There is limited evidence on the long-term associations between cardiometabolic multimorbidity (CMM) and multiple domains of functioning, and the potential role of social activity in these associations. We aimed to examine the associations between CMM and joint trajectories of physical disability, depressive symptom, and cognitive function, and whether social activity modifies these trajectories.

This multicohort study used pooled data of four prospective cohorts of adults from China, the UK, the USA, and Europe. Participants with complete information on cardiometabolic diseases (CMDs, including heart diseases, stroke, and diabetes) and social activity at baseline were included. Physical disability, depressive symptom, and cognitive function were measured one to five times. Longitudinal modelling was used to describe post-baseline trajectories of the three domains, stratified by CMM status and social activity.

Among 73,778 participants (age 63.4 ± 9.1 years, 56.0% female), 20.0% had single CMD and 4.3% had CMM at baseline. Participants with single CMD or CMM had persistently worse physical disability, depressive symptom, and cognitive function compared to those without CMD. CMM was associated with faster worsening of physical disability (β_{linear change*CMM} = - 0.017 [95% confidence interval = - 0.030 to - 0.004]) and cognitive function (- 0.035 [- 0.050 to - 0.019]), particularly among those with social inactivity. Among 40,883 participants (age 62.9 ± 8.9 years, 55.6% female) in joint trajectory analysis, four trajectories were identified: 'favourable trajectories of physical disability, depressive symptom, and cognitive function' (48.1%); 'worsening cognitive function' (32.6%); 'worsening depressive symptom and cognitive function' (14.6%); and 'rapidly-worsening physical disability and worsening depressive symptom and cognitive function' (4.7%). CMD or CMM were associated with all the three worsening joint trajectories. The highest odds were observed for concurrent worsening across all three functional domains in participants with CMM (odds ratio 3.43 [2.80-4.20]), with more unfavourable trajectories in those with social inactivity (7.26 [5.49-9.59], P for additive interaction < 0.001).

CMM was associated with worse levels, faster progression, and concurrent deterioration in physical disability, depressive symptom, and cognitive function, with the poorest trajectories among those who were socially inactive. This underscores the importance of implementing prevention strategies that integrate physical, psychological, cognitive, and social activities.

Postoperative cardiac dysfunction and arrhythmias are significant complications following cardiac surgery, frequently resulting in increased mortality, longer hospital stays, higher healthcare costs, and diminished patient quality of life. This study investigates the effects of mannitol on cardiac function and the incidence of postoperative arrhythmias after coronary artery bypass grafting (CABG).

In a single-center, double-blind, randomized controlled trial, ninety patients undergoing elective on-pump CABG were randomly assigned (1:1) to receive either 200 mL of mannitol 20% (n = 45) or 200 mL of lactated Ringer's solution (n = 45) during cardiopulmonary bypass priming. Postoperative assessments included cardiac enzyme levels (creatine phosphokinase, creatine kinase-MB isoenzyme, and cardiac troponin I), incidence of arrhythmias (atrial fibrillation, ventricular fibrillation, ventricular tachycardia), and left ventricular ejection fraction. Statistical significance was defined as a p-value < 0.05.

No significant differences were observed between the mannitol and control groups in baseline demographics or clinical risk factors (p > 0.05). Left ventricular ejection fraction was similar between the groups (45.22 ± 9.82 in the mannitol group vs. 42.66 ± 7.94 in the control group; p = 0.178). Atrial fibrillation occurred in 9 of 45 patients (20%) in the mannitol group and 12 of 45 (26.7%) in the control group (p = 0.309). Ventricular tachycardia was observed in 2 of 45 (4.4%) vs. 4 of 45 (8.9%) patients, respectively (p = 0.338). Thirty-day mortality was 2 of 45 (4.4%) in the mannitol group and 1 of 45 (2.2%) in the control group (p = 0.50). Cardiac enzyme levels (CPK, CK-MB, and cTnI) showed no significant differences between groups (p > 0.05). However, ventricular fibrillation occurred in 2 of 45 patients (4.4%) in the mannitol group versus 8 of 45 (17.8%) in the control group, a statistically significant difference (p = 0.045).

In conclusion, while mannitol was associated with a lower incidence of ventricular fibrillation, this is a single-center study with limited power to detect differences in other outcomes. Further studies with larger sample sizes are needed to confirm these findings.

