This study aimed to analyse the influence of nocturnal environmental noise levels on sleep quality and the frequency of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).

A retrospective cohort study was conducted by reviewing the clinical data of 120 patients with COPD admitted to Central Hospital Affiliated to Shandong First Medical University between January 2022 and December 2024. Patients were categorised into a poor sleep quality group (Athens Insomnia Scale [AIS] score >6) and a good sleep quality group (AIS score ≤6) based on their mean AIS scores. Nocturnal environmental noise levels, polysomnography (PSG) parameters and acute exacerbation frequency were compared between the two groups. Univariate analysis was employed to screen variables ( P < 0.1), which were subsequently incorporated into multivariate logistic regression models and Pearson correlation analysis to investigate the influence of noise levels on sleep quality and acute exacerbation frequency.

Compared with the good sleep quality group ( n  = 70), the poor sleep quality group ( n  = 50) had significantly higher nocturnal noise levels ( P < 0.05) and worse PSG parameters, including reduced total sleep time; efficiency and N2/N3 sleep and increased sleep latency, N1 sleep and awakenings (all P < 0.05). No significant inter-group differences were found in demographics or exacerbation frequency. Multivariate analysis identified nocturnal noise level as an independent risk factor for poor sleep quality [odds ratio (OR) = 3.012 per 5 dB increase; 95% confidence interval (CI): 1.650-5.611, P < 0.001]. Noise levels were negatively correlated with restorative sleep measures and positively correlated with sleep fragmentation indicators (all P < 0.05) but showed no association with acute exacerbation frequency.

Nocturnal environmental noise is an independent risk factor for impaired sleep quality in hospitalised patients with COPD, but it is not associated with short-term exacerbation frequency. Interventions aimed to reduce ward noise at night may improve sleep quality in this population.

Transmission routes of highly pathogenic H5N1 between cows or to humans remain unclear due to limited data from affected dairy farms. We performed air, farm wastewater, and milk sampling on 14 H5N1-positive dairy farms across two different California regions. Infectious virus was detected in the air in milking parlors and in wastewater streams, while viral RNA was found in exhaled breath of cows. Sequence analysis of infectious H5N1 virus from air and wastewater samples on one farm revealed viral variants relevant for potential human susceptibility. Longitudinal analysis of milk from the individual quarters of cows revealed a high prevalence of subclinical H5N1-positive cows. Additionally, a heterogeneous distribution of infected quarters that maintained a consistent pattern over time was observed, inconsistent with shared milking equipment serving as the sole transmission mode. The presence of subclinically infected cows was further supported by detection of antibodies in the milk of animals that exhibited no clinical signs during the H5N1 outbreak on one farm. Our data highlight additional sources and potential modes of H5N1 transmission on dairy farms.

BACKGROUND Congenital nasal vestibule stenosis (CNVS) is a rare condition often inconsistently termed "congenital anterior nostril stenosis" in the literature. This nomenclatural ambiguity complicates anatomical description and surgical planning. We report the successful management of a late-presenting pediatric case and propose a standardized nomenclature to improve clinical categorization. CASE REPORT An 11-year-old boy presented with a lifelong history of nasal deformity and mouth breathing. Physical examination revealed a flattened nasal tip and bilateral, small, oval nostrils. Each nostril was obstructed 3 mm posterior to the rim by a membranous diaphragm with a 1-mm residual gap. Magnetic resonance imaging (MRI) demonstrated bilateral anterior vestibular narrowing, alar cartilage hypoplasia, and septal deviation. Treatment involved diaphragm excision and vestibular reconstruction using bilateral intranasal Z-plasties, avoiding external incisions. Postoperatively, nasal symmetry, aesthetics, and transnasal airflow significantly improved and remained stable at 3-month follow-up. CONCLUSIONS This case demonstrates that intranasal Z-plasty effectively minimizes external scarring in membranous CNVS for children over 9 years old. We advocate for the unified term "CNVS" and propose a classification based on anatomical location (anterior, middle, or inner) and extent (partial or total). Prioritizing skin conservation, we recommend Z-plasty for partial stenosis and skin grafting for total stenosis to optimize long-term outcomes. Further studies are needed to evaluate the impact on adolescent nasal development.

