The incidence of corrected QT interval (QTc) prolongation and torsades de pointes (TdP) in individuals undergoing methadone maintenance treatment (MMT) is a significant concern, as studies indicate that methadone can lead to these cardiac complications.

A systematic search was performed across various databases including PubMed, Scopus, and Embase from January 2000 to July 2025. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) for observational studies.

Twenty-two observational studies were included. The pooled mean age of patients undergoing MMT across the included studies was 40.8 years (95% confidence interval [CI]: 37.9-43.8). The overall pooled proportion of male participants across the included studies was 73% (95% CI: 66-81%). Incidence of QTc prolongation among patients on MMT showed a prevalence of 34% (95% CI: 24-43%). The pooled incidence of TdP was 2% (95% CI: 0-5%) after removing outlier study. The majority of evidence supports a dose-dependent relationship between methadone and QTc prolongation, though TdP remains rare and inconsistently linked to dose. This underscores the need for individualized dose titration and electrocardiogram monitoring, especially at higher daily doses (>100 mg).

MMT is associated with a substantial risk of QTc prolongation and a low but clinically relevant risk of TdP. Careful dose adjustment and regular electrocardiogram monitoring, particularly at higher doses, are essential to minimize cardiac complications.

Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for language recovery in post-stroke aphasia, yet the efficacy of different frequency protocols remains to be fully understood. This study aims to explore the efficacy of high versus low-frequency rTMS on language recovery in post-stroke aphasia. In this retrospective cohort study, 194 patients with post-stroke aphasia who underwent rTMS treatment from December 2019 to December 2022 were analyzed. Patients were categorized into 2 groups based on the frequency of rTMS received: low frequency (≤1 Hz, n = 101) and high frequency (≥5 Hz, n = 93). National Institutes of Health Stroke Scale scores were recorded to quantify overall neurological deficits at baseline. Language outcomes were assessed using the Western Aphasia Battery-Aphasia Quotient (WAB-AQ) and the Boston Naming Test (BNT) at baseline, immediately post-treatment, and 2 months later. Adverse events were also recorded. One day post-treatment, the low-frequency rTMS group showed significantly greater improvements in WAB-AQ scores compared to the high-frequency group (P < .001), with significant enhancements in spontaneous speech, auditory comprehension, repetition, and naming (all P < .001). BNT scores also improved significantly in the low-frequency group (P = .025). At the 2-month follow-up, both groups exhibited continued improvement, but the low-frequency group maintained significantly greater gains in WAB-AQ (P < .001), BNT (P = .032), spontaneous speech (P < .001), auditory comprehension (P = .003), repetition (P = .041), and naming (P = .019). Linear mixed model analysis confirmed that low-frequency rTMS facilitated superior language recovery, with significant Time*Group interactions observed for WAB-AQ (P < .001), spontaneous speech (P < .001), auditory comprehension (P < .001), and naming (P = .034). High-frequency rTMS was associated with a higher frequency of headaches (P = .018) and scalp dysesthesia (P < .001). Serious adverse events were significantly less frequent in the low-frequency group (P < .001). Low-frequency rTMS is more effective and safer than high-frequency rTMS in improving language recovery for patients with post-stroke aphasia. These findings suggest a potential preference for low-frequency rTMS in clinical settings.

Music can stimulate the central nervous system and may exert calming, analgesic, and negative emotion-reducing effects. It has been applied in the treatment of various psychological disorders, including post-stroke depression (PSD). This study systematically assesses the efficacy of music therapy in improving depressive symptoms in patients with PSD.

A comprehensive search was conducted in 9 databases including Web of Science, PubMed, EMBASE, CNKI, VIP, and Wanfang, covering all publications up to January 7, 2024. Two researchers independently screened articles on music therapy interventions for PSD. Quality assessment and meta-analysis were performed using RevMan 5.3.

