the group of patients who underwent open vascular surgery. To definitively assess the comparative effectiveness of treatment methods, larger-scale studies are needed, with careful adjustment for confounding factors, standardized collection of functional and patient-oriented outcomes, and analysis of long-term treatment results.

Thus, with comparable risks of complications in elderly patients in the vascular surgery department with MFA and atherosclerotic lesions in various arterial territories, endovascular surgery allows for the operation of more "fragile" patients.

To evaluate prognostic value of reversible and persistent intraoperative changes in somatosensory evoked potentials, motor evoked potentials and H-reflex for postoperative motor neurological deficit after open thoracoabdominal aortic replacement.

A single-center prospective observational study included 59 patients who underwent open thoracoabdominal aortic replacement under intraoperative neurophysiological monitoring. Somatosensory evoked potentials were recorded in 58 patients (98.3%), motor evoked potentials in 54 (91.5%), and H-reflex in 24 (40.7%) patients. The primary endpoint was new postoperative motor neurological deficit. Diagnostic performance of any signal decrease and no recovery by the end of surgery was assessed. An exploratory analysis of surgical factors associated with persistent absent recovery of motor evoked potentials and/or H-reflex was also performed.

Postoperative spinal cord ischemia was detected in 4/59 patients (6.8%): 3 cases of monoparesis (5.1%) and 1 case of paraplegia (1.7%). Any evoked potential decrease had high sensitivity but low specificity. No recovery of somatosensory evoked potentials among patients with their decrease had 25.0% sensitivity and 95.1% specificity. No recovery of motor evoked potentials had 75.0% sensitivity and 71.4% specificity, no recovery of H-reflex - 100.0% sensitivity and 53.3% specificity. The combined criterion of no recovery of motor evoked potentials and/or H-reflex demonstrated 100.0% sensitivity, 70.6% specificity and 100.0% negative predictive value. In exploratory analysis of surgical factors, significant difference was found in the number of intraoperatively sutured thoracic intercostal arteries: 4 [3; 5] in the absent recovery group versus 6 [4; 8] in the recovery group (p=0.048).

Persistent abnormalities remaining by the end of surgery have the greatest prognostic value rather than any intraoperative signal decrease. No recovery of motor evoked potentials and/or the H-reflex may be considered a clinically relevant risk factor for postoperative motor deficit.

Cardiovascular implantable electronic devices (CIEDs) are increasingly utilized for arrhythmia management, but device-related infections remain a significant complication. Rapidly growing non-tuberculous mycobacteria (RGM), including Mycobacterium smegmatis, are rare causes of CIED infections, typically reported in immunocompromised patients or in association with indwelling catheters. These infections pose diagnostic and therapeutic challenges due to non-specific clinical presentations and intrinsic antimicrobial resistance. We report an immunocompetent elderly patient who developed complete heart block requiring pacemaker implantation. The patient subsequently experienced device-related complications, including lead dislodgement and multiple revisions, followed by development of a pacemaker pocket site infection. Blood cultures grew M. smegmatis, and imaging revealed a significant fluid collection at the pocket site. The patient was managed with complete device removal, placement of a leadless pacemaker, and targeted multidrug antimicrobial therapy guided by susceptibility testing. The patient responded favorably, with resolution of bacteremia and pocket site infection. This case highlights the importance of considering M. smegmatis as a potential pathogen in CIED infections, even in immunocompetent hosts. Successful management requires prompt recognition, source control through device removal, accurate microbiologic diagnosis, and prolonged, susceptibility-guided antimicrobial therapy. Clinicians should maintain a high index of suspicion for RGM infections in patients with indwelling device infections, particularly when initial empiric therapy fails. Although rare, M. smegmatis CIED infections can occur in immunocompetent patients and are associated with device manipulation or revisions. This report underscores the need for vigilance, multidisciplinary management, and prolonged follow-up in such complex infections.