Vascular aging, characterized by progressive structural and functional deterioration of the vasculature, serves as a critical pathophysiological nexus between chronological aging and cardiovascular disease (CVD). This study establishes a quantitative vascular age model to decode individualized vascular senescence patterns, thereby enabling early identification of accelerated aging phenotypes for targeted intervention. We collected physical examination records from 2009 to 2019 and a total of 8578 participants aged 20-70 years were enrolled in this study. We constructed sex-specific basic vascular age models based on healthy individuals by Klemera-Doubal method and calculated the normalized cardiovascular age acceleration (NCAA, η) as an estimate of vascular aging status. The association between η and CVD risk were evaluated across subgroups. Furthermore, we developed expanded models by incorporating traditional CVD risk factors that were significantly associated with η index. Male with lower values of η, which meant relatively higher vascular aging velocity, had a higher risk of CVD adjusted by chronological age (HR = 1.21, 95% CI = 1.01-1.45). In subgroup analysis, η index exhibited age- and sex-specific associations with traditional CVD risk factors. After adding body mass index, fasting blood glucose, and triglycerides significantly related to η in male, the CVD prediction by expand η were improved in age-adjusted model (HR = 1.25, 95% CI = 1.04-1.50). The vascular age model emerges as a robust composite biomarker for CVD risk stratification. Our findings establish an evidence-based framework for precision prevention, prioritizing high-risk phenotypes for early intervention to mitigate CVD burden.

Hypertensive disorders of pregnancy (HDP) are a prevalent complication and a leading cause of maternal and perinatal mortality. While vaginal delivery is generally possible for most women with HDP, there is no standardized framework detailing variations in vaginal delivery outcomes across different HDP classifications or identifying the factors influencing emergency cesarean section (EmCS).

To explore the vaginal trial outcomes and risk factors associated with emergency cesarean section among women with different classifications of HDP.

This was a single-center retrospective cohort study of 894 pregnant women with HDP who underwent a vaginal trial. Of these, 584 were diagnosed with gestational hypertension, 216 with pre-eclampsia, and 94 with chronic hypertension. The study collected and compared detailed maternal and perinatal outcomes.

(1) The success rate of vaginal delivery ranged from 85.1% to 90.8% across various classifications of HDP without significant differences. (2) Chronic hypertension was four times more likely to lead to intrapartum poorly controlled blood pressure than gestational hypertension. (3) Factors influencing EmCS in HDP included parity, antepartum BMI, labor induction, intrapartum fever, intrapartum antihypertensive use, and oxytocin during stages of labor. Parity served as an independent protective factor across all HDP classifications. Stratified analysis revealed that for gestational hypertension, risk factors included antepartum BMI ≥ 30 kg/m², labor induction, and intrapartum antihypertensive use. For pre-eclampsia, oxytocin and intrapartum fever were risk factors. In chronic hypertension, antepartum BMI ≥ 30 kg/m² and intrapartum fever were identified as risk factors, although the former was not significant.

The success rate of vaginal trials across various classifications of HDP is high. Vaginal trial can impact intrapartum blood pressure, particularly for women with chronic hypertension. Tailored management strategies should include encouraging vaginal trial for multiparous women, control of antepartum BMI, judicious use of labor induction, and vigilant monitoring of hypertension and fever, with individualized evaluation and treatment based on HDP classification.

Early detection and timely treatment of urinary tract infections (UTIs) can prevent the aggravation of the inflammatory response following a stroke and enhance the recovery of neurological function. This study aimed to develop a simple scoring system by integrating nutritional and inflammatory markers to predict the occurrence of UTIs in patients with acute stroke.

Reviews of 1011 patients with acute stroke were retrieved. The Geriatric Nutritional Risk Index (GNRI) and systemic inflammation response index (SIRI) were utilized to develop a composite score of nutritional-systemic inflammation response index (G-SIRI). The primary endpoint was the efficacy of predicting stroke-associated UTIs through an area under the curve (AUC) using receiver operating characteristic analysis. Secondary outcomes included the optimal cut-off value, hazard ratio (HR), in-hospital mortality, and length of hospital stay.

