Left-ventricular end-systolic dimension (LVESD) and end-diastolic dimension (LVEDD) are associated with adverse outcomes in heart failure (HF). The prognostic significance of a change in LVESD or LVEDD is uncertain.

This retrospective cohort study included patients experiencing ≥ 1 HF hospitalization or emergency department (ED) visit between April 2008 and March 2016 and underwent ≥ 2 echocardiograms, separated by ≥ 6 months. The primary outcome was the composite all-cause mortality, HF hospitalization, and ED visits for HF. We performed cut-point analysis to determine the threshold increase in LVESD or LVEDD associated with all-cause mortality. We evaluated characteristics associated with an increase in LVESD and LVEDD above threshold using multivariable logistic regression.

We included 8790 patients, 56.1% were male, with a mean (SD) age of 70.9 (14.5). The thresholds for change in LVESD and LVEDD associated with all-cause mortality were -3.13% and 1.33%, respectively. Patients with ischemic cardiomyopathy and lower LVEF were at increased risk of a change in LV size above the threshold. There was a significant association between an increase in LVESD or LVEDD above threshold and the composite outcome (HR 1.13; 95% CI 1.06, 1.20; HR 1.07; 95% CI 1.01, 1.13, respectively). An increase in LVESD or LVEDD above threshold was associated with increased risk of HF hospitalization (HR 1.27; 95% CI 1.15, 1.39; HR 1.24; 95% CI 1.12, 1.36) and an increased risk of ED visits for HF (HR 1.25; 95% CI 1.15, 1.37; HR 1.16; 95% CI 1.06, 1.26).

Small adverse changes in linear dimensions of LVESD and LVEDD are clinically significant in patients with HF.

Cardiovascular disease (CVD) is a major cause of morbidity in middle-aged and older adults with hip fracture. This study examined the association between the hemoglobin glycation index (HGI) and CVD prevalence in this population.

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) and the National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models were used to examine the association between HGI and prevalent CVD among participants with a history of hip fracture. Sensitivity analyzes and subgroup analyzes were performed to evaluate result robustness.

The final analysis included 264 participants from CHARLS and 194 from NHANES. In CHARLS, the highest HGI tertile was significantly associated with higher CVD prevalence after full multivariable adjustment; a positive association was also observed when HGI was modeled continuously. In NHANES, after accounting for the complex survey design, the associations for HGI tertiles were no longer statistically significant, although a significant positive association persisted for continuous HGI. Sensitivity analyzes yielded broadly consistent patterns within each cohort.

Elevated HGI was significantly associated with higher CVD prevalence among middle-aged and older adults with hip fracture in the CHARLS cohort, independent of diabetes status. In the NHANES cohort, the association was attenuated and largely non-significant after full adjustment. These heterogeneous findings suggested that HGI may serve as a complementary marker of inter-individual glycation variation in selected populations. Given the cross-sectional design, the results should be regarded as hypothesis-generating; prospective studies are needed to evaluate any potential clinical utility.

Not applicable.

Ischemic heart disease (IHD) remains a major cause of morbidity and mortality in Iran, but evidence is dispersed across model-based estimates, population studies, registries, hospital surveillance, and death-registration data. We synthesized national and subnational evidence on IHD burden in Iran from 1990 to 2023.

PubMed/MEDLINE and Scopus were searched through August 15, 2026, supplemented by Google Scholar and citation searching. Eligible studies reported incidence, prevalence, mortality, hospitalization, case fatality, post-myocardial infarction survival, or burden-of-disease measures. Model-based and empirical evidence were synthesized separately, overlapping data sources were mapped, and findings were narratively synthesized because of heterogeneity.

Fifty-two reports representing 35 evidence-source families were included. Within GBD 2019, age-standardized IHD mortality declined from 285.7 to 163.6 per 100 000 between 1990 and 2019, incidence from 898.3 to 829.1, and prevalence from 6250.6 to 6198.5 per 100 000, while incident cases increased from 218 181 to 593 001. Successive GBD vintages also showed declining age-standardized mortality but were not directly comparable because of modeling differences. Empirical studies generally showed higher coronary event rates in men, while Isfahan surveillance and the Iranian MI Registry indicated higher short-term post-MI case fatality among women. Burden increased with age, provincial variation was substantial, and urban-rural patterns were inconsistent. Hospital surveillance suggested improving short-term outcomes.

Successive GBD analyses estimated substantial declines in age-standardized IHD mortality, while absolute burden remained large and differences persisted by age, sex, geography, and data source. Stronger prevention and geographically representative surveillance are needed.

Hospitalised patients with advanced chronic heart failure (CHF) waiting for transplantation may experience increased thirst due to their critical illness and therapy-related requirements. The perspective of patients and nurses is important for developing a nurse-based counselling intervention to reduce thirst.

To identify patients' and nurses' experiences and perceptions of thirst, as well as their information needs and preferences on information dissemination.

This convergent mixed methods study used semi-structured interviews with patients, focus groups and a survey with nurses in Germany. We analysed the qualitative data using content analysis and the quantitative data descriptively. We compared the results of both methodological approaches and summarized the data as meta-inferences.

We conducted 10 interviews with patients on intensive care units, intermediate care units and general wards during their waiting time for transplantation, two focus groups with, respectively, five nurses and a survey with 59 nurses caring for these patients. Analyses resulted in five common categories: experiences of thirst, factors that influence thirst, assessment of thirst, dealing with thirst and information about thirst. Patients' experiences with thirst differ markedly, ranging from mild to severe thirst, and they use various strategies to deal with thirst. Nurses consider thirst relevant for patients and nursing care. Strategies used in practice for assessment of thirst are very heterogeneous. In the survey, less than half of the nurses claimed to regularly assess patients' thirst. Nurses and patients wish to receive individual information and counselling.

Thirst in hospitalised patients with advanced CHF waiting for transplantation can be severe and is experienced differently. Standardised procedures for assessing and managing thirst on the ward seem essential to address patients' needs and preferences.

Patients and nurses express a need for professional counselling on managing thirst in clinical practice.

To determine the potential feasibility and acceptability of combined screening for raised blood pressure (BP), atrial fibrillation (AF) and cognitive impairment (CI) in older adults within a setting of hearing health assessment for detection of hearing loss.

We recruited participants aged 65 years or older (n = 35; mean age 73 ± 6 years, 51% females) from the community to attend a single visit lasting approximately 60-90 min. Prior to a comprehensive hearing assessment, BP was measured with an automatic BP monitor with AF detection, and CI screening was conducted using the patient section of the General Practitioner Assessment of Cognition instrument. A subset of participants (n = 16, 50% females) was interviewed post study to evaluate acceptability.

A total of 21 positive screens (six raised BP; two possible AF; 13 hearing loss) and 12 potential positive screens for possible CI were detected in 25 (71%) participants. Eight participants (23%) had more than one newly detected condition. Interviews revealed that combined screening was feasible and acceptable as participants felt it was 'convenient,' 'saves time' and 'more efficient.'

Combined screening for raised BP, AF and CI in older adults within a hearing health assessment setting appears feasible and was generally perceived positively by participants in this pilot study. Further implementation studies should be conducted with process and outcome evaluation embedded to confirm feasibility and acceptability as well as to evaluate cost-effectiveness and health outcomes for combined screening in older adults.

Breviscapine (BRE) possesses excellent cardioprotective efficacy against myocardial infarction (MI). However, its oral application is severely hindered by BCS Class IV properties, including poor solubility and permeability, accompanied by P-glycoprotein (P-gp)-mediated drug efflux and gastrointestinal absorption barriers. Arginine-rich CPPs such as R8 can promote cellular uptake, whereas cationic surface characteristics may restrict particle mobility in gastrointestinal mucus. Conversely, hydrophilic and electro-neutral surfaces favor mucus penetration but may reduce epithelial uptake. This imposes challenges for balancing these two absorption barriers. To solve these problems, we developed surface-engineered nanocrystals with sequential barrier-crossing capability (R8-F127-VES@BRE-NCs).

We engineered multifunctional nanocrystals (R8-F127-VES@BRE-NCs) featuring a sequential barrier-crossing design: nanocrystal technology increases saturation solubility, Pluronic F127 imparts mucus-penetrating capability, R8 peptide facilitates epithelial internalization, and Vitamin E Succinate (VES) may contribute to efflux modulation.

Comprehensive characterization and in vitro studies suggested that this integrated design helped address the trade-off between mucus diffusion and epithelial uptake. Pharmacokinetic studies revealed a marked enhancement in oral BRE absorption, with C_max and AUC_0-∞ increased to 185.76 ng/mL and 1418.34 ng·mL^-1·h (4.27- and 7.37-fold over BRE-raw). Following establishment of the isoprenaline-induced myocardial injury model, 14-day oral treatment with R8-F127-VES@BRE-NCs showed enhanced cardioprotective effects, as evidenced by reduced infarct size and improved oxidative stress-related biochemical indicators.

R8-F127-VES-modified nanocrystals provide a promising strategy for overcoming oral delivery barriers and enhancing the cardioprotective effects of orally administered BRE.

Exosomes have emerged as important mediators in the pathophysiology of hypertension, facilitating intercellular communication through the transfer of bioactive molecules such as microRNAs. This review synthesizes current evidence on the multifaceted roles of exosomes in hypertensive vascular damage, highlighting their involvement in endothelial dysfunction, vascular smooth muscle cell phenotypic switching, renin-angiotensin-aldosterone system modulation, and renal ion transport regulation. Circulating exosomal microRNAs are identified as central drivers of inflammation and vascular remodeling, while urinary exosomes offer non-invasive insights into renal sodium handling and early hypertensive injury. Conversely, mesenchymal stem cell-derived exosomes demonstrate considerable vasoprotective and immunomodulatory properties, positioning them as therapeutic candidates. We further discuss emerging engineering strategies, both endogenous and exogenous, that aim to enhance exosomal targeting, cargo delivery, and therapeutic efficacy. Despite progress, challenges related to biological heterogeneity and long-term safety remain barriers to clinical translation. This review underscores the dual potential of exosomes as diagnostic biomarkers and therapeutic platforms, while outlining directions for future research toward clinical implementation in hypertension management.