Immune-cell dynamics within the tumor microenvironment (TME) determine whether immune cells can reach, recognize, and sustain antitumor function against malignant cells under suppressive pressure. These dynamics are shaped by hypoxia, nutrient stress, cytokine and chemokine signaling, stromal architecture, vascular access, and multicellular crosstalk, and are further regulated by transcriptional and epigenetic programs. In this review, we organize TME immunity around four major barriers to effective therapy: failed immune access, defective antigen visibility and priming, failure to sustain effector function, and suppressive tissue remodeling. We use FOSL2/Fra-2, a component of activator protein-1 (AP-1) transcription factor complexes, as an example of how local signals can produce distinct regulatory effects in malignant, immune, and stromal compartments. FOSL2-associated programs have been linked to differentiation, plasticity, myeloid and stromal remodeling, stress adaptation, and selected immune-regulatory processes; however, the strength and direction of these associations vary by lineage, tumor type, model system, and level of functional evidence. We distinguish perturbation-supported mechanisms from correlative state signatures and identify the need for spatial validation, functional perturbation, and biomarker validation. This perspective supports biomarker-guided TME-directed therapy matched to the dominant immune barrier.

Background Lung cancer remains the leading cause of cancer-related mortality worldwide. Although obesity is an established risk factor for multiple malignancies, numerous studies have reported an "obesity paradox," wherein patients with obesity demonstrate improved survival compared with normal-weight or underweight individuals. Whether this survival advantage reflects a true protective biological mechanism or methodological artifacts such as reverse causation driven by cancer cachexia and selection bias remains controversial, particularly within the acute inpatient setting. We evaluated the independent association between documented obesity and in-hospital mortality among lung cancer hospitalizations. Methods We performed a retrospective cross-sectional analysis of the US National Inpatient Sample (2020-2022). Adult hospitalizations (age ≥18 years) with a diagnosis of lung cancer were identified and dichotomized by the presence or absence of an International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) obesity code; the unit of analysis was the hospitalization rather than the individual patient, and the exposure was documented obesity coding rather than measured adiposity. Baseline demographics, comorbidities, and in-hospital complications were compared using the chi-squared test (categorical variables) and the Mann-Whitney U test (continuous variables). The primary outcome was in-hospital mortality; multivariable logistic regression adjusted for demographic, clinical, and hospital-level covariates. Results Of 61,963 unweighted lung cancer hospitalizations, 7,065 (11.4%) carried an obesity code. Obese patients were younger (median: 68 vs. 70 years) and more often female (4,090/7,065 (57.9%) vs. 28,011/54,898 (51%)). They had a higher prevalence of hypertension, diabetes, dyslipidemia, and obstructive sleep apnea (1,703 (24.1%) vs. 2,910 (5.3%)) but a lower weighted Elixhauser score (median: 10 vs. 16). In-hospital mortality was lower in the obese group (278 (3.9%) vs. 3,746 (6.8%); p<0.001). After adjustment, an obesity code was independently associated with 33% lower odds of in-hospital death (adjusted odds ratio (aOR): 0.67; 95% CI: 0.58-0.77; p<0.001). Conclusions Documented obesity coding was independently associated with lower in-hospital mortality among lung cancer hospitalizations. However, the low sensitivity of administrative obesity coding, a binary exposure that cannot separate normal-weight from cachectic patients, and the susceptibility of hospitalized cohorts to collider and reverse-causation bias mean this association should not be interpreted as a protective effect of adiposity. The paradox is most parsimoniously explained by confounding by illness severity rather than a therapeutic target, and the finding should be interpreted as an association involving documented obesity coding rather than an effect of adiposity itself.

Ras-associated autoimmune leukoproliferative disorder (RALD) is a rare, nonmalignant condition characterized by monocytosis, lymphoproliferation, and autoimmunity, driven by KRAS or NRAS variants. Immune thrombotic thrombocytopenic purpura (iTTP) results from autoantibodies against ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13).

Can RALD co-occur with iTTP, and how can it be diagnosed?