A total of 37 randomized controlled trials with 2776 patients were included in the study. Meta-analysis showed that music was effective in improving Hamilton depression scale scores (mean differences [MD] = -4.76, 95% confidence interval [CI]: -6.11 to -3.40, P < .00001), Zung Self-Rating Depression Scale scores (MD = -5.25, 95% CI: -6.20 to -4.30, P < .00001), Zung Self-Rating Anxiety Scale scores (MD = -7.34, 95% CI: -8.71 to -5.97, P < .00001), Barthel index (MD = 13.59, 95% CI: 6.83-20.35, P < .00001, activities of daily living scores (MD = 13.09, 95% CI: 4.12-22.05, P < .00001), neurological deficit score (standardized mean difference = -1.62, 95% CI: -1.88 to -1.35, P < .00001), 5-hydroxytryptamine (MD = 0.86, 95% CI: 0.56-1.16, P < .00001) in PSD patients compared to the conventional rehabilitation group.

Music therapy has demonstrated significant clinical efficacy in improving depressive symptoms, daily living skills, the degree of neurological deficits, and serum 5-hydroxytryptamine levels in individuals with PSD.

Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. Middle meningeal artery embolization (MMAE) combined with subdural drainage has become the mainstream treatment option, significantly reducing surgical trauma and hospitalization time. However, in clinical practice, a certain proportion of patients still experience postoperative recurrence, which not only affects patient prognosis but also increases the burden on medical care. Currently, the risk factors for recurrence after this combined surgical procedure have not been fully identified, and there is an urgent need for in-depth research to provide scientific evidence for clinical intervention. To investigate the risk factors for recurrence in patients with CSDH after MMAE combined with subdural drainage and to establish a predictive model. A total of 211 patients were included in this study, among whom 35 patients experienced postoperative hematoma recurrence. The patients enrolled in this study were randomly divided into a training set and a validation set in a 7:3 ratio, with 147 patients in the training set and 64 patients in the validation set. This study collected patients' medical histories, onset conditions, and relevant information during hospitalization to study the factors affecting recurrence in patients with CSDH after MMAE combined with subdural drainage, and established a predictive model. Potentially relevant factors were included in univariate logistic regression analysis, and the results showed that gender, postoperative drainage volume, postoperative statin use, postoperative hyperbaric oxygen therapy, admission Glasgow Coma Scale score, and preoperative hematoma volume were potential risk factors for recurrence in patients with CSDH who underwent MMAE combined with subdural burr hole drainage, P < .2. Further inclusion of the obtained data in a multivariate retrospective analysis revealed that postoperative drainage volume, postoperative hyperbaric oxygen therapy, admission Glasgow Coma Scale score, and preoperative hematoma volume were independent risk factors for recurrence in patients with CSDH who underwent MMAE combined with subdural burr hole drainage (P < .05). The predictive model developed in this study can help neurosurgeons accurately identify high-risk CSDH patients who are likely to experience recurrence after MMAE combined with subdural burr hole drainage.

This study aims to reveal the correlation between the hemoglobin-to-red cell distribution width ratio (HRR) and mortality among the patients with aortic dissection (AD). We identified critically ill patients with AD in MIMIC-IV database. The optimal cutoff value of HRR was calculated through ROC curve analysis conducted by using the maximum Youden index for the prediction of survival status. The primary outcome was 30-day mortality, with 90-day and 365-day all-cause mortality as secondary outcomes. The Cox proportional hazard regression models were utilized to analyze the association between baseline HRR and mortality. Restricted cubic splines analysis was utilized to determine the relationship curve between mortality and the HRR level and examine the threshold saturation effect. We further applied Kaplan-Meier survival curve analysis to examine the consistency of these correlations. The interaction test was used to identify subgroups with differences. A total of 540 patients were included, the optimal cutoff value of the HRR was determined as 5.2 and the 30-day, 90-day, and 365-day all-cause mortality rates were 11.3%, 14.8%, and 20%, respectively. Multivariate Cox proportional hazards analysis revealed that the HRR was independently associated with mortality at 30 days (hazard ratio [HR] [95% confidence interval (CI)] 0.82 (0.69-0.98), P = .025), 90 days (HR [95% CI] 0.81 [0.7-0.93], P = .004), and 365 days (HR [95% CI] 0.83 [0.74-0.94], P = .003). Restricted cubic splines regression showed a positive linear association between the HRR and 90-day mortality risk, whereas a curvilinear relationship among 30-day and 365-day mortality. Kaplan-Meier survival curves further confirmed the significant survival disparities across HRR groups. Furthermore, subgroup analysis showed that there was an interaction between HRR and age in all-cause mortality. Low HRR is associated with increased all-cause mortality at 30, 90, and 365 days in critically ill AD patients, highlighting its potential as a prognostic indicator for risk stratification, particularly in elderly patients.

