Convective extracorporeal dialysis modalities, haemofiltration (HF), haemodiafiltration (HDF), and acetate-free biofiltration (AFB), remove excess body fluid across the dialysis membrane through an interplay of positive and negative pressures and accumulated middle- and larger-sized solutes more efficiently than haemodialysis (HD). This increased removal of larger solutes, combined with the use of ultrapure dialysis fluid in convective dialysis, is hypothesised to reduce the frequency and severity of symptoms during HD and improve long-term clinical outcomes. This is an update of a review first published in 2006 and updated in 2015.

To determine the benefits and harms of convective (HF, HDF, or AFB) versus diffusive (HD) dialysis modalities, or expanded HD (HDx), in preventing all-cause and cardiovascular death, cardiovascular morbidity, fatigue, and vascular access problems in adults with kidney failure.

We searched the Cochrane Kidney and Transplant Specialised Register, CENTRAL, MEDLINE, Embase and two trial registers up to 3 April 2025. Additionally, handsearching of journals and conference abstract books was performed, and the references of the included studies were reviewed.

We included randomised controlled trials (RCTs) comparing convective therapy (HF, HDF, AFB) with another convective therapy or with diffusive therapy (HD or HDx) for treating adults with kidney failure.

Critical and important outcomes included all-cause and cardiovascular death, nonfatal cardiovascular events, fatigue, problems with vascular access, hospitalisation, and health-related quality of life (HRQoL).

Two authors independently assessed the risk of bias using the Cochrane RoB 1 tool.

We summarised treatment effects using the random-effects model and reported risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous data with 95% confidence intervals (CI). We assessed the confidence of the evidence using the GRADE approach.

We identified 62 eligible studies (6897 participants). In total, 54 studies (6525 participants) compared HF, HDF or AFB with HD (both high-flux and low-flux); two studies (24 participants) compared AFB with HDF; three studies (62 participants) compared HDF with HF; and four studies (163 participants) compared HDx with HDF/HD.

Convective dialysis, compared with diffusive therapy, likely reduces the risk of death (any cause) (RR 0.88, 95% CI 0.80 to 0.96; I² = 0%; 15 studies, 5463 participantss; moderate-certainty evidence due to indirectness) and cardiovascular death (RR 0.78, 95% CI 0.66 to 0.92; I² = 0%; 9 studies, 4761 participants; moderate-certainty evidence due to indirectness). Cardiovascular morbidity was likely not different between convective and diffusive dialysis (RR 1.05, 95% CI 0.90 to 1.22; I² = 0%; 2 studies, 2074 participants; moderate-certainty evidence due to indirectness). Little to no differences were found between convective and diffusive dialysis on fatigue (MD -0.95, 95% CI -2.50 to 0.60; 1 study, 543 participants; low-certainty evidence due to imprecision), problems with vascular access (RR 0.87, 95% CI 0.50 to 1.50; 1 study, 124 participants; low-certainty evidence due to imprecision), hospitalisation (RR 1.14, 95% CI 0.96 to 1.37; I² = 0%; 3 studies, 600 participants; low-certainty evidence due to indirectness and imprecision), or physical quality of life (MD 0.66, 95% CI -1.08 to 2.40; 1 study, 538 participants; low-certainty evidence due to imprecision). Direct comparisons between different convective modalities were limited and underpowered to detect meaningful differences.

Convective dialysis likely reduces all-cause and cardiovascular death. Effects on nonfatal cardiovascular events, fatigue, vascular access failure, and hospitalisation are inconclusive. Future RCTs should prioritise methodological rigour and could focus on unresolved questions, including the impact of convective therapies on patient-centred outcomes such as symptom burden, HRQoL, functional status, and intradialytic tolerance, as well as investigating barriers to uptake, evaluating health system readiness, assessing cost-effectiveness, and identifying strategies to promote equitable access.

No specific funding.

Previous versions available via DOI: 10.1002/14651858.CD006258 and DOI: 10.1002/14651858.CD006258.pub2.

Epidemiological studies have shown that coffee consumption is associated with a lowered risk of incident venous thromboembolism (VTE). No previous study has explored whether coffee consumption influences the risk of VTE recurrence.

This study aimed to investigate whether the amount of coffee consumption (cups/d) is associated with the risk of VTE recurrence in a population-based cohort of incident VTEs.

The cohort consisted of 2071 patients with incident VTE recruited from 4 surveys of the Tromsø Study (enrolment, 1994-2008) and the third survey of the Trøndelag Health Study (enrolment, 2006-2008), followed from the date of the index VTE until 2020. Information on coffee consumption (cups/d) and potential confounders was extracted. Cox regression models were used to estimate hazard ratios (HRs) with 95% CIs for VTE recurrence.

