Hypertension in the elderly is closely associated with vascular aging, characterized by endothelial dysfunction (ED) and a progressive decline in nitric oxide (NO) bioavailability. Age-related dysfunction of endothelial nitric oxide synthase (eNOS), compounded by increased oxidative stress, creates a vicious cycle of oxidative-nitrosative imbalance, leading to chronic inflammation and arterial stiffness. The Dietary Approaches to Stop Hypertension (DASH) diet was developed as a primary intervention to restore NO balance by protecting endogenous pathways and supplying alternative nitrate-nitrite-NO precursors. However, its cardiovascular benefits are often diminished by age-related alterations in nitrate metabolism and the extensive use of multiple medications in the elderly. Thus, while restoring balance remains a key therapeutic goal, future clinical strategies must evolve from broad dietary recommendations to more personalized, precise nutritional approaches, considering the unique physiological and pharmacological challenges faced by older adults.

This observational study evaluated the clinical utility of ultrasound-guided midline catheters (MCs) for the delivery of cardiovascular medications in the cardiovascular intensive care unit (CICU). Conducted at a tertiary hospital in China between 2020 and 2022, 387 critically ill CICU patients (median age 78 years) requiring multi-drug infusions were analysed. MCs demonstrated a median dwell time of 9 days (IQR: 6-13 days), successfully administering 13 cardiovascular medications, including vasopressors and antiarrhythmics. Complication rates were remarkably low (1.3%), with two lumen occlusions, two haemorrhages, and one phlebitis. No central line-associated bloodstream infections (CLABSIs) or symptomatic thromboses occurred. Compared to central venous catheters (CVCs), MCs reduced insertion complexity and infection risk while maintaining efficacy for prolonged therapy. The findings support MCs as a safe alternative to traditional CVCs in CICU settings, particularly for elderly patients with complex comorbidities. Nurses performed most insertions (78%), highlighting procedural accessibility. This study underscores the value of ultrasound-guided MCs in optimising vascular access strategies for critical cardiovascular care. Key Words: Midline catheter, Central venous catheter, Peripherally inserted central catheter, Cardiovascular intensive care unit.

This study examined the association between females' sleep duration and the development of hypertension (HTN). Searches were conducted in Embase, PubMed, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases up to March 15, 2024. Using RR as the effect measure, the combined RR and 95% CI were calculated using Stata 15.0. A total of 10 articles, comprising 12 cohort studies, were included in the meta-analysis. Inadequate sleep duration is associated with HTN in women (RR: 1.10, 95% CI: 1.06-1.13, p <0.001). However, long sleep duration was not associated with HTN in women (RR: 1.00, 95% CI: 0.96-1.05, p = 0.958). Short- and long-sleep duration groups showed no publication bias. Subgroup and meta-regression analyses indicated that age and variation in the operational definition of sleep duration were the principal sources of heterogeneity. In age-stratified analysis, both <50 years (RR = 1.19, 95% CI: 1.11-1.28, p <0.001) and ≥50 years (RR = 1.06, 95% CI: 1.00-1.12, p = 0.036) showed increased HTN risk among women with short sleep duration. The dose-response association was L-shaped; using 4 hours/day as the reference, the lowest risk was observed at approximately 7.5 hours/day. For women, insufficient sleep duration is linked to a higher risk of developing HTN. Key Words: Hypertension, Women, Sleep duration, Prospective cohort study, Meta-analysis.

To evaluate the short-term neurological outcomes in neonates with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE) treated with citicoline.

A randomised controlled trial. Place and Duration of the Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from 2024 to 2025.

Seventy neonates presenting with moderate or severe HIE, according to the Sarnat scoring system, were enrolled. Participants were allocated into two equal groups (n = 35 each) by using a simple randomisation method. The citicoline-treated group received citicoline in addition to routine care, while the control group received only routine care. Clinical outcomes were compared. Data were analysed using the chi-square test for qualitative variables and the Student's t-test for quantitative variables. A p-value of <0.05 was considered statistically significant.

Out of 70 neonates, 37 (52.8%) were female, while 33 (47.2%) were male. In the citicoline-treated group, the mean duration of NICU stay was 6.23 ± 3.42 days, compared with 8.46 ± 3.26 days in the control group (p = 0.007). Furthermore, the suck and Moro reflexes were established significantly earlier than the control group, with p-values of 0.001 and 0.002, respectively.

This study demonstrated the neuroprotective effects of citicoline in the treatment of HIE in neonates, with statistically significant earlier establishment of suck and Moro reflexes in the citicoline-treated group compared with the control group.

Citicoline, Hypoxic-ischaemic encephalopathy, Neonates, Seizures, Suck reflex.

To validate the Emergency Department Assessment of Chest Pain Score-Accelerated Diagnostic Pathway (EDACS-ADP) for predicting 30-day major adverse cardiac events (MACE) in patients with chest pain.

An observational study. Place and Duration of the Study: Department of Emergency, Alsancak Nevvar-Salih Isgoren State Hospital, Izmir, Turkiye, from July to November 2025.

