We assessed the effects of a new quadruple anti-heart failure treatment on the blood pressure rhythm of patients with acute heart failure and its relationship with heart failure prognosis. A total of 135 patients with heart failure were treated with the new quadruple anti-heart failure treatment. Dynamic blood pressure was monitored before and after treatment for 12 to 16 weeks, and changes in the blood pressure rhythm were analyzed. The Kaplan-Meier method was used to calculate the 1-year incidence of major adverse cardiovascular events (MACE). Before and after 12 to 16 weeks of the new quadruple anti-heart failure treatment, the respective mean blood pressure drop rates were 0.44% ± 0.086 and 4.42% ± 0.068 (t = -6.149, P < .001); the systolic blood pressure (SBP) drop rates were 0.54% ± 0.089 and 5.59% ± 0.069 (t = -7.534, P < .001); and the diastolic blood pressure (DBP) drop rates were 0.25% ± 0.104 and 3.37% ± 0.08 (t = -3.943, P < .001); while the mean blood pressure dipper type ratios were 13.3% and 25.9% (χ² = 29.077, P < .001); the systolic dipper type ratios were 13.3% and 28.1% (χ² = 7.714, P = .005); and the diastolic dipper type ratios were 12.6% and 23.0% (χ² = 14.139, P < .001). The 1-year MACE incidence rate in the posttreatment dipper-type blood pressure group was lower than that in the non-dipper-type group (P < .05), and the 1-year MACE incidence rate in patients with improvement in blood pressure rhythm after treatment was lower than that in the non-improvement group (P < .05). The blood pressure rhythms before and after treatment were finally divided into 4 subgroups; 1-year MACE incidence in the mean blood pressure rhythm (P = .037), SBP rhythm (P = .008), and DBP rhythm (P = .005) was the lowest in the dipper-type dipper type group. The new quadruple anti-heart failure treatment regimen can improve the blood pressure rhythm in patients with acute heart failure, and this improvement was associated with a decreased MACE incidence in these patients within 1 year.

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency with high mortality, characterized by sudden cardiovascular collapse, hypoxia, and coagulopathy. Current management is primarily supportive, but emerging case reports suggest a potential benefit from a novel regimen combining atropine, ondansetron, and ketorolac (A-OK). However, due to AFE's extreme rarity, large-scale studies are lacking.

Three women with suspected AFE presented with acute hemodynamic instability, hypoxia, or coagulopathy during or shortly after delivery.

AFE was clinically diagnosed based on sudden cardiovascular collapse, respiratory distress, and coagulopathy in the peripartum setting.

A modified A-OK protocol, atropine, granisetron (replacing ondansetron), and lornoxicam (replacing ketorolac) (A-GL), was administered early alongside standard resuscitation measures.

Rapid hemodynamic stabilization and improved oxygenation were observed within minutes of A-GL administration. All 3 patients survived with favorable outcomes.

These cases suggest that early A-OK-based therapy (or its modified A-GL regimen) may improve outcomes in AFE. Further research is warranted to validate this approach and refine treatment protocols.

Vertebrobasilar dolichoectasia (VBD) is a rare vascular disorder characterized by the dilation, elongation, and tortuosity of the vertebrobasilar artery; a condition which tends to culminate in an ischemic stroke. In cases of VBD complicated by ischemic strokes, reperfusion therapies include chemical thrombolysis and mechanical endovascular thrombectomy. The efficacy of endovascular therapy compared to that of pharmacological treatment in VBD-related ischemic stroke remains unclear. In this study, we present the case of a patient with VBD complicated by ischemic stroke who underwent thrombectomy, shedding light on the complexities and considerations involved in managing this condition.

This report presents a case of a 59-year-old male patient admitted with speech difficulties and altered perceptual capabilities. It is worth noting that this patient had a history of hypertension.

Cranial and cervical computed tomography angiography (CTA) revealed aneurysmal dilation of the basilar artery with a filling defect, indicative of formation of a mural thrombus.

The patient underwent endovascular thrombectomy.

The patient succumbed to brainstem and bilateral cerebellar hemisphere infarctions, as well as obstructive hydrocephalus.

VBD is a rare condition, with ischemic stroke serving as its most common clinical presentation and cause of death. Although the superiority of endovascular therapy over thrombolysis for acute ischemic stroke caused by VBD is not yet established, endovascular interventions are recommended for patients presenting with moderate to severe symptoms. Overall, larger-scale clinical trials are essential to evaluate the safety and effectiveness of endovascular treatment for basilar artery occlusion.

This study aimed to provide a thorough overview of research hotspots in hypertension-induced myocardial fibrosis (MF) through a bibliometric analysis approach.