During a median follow-up of 2.8 years, 310 recurrent VTEs occurred. There was no linear relationship between increasing coffee intake and VTE recurrence. The HR for recurrence was 0.49 (95% CI, 0.30-0.81) for those consuming 1 to 2 cups of coffee per day and 0.71 (95% CI, 0.44-1.12) for those consuming >6 cups compared with noncoffee consumers. The association between coffee consumption (yes/no) and lowered recurrence risk was more pronounced for provoked index VTE event (HR, 0.50; 95% CI, 0.30-0.82) than for unprovoked index VTE (HR, 1.01; 95% CI, 0.53-1.94).

Coffee consumption was associated with a nonlinear, lowered risk of VTE recurrence, particularly after provoked VTE. Our findings suggest that coffee can be safely consumed after VTE, potentially with a beneficial effect on recurrence risk.

Ischemic stroke remains a leading cause of death and disability, and mitochondrial dysfunction links bioenergetic failure, oxidative stress, neuroinflammation, blood-brain barrier (BBB) injury, and cell death. Despite extensive preclinical neuroprotection research, translation has often failed because candidate interventions show inadequate brain exposure and mitochondrial target engagement, are tested under pretreatment or simplified experimental conditions, emphasize short-term infarct reduction rather than durable functional recovery, and are difficult to integrate with time-critical reperfusion care. This Review analyzes mitochondria-targeted delivery as a sequential cascade spanning systemic stability, BBB or nose-to-brain entry, lesion and cell selection, endosomal escape, mitochondrial access, and functional rescue. We compare brain-targeted, intranasal, biomimetic, and organelle-transplantation platforms; place recent examples alongside established mitochondria-targeted antioxidant and mitochondrial-transfer literature; and distinguish localization evidence from causal mitochondrial recovery. The most tractable next steps are a standardized, disease-relevant validation framework and simplified delivery designs compatible with acute stroke workflows. Translational success will require integrated systems that address the complete sequential delivery cascade with the minimum necessary complexity, reproducible manufacturing, clinically relevant treatment windows, and long-term functional and safety endpoints.

Active component military service members are exposed to increased risk of occupational blast overpressure (BOP) exposure during deployment as well as training. This retrospective cohort study examined the incidence of first-time diagnoses of traumatic brain injury (TBI), insomnia, migraine headache, depressive or anxiety disorders, noise-induced hearing injury (NIHI), and essential hypertension among active component service members (ACSMs) in the U.S. Army, Air Force, and Marine Corps. Incidence rates (IRs) were compared between ACSMs who served in occupations at high risk for BOP exposure (n=831,050) and those who never served in such occupations (n=2,229,594). Overall incidence of TBI was 243.8 per 10,000 person-years in the high-risk occupational cohort and 140.9 per 10,000 person-years in the low-risk occupational cohort. Incidence of NIHI was 342.7 and 218.1 per 10,000 person-years in the high- and low-risk cohorts, respectively. After adjusting for demographic and military characteristics, ACSMs in occupations with high risk of BOP experienced higher IRs of TBI (adjusted IR ratio [aIRR] 1.43; 95% CI 1.42, 1.44) and NIHI (aIRR 1.39; 95% CI 1.38, 1.40). Increasing time since entering the cohort was associated with a greater increase in migraine headache incidence among ACSMs in high-risk BOP occupations compared with those in low-risk occupations. Despite these differences, the distribution of disease burden categories from 2024 health care encounters was similar among cohorts. These findings emphasize the importance of mitigating occupational blast hazards and strengthening surveillance efforts to protect the long-term health of ACSMs. Adjusted IRs of TBI and NIHI were higher among service members in occupations at high risk for BOP exposure than among those who had never worked in such occupations. Increasing time in the cohort was associated with a greater increase in migraine headache incidence among service members in high-risk BOP occupations than among those in low-risk occupations.

Early allograft dysfunction (EAD) is a major complication of pediatric liver transplantation associated with prolonged ICU stay, increased mortality, and graft loss. Existing risk models focus on donor and surgical variables; the contribution of intraoperative anesthetic management remains poorly characterized in pediatric living donor liver transplantation (LDLT).

We conducted a retrospective single-center cohort study of 124 consecutive pediatric LDLT recipients. Three intraoperative anesthetic parameters were evaluated as predictors of EAD (Olthoff criteria): relative mean arterial pressure (MAP) drop (%), norepinephrine (NE) infusion duration (min), and peak intraoperative lactate (mmol/L). Discriminative performance was assessed by receiver operating characteristic (ROC) analysis. Multivariable Firth penalized logistic regression addressed near-complete separation. Internal validation used bootstrap resampling (1000 iterations).