The impact of septal myectomy on the progression of ascending aortic (AAo) dilation in patients with obstructive hypertrophic cardiomyopathy (HOCM) remains uncertain. This study aimed to investigate the relationship between septal myectomy and AAo dilation in HOCM patients.

A total of 69 patients with HOCM were enrolled. All the participants underwent sequential cardiac magnetic resonance scans at a mean interval of 5.13 ± 2.04 years, with each scan being more than 3 years apart.

At baseline, 17 patients with HOCM (25%) exhibited AAo dilation (Indexed AAo dimension > 19 mm/m²). Age (OR 1.10, 95%CI: 1.01-1.019, P = 0.026) and female (OR 4.80, 95%CI: 1.05-21.93, P = 0.043) were independently associated with AAo dilation. In patients who underwent myectomy, the AAo dimension at follow-up was similar to that at baseline (32.47 ± 4.70 mm vs. 32.81 ± 5.06 mm, P = 0.197). Furthermore, the rate of AAo dilation was lower in patients with myectomy compared to those without myectomy (-0.06 ± 0.38 mm/year vs. 0.18 ± 0.43 mm/year, P = 0.016). Additionally, moderate or severe mitral regurgitation was significantly associated with AAo dilation rate (B = 0.273, P = 0.032).

Myectomy in patients with HOCM was associated with the absence of progression of AAo dilatation.

Coronary artery bypass grafting (CABG) is commonly recommended for patients with severe coronary artery disease (CAD). However, the current literature lacks consensus on whether on-pump or off-pump CABG provides superior outcomes between dialysis and non-dialysis patients.

This nationwide retrospective cohort study analysed the demographic and comorbid data of 31,016 participants in Taiwan between January 1, 2006 and December 31, 2015. CAD patients who had undergone CABG were stratified by presence of dialysis and the procedure type into the following four groups: non-dialysis, on-pump; non-dialysis, off-pump; dialysis, on-pump; and dialysis, off pump. Study outcomes included postoperative complications and long-term follow-up.

Non-dialysis on-pump CABG patients experienced worse postoperative outcomes including higher mortality, longer hospital stays, and increased mechanical ventilation use, compared to non-dialysis off-pump CABG patients. Similar trends were observed between the dialysis on-pump CABG and off-pump CABG groups. Cox regression analysis revealed a lower risk of myocardial infarction (MI) and percutaneous coronary intervention (PCI) but higher mortality among non-dialysis on-pump CABG patients (hazard ratio [HR], 0.911, 0.828, and 1.530; 95% confidence interval [CI], 0.850-0.977, 0.761-0.901, and 1.445-1.621; respectively] compared to non-dialysis off-pump CABG patients. In the dialysis population, on-pump CABG patients showed a higher risk of MI and mortality but lower PCI risk than did dialysis off-pump patients (HR, 1.044, 1.262, and 0.724; 95% CI, 0.824-1.322, 1.107-1.439, and 0.582-0.902; respectively). Five-year Kaplan-Meier analysis revealed similar trends.

Off-pump CABG was generally associated with better mortality outcomes in both non-dialysis and dialysis populations.

Epicardial adipose tissue is gaining increasing interest as a cardiometabolic imaging biomarker, but its exact role in coronary artery disease is not fully understood. This study aimed to investigate the relationship between epicardial adipose tissue, coronary plaque characteristics, and risk of myocardial infarction in patients with suspected coronary artery disease, and in those with concomitant cardiometabolic disease.

In a post-hoc analysis of the SCOT-HEART trial, epicardial adipose tissue volume and attenuation were quantified automatically from computed tomography (CT) angiography using deep-learning. Quantitative and high-risk coronary plaque characteristics were also assessed. The primary endpoint was fatal or non-fatal myocardial infarction.

The study population consisted of 1770 patients (58 ± 9 years, 56% males) of whom 313 (18%) with cardiometabolic disease. Epicardial adipose tissue volume was higher in patients withcardiometabolic disease (123 ± 44 versus 88 ± 36 mL, p < 0.001), and increased with the coronary calcium score (0: 82 ± 35 mL, 1-400: 97 ± 38 mL, > 400: 113 ± 44 mL; p < 0.001), and low-attenuation plaque burden (burden ≤ 4%: 85 ± 36mL, burden > 4%: 103 ± 41mL; p < 0.001), while there were no interactions between these features and epicardial adipose tissue attenuation (p > 0.05 for all). During a median follow-up of 8.6 years, 82 (4.6%) patients experienced myocardial infarction. In the total study cohort, epicardial adipose tissue volume predicted myocardial infarction both in univariable analysis, and after adjustment for established markers of cardiovascular risk. In patients with cardiometabolic disease, epicardial adipose tissue volume independently predicted myocardial infarction after adjustment for clinical risk factors and plaque features but this relationship was not found in those without cardiometabolic disease.