Low bone mineral density (BMD) is prevalent among older adults and has been associated with higher mortality risk. However, the relationship between BMD and mortality remains unclear. We investigated the association between total femur BMD and all-cause mortality, as well as cardiovascular disease (CVD) mortality, in a nationally representative cohort of US older adults. We analyzed 7397 participants aged ≥60 years from the National Health and Nutrition Examination Survey 1999 to 2018. Total femur BMD (g/cm²) was measured by dual-energy X-ray absorptiometry at baseline. Mortality follow-up was ascertained via linkage to National Death Index records through 2019, with cause of death classified by ICD-10 codes. Cox proportional hazards models estimated hazard ratios (HRs) for all-cause and CVD mortality in relation to BMD, adjusting for age, sex, race/ethnicity, education, marital status, poverty income ratio, smoking, and alcohol use. We used generalized additive models with penalized splines and 2-piecewise Cox models to explore nonlinear associations and identify potential threshold. Sensitivity analyses were performed to test the robustness of results. The mean age was 70.0 ± 7.1 years, and 53% of participants were women. During a median follow-up of ~10 years, 1989 participants (26.5%) died from all causes. A 2-piecewise Cox model identified an inflection point at BMD = 0.682 g/cm². Below this threshold, each 0.1 g/cm² increase in BMD was associated with a 39% decrease in all-cause mortality risk (HR = 0.61, 95% confidence interval: 0.53-0.69, P < .0001). Above 0.682 g/cm², the mortality reduction per 0.1 g/cm² increase was more modest (HR = 0.91, 95% confidence interval: 0.87-0.94, P < .0001). A similar pattern was observed for CVD mortality: lower BMD conferred disproportionately higher CVD death risk, with the protective impact of higher BMD leveling off beyond the ~0.68-g/cm² inflection point. All findings remained robust in sensitivity analyses. In this cohort, total femur BMD showed a nonlinear inverse association with mortality. Low femur BMD was associated with higher all-cause and CVD mortality, whereas differences in BMD above ~0.68 g/cm² had comparatively smaller effects on survival. Further research including prospective or interventional studies is needed to examine the potential relationship between BMD improvement and mortality risk reduction in this age group.

This study was designed to explore the cross-sectional association between dietary and serum sodium levels and the risk of hypertension within the general US population. A total of 15,349 adult participants were obtained from the National Health and Nutrition Examination Survey from 2011 to 2018. Weighted logistic regression analyses were employed to examine the associations between dietary and serum sodium and hypertension. The weighted restricted cubic spline was constructed based on the fully adjusted model to explore the dose-response relationship. Additionally, further stratified analyses were carried out. All data handling and analyses were executed using the "Survey" package in R software (Version 4.4.1). The mean age of the study population was 47.53 ± 0.33 years, with an average body mass index of 29.36 ± 0.12 kg/m2. Males accounted for 48.11%, and the weighted prevalence of hypertension was 38.14%. This study uncovered a positive association between the highest quartile of dietary sodium intake and the risk of hypertension among older adults, females, overweight or obese individuals, nonsmokers and nondrinkers, those with low levels of physical activity, and those without cardiovascular diseases. Moreover, a "V"-shaped nonlinear relationship was identified between serum sodium levels and the risk of hypertension among older, sedentary participants. Adopting a low-sodium diet and maintaining serum sodium levels at around 141 mmol/L may confer significant health advantages. Such an approach holds the potential to decrease the risk of hypertension and enhance overall cardiovascular health.

