To examine the mediating role of cardiac self-efficacy in the relationship between patient empowerment and medication adherence among patients with coronary artery disease (CAD) and to identify which empowerment sub-dimensions are most prominent.

A cross-sectional correlational study.

A convenience sample of adults attending a cardiology clinic completed validated versions of the Coronary Artery Disease Empowerment Scale (CADES), Cardiac Self-Efficacy Scale and Morisky Medication Adherence Scale. Data were analysed using Spearman's correlations, ordinal logistic regression and path analysis with bootstrap mediation testing.

Positive correlations were found among empowerment, self-efficacy and adherence. Regression analysis showed that cardiac self-efficacy predicted adherence, while empowerment did not directly predict adherence. Path analysis confirmed that self-efficacy mediates the empowerment-adherence relationship. The self-determination subscale of empowerment was the strongest predictor of self-efficacy, whereas personal competence was not significant.

Patient empowerment enhances medication adherence indirectly by building cardiac self-efficacy, primarily through fostering patient autonomy rather than merely providing knowledge.

Nurse-led strategies should target cardiac self-efficacy. Motivational interviewing and autonomy-supportive interventions may be more effective than traditional education.

What problem did the study address? The study addressed the gap in understanding the nurse-led interventions that translate patient empowerment into actual medication adherence behaviours. What were the main findings? Self-efficacy acts as the essential bridge between empowerment and adherence and this bridge is built most effectively through self-determination rather than personal competence. Where and on whom will the research have an impact? These results will impact clinical nurses, nurse educators and healthcare professionals involved in cardiac care by highlighting that nurse-led counselling strategies and autonomy-supportive interventions may be more effective for improving medication.

We adhered to the STROBE guidelines.

No Patient or Public Contribution.

Cardiovascular diseases (CVDs) are a leading global cause of mortality and disease burden, closely associated with the remodeling of myocardial energy metabolism. Acylcarnitines (Acs) are key intermediates in the carnitine shuttle and fatty acid β-oxidation (FAO) processes. They play a critical role in transporting long-chain fatty acids across the mitochondrial membrane, maintaining the intracellular acyl-CoA/CoA balance, and buffering metabolic flux. Recent metabolomics studies have demonstrated significant abnormalities in acylcarnitine profiles across various cardiac diseases, including coronary artery disease, ischemia-reperfusion injury, heart failure, diabetic cardiomyopathy, and arrhythmias. These abnormalities are closely correlated with disease severity, metabolic disturbances, and poor clinical prognosis. Mechanistically, the pathological accumulation of long-chain acylcarnitines triggers lipotoxicity, exacerbates mitochondrial oxidative stress, and impairs calcium homeostasis, which collectively drive inflammation and cardiomyocyte apoptosis. This review systematically summarizes the physiological roles of the carnitine shuttle, explores the underlying mechanisms of acylcarnitine-induced cardiac injury, and highlights their translational potential as promising diagnostic biomarkers and novel therapeutic targets for cardiovascular metabolic interventions.

Patients with acute myocardial infarction are found to have layered plaque in the culprit lesion site during optical coherence tomography, indicating that these patients have experienced recurrent thrombotic events locally. Whether inflammation factors are associated with this phenomenon remains unknown.

A total of 125 patients with acute myocardial infarction who underwent coronary angiography followed by optical coherence tomography were prospectively enrolled. 17 patients were excluded due to various reasons. Peripheral blood samples were collected from all patients, and blood samples from the culprit vessel were collected during thrombus aspiration in a subset. All optical coherence tomography images of the culprit vessels were analyzed as well as quantitative coronary angiography. The mRNA expression of IL-1β, IL-4, IL-8, IL-10, IL-18, ELANE, MPO in monocytes of both peripheral and culprit lesion blood samples were analyzed.

Of the 108 eligible patients, 56 (51.9%) had layered plaque at the site of the culprit lesion. Clinical characteristics and quantitative coronary angiography showed no significant difference between the layered plaque and non-layered plaque groups. Layered plaque group had greater mean lipid arc (304.23° [284.52, 330.80] vs 288.16° [256.00, 311.00], p=0.047). Peripheral blood samples revealed no difference in any inflammatory factors expression, however, higher mRNA expression level of IL-1β in culprit lesion blood was observed in layered plaque group, with a mean difference of 1.81 (95% BCa CI [0.66, 3.10], p =0.023). Firth's penalized likelihood logistic regression analysis showed that mRNA expression level of IL-1β was significantly associated with layered plaque (OR, 1.78, 95% CI, 1.16-3.29, p=0.005) after adjusting for age and sex. ROC analysis demonstrated that IL-1β yielded an AUC of 0.781 (95% CI: 0.637-0.924) for predicting layered plaque.

IL-1β was expressed more in the culprit vessel in patients whose culprit lesion showed layered plaque, proving that local IL-1β is associated with layered plaque.