The Web of Science Core Collection database was searched for publications on hypertension-induced MF from 1976 to 2024. Bibliometric analysis and visualization were conducted by VOSviewer, CiteSpace, and Bibliometrix R package.

The study analyzed 1127 articles from 51 countries, with the USA and China leading in contributions. The volume of publications on hypertension-induced MF has grown annually. Key research institutions include Harvard University and Institut National De La Sante Et De La Recherche Medicale. The journal Hypertension is the most popular, while Circulation is the most cited. The research involves over 7249 authors, with Weber Kt having the highest publication count and international collaborations. The main research focuses are the pathogenesis and treatment strategies, with "pulmonary hypertension," "pressure" and " mechanisms" emerging as primary research hotspots.

This bibliometric study provides an overview of research trends and advancements in hypertension-induced MF. Future research is expected to focus on noninvasive imaging methods, therapeutic targets and strategies, and left ventricular fibrosis associated with pulmonary arterial hypertension, aimed at improving diagnosis and treatment.

In this province, ensuring hepatitis E virus (HEV)-free blood products is imperative. Monitoring HEV antibodies in symptomatic patients with abnormal liver function is key to preventing transfusion-induced hepatitis.

A 34-year-old female had a sudden cardiopulmonary arrest, treated with cardiopulmonary resuscitation, defibrillation, and extracorporeal membrane oxygenation (ECMO). She was discharged but developed liver dysfunction 15 days postsurgery, with positive HEV-IgM.

She was diagnosed with HEV infection. Considering her critical postresuscitation status during ECMO support, the blood transfusion received at that time is highly suspected as the potential route of HEV transmission.

The patient received immediate treatment with Baojians, a hepatoprotective agent, to reduce elevated liver enzymes. Serial monitoring of her liver function was conducted, including regular assessments of aminotransferases, bilirubin, and coagulation parameters. Additionally, a detailed review of her transfusion history was performed to identify potential sources of HEV exposure, such as previous blood product transfusions or organ transplants.

The patient achieved complete recovery, with liver function parameters returning to normal ranges. This outcome not only validated the effectiveness of the implemented treatment regimen but also underscored the significant risk of HEV transmission via blood transfusion.

Blood transfusions in ECMO rescue enhance coagulation and manage anemia, but they also pose risks associated with transfusions. Among these, acute jaundice hepatitis E caused by blood transfusion requires our special attention. To reduce the incidence of hepatitis E from blood transfusions, it is advisable to incorporate hepatitis E antibody monitoring into blood product testing.

Vertebral artery dissection (VAD) is a frequently overlooked cause of posterior circulation stroke in young adults, and the safety of intravenous thrombolysis in this setting remains debated. We report a case of acute ischemic stroke secondary to V3-segment VAD that progressed despite dual antiplatelet therapy, responded promptly to recombinant tissue-plasminogen activator thrombolysis, and showed complete vascular healing at 3 months. The study aim is to underscore that VAD is not an absolute contraindication to thrombolysis and to highlight the value of early recognition and individualized thrombolytic therapy for improving outcomes in young patients with VAD-related stroke.

The patient, a 30-year-old male, was admitted to the hospital at 11:45 on January 24, 2019, due to transient episodic weakness in the right limbs that occurred 2 hours ago, lasting for 30 minutes.

Left vertebral artery V3 dissection; bulbar lacunar infarction; grade 2 hypertension; polycystic kidney; polycystic liver; lung infection.

The patient was diagnosed with a dissection of the V3 segment of the vertebral artery through cranial computed tomography angiography. The disease continued to progress despite dual antiplatelet aggregation therapy with aspirin and clopidogrel. Therefore, intravenous thrombolytic therapy was administered.

On February 11, 2019, the patient was discharged after an improvement in symptoms. There were no neurological deficit symptoms observed at that time. The patient did not experience any subsequent acute ischemic stroke events. The patient showed no hemorrhagic transformation or serious complications. Three months later, the patient had returned to work. Follow-up imaging after 3 months showed complete repair of the vessel with vertebral artery dissection.

The most common clinical manifestations of VAD include dizziness/vertigo, headache, neck pain, and secondary neurologic deficits. However, these symptoms are often nonspecific. This can lead to frequent misdiagnosis or missed diagnosis of the disease. The efficacy and safety of intravenous thrombolysis for ischemic stroke due to VAD remains controversial due to its potential risks. VAD is not considered a contraindication to intravenous thrombolysis.In some cases, VAD endometrial damage can be repaired on its own after regular medical treatment.

Patent foramen ovale (PFO) is a remnant of normal fetal anatomy and is present in approximately 25% of adults. PFO mainly causes right-to-left shunt (RLS). Clinical identification of RLS is crucial for certain patients, particularly those with a history of cryptogenic stroke or other embolic events. Contrast-enhanced transