Blood pressure management following successful reperfusion with endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion remains debated. This meta-analysis aimed to determine whether intensive systolic blood pressure (SBP) management improves clinical outcomes compared with a standard approach after endovascular thrombectomy.

We systematically searched PubMed, Scopus, Embase, and Web of Science through October 2025 for relevant randomized controlled trials comparing intensive (SBP target <140 mm Hg) versus standard (SBP target <180 mm Hg) management. The primary efficacy and safety outcomes were functional independence (modified Rankin Scale score, 0-2) and any intracranial hemorrhage, respectively. We performed frequentist and Bayesian random-effects meta-analyses, supplemented by trial sequential analysis.

Six randomized controlled trials comprising 1972 patients were included. In frequentist analysis, intensive SBP management was associated with a significantly reduced likelihood of achieving functional independence (risk ratio, 0.83 [95% CI, 0.73-0.93]). Bayesian analysis confirmed this harmful effect (posterior median risk ratio, 0.83 [95% credible interval, 0.7-1.02]), with a posterior probability of benefit of only 3.2%. Furthermore, ordinal shift analysis indicated that intensive SBP management was associated with a significant shift toward worse functional outcomes across the full modified Rankin Scale score distribution (common odds ratio, 1.26 [95% CI, 1.10-1.44]), a finding supported by a low posterior probability of benefit of 2.1%. No significant differences were observed in the risk of any intracranial hemorrhage (risk ratio, 1.05 [95% CI, 0.96-1.16]). The corresponding Bayesian analysis yielded a posterior risk ratio estimate of 1.05 (95% credible interval, 0.90-1.21) for any intracranial hemorrhage, with a posterior probability of benefit of 23%. Trial sequential analysis indicated that the cumulative evidence reached the boundary for harm and futility for the primary efficacy and safety outcomes, respectively.

In patients with acute ischemic stroke following successful endovascular thrombectomy, intensive SBP management was associated with worse functional outcomes and provided no clear safety benefit. These findings support a standard, guideline-based SBP management strategy over an intensive approach.

Ultra-processed foods (UPFs) now dominate dietary intake in many countries and are consistently associated with higher risks of cardiovascular disease (CVD), including myocardial infarction, stroke, and heart failure. Beyond excess sodium, sugar, and unhealthy fats, UPFs may exert cardiovascular harm through food matrix disruption, processing-generated toxicants, additive exposure, and microbiome perturbation. These upstream insults converge on inflammatory, oxidative, and metabolic signaling pathways that regulate microRNAs (miRNAs), a class of small non-coding RNAs that orchestrate post-transcriptional gene expression across endothelial cells, vascular smooth muscle cells, macrophages, platelets, and metabolic tissues. In this review, we propose a unifying mechanistic framework in which UPF exposure reshapes both intracellular and extracellular vesicle (EV)-associated miRNA networks, thereby linking gut, liver, adipose tissue, and the vascular wall in a feed-forward cardiometabolic signaling loop. We synthesize evidence across epidemiology, experimental models, and human dietary intervention studies, while explicitly distinguishing established, emerging, and speculative mechanisms to avoid over-interpretation. We further discuss translational opportunities, including circulating miRNA/EV-miRNA biomarkers, nutritionally responsive miRNA signatures, and miRNA-targeted therapeutics. Together, this framework positions the UPF-miRNA/EV axis as a plausible molecular bridge between modern dietary exposure and atherosclerotic disease progression, and highlights priority areas for mechanistic validation and clinical translation.