The cohort (median age 18.5 months, IQR 8.0-96.0; biliary atresia the most common indication) included 50 patients (40.3%) with EAD. All three parameters showed excellent univariable discrimination: NE duration (AUC = 0.993), peak lactate (AUC = 0.936), and MAP drop (AUC = 0.894); all p < 0.001. Three preoperative variables (hemoglobin, bilirubin, albumin) reached univariable significance (all p < 0.05) but with modest discrimination (AUC 0.384-0.617), markedly inferior to all intraoperative parameters (AUC 0.894-0.996). In the multivariable model, MAP drop (OR 22.27; 95% CI 1.80-275.4; p = 0.016) and NE duration (OR 3066657; p = 0.018) independently predicted EAD. The combined model achieved AUC = 0.999 (bootstrap 95% CI: 0.994-1.000; Brier score = 0.013). NE duration ≥ 70 min yielded sensitivity 1.000 and NPV 1.000. EAD-positive patients had significantly longer ICU stay (5 vs. 3 days; p = 0.004) and mechanical ventilation duration (24 vs. 0 h; p < 0.001).

Intraoperative anesthetic parameters-particularly NE duration and MAP drop-are powerful independent predictors of EAD in pediatric LDLT, substantially outperforming preoperative variables, three of which reached statistical significance but with markedly lower discriminative power. Intraoperative hemodynamic management may represent a modifiable determinant of early graft outcomes. External validation is warranted.

The Global Registries and Surveys Programme-Heart Failure (GRASP-HF) is a prospective, multicentre, international observational study assessing implementation of the 2021/2023 ESC-HF-Guidelines. GRASP-HF is aligned with the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme, which links centre-characteristics with guideline-implementation performance.

To compare baseline characteristics, guideline-directed-medical-therapy (GDMT) implementation, and in-hospital outcomes between GRASP-HF patients managed in centres participating or not participating in the ICARe-HF programme.

GRASP-HF patients were stratified by ICARe-HF participation, clinical settings, acute (AHF) vs chronic HF (CHF) and ejection fraction (EF) subtypes. Hierarchical multivariable logistic regression models evaluated associations with quadruple therapy implementation and in-hospital mortality.

Among 10,936 patients (63.3% CHF, 36.7% AHF), patients from ICARe-HF participating centres (51.3%) were older, more comorbid but with less severe congestion. In both CHF and AHF, ICARe-HF centres demonstrated greater GDMT utilization, particularly angiotensin receptor-neprilysin inhibitors and sodium-glucose-cotransporter-2 inhibitors. In HFrEF, quadruple therapy was more frequently implemented (47% vs 40% in CHF; 27% vs 24% at AHF discharge) and remained associated with ICARe-HF participation after adjustment, Odd Ratio (OR) =1.73, 95% Confidence Interval (CI) :1.17-2.55. Target doses remained suboptimal, particularly after AHF. Although crude in-hospital mortality was lower in ICARe-HF centres (2.3% vs 5.5%), this association was attenuated after multivariable adjustment (OR=0.87, 95% CI:0.48-1.56).

Participation in the ICARe-HF programme was associated with more comprehensive implementation of contemporary GDMT, particularly in HFrEF. The association with in-hospital mortality was attenuated after adjustment and should be considered exploratory.

Background The clinical utility of quantitative T1 mapping in cardiac MRI is constrained by variability across acquisition protocols, and a comprehensive comparison between commonly used sequences remains unavailable. Purpose To provide a full range of cardiac MRI native T1 and extracellular volume fraction (ECV) values at 3 T in healthy Chinese adults and participants with various cardiovascular diseases and, as a secondary aim, to establish the relationship between modified Look-Locker inversion recovery (MOLLI) and shortened MOLLI (ShMOLLI) measurements. Materials and Methods This prospective study included healthy volunteers, participants with normal cardiac MRI findings, and participants representing 13 cardiovascular conditions. All participants underwent 3-T cardiac MRI with both MOLLI and ShMOLLI sequences during a single examination. Global native T1 and ECV values were quantified and compared between sequences and across disease groups. Statistical approaches included t tests, Pearson correlation, Bland-Altman analysis, and Cohen D standardization. Results This study included 1237 clinical participants (mean age ± SD: 51 years ± 14.8; 854 men). Reference values (adjusted mean ± SE) in healthy volunteers were 1170 msec ± 9 (MOLLI) and 1135 msec ± 10 (ShMOLLI) for native T1 and were 24.8% ± 0.6 (both MOLLI and ShMOLLI) for ECV, with women showing higher native T1 values than men (all P ≤ .002). MOLLI yielded systematically higher native T1 than ShMOLLI across all conditions (mean difference: 46.0 msec ± 27.2; all P < .01), whereas ECV did not differ for most conditions (10 of 15 groups; P > .05). Strong intersequence correlations were observed for native T1 (Pearson r = 0.93; P < .001) and ECV (r = 0.95; P < .001). After standardization to sequence-specific baselines, pathologic deviations were comparable between sequences (Cohen D differences ≤0.5 in most groups). A supplementary swine study supported the technical validity of both sequences (r = 0.87-0.90; P < .001). Conclusion In participants who underwent 3-T cardiac MRI with both MOLLI and ShMOLLI sequences, native T1 was higher with MOLLI than ShMOLLI, but ECV was consistent across sequences. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Dacher and Cadour in this issue.