This structured narrative review evaluates endovascular thrombectomy (EVT) through an author-developed, population-level treatment-response framework. In this framework, treatment response is the causal contrast between EVT plus best medical care and best medical care alone on a specified patient-centered outcome; it is not the outcome observed after EVT, and it cannot be observed for an individual patient because the untreated counterfactual is unknown. The framework is an evidence-interpretation tool, not a statistical estimator, a validated decision aid, or an individual prediction model. It separates four clinically actionable questions: first, trial eligibility-does the patient resemble a population in which EVT was tested; second, baseline prognosis-which features predict outcome under either strategy; third, procedural feasibility and safety-can reperfusion be achieved promptly at acceptable risk; and fourth, treatment-effect modification-does randomized evidence support a different relative or absolute effect across levels of a baseline variable? We conducted targeted, purposive searches across PubMed/MEDLINE, supplemented by backward and forward citation tracking, to identify pivotal randomized trials, individual participant data meta-analyses, population-specific guidelines, and directly relevant secondary analyses through 15 August 2026. Randomized evidence supports EVT for proximal anterior-circulation large-vessel occlusion in the early window, selected 6-24 h anterior-circulation populations, trial-defined large-core infarction, and selected moderate-to-severe basilar artery occlusion. Dedicated randomized evidence remains absent beyond 24 h and incomplete for large-vessel occlusion with a low National Institutes of Health Stroke Scale (NIHSS) score. ESCAPE-MeVO, DISTAL, and DISCOUNT did not demonstrate average functional benefit in broad medium/distal-vessel populations, whereas ORIENTAL-MeVO reported benefit in an enriched population with NIHSS at least 6; these results should not be generalized across all distal occlusions. Failure to detect an interaction does not establish homogeneous effects because interactions are outcome- and scale-specific, and most EVT trials are underpowered to detect them. Poor outcomes after successful reperfusion are descriptive of post-treatment states, not proof that EVT was futile. This framework clarifies what randomized evidence establishes, what remains prognostic or procedural, and where prospective testing is still required.

Stroke disproportionately affects Africa, where incidence and prevalence rates rank among the highest reported worldwide, and case-fatality remains high. As acute survival improves in many, though not all, African settings, the burden of chronic post-stroke sequelae is growing, yet non-motor complications such as pain remain comparatively neglected in both clinical practice and research relative to motor and cognitive outcomes. Post-stroke pain is a heterogeneous group of syndromes, including central post-stroke pain, hemiplegic shoulder pain, spasticity-related musculoskeletal pain, post-stroke headache, and complex regional pain syndrome, each with distinct mechanisms and management pathways. This narrative review summarizes the sparse but growing African evidence base on post-stroke pain epidemiology and clinical phenotypes, drawing on data from Egypt, Nigeria, Zimbabwe, Ghana, Kenya, South Africa, and Uganda, and situates it within global comparators. We identify substantial unmet needs across assessment, including the absence of pain-screening tools validated in African languages, limited diagnostic infrastructure, and low clinician awareness, and across management, including restricted pharmacological access, scarce rehabilitation workforce, limited access to interventional options, and the parallel, poorly integrated use of traditional and complementary medicine. We propose a research and policy agenda prioritizing validated assessment tools, phenotype-specific prevalence studies, and pragmatic, resource-appropriate management models suited to African health systems.

Uric acid-to-HDL cholesterol ratio (UHR) and uric acid-to-albumin ratio (UAR) are emerging composite biomarkers of nutrition and metabolic inflammation. This study investigates and compares their associations with advanced cardiovascular-kidney-metabolic (CKM) syndrome and all-cause mortality.

This cross-sectional study included 17,833 adults from NHANES 2001-2020, with external validation in a clinical cohort of 300 hospitalized patients. Weighted logistic regression, restricted cubic spline (RCS), ROC curve, and Cox regression analyses were performed.

Both UHR and UAR were significantly elevated in patients with advanced CKM syndrome (both P < 0.001) and independently associated with increased CKM risk (UHR: OR = 1.07, 95%CI: 1.06-1.09; UAR: OR = 1.08, 95%CI: 1.06-1.10). Nonlinear associations were observed for both biomarkers, with inflection points at 9.46 for UHR and 15.79 for UAR (both P for nonlinear < 0.001). In ROC analysis, UAR slightly outperformed UHR in the NHANES cohort (AUC: 0.640 vs. 0.602), whereas UHR showed superior performance in the clinical cohort (AUC: 0.787 vs. 0.686). Both biomarkers remained independently associated with all-cause mortality after full adjustment.

UHR and UAR are independently associated with advanced CKM syndrome and have complementary clinical utility. UAR may be preferred for early screening, whereas UHR may be better suited for CKM diagnosis and metabolic risk stratification. Their combined use may facilitate prognosis evaluation and mortality risk warning.