This study aimed to analyze the impact of the residual cholesterol inflammatory index (RCII) and the triglyceride-glucose-body mass index (TyG-BMI) on the risk of cardio-cerebrovascular disease (CCVD). Data were obtained from the China Health and Retirement Longitudinal Study, and participants were categorized into 4 groups based on optimal cutoff values of RCII and TyG-BMI. The influence of RCII, TyG-BMI, and their combination on CCVD was assessed using Cox proportional hazards regression and Kaplan-Meier survival models. A total of 7677 individuals were included. Both higher RCII and higher TyG-BMI were independently associated with increased risk of CCVD. Importantly, the combined elevation of RCII and TyG-BMI showed the highest risk (HR = 1.47, 95% CI = 1.21-1.78, P < .05), whereas elevation of either marker alone was not statistically significant. Furthermore, no significant multiplicative or additive interaction between RCII and TyG-BMI was observed. These findings suggest that combined assessment of RCII and TyG-BMI may better identify high-risk individuals, although the lack of interaction indicates that the 2 indices contribute independently to CCVD risk.

Patients with frailty still have a high risk of postoperative death even after undergoing medium and low stress surgeries. Early and effective identification of frailty helps improve the poor prognosis of those who need surgery. This study aims to explore the relationship between C-reactive protein/albumin ratio (CAR) and frailty and the risk of mortality. The clinical data of 14,743 participants in National Health and Nutrition Examination Survey were analyzed. The weighted logistic regression model was used to estimate the odds ratios of CAR and frailty. The weighted Cox regression model was used to estimate the hazard ratios of CAR and all-cause mortality, cardiovascular disease (CVD)-specific mortality, and cancer-specific mortality of frail participants. In addition, the nonlinearity of the above associations was evaluated and subgroup analysis was performed. The fully adjusted weighted logistic regression model showed a positive correlation between CAR and frailty [odds ratio (95% confidence interval [CI]): 1.23 (1.15-1.31), P < .0001]; restricted cubic spline regression indicated that this association was linear (nonlinear P = .059). Subgroup analysis suggested that the association between CAR and frailty was stronger in hypertension and CVD. In survival analysis, CAR significantly predicted all-cause mortality [hazard ratio [HR] (95% CI): 1.12 (1.05-1.20), P = .001], CVD-specific mortality [HR (95% CI): 1.18 (1.06-1.32), P = .003], and cancer-specific mortality [HR (95% CI): 1.12 (1.01-1.24), P = .03] in frail participants. CAR is independently and linearly positively correlated with frailty. In addition, an increase in CAR in frail participants also indicates a higher risk of death.

Thrombotic complications, particularly stroke, are significant causes of morbidity in children with sickle cell disease (SCD). While the Factor V Leiden (FVL) G1691A mutation is a recognized genetic risk factor for thrombophilia in Caucasian and Middle Eastern populations, its role in African pediatric SCD patients remains unclear. To determine the prevalence of the FVL G1691A mutation and its association with activated protein C resistance in Sudanese pediatric SCD patients with a history of cerebrovascular accidents. This descriptive cross-sectional study was conducted from December 2015 to May 2016 at Jaafar Ibn Auf Specialized Hospital for Children in Khartoum, Sudan. One hundred Sudanese children (<18 years) with homozygous SCD and documented cerebrovascular accidents were recruited. Genotyping for FVL was performed using allele-specific polymerase chain reaction (PCR), and activated protein C resistance was assessed using a clotting-based assay. Demographic, clinical, and familial data, including tribal affiliation and parental consanguinity, were collected. Data were analyzed using SPSS V29. Among the 100 participants (mean age 6.1 ± 3.3 years; 57% male), 2% were heterozygous for the FVL mutation (GA genotype), and none were homozygous mutants. Both heterozygous individuals demonstrated resistance to activated protein C. Parental consanguinity was reported in 79% of cases. No other FVL-associated thrombophilia was detected in the remaining 98 patients, all of whom had the wild-type genotype. The FVL mutation is rare among Sudanese pediatric SCD patients with stroke, suggesting it is unlikely to be a significant contributor to thrombosis risk in this population. These findings support the need for broader genetic and clinical investigations to identify more relevant risk factors and inform stroke prevention strategies in African children with SCD.