Yangxin Dingji Capsules (YXDJ), derived from Zhigancao Decoction, are used clinically for arrhythmia. Four D101 macroporous-resin purification procedures involving different Asini Corii Colla incorporation modes and elution solvents were compared; the co-decoction procedures additionally included centrifugation and filtration before resin purification. The unpurified preparation and four purified preparations were characterized by UPLC-Q-TOF-MS/MS and evaluated in a barium chloride-induced rat arrhythmia model using electrocardiographic, biochemical, and histopathological indicators. Fifty-five constituents were tentatively identified. The 60% ethanol-eluted preparations CF1 and CF3 retained 52 and 51 constituents, respectively, whereas the water-eluted preparations CF2 and CF4 retained 21 and 14. CF1 showed the highest Pearson correlation with YXDJ among the purified preparations (r = 0.520), while CF3 had the highest five-indicator comprehensive pharmacodynamic score among the purified preparations (CPS5 = 3.540); unpurified YXDJ scored 3.827. Compared with the model group, CF3 significantly increased heart rate, shortened QRS duration, reduced serum lactate dehydrogenase, and increased Na⁺/K⁺-ATPase activity. Exploratory one-component partial least-squares variable-importance and gray relational analyses generated a provisional list of 12 constituents for subsequent targeted quantification and pharmacological verification.

Hypertensive disorders of pregnancy (HDP) encompass chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension, affecting about 5% to 10% of pregnancies worldwide and remaining a major cause of maternal and perinatal morbidity and mortality. Their burden is increasing with rising obesity, advanced maternal age, evolving diagnostic criteria, and marked socioeconomic and racial-ethnic disparities. This review summarises current evidence on the epidemiology, pathophysiology, biomarkers, clinical management, and long-term outcomes of HDP, highlighting recent advances and unresolved questions. Mechanistically, HDP is characterised by systemic endothelial dysfunction and angiogenic imbalance, particularly involving soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), together with immune maladaptation, oxidative stress, and genetic and environmental contributors such as endocrine-disrupting chemicals (EDCs) and sleep-disordered breathing (SDB). The sFlt-1/PlGF ratio is among the most validated tools for short-term risk assessment in suspected preeclampsia, while retinal microvascular imaging may provide a non-invasive marker of systemic microvascular dysfunction. Clinically, trial evidence supports treating mild chronic hypertension to below 140/90 mmHg to reduce adverse outcomes without compromising foetal growth. Long-term maternal cardiovascular and metabolic risks vary according to HDP phenotype, severity, gestational age at onset, and associated preterm delivery or foetal growth restriction, whereas offspring neurodevelopmental associations are largely observational and may be influenced by prematurity and shared familial or socioeconomic factors. Experimental strategies supported primarily by preclinical or early translational evidence include PPARγ agonists, placenta-targeted nanomedicine, and transcutaneous auricular vagus nerve stimulation. Machine learning combined with longitudinal multi-omics data may support precision risk stratification and individualised management.

Fractional flow reserve (FFR) assessment represents the most widely used revascularisation strategy of the last two decades. However, many FFR (+) lesions, particularly those in the grey zone, can be safely treated medically, while other lesions carrying vulnerable plaque (VP) features can cause future events despite the absence of ischaemia. Optical coherence tomography (OCT) can identify lesions with VP morphology. The objective of this study is to determine whether a combined revascularisation strategy - targeting only severely ischaemic lesions (FFR ≤0.75) and extending treatment to OCT-assessed VP, even in the absence of ischaemia (FFR>0.80) - could reduce future adverse events compared with the current revascularisation practice based exclusively on the presence of ischaemia (FFR ≤0.80). The COMBINE-INTERVENE Trial is a global, prospective, randomised, single-blinded, sham-controlled, superiority trial. A total of 1,223 all-comer patients with multivessel disease (≥2 lesions with a diameter of stenosis ≥50%) will be randomised 1:1 to revascularisation if the FFR is ≤0.75 or a VP is present (experimental arm) versus FFR ≤0.80 in the comparative arm. The primary endpoint is a composite of cardiac death, any myocardial infarction, or any clinically driven revascularisation within 24 months. The trial has already completed enrolment in 50 centres worldwide. COMBINE-INTERVENE is the first trial evaluating the impact of a revascularisation strategy that targets lesions that are either severely ischaemic or carry an OCT-assessed VP versus revascularisation based on ischaemia alone. The trial is powered for superiority. (ClinicalTrials.gov: NCT05333068).