A patient presenting with neutropenia, monocytosis, and thrombocytopenia was initially diagnosed with chronic myelomonocytic leukemia. She later developed splenomegaly, lymphadenopathy, and iTTP. Reevaluation identified a somatic KRAS G12A variant in peripheral blood, prompting a diagnosis of RALD. Flow cytometry demonstrated immunophenotypic changes involving B cells, T cells, and monocytes. The patient had four ADAMTS13 relapses, responsive to rituximab.

This case highlights co-occurrence of RALD and iTTP, extending the spectrum of Ras-associated autoimmune cytopenias.

Sexual function can be negatively affected in individuals with congenital bleeding disorders (CBDs). Patient-reported outcome measures can provide insight into patients' experiences and help address sexual function and sexual satisfaction in clinical care.

This study evaluates the measurement properties of a selection of PROMIS Sexual Function and Satisfaction (PROMIS SexFS) measures in adults with CBDs and describes the outcomes.

In this cross-sectional multicenter study, men with hemophilia and women with hemophilia or von Willebrand disease were invited to participate. Six screener items, 12 measures from the PROMIS SexFS, and disease-specific items on sexual function and satisfaction were completed. Reliability was evaluated using standard error of T-scores. Internal consistency was evaluated using item-total correlation. Known-group validity was examined by testing predefined hypotheses. Feasibility was evaluated using percentage of lowest and highest scores, and relevance was evaluated qualitatively. Lastly, PROMIS T-scores were compared with reference data from the Dutch general population using independent samples t-test.

Data from 231 patients (mean age 44 years, range 18-81 years; 54% male) were collected. For all measures, >78% met the reliability criterion. Internal consistency and feasibility were sufficient, and known-group validity was supported. Compared with reference data, patients reported greater orgasm pleasure (d = 0.23) and more interest in sexual activity (d = 0.19). Males reported better erectile function (d = 0.26), while females reported more vaginal discomfort with sexual activity (d = 0.48).

The Dutch PROMIS SexFS measures showed sufficient reliability and validity for assessing sexual function and satisfaction in individuals with CBDs. It can inform research and support clinical discussions.

Frailty predicts poor outcomes in older adults with cardiovascular disease (CVD) and is closely related to neuromuscular dysfunction. Lower limb surface electromyography (sEMG) during walking may capture frailty-related motor alterations, but its characteristics and discriminative value in older adults with CVD remain unclear. This study aimed to compare lower limb sEMG features between frail and nonfrail older adults with CVD and evaluate their ability to identify frailty.

This case-control study included 150 older adults with CVD (75 frail, 75 nonfrail; 80 men, 70 women). Frailty was defined using the Fried frailty phenotype. Wireless sEMG signals were recorded bilaterally from the rectus femoris, semitendinosus, tibialis anterior and medial gastrocnemius during a standardized 10-m walk test. Time-domain parameters, frequency-domain parameters, symmetry indices, contribution ratios and activation-sequence rank were compared with false-discovery-rate correction. Binary logistic regression and receiver operating characteristic (ROC) analysis were used to identify factors independently associated with frailty and evaluate discriminative performance.

