A 58-year-old male wearing a wearable cardioverter defibrillator due to severe dilated cardiomyopathy with multi-vessel coronary disease presented a cardiac arrest (CA) with ventricular fibrillation refractory to conventional cardiopulmonary resuscitation (CPR). The decision was made to expand CPR to extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal life support in the prehospital setting. ROSC was obtained after pump activation, and the patient was admitted to the intensive care unit, sedated and mechanically ventilated while under ECPR support. Despite an initial hemorrhagic shock due to mispositioning of the initial arterial canula requiring surgical repair, neurological evaluation was favorable and allowed for emergency heart transplantation candidacy. The patient was transplanted on day 7 after CA and discharged neurologically intact for rehabilitation on day 60. This case report shows how ECPR can be a bridge to definitive treatment if adequately integrated into an optimized out-of-hospital cardiac arrest chain of survival.

BackgroundPost-cardiotomy cardiogenic shock (PCCS) remains one of the most lethal complications of cardiac surgery, with high in-hospital mortality despite major improvements in operative techniques, and intensive care management. Temporary mechanical circulatory support (tMCS) is widely applied as a rescue therapy for refractory PCCS. However, outcomes remain suboptimal, also due to delayed initiation after the onset of severe hemodynamic collapse and irreversible compromised end-organ states. This review summarizes current concepts of PCCS management and evaluates the emerging role of prophylactic tMCS within the framework of "protected cardiac surgery".MethodsA narrative review of the current international guidelines, expert consensus statements, and major observational studies addressing post-cardiotomy tMCS and prophylactic support strategies was carried out. Emphasis was placed on pathophysiology, indications, timing of support, and device selection.ResultsProphylactic tMCS has been applied in selected high-risk scenarios including acute coronary syndromes, acute valvular dysfunction, ventricular septal rupture, papillary muscle rupture, advanced heart failure requiring bridge-to-decision or to-transplant, or difficult and complex weaning from cardiopulmonary bypass. The concepts of preoperative (Type 1), planned intraoperative (Type 2), and unplanned early intraoperative (Type 3) protected cardiac surgery provide a practical framework for a timely evaluation and related action aiming at metabolic stabilization to reduce or prevent postoperative low cardiac output syndrome. Successful implementation depends on multidisciplinary Heart Team decision-making, advanced hemodynamic assessment, and tailored perfusion strategies as well as device selection also based on local resources and expertise.ConclusionsProphylactic tMCS represents a paradigm shift from reactive rescue therapy toward proactive cardio-circulatory protection in selected high-risk patients undergoing cardiac surgery procedures. While early observational data are encouraging, prospective trials, standardized risk stratification tools, and cost-effectiveness analyses are required to define its role in modern cardiac surgery.

Post-Cardiotomy Cardiogenic Shock (PC-CS) after Mitral Valve Replacement (MVR) is a rare but severe complication, which may require ECMO for the acute phase of the illness. These PC-ECMO (Post-Cardiotomy ECMO) are particularly complex cases, as the low flow through the newly replaced valve may cause a very rapid formation of thrombus, blocking the leaflets, that worsens the blood stasis inside the left atrium, extending the thrombosis. To maintain the trans-mitral flow during PC-ECMO, three milestone should be present: the transpulmonary flow should be maintained, the blood reaching the left atrium should be free to cross the mitral prosthesis and the left ventricle should be fully unloaded. The selection of the appropriate PC-ECMO configuration should be guided by the specific functional status of the right ventricle (RV) and left ventricle (LV). When only one ventricle is failing, monoventricular support is preferable. However, when PC-CS involves both ventricles, ex-BiVAD might be a valuable option, but it requires invasiveness on the LV and may be challenging to manage, especially in the early phase of the illness. Conversely, when minimal residual LV function is preserved, the blood flow drained by the venous cannula (V) can be divided into two components, supporting respectively the RV and the systemic circulation. This newly proposed configuration may be referred to as V-PaA ECMO. In this case series, we analyse the physiological implication and the management consideration of three different ECMO configurations: Vpv-A ECMO, V-Pa\LVxA ECMO (ex-BiVAD) and our newly proposed configuration for biventricular support, V-PaA ECMO. This case series underscores how tailoring PC-ECMO configuration to ventricular physiology can critically influence clinical outcomes, highlighting the need for individualized support strategies after MVR.

Long-term oxygen therapy (LTOT) is a cornerstone of management for chronic hypoxemic respiratory diseases, such as chronic obstructive pulmonary disease, yet its physiological impact as a potent modulator of cardiovascular function remains a subject of ongoing investigation. While oxygen is primarily prescribed to correct arterial desaturation, its role as a regulator of vascular tone and cellular metabolism suggests it can exert significant, and sometimes contrasting, effects on the heart and systemic circulation. This review evaluates the evidence for LTOT in heart failure and pulmonary hypertension, 2 conditions where oxygen is frequently utilized despite varying levels of baseline hypoxemia. In heart failure, LTOT has not been shown to improve key hemodynamic variables and relevant endpoints, such as exercise capacity, in normoxemic patients. Some studies suggest that supplemental oxygen may even impose hemodynamic strain in this population by increasing systemic vascular resistance and reducing cardiac output. On the other hand, LTOT shows promise in improving relevant hemodynamic variables in pulmonary hypertension, such as mean pulmonary arterial pressure, as well as exercise capacity and other clinical measures across various baseline oxygen saturation levels. These findings suggest that the cardiovascular response to LTOT is highly dependent on the specific underlying pathology.

Chronotropic incompetence (CI), defined as the inability of the heart to appropriately increase its rate in response to exercise, is associated with exercise intolerance and adverse events. However, the diagnostic criteria for CI vary widely, limiting their clinical applicability and comparability across studies. Here we aim to systematically map the current definitions of CI and the prediction models used to estimate age-predicted maximal heart rate (APMHR). We illustrate how this diagnostic variability affects the identification of CI in patients enrolled in a cardiac rehabilitation program.

A scoping review systematically identified all published definitions of CI and prediction models for APMHR. A retrospective study evaluated the agreement between definitions in patients participating in cardiac rehabilitation.

A total of 86 studies were included. Seventeen distinct methods to define CI were identified, ranging from absolute or relative peak heart rate parameters to approaches incorporating workload. In many cases, the applied cut-off values lacked a rationale. In parallel, numerous APMHR formulas were identified, differing by sex, age category, fitness level, clinical status, and the use of beta-blocker therapy, showing limited accuracy. In the clinical setting agreement between four major definitions was poor and pairwise comparisons between them showed significant differences in classification.

Current methods to define CI and predict APMHR are inconsistent and problematic. This review provides a practical framework for selecting a context-appropriate definition and formula. It identifies current methodological gaps and highlights the need for future research to establish a consensus definition of CI.

The cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway and inflammasomes were long regarded as distinct innate immune modules that respond to different classes of danger signals. However, accumulating evidence now reveals extensive, bidirectional crosstalk between these pathways, forming an integrated regulatory network that critically shapes the magnitude, quality, and outcome of immune responses. The balance of this network determines whether the host mounts effective pathogen control and tumor immunosurveillance, or instead succumbs to excessive inflammation, tissue injury, or autoimmune pathology.

In this review, we synthesize current mechanistic understanding of STING-inflammasome interactions, highlighting how shared upstream triggers - particularly cytosolic DNA - coordinate the activation, amplification, or restraint of these pathways. We further examine how this axis exerts context-dependent, dualistic functions across diverse disease settings, including cancer, autoimmunity, neurodegeneration, chronic infection, and aging. From a pharmacological perspective, we discuss emerging therapeutic strategies aimed at modulating key regulatory nodes within this signaling network, ranging from STING agonists for cancer immunotherapy to selective STING or the NLR family pyrin domain-containing 3 (NLRP3) inhibitors for autoimmune and inflammatory diseases.

Together, these insights provide a conceptual and translational foundation for the rational development of next-generation immunomodulatory agents targeting the STING-inflammasome axis.

Whereas the brain-heart axis is an emerging field in neuropsychocardiology, a central autonomic network including the insular cortex (Ic) regulates the cardiovascular system via the intrinsic cardiac nervous system. Cardiac interoception, represented in Ic, has been studied in cardiovascular diseases and inflammation. Therefore, it is important to investigate how interoception is related to cardiovascular disease in terms of its prevention and treatment. To examine the role of the Ic in cardiovascular and immune regulation, we focus on converging evidence from human stroke cohorts, lesion-symptom mapping studies, and experimental models that implicate the Ic as a causal hub within the brain-heart-immune axis. In particular, Ic plays a pivotal role in processing interoception as well as immunoception, and based on this information, Ic regulates cardiovascular and immune systems via efferent autonomic networks. Furthermore, vagally mediated neuromodulation is likely to influence interoception and immunoception and plays a pivotal role in improving cardiovascular dysregulation.