Chronic limb-threatening ischemia (CLTI), a severe manifestation of peripheral artery disease, is particularly prevalent among patients receiving maintenance hemodialysis (HD) and is associated with poor limb and survival outcomes. Low-density lipoprotein (LDL) apheresis, including Rheocarna, is used as adjunctive therapy for refractory CLTI; however, intraprocedural hypotension remains a major limitation, especially when combined with HD. We examined the effects of dialyzer membrane type and extracorporeal circuit sequence on hemodynamic stability during concomitant therapy. This case series comprised two patients with CLTI receiving maintenance HD. Each patient underwent four treatment sessions representing the four configurations defined by two dialyzer membranes (polysulfone [PS] and AN69) and two circuit sequences (Rheocarna → dialyzer vs. dialyzer → Rheocarna). Hemodynamic parameters, including systolic blood pressure, relative blood volume change (ΔBV), and peripheral microvascular perfusion assessed by laser Doppler flowmetry (ΔLDF), were assessed during each treatment session. In both cases, the Rheocarna → AN69 configuration showed the smallest early decrease in systolic blood pressure and the most favorable early ΔBV pattern among the four sessions. Toe ΔLDF was preserved or increased with this configuration. The other three configurations were associated with larger early decreases in systolic blood pressure in one or both patients, including a decrease to below 90 mmHg in Case B. These findings suggest that dialyzer membrane type and circuit sequence may influence intraprocedural hemodynamic stability during concomitant Rheocarna therapy and HD. Among the tested configurations, Rheocarna → AN69 showed better hemodynamic tolerance and preservation of peripheral perfusion. These hypothesis-generating findings warrant further evaluation in larger prospective studies.

Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide; however, effective clinical therapies that achieve myocardial regeneration are still lacking, underscoring the urgent need for novel therapeutic strategies. In this study, we identified an RNA-binding protein Ptbp1, a key component of RNA metabolism, as a critical regulator of cardiomyocyte proliferation via the formation of biomolecular condensates. We found that Ptbp1 exhibits granule-like structures in cardiomyocyte nuclei during fetal to early postnatal stages. These Ptbp1 foci are phase-separated liquid droplets formed via its multivalent RNA binding domains. Functional analyses revealed that Ptbp1 is essential for cardiomyocyte proliferation in neonatal mouse primary culture assays. Furthermore, proximity labeling using a primary antibody-based approach combined with RIP-seq in highly purified cardiomyocyte populations demonstrated that these condensates are enriched with multiple proliferation-associated factors. Our findings identify a novel phase-separated condensate in cardiomyocytes and provide a new potential therapeutic target for cardiac regeneration.

Myxomatous mitral valve disease (MMVD), the most common heart disease in small-breed dogs, is characterized by mitral regurgitation (MR) resulting from valvular degeneration, which may progress to left-sided heart failure. This report describes the cases of three dogs with severe MMVD (American College of Veterinary Internal Medicine Stages C or D) who exhibited an unexpected spontaneous reduction in MR despite continued valve degeneration.

Three dogs initially presented with symptoms of heart failure and left atrial and ventricular enlargement. Standard treatment, including diuretics, improved their conditions; however, further monitoring revealed that the coaptation gap decreased due to mitral valve thickening, leading to a reduction in MR. This was accompanied by a significant decrease in heart size. As a result, diuretics were discontinued, and all dogs were successfully managed with pimobendan alone.

To our knowledge, this is the first report of spontaneous MR reduction in MMVD, where coaptation gap narrowing played a role in clinical improvement. These cases may broaden the current understanding of MMVD progression, suggesting that, in rare instances, changes in cardiac remodelling and clinical status can occur. Further research is warranted to better understand the underlying mechanisms.

This study was an exploratory secondary analysis of data from a previously conducted randomized controlled trial (RCT) involving older adults receiving long-term care (LTC). The present secondary analysis explored the effects of an accelerometer-guided self-monitoring intervention on prolonged sedentary behavior (≥ 30 min) and physical activity in older adults with cardiovascular conditions.

This exploratory secondary analysis used data from an RCT conducted at a Japanese daycare center (October 2022-January 2023). The parent RCT included 52 participants (26 in the intervention group and 26 in the control group). Of these, 36 participants with cardiovascular conditions were eligible for the present exploratory secondary analysis (intervention, n = 21; control, n = 15). The main outcome was prolonged sedentary behavior accumulated in bouts of ≥ 30 min. Other outcomes included daily step count, sedentary behavior in bouts of ≥ 1 and ≥ 60 min, sedentary bout counts and break counts, physical activity intensity, and EQ-5D-5L utility scores. Outcomes were analyzed using linear mixed-effects models.

Thirty-three participants with available baseline outcome data were included in the analyses (intervention, n = 19; control, n = 14). Significant group × time interactions were observed for step count, sedentary behavior in bouts of ≥ 1 min and ≥ 30 min, sedentary bout counts, and light physical activity (p < 0.05). Moderate-to-vigorous physical activity and EQ-5D-5L utility scores did not change significantly.