CT-derived Epicardial adipose tissue volume correlates with quantitative and high-risk plaque features, and independently predicts risk of myocardial infarction in patients with cardiometabolic disease.

Manually modified microvascular plugs (MVPs) to pulmonary flow restrictors (PFRs) are innovative devices for managing pulmonary overcirculation percutaneously, though achieving optimal restriction while maintaining device stability can be challenging.

We describe a full-term newborn with a double outlet right ventricle and a large malaligned subaortic ventricular septal defect, complicated by pulmonary overcirculation. At 24 days of life (2.4 kg, 50 cm), bilateral MVP-based PFRs were implanted, with an MVP-7Q placed in the right pulmonary artery (4.1 mm diameter) and an MVP-5Q in the left (3.8 mm diameter), after fenestrating the MVPs by removing one triangle with a surgical scalpel. Immediate severe flow restriction to the right lung was managed with dilation of the para-right PFR space using 2 mm and then 3 mm semi-compliant coronary balloons, increasing oxygen saturation from 60 to 87%. By the end of the procedure, the Qp: Qs ratio decreased from 2.3:1.0 to 1.1:1.0. At 12 weeks, the patient weighed 4.8 kg, with oxygen saturation at 92% and Doppler gradients of 70 mmHg on the left and 45 mmHg on the right. Nine months post-intervention, the patient underwent biventricular repair and PFR removal at 7.9 kg. A fibrotic endothelial reaction with wall thinning on the right required autologous patch repair. A two-week follow-up ultrasound showed no stenosis.

Para-device space dilation with semi-compliant coronary balloons effectively relieves severe flow restriction in oversized PFRs, restoring flow while preserving device integrity. However, long-standing oversized PFRs cause intimal damage, necessitating patch repair, despite excellent surgical outcomes.

Not applicable.

As a novel selective anticholinergic drug, penehyclidine hydrochloride (PHC) provided the potential to protect organs by inhibiting the inflammatory response, attenuating oxidative stress, and alleviating ischemia / reperfusion injury. This study aimed to evaluate the organ protective effects of PHC in patients undergoing cardiac surgery.

Six electronic databases were searched systematically for randomized-controlled trials (RCTs) published April 30th 2025 that explored the application of PHC on cardiac surgical patients. Primary outcomes of interest included the biomarkers and variables of major organs (e.g. heart, lung, gastrointestinal tract and immune system) injury. Secondary outcomes of interest included the mechanical ventilation duration and hospital length of stay (LOS). Mean difference (MD) with 95% confidence interval (CI) or odds ratios (OR) with 95% CI were employed to analyze the data.

A total of 37 RCTs with 1929 cardiac surgical patients (PHC group, 1043 patients; Control group, 886 patients) were included. The current study demonstrated that the adult patients in PHC group had lower cardiac troponin I (cTnI) [MD: -1.70, 95%CI: -2.63 to -0.77, P = 0.0003, with heterogeneity (P < 0.00001)] and creatine kinase (CK)-MB levels on post-operative day (POD)-1 after cardiac surgery, while the pediatric patients had lower cardiac troponin T (cTnT) (MD: -0.10, 95%CI: -0.12 to -0.09, P < 0.00001, without heterogeneity) in PHC group on POD-1. The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were significantly lower in both adult and pediatric patients of PHC group on POD-1. The incidence of postoperative pulmonary infection was significantly reduced in the PHC group, and the duration of mechanical ventilation and hospital LOS were shortened in adult patients.

This meta-analysis demonstrated that PHC could provide myocardial protection and suppress the inflammatory response in patients undergoing cardiac surgery, thereby potentially facilitating rapid recovery.

PROSPERO registration number CRD42020183260.