The composite scoring system of G-SIRI had a superior predictive accuracy for the occurrence of UTIs after acute stroke with a greater AUC of 0.850 (95% CI: 0.825-0.874) compared to either of isolated GNRI (0.782 [95% CI: 0.751-0.812]) or SIRI scores (0.796 [95% CI: 0.767-0.826]) (p < 0.001). A high-risk G-SIRI score was an independent predictor of stroke-associated UTI (HR = 2.192, 95% CI: 1.702-2.940) with a specificity of 0.784 and sensitivity of 0.899. A shorter survival time from post-stroke UTIs was observed in the high-risk G-SIRI cohort as opposed to the low-risk cohort (6.05 ± 1.14 vs. 3.22 ± 1.44 days, p < 0.001). The high-risk G-SIRI cohort showed significantly higher in-hospital mortality and longer length of hospital stays (all p < 0.05).

The G-SIRI scoring system showed a superior efficacy in predicting stroke-associated UTIs as opposed to the individual GNRI or SIRI scores, which underscored the clinical utilization of integrating nutritional and inflammatory factors for UTI risk stratification among patients with acute stroke.

Venous thromboembolism (VTE) remains highly prevalent among medically ill patients and often leads to increased mortality. Therefore, this study aimed to assess compliance with VTE prophylaxis guidelines and associated factors among admitted medical inpatients at Mehal Meda General Hospital, North Shewa Zone, Ethiopia, in 2024.

An institution-based cross-sectional study was conducted. Data were collected via medical chart review and interview-administered questionnaires, entered into EPI Data V.4.6, and exported to SPSS V.26 for analysis. Data were presented using frequency tables and graphs. Binary logistic regression was used to identify factors associated with compliance with VTE prophylaxis. Variables from the bivariable logistic regression analysis with a value of p<0.3 were included in the multivariable logistic regression model. A value of p<0.05 and an adjusted OR (AOR) with a 95% CI were used to identify factors associated with compliance with VTE prophylaxis. Model fitness was assessed using the Hosmer and Lemeshow goodness-of-fit test.

The study was conducted at Mehal Meda General Hospital.

The study was conducted among 365 admitted medical inpatients. The study participants were selected using a systematic random sampling technique.

The overall proportion of compliance with VTE prophylaxis guidelines among admitted medical inpatients was 24.2% (95% CI 19.9% to 28.8%). In this study, being a patient with heart failure (AOR = 6.8, 95% CI 3.7 to 12.54) and being a patient with diabetes (AOR = 3.98, 95% CI 2.2 to 7.2) were positively associated with compliance with VTE prophylaxis.

The overall proportion of compliance with VTE prophylaxis guidelines among admitted medical inpatients was low compared with previous studies. Heart failure and diabetes were positively associated with compliance with VTE prophylaxis guidelines. Therefore, greater attention should be given to both, patients with diabetes and patients with heart failure.

Acute decompensated heart failure (ADHF) is associated with high mortality rates and significant decline in physical function following hospitalisation. Although exercise-based cardiac rehabilitation is recognised as a key component of comprehensive heart failure management, clinical evidence supporting its application in patients with ADHF remains limited. The trial aims to evaluate the efficacy and safety of an early initiated comprehensive rehabilitation in patients with ADHF.

This is a prospective, multicentre, randomised, open-label, parallel-group clinical trial. A total of 140 patients hospitalised with ADHF will be enrolled and randomised in a 1:1 ratio to receive either comprehensive rehabilitation intervention or attention control. The intervention group will receive a supervised, 6-week structured comprehensive rehabilitation programme consisting of progressive balance, endurance, strength and inspiratory muscle training. Rehabilitation therapy commences after admission and continues into the outpatient period with a total of 18 sessions. The control group will receive standard usual care supplemented by fortnightly non-rehabilitation-related contact from study personnel to control for attention. Coprimary outcomes are changes in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score and in maximum inspiratory pressure expressed as a percentage of predicted value (PImax%pred) at 6 weeks postrandomisation. Secondary outcomes include changes in the Short Physical Performance Battery score, frailty phenotype, pulmonary function tests and 6-month all-cause rehospitalisation.