Accelerometer-guided self-monitoring may influence prolonged sedentary behavior and physical activity in older adults with cardiovascular conditions receiving LTC. These findings provide preliminary, hypothesis-generating evidence that self-monitoring may represent a promising approach to reducing prolonged sedentary behavior in older adults receiving LTC. Confirmation in adequately powered RCTs is warranted.

Foot drop is a common post-stroke gait impairment that reduces toe clearance and compromises walking safety. Existing assistive interventions are often limited by passive compensation, external power requirements, and manual tuning. Here, we introduce a wearable, gait-timing-adaptive, self‑powered neuroprosthesis (SPN) that augments ankle dorsiflexion and corrects gait patterns, avoiding labor-intensive parameter tuning and eliminating the charging and reliability burdens of external batteries. The SPN leverages gait's out‑of‑phase mechanics: it harvests mechanical energy during stance on the non‑paretic limb and immediately converts it into electrical stimulation of the tibialis anterior on the paretic limb during swing, increasing dorsiflexion when foot clearance is required. In ambulatory stroke survivors with preserved walking capacity, foot drop, and lower-limb impairment (Fugl-Meyer LE Score: 13-27/34, Modified Ashworth Scale-Ankle Plantarflexors: 0-2), the SPN assistance produced immediate, clinically meaningful gains during outdoor walking: dorsiflexion angle improved from -1.1° to 6.8°, walking distance increased by 67.3%, speed by 43.5%, and gait variability decreased by 71.9%. These findings demonstrate the SPN's potential to restore dorsiflexion, enhance mobility, and improve overall quality of life for individuals recovering from stroke, particularly those at later stages of life.

Palestinian refugee camps in the occupied West Bank share the same geographic space as adjacent urban neighbourhoods but remain socially, politically and institutionally distinct. This study examined whether refugee camp residence is associated with greater exposure to human rights violations, political violence, deprivation and poorer mental health. A cross-sectional survey of 3000 Palestinian adults was conducted in 2025 across three refugee camps and neighbouring urban areas. Multivariable logistic regression was conducted. Overall, 77.1% reported at least one human rights violation, 91.7% deprivation, 77.1% personal exposure to political violence, 81.1% witnessed political violence and 30.0% dissatisfaction with mental health. Compared with urban residents, refugee camp residents had higher odds of reporting any human rights violation (aOR 1.52, 95% CI 1.28-1.81), personal (aOR 3.48, 95% CI 2.54-4.78), household (aOR 4.24, 95% CI 3.62-4.98) and witnessing political violence (aOR 4.48, 95% CI 3.52-5.69), deprivation (aOR 1.60, 95% CI 1.34-1.91) and dissatisfaction with mental health (aOR 2.51, 95% CI 1.97-3.19). The results suggest that health inequities experienced by Palestinian refugee camp residents are produced through the cumulative effects of structural violence, deprivation and systematic human rights violations rather than by spatial location alone.

Aphasia affects both the individuals and their families, impacting communication, social connectedness, roles and mental health. The focus in neurorehabilitation often remains on the individual, yet research suggests that addressing the family as a system would be beneficial. It remains unknown to what extent this is translated into clinical practice.

To explore professionals' perspectives on communication support and training addressing the needs of families living with aphasia across disciplines, positions and stages of neurorehabilitation in Denmark.

An online survey with 21 items was developed and distributed via clinical networks and social media. The survey focused on characteristics of current services, perceived needs, barriers and facilitators related to communication support and training. Descriptive statistics and qualitative content analysis were applied.

A total of 285 professionals from different professions and positions completed the survey. The majority of respondents reported that their institution provided communication support and training for individuals living with aphasia and/or their relatives, but often inadequately and several unmet needs were highlighted. The need for a more systematic, flexible, tailored and outreached approach to communication training to address the multi-faceted and evolving needs of families living with aphasia was highlighted.

The results highlight the importance of supporting and training professionals in addressing the needs of families living with aphasia throughout the course of rehabilitation and life with aphasia. This highlights the necessity of developing and providing more flexible and tailored interventions directed at these families in order to achieve genuine and sustainable changes.

What is already known on the subject Aphasia impacts both the individual and their families, whose rehabilitation needs are complex and evolving over time. Family-focused interventions such as communication partner training (CPT) are recognised as beneficial yet remain inconsistently implemented and rarely embedded in routine clinical services. What this paper adds to existing knowledge This study provides insight into professionals' experiences with CPT and informational support. It reveals that while such services are often offered, they are rarely sufficient in term of timing, content and consistency. It identifies barriers to implementation, including organisational fragmentation, lack of structured training and limited interdisciplinary coordination. What are the potential or actual clinical implications of this work? The findings emphasise the importance of recognising the family as a unit of care in aphasia rehabilitation. To meet complex and evolving needs, rehabilitation should be tailored, repeated, outreached and flexible. Sustainable implementation of CPT requires organisational commitment and interdisciplinary collaboration, ensuring that support is both accessible and responsive.