The pain associated with experimental myocardial infarction in pigs has never been investigated. We aimed at assessing pain and its correlation with myocardial damage. Twenty-four Göttingen minipigs undergoing closed chest myocardial infarction followed by coronary reperfusion under general balanced anaesthesia were included in the trial. Pain was assessed through mechanical and thermal thresholds, sensitivity to Von Frey filaments and behavioural indicators before (Pre MI), the day after (Post MI) and at the study endpoint (Post MI-endpoint). Over time differences in mechanical thresholds (MT) and thermal thresholds (TT) were assessed using one-sample t-test and their correlations with troponin I/cytokines using logistic regression. In four minipigs at Post MI acute pain requiring analgesia was identified. Pain thresholds decreased significantly at Post MI (MT: 51 [35.6; 74] TT: 44.8 [42.7; 48.7]) and Post MI-endpoint (MT: 47.5 [35; 64.3]; TT: 44.3 [43.1; 48.6]) compared to Pre MI (MT: 72 [53.4; 84], TT: 46.3 [43.8; 53.8]). The response to von Frey filaments remained sporadic. Troponin I highly increased at Post MI, but no correlations with pain thresholds were found. Following balanced anaesthesia, acute pain had low incidence and mild to moderate intensity. Somatic hyperalgesia remained until the study endpoint, but its relevance remains to be unravelled.

Stroke remains a leading global threat to life and health, with secondary prevention of recurrence and restoration of physical/neurological function representing critical challenges in post-stroke care. While surgical and pharmacologic treatments for stroke are well-studied, fewer studies have explored strategies to improve health promotion intention in stroke patients, which could enhance long-term prognosis. This study aimed to explore the relationship between health promotion intention, hope, and self-efficacy. From June 2023 to November 2023, a questionnaire survey was conducted among 521 stroke patients in the affiliated hospitals of Hunan University of Chinese Medicine using cluster sampling. The survey instruments included a general demographics questionnaire, Health-Promoting Lifestyle Scale-II R, General Self Efficacy Scale, and Herth Hope Index. Multiple regression analysis was used to explore the influencing factors of health promotion intention, and structural equation modeling was constructed to test the mediating role of self-efficacy between hope and health promotion intention. A total of 499 valid questionnaires were included. There was a significant positive correlation between health promotion intention, hope, and self-efficacy (p < 0.01). Hope (β = 0.160, p < 0.01), self-efficacy (β = 0.390, p < 0.001), and disease knowledge (β = 0.167, p < 0.001) significantly and positively influenced health promotion intention. Self-efficacy partially mediated the relationship between hope and health promotion intention [β = 0.258, 95%CI (0.126, 0.401)], with the indirect effect accounting for 41.55%. This study demonstrated that hope directly enhances health promotion intention in stroke patients, with self-efficacy partially mediating this relationship. Future interventions should target both hope and self-efficacy to optimize outcomes, while accounting for additional unexamined variables that may influence this pathway. Further research is needed to identify other potential mediators and refine evidence-based behavioral intervention programs.

To develop and validate a clinical-laboratory screening model for rapid differentiation of intracranial aneurysm (IA)-related acute ocular motor nerve palsy (AOMNP) from microvascular ischemia (MI), thereby reducing diagnostic delays and optimizing resource utilization. In this multicenter retrospective study, 62 AOMNP patients from Anhui Provincial Hospital (derivation cohort: IA = 29, MI = 33) and 29 from Suzhou Municipal Hospital (validation cohort: IA = 9, MI = 20) were categorized based on rigorous imaging criteria. Independent predictors of IA were identified via multivariable logistic regression, followed by nomogram construction. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves, with model generalizability assessed through external validation. Female sex (adjusted odds ratio [OR] = 7.94, 95% CI: 1.60-40.00), pupillary changes (OR = 10.02, 95% CI: 2.22-45.15), and elevated D-dimer levels (> 0.675 mg/L; OR = 1.58 per 0.1 mg/L increment, 95% CI: 1.05-2.39) emerged as independent predictors of IA. The integrated model demonstrated robust discriminative capacity (AUC = 0.899, derivation cohort), with preserved performance in the validation cohort (sensitivity: 77.8%, specificity: 85.0%, negative predictive value: 89.5%). Implementation of a simplified triage algorithm (female sex + pupillary abnormalities + D-dimer > 0.675 mg/L) prioritized high-risk patients for urgent vascular imaging, potentially reducing unnecessary testing by 73.3% in low-risk subgroups.