Adult patients with chest pain were prospectively evaluated using the EDACS-ADP. The predictive ability of EDACS-ADP for 30-day MACE was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value (NPV), likelihood ratios, and by receiver operating characteristic curve analysis with area under the curve estimation.

Of the 1,389 screened patients, 773 completed the 30-day follow-up period. The mean age was 45.3 ± 16.1 years, and 55.1% were male. MACE occurred in 49 patients (6.3%), including 32 patients with myocardial infarction and three patients with cardiac death. Using the EDACS-ADP, 608 patients (78.7%) were classified as low-risk, accounting for 6 (12.2%) of all 30-day MACE events. In contrast, 165 patients (21.3%) were classified as at risk, accounting for 43 (87.8%) MACE events (p = 0.001). The diagnostic performance of EDACS-ADP was significantly superior to that of EDACS alone, with a sensitivity of 87.8% versus 34.7% and an NPV of 99.0% versus 95.3%. The relative risk of MACE for at-risk patients was 5.2, with an odds ratio of 35.3.

EDACS-ADP showed a high diagnostic accuracy and excellent NPV for detecting low-risk patients with chest pain in the emergency department, confirming its usefulness in secondary care settings in Turkiye.

Chest pain, Emergency department, Acute coronary syndrome, Accelerated diagnostic pathway, Major adverse cardiac events, Risk stratification.

Central line-associated bloodstream infection (CLABSI) is a major cause of morbidity in pediatric cardiac intensive care units. Closed vascular access systems are modern devices used to prevent both needle-stick injuries and CLABSI. This study aimed to compare CLABSI rates between three-way stopcock (TWS) systems and closed vascular access systems (CVAS) in a pediatric cardiovascular surgery intensive care unit (PCSICU).

This study included patients with central venous catheters (CVC) between September 1, 2024, and October 31, 2025. CVC bundle practices were used in this study. The study included 2 time periods: the 7-month TWS period before the initiation of the CVAS, and the 7-month CVAS period.

A total of 111 patients were included. In the 7-month TWS period, 48 patients were admitted to the PCSICU, 334 patient days, and 312 CVC days were recorded. During the CVAS period, 63 patients were admitted to the PCSICU, and 277 patient days and 274 CVC days were recorded. The CLABSI rate decreased from 12.8 per 1000 catheter-days in the TWS period to 0 per 1000 catheter-days in the CVAS period [Poisson comparison, p = 0.17]Conclusions:The CLABSI was not observed in the CVAS period. These findings suggest that closed systems, which may reduce line manipulation, could contribute to lowering CLABSI risk, warranting further investigation in larger studies.

Cardiovascular diseases (CVDs) are a leading cause of global mortality, with ischemic heart disease, stroke, and other related conditions contributing to over one-third of deaths worldwide. The rising prevalence of CVDs is driven by aging populations and various risk factors, including poor diet, physical inactivity, and dyslipidemia. Recent studies suggest that natural supplements like sumac (Rhus coriaria L.) and cinnamon (Cinnamomum verum J. Presl) may have beneficial effects on lipid profiles and overall cardiovascular health. This study is designed to investigate the combined effects of sumac and cinnamon supplementation on lipid profiles and quality of life in a high-risk population of patients with acute myocardial infarction (MI), type 2 diabetes, and overweight/obesity.

This randomized, double-blind controlled trial will involve 76 participants meeting the specified criteria. Participants will be randomly assigned to one of four groups: sumac (S), cinnamon (C), a combination of sumac and cinnamon (S + C), or a placebo, for eight weeks. The primary outcome is the change in serum low-density lipoprotein cholesterol (LDL-C) from baseline to week 8. Secondary outcomes include other lipid parameters (HDL-C, TG, TC, VLDL), pain levels, quality of life (QoL), and inflammatory markers such as interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR). A Complete Blood Count (CBC) will be performed as well. Blinding success will be assessed using the Bang Blinding Index (BBI). Blood samples will be collected at baseline and at the end of the intervention period to measure the relevant biomarkers. Lipid profiles will be measured using standard photometric/enzymatic methods, while IL-6 and hs-CRP will be assayed using ELISA. Data analysis will involve comparisons between the four groups using ANCOVA, adjusting for baseline values and statin intensity.

This study will provide valuable insights into the potential of sumac and cinnamon, both individually and in combination, as complementary therapies for managing lipid profiles and improving the quality of life in patients with CVDs. The findings could contribute to the development of novel dietary interventions aimed at reducing cardiovascular risk and promoting heart health. Additionally, the study will explore the combined effect of sumac and cinnamon, offering insights into whether their joint use provides synergistic benefits beyond those observed with each supplement individually.

Version 4.1 - Protocol, dated 10 June 2026. Recruitment will commence on February 10, 2026.

Iranian Registry of Clinical Trials (irct.ir) IRCT20150711023153N5 ( https://irct.behdasht.gov.ir/trial/70581 ). Registered on 6 December 2023.