Brain health encompasses a multitude of health and lifestyle factors that can reduce the occurrence and severity of dementia. Older Veterans face unique risk factors for dementia, which makes promoting brain health a priority for the Veteran Health Administration (VHA). However, Veterans encounter barriers to implementing these recommendations, such as uncertainty about where to start, minimal personal investment, lack of social support, or negative emotional reactions to cognitive changes. We explain how principles from acceptance and commitment therapy (ACT) can address these barriers and facilitate personal engagement with brain health, and describe a group ACT intervention called Balanced Brain. We used a mixed-method, multiphase approach using clinician interviews to develop and refine the intervention, followed by pilot testing to determine feasibility and acceptability with older Veterans. Six VHA clinicians described barriers and facilitators to brain health promotion and suggested content to include in an intervention. We then recruited 21 Veterans into two group cohorts, collected data on feasibility and attrition, and assessed program satisfaction using the Client Satisfaction Questionnaire-8. Over three-quarters of Veterans attended 75% or more of group sessions, although telehealth connectivity issues were common. Veterans indicated high overall satisfaction with Balanced Brain, suggesting it as a feasible and acceptable intervention for teaching brain health principles alongside ACT coping skills to address psychosocial barriers to health behavior change.

Stigma negatively affects the well-being of individuals with severe mental disorders (SMD). However, its specific impact on romantic and sexual intimacy remains fragmented in the literature. This study aimed to identify which aspects of intimate life are affected by stigma and the factors mediating this relationship.

A systematic review following PRISMA-P guidelines was conducted using Scopus, Web of Science, PubMed, EBSCOhost, VHL, and SciELO without date restrictions. Due to high methodological heterogeneity among the 26 included studies, a narrative synthesis was utilized to integrate findings.

Findings involving participants with Schizophrenia Spectrum, Bipolar, and Major Depressive Disorders reveal distinct stigma mechanisms. Medication side effects (e.g., sexual dysfunction, weight gain) act as catalysts for internalized stigma, transforming physical symptoms into barriers for romantic desirability. Gender norms exacerbate exclusion: women face intense scrutiny regarding parenting capacity and are vulnerable to intimate partner violence to avoid isolation, while men perceive functional impairment as a failure of masculine identity. Additionally, professional silence regarding sexuality reinforces the 'asexual' stereotype, leaving relational needs unsupported.

The results underscore that stigma permeates the intimate lives of individuals with SMD through biological, social, and professional pathways. Clinical practice must urgently integrate sexual health assessments and relational support into routine care. Future interventions should focus on reducing professional bias and supporting the sexual and reproductive rights of this population.

This study tested whether adverse mood effect of the oral contraceptive pill (OCP) is associated with reproductive depressive episodes, including peripartum depression (PPD), premenstrual dysphoric disorder (PMDD), and perimenopausal depression.

In a sample of 3,547 OCP users from the Australian Genetics of Depression Study, who reported a lifetime depression diagnosis, logistic regression was used to test the association of PPD, PMDD, and perimenopausal depression with OCP adverse mood effect. Polygenic scores (PGS) for major depression (MD) were also tested for association with adverse mood effect. Sensitivity analyses tested for modification of these associations by a history of depression prior to first OCP use (prior depression), or by depression onset before the age of twenty (child/teen depression onset).

Adverse mood effect was reported by 1,342 OCP users (38%). PPD, PMDD, prior depression and child/teen depression onset were significantly associated with adverse mood effect (PPD: Relative Risk (RR) = 1.66,CI=[1.4-2.0], P = 2.0 × 10^- 6; PMDD: RR = 3.78,CI=[2.4-6.0], P = 2.2 × 10^- 8; prior depression: RR = 1.32,CI=[1.1-1.5], P = 5.9 × 10^- 4; child/teen depression onset: RR = 1.56,CI=[1.3-1.8], P = 1.1 × 10^- 7). The association of PPD with adverse mood effect remained significant for women with no prior or child/teen depression onset (RR = 1.77,CI=[1.3-2.4], P = 4.6 × 10^- 4), but was not significant for women with both prior and child/teen depression onset. Adverse mood effect was significantly associated with PGS for MD: full sample: RR = 1.18,CI=[1.1-1.3], P = 3.6 × 10^- 5); no prior or child/teen depression onset: RR = 1.27,CI=[1.1-1.4], P = 3.1 × 10^- 4.

Participants who experience an adverse mood effect with OCP use are likely to have higher genetic vulnerability for depression, and experience child/teen depression onset, as well as reproductive depressive episodes such as PPD.