Frail participants were older (76.04 ± 7.57 vs. 68.55 ± 6.09 years), more frequently exposed to polypharmacy (93.33% vs 70.67%), required longer to complete the 10-m walk test (13.34 ± 3.23 vs. 9.44 ± 1.21 s) and had lower Tinetti Performance-Oriented Mobility Assessment (POMA) scores (21.51 ± 4.27 vs. 27.59 ± 0.92; all p < 0.001). The frail group showed higher median integrated EMG (IEMG) of the left semitendinosus (534.4 [451.3, 680.7] vs. 455.5 [384.5, 542.0] μV·s, FDR-adjusted p = 0.0084) and higher activation-sequence rank of the left rectus femoris (4.333 [3.000, 5.667] vs. 3.333 [2.333, 4.333], FDR-adjusted p = 0.0404). In the frequency domain, median frequency (MF) was higher in the right rectus femoris, bilateral tibialis anterior and right medial gastrocnemius, whereas mean power frequency (MPF) was higher in six muscles (all FDR-adjusted p < 0.05). In multivariable analysis, MF of the right rectus femoris (OR = 1.067, 95% CI 1.003-1.135, p = 0.038), MF of the right medial gastrocnemius (OR = 1.054, 95% CI 1.009-1.102, p = 0.019), activation-sequence rank of the right tibialis anterior (OR = 0.640, 95% CI 0.448-0.914, p = 0.014), age (OR = 1.128, 95% CI 1.044-1.218, p = 0.002) and Tinetti POMA score (OR = 0.784, 95% CI 0.669-0.918, p = 0.003) were independently associated with frailty. The sEMG + age model achieved an area under the curve (AUC) of 0.8418 (sensitivity = 0.8933; specificity = 0.6400), approaching the full model including Tinetti POMA score (AUC = 0.8740; sensitivity = 0.9200; specificity = 0.7067).

Lower limb sEMG features during walking were independently associated with frailty in older adults with CVD. The simplified sEMG + age model showed good discriminative performance and may provide candidate objective markers to complement conventional frailty assessment.

Cerebrovascular endothelial function can be assessed by measuring the shear-mediated dilation or cerebrovascular reactivity (CVR) of the internal carotid artery (ICA) in response to transient hypercapnia (30 s). ICA CVR is blunted with aging; however, it is not known whether age-related reductions in ICA CVR are influenced by antioxidant-responsive mechanisms. The purpose of this study was to determine whether infusion of the antioxidant, ascorbic acid (AA) restores ICA CVR in middle-aged and older (MA/O) adults. We also examined the effect of AA on middle cerebral artery (MCA) CVR to sustained (3-min) hypercapnia. We hypothesized that MA/O adults would exhibit lower cerebrovascular function compared to young (Y) adults, and that infusion of AA would improve cerebrovascular function in MA/O adults, whereas infusion of saline (SAL) would not. The primary analytic sample included nine Y adults (25 ± 2 years) and nineteen (65 ± 6 years) MA/O adults, with analyzable data varying by outcome. ICA CVR was measured using high-resolution duplex ultrasound, and MCA CVR was measured using transcranial Doppler ultrasound. AA infusion improved ICA CVR and MCA CVR in MA/O adults but had no effect in Y adults. These findings suggest that age-related impairments in cerebrovascular function may be partly attributable to mechanisms responsive to acute, supraphysiological AA administration.

Cardiovascular reserve represents the integrated physiological capacity of the cardiovascular system to maintain tissue perfusion during increasing physiological stress. Although reserve has long been recognized conceptually, its direct assessment remains challenging. No universally accepted definition or gold-standard measure of cardiovascular reserve currently exists. Nevertheless, if cardiovascular reserve can be estimated reliably, reserve-based monitoring could permit earlier recognition of impending circulatory deterioration before conventional physiological indicators become abnormal. Among the reserve-monitoring technologies currently under investigation, the Compensatory Reserve Metric (CRM) and the Cardiovascular Reserve Index (CVRI) represent two distinct approaches to estimating remaining cardiovascular reserve. This review examines the physiological basis of reserve-based monitoring, critically evaluates the available experimental and clinical evidence supporting CRM and CVRI, assesses their strengths and limitations and outlines priorities for future research and potential clinical applications. CRM has demonstrated strong performance in experimental haemorrhage models and remains the most extensively studied reserve-monitoring technology in low output conditions. Although evidence supporting CVRI is more limited, findings from cardiopulmonary exercise testing, haemorrhage and heat stress suggest that it may reflect progressive depletion of cardiovascular reserve across diverse forms of circulatory and physiological stress. Although seemingly promising, current evidence remains limited by small clinical cohorts, heterogeneous study designs and limited independent validation.