Pathological remodeling in cardiomyocytes during heart failure is driven by excessive activation of mTORC1. Preclinical studies in mice demonstrated that reducing mTORC1 activity protects against cardiac dysfunction and hypertrophic remodeling. However, clinical application of current mTOR inhibitors is limited by incomplete mTORC1 inhibition and off-target effects, including suppression of mTORC2-mediated pro-survival signaling. To address these challenges, the therapeutic effects of the third-generation bi-steric mTORC1 inhibitor RMC-6272 was tested in pressure overload induced heart failure models. The potency and selectivity of RMC-6272 were evaluated in isolated cardiomyocytes. Hypertrophy was induced by phenylephrine in vitro and aortic banding in vivo. Cardiomyocyte-specific mRNA translation changes were assessed in αMHC-Cre Ribo-tag mice. RMC-6272 demonstrated superior potency and specificity for mTORC1 compared to rapamycin and Torin1. RMC-6272 prevented pathological hypertrophic growth in vitro and suppressed mTORC1-dependent mRNA translation, particularly those encoding components of the translational machinery. Preventive RMC-6272 treatment preserved cardiac function under pressure overload, maintaining contractile dysfunction in mice. Therapeutic treatment improved function in established hypertrophy, demonstrating therapeutic potential even after disease onset.

Allergic rhinitis displays a relevant impact on quality of life. Medications used in the treatment of rhinitis have been assessed on their impact on rhinoconjunctivitis-related quality of life, but not on generic health-related quality of life metrics, such as utilities or EQ-5D visual analogue scale (VAS) levels. This study aimed to compare different medication classes and individual medications on utilities and EQ-5D VAS levels using data from a mobile app.

We conducted an observational study using direct patient data from the MASK-air mobile application, collected between May 2015 and December 2024. We compared rhinitis medication classes and individual medications on health utilities (computed from the EQ-5D-5L questionnaire) and the EQ-5D VAS. To account for confounding, we employed inverse probability treatment weighting based on propensity scores, adjusting for demographics, baseline symptom control, and asthma status.

The study analysed 69,973 observations with EQ-5D VAS data and 842 observations with utility data. At the medication class level, fixed combinations of intranasal antihistamines and corticosteroids were associated with improvements in EQ-5D VAS (mean difference = 1.900; 95% CI = 1.316-2.484) and utilities (mean difference = 0.022; 95% CI = -0.015 to 0.059) compared with oral antihistamines (OAH). Intranasal antihistamines were associated with lower EQ-5D VAS and utility scores than other intranasal treatments. For individual medications, mometasone was associated with a lower EQ-5D VAS than budesonide and fluticasone furoate, while fexofenadine and levocetirizine tended to be associated with lower VAS values than other OAH.

Fixed combinations of intranasal antihistamines and corticosteroids were associated with better quality-of-life than oral antihistamines and intranasal antihistamines. These findings could support future cost-effectiveness analyses.

Atrial fibrillation (AF) is a common cardiac dysrhythmia encountered in the Emergency Department (ED) setting. The term, 'recent-onset AF', whilst inconsistently defined across protocols and guidelines, generally refers to the 48-h window for cardioversion when used in the ED setting. A clear terminology and taxonomy of AF is needed to guide ED clinicians, researchers and patients with respect to AF and its acute presentation to the ED. In this article, we discuss the current inconsistencies with terminology pertaining to acute AF and present evidence to support the use of the term 'acute recent-onset AF'. In addition, a three-part taxonomy is suggested to better delineate the various presentations of AF to the ED.

A 41-years-old woman presented with left-sided headache, diplopia, and ptosis of the left eyelid. Cerebral computed tomography angiography revealed a left persistent primitive trigeminal artery cavernous sinus fistula and a dissecting aneurysm in the V4 segment of the left vertebral artery. Digital subtraction angiography confirmed the diagnosis. The fistula was successfully occluded using dual-microcatheter coil embolization combined with Onyx-18 injection, assisted by balloon protection of the internal carotid artery. The vertebral artery dissecting aneurysm was managed conservatively by administering dual antiplatelet therapy (aspirin (100 mg/day) and clopidogrel (75 mg/day) for 3 months). Follow-up imaging at 11 months demonstrated complete resolution of the aneurysm.