Hyperuricemia-related vascular endothelial injury is closely associated with hypertension, atherosclerosis, and other cardiovascular diseases. Although GPR75 has been implicated in vascular inflammation and hypertension, whether it mediates hyperuricemia-induced endothelial dysfunction and how it is regulated upstream remain unknown.

Human umbilical vein endothelial cells were exposed to uric acid and subjected to gain- and loss-of-function experiments targeting HOTAIR, miR-141-3p, and GPR75. A CRISPR/Cas9-generated Hotair knockout mouse model of hyperuricemia was used for in vivo validation. qRT-PCR, Western blotting, immunofluorescence, flow cytometry, and dual-luciferase reporter assays were performed.

Uric acid markedly induced HOTAIR and GPR75 expression in endothelial cells. Dual-luciferase reporter assays further confirmed the direct interactions between HOTAIR and miR-141-3p, as well as between miR-141-3p and GPR75. Mechanistically, HOTAIR functioned as a competing endogenous RNA to sequester miR-141-3p, thereby releasing its inhibitory effect on GPR75. HOTAIR silencing or miR-141-3p overexpression reduced GPR75 expression and NF-κB activation, decreased the expression of inflammatory mediators, including IL-1β, IL-6, and VCAM-1, preserved membrane-associated VE-cadherin, and attenuated endothelial apoptosis. Conversely, these protective effects were largely abolished by miR-141-3p inhibition or GPR75 overexpression. In vivo, Hotair knockout significantly reduced GPR75 expression, NF-κB activation, and vascular inflammatory markers (IL-1β and VCAM-1) in hyperuricemic mice, without altering serum uric acid levels.

This study indicates that HOTAIR aggravates hyperuricemia-induced endothelial injury by regulating the miR-141-3p/GPR75/NF-κB axis and provides new mechanistic insights into hyperuricemia-associated vascular dysfunction.

Despite the remarkable technical success of endovascular thrombectomy (EVT) in achieving high recanalization rates for acute ischemic stroke due to large vessel occlusion (LVO), angiographic success does not consistently translate into functional recovery. Approximately 50% of successfully recanalized patients failed to achieve functional independence at 90 days, a phenomenon termed futile recanalization (FR). Futile recanalization highlights the biological limitations of macrovascular reperfusion alone. We propose a mechanistic framework for FR centered on the "3 R's" of stroke recovery: No-Reflow, No-Rescue, and No-Regrow. No-Reflow refers to microvascular failure despite proximal recanalization, driven by capillary obstruction, endothelial injury, pericyte constriction, and thromboinflammatory processes. No-Rescue describes secondary loss of initially salvageable neurons due to complement activation, neuroinflammation, oxidative stress, and blood-brain barrier dysfunction. No-Regrow reflects impaired neuroplasticity in the subacute and chronic phases, including failed neurogenesis, axonal degeneration, white matter injury, and disrupted network reorganization. This review examines the clinical, imaging, procedural, and molecular determinants of FR to better understand why successful reperfusion does not always result in neurological recovery. Understanding the multifactorial nature of FR is essential to improving EVT outcomes. Future strategies should target microvascular injury and inflammation, refine patient selection criteria, and explore adjunctive therapies aimed at restoring downstream perfusion and mitigating neuroinflammation. By addressing both macrovascular and microvascular factors, it may be possible to translate angiographic success into meaningful functional recovery.

Chronic urticaria is a common mast-cell-driven inflammatory disorder characterized by recurrent wheals, angioedema, or both. Angioedema is associated with higher disease burden, impaired quality of life, and greater difficulty in clinical assessment, yet the overall research structure of chronic urticaria in the context of angioedema has not been systematically mapped. Publications were retrieved from the Web of Science Core Collection on July 14, 2026. English-language Articles and Reviews published between 1947 and 2026 were included after independent screening by two researchers, with disagreements resolved by a third researcher. Bibliometrix, VOSviewer, CiteSpace, Scimago Graphica, and GraphPad Prism were used to analyze annual output, countries, institutions, authors, journals, co-cited references, and keyword evolution. A total of 881 publications were included. Annual output increased over time, with faster growth after 2014. The United States ranked first in productivity, Germany had the highest citation count and total link strength, and Charité - Universitätsmedizin Berlin was the leading institution. The knowledge base was concentrated in mast cell biology, autoimmune mechanisms, anti-IgE therapy, and patient-reported outcomes. Keyword analysis showed a shift from early immune plausibility and idiopathic descriptions toward disease standardization, quality of life, and targeted therapy, including omalizumab and newer targeted treatments. Angioedema remained a high-frequency term and was repeatedly linked to disease burden, assessment, and treatment. The literature addressing both chronic urticaria and angioedema showed increasing emphasis on structured clinical assessment, mast-cell and autoimmune mechanisms, patient-reported outcomes, biomarker-oriented stratification, and targeted treatment. Future research should broaden international participation and evaluate clinically useful biomarkers and patient-centered outcomes across diverse populations.