The Early Comprehensive Rehabilitation in patients with ADHF (EACH-ADHF) trial was granted by the Medical Research Ethics Committee of Guangdong Provincial People's Hospital (KY-Q-2022-487). Findings will be disseminated to patients, clinicians and commissioning groups through peer-reviewed publication.

NCT06161987.

Adequate self-management support following percutaneous coronary intervention (PCI) remains a recognised challenge. This study evaluated the Integrated Psychocardiology Transitional Care (IPTC) programme's effect on self-management and quality of life, and the mechanism of their interaction.

Retrospective cohort study.

Outcomes were analysed for 697 patients after propensity score matching from an initial PCI registry cohort of 1148.

The primary outcome was change in Coronary Artery Disease Self-Management Scale Score over 12 months. Secondary outcomes included the Seattle Angina Questionnaire (SAQ), 36-Item Short Form Health Survey (SF-36), Generalised Anxiety Disorder 7 and Patient Health Questionnaire 9 scores. Mixed-effects models and time-lagged mediation analysis were used to examine longitudinal changes and the mediating role of self-management.

No between-group difference in self-management was observed at 1 month. Significant differences in self-management emerged at 3 months, 6 months and 12 months (all p<0.001). The mixed-effects model for repeated measures analysis revealed significant group × time interaction effects (F=183.1, p<0.001), indicating differential improvement trajectories favouring the IPTC group. The IPTC group showed significantly better SF-36 physical (45.6±9.6 vs 39.8±8.4, 95% CI 4.5 to 7.2, p<0.001) and mental (44.9±8.3 vs 41.7±8.1, 95% CI 2.0 to 4.4, p<0.001) scores at 12 months. Time-lagged mediation analysis confirmed self-management improvement mediated quality of life effects.

The IPTC programme is associated with improved quality of life in PCI patients, and this association appears to be partly explained by enhanced self-management. These findings suggest that integrating psychology-informed transitional care into post-PCI care may be beneficial.

Three-dimensional modalities are increasingly being used as adjuncts for medical trainees learning about complex anatomical concepts, such as congenital heart disease.

This study aimed to evaluate the use of 2 such modalities, 3D-printed models, and augmented reality (AR), in improving medical students' understanding and knowledge retention of congenital heart disease when compared to traditional teaching methods.

A prospective cohort pilot study was performed with 26 first-year medical students. Students were randomly assigned to receive a 30-minute teaching session using traditional slide-based lecture, 3D-printed model, or AR. Participants completed a 16-question pretest consisting of 4 basic general cardiology questions and 6 questions each regarding the anatomy and physiology of tetralogy of Fallot and hypoplastic left heart syndrome. Participants completed a posttest immediately following the teaching session, as well as a delayed posttest 3 weeks later.

When comparing overall and subsection posttest scores, the AR group obtained perfect immediate posttest scores at a significantly increased rate compared to the lecture and 3D model groups (6/9, 67% vs 1/8, 13% and 1/9, 11%, respectively; large effect size Cramér V=0.57; P=.02). Participants in the lecture group reported difficulty understanding cardiac anatomy and physiology using only 2D diagrams, whereas those in the 3D-printed model and AR groups almost unanimously reported improved visualization of complex cardiac defects, which enhanced their understanding.

Due to the visuospatial benefits of 3D-printed models and AR, there is potential for use in medical education to improve students' knowledge of complex anatomical and physiological concepts. Students who received teaching using 3D-printed models or AR overwhelmingly reported improved 3D visualization of congenital cardiac defects compared to those who were taught via lecture. Additionally, AR and 3D-printed models offer practical opportunities for implementation into medical education curricula as both adjunct and stand-alone teaching modalities.