IntroductionOne potential indication for ECPR is drug poisoning complicated by shock and severe cardiac failure. Over the past 3 years, only one case of in-hospital cardiac arrest due to poisoning was managed with ECPR at our center.Case reportThe patient was a 12-year-old girl with a body weight of 60 kg. She attempted suicide by ingesting molsidomine and cinnarizine tablets. Shortly after admission, she developed cardiac arrest, and ECPR was indicated. After 67 min of CPR, ECMO support was established. A pigtail catheter was subsequently inserted for left ventricular unloading. During treatment, the patient was converted to V-V ECMO due to the development of Harlequin syndrome. Finally, she was discharged from the hospital with a good neurological outcome.DiscussionRecent advances in ECPR highlight its potential role in the management of drug-induced cardiac arrest. Centers providing ECPR must be prepared for subsequent ECMO management, including the need for conversion to alternative ECMO configurations.ConclusionThe use of ECPR, particularly in cases of cardiac arrest caused by drug overdose, is justified and effective, as ECMO provides time for drug metabolism and subsequent organ recovery.

IntroductionThe mortality of patients with mechanical complications following myocardial infarction is high. Surgical repair is challenging due to the fragility of ischemic myocardial tissue. The course is frequently complicated by cardiogenic shock, acute kidney injury and respiratory failure.Case reportWe present a patient with out-of-hospital cardiac arrest due to myocardial infarction and left ventricular free-wall rupture, who received extracorporeal cardiopulmonary resuscitation (ECPR), early surgical repair and prolonged veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. The physical outcome of the patient was good with satisfactory exercise tolerance (NYHA II) and there were no neurological deficits following ECPR.DiscussionIn select cases, VA ECMO can be an option to stabilize patients before and after surgical repair to allow for myocardial scarring and hemodynamic recovery. Advanced hemodynamic monitoring should be considered during the run and weaning from ECMO.ConclusionCases of free-wall rupture and cardiogenic shock are challenging and multidisciplinary teamwork of cardiac surgeons, cardiologists, intensivists and nurses is indispensable.

IntroductionExtracorporeal Cardiopulmonary Resuscitation (ECPR) is a lifesaving intervention for in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA). However, severe aortic regurgitation (AR) has traditionally been considered an absolute contraindication for veno-arterial extracorporeal membrane oxygenation (V-A ECMO).Case reportA 63-year-old man with aortic regurgitation experienced IHCA with 50 min of low-flow time. The patient received ECPR and emergent valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) through a rapid multidisciplinary approach. Despite transient focal neurological symptoms in the early post-resuscitation period, the patient steadily recovered and was discharged with a favourable Cerebral Performance Category (CPC) of 2.DiscussionThis case challenges the absolute contraindication of severe aortic regurgitation for veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and ECPR candidacy, demonstrating that a multidisciplinary approach with planned venting strategies and rapid definitive intervention can lead to satisfactory patient outcomes.ConclusionSevere aortic regurgitation may not absolutely preclude candidacy for peripheral V-A ECMO. A pre-emptive approach integrating detailed venting strategies with emergent transcatheter interventions expands the salvageable population with valvular heart disease.

IntroductionRefractory cardiac arrest carries a poor prognosis. Extracorporeal cardiopulmonary resuscitation (ECPR) can be lifesaving but is associated with high morbidity and mortality. We report a likely underdiagnosed complication - non-occlusive mesenteric ischemia (NOMI) - following ECPR, emphasizing the diagnostic challenges and the role of early endoscopic evaluation and an interdisciplinary assessment of these patients.Case PresentationA 48-year-old man presented with ST-elevation myocardial infarction and developed refractory cardiac arrest due to ventricular fibrillation. ECPR was initiated, and extracorporeal membrane oxygenation (ECMO) flow was achieved after 77 min of cardiopulmonary resuscitation. Early after arrest, the patient passed bloody stool, raising suspicion of mesenteric ischemia. Computed tomography was inconclusive, but colonoscopy revealed ischemic bowel injury. Given the fatal potential of untreated NOMI, prompt colectomy was performed. The patient stabilized postoperatively, recovered progressively, and was discharged from the intensive care unit in good condition after 14 days.ConclusionNOMI should be considered in ECPR patients presenting with gastrointestinal bleeding, even when cross-sectional imaging findings are inconclusive. Early colonoscopy enables timely diagnosis and surgical intervention, potentially improving survival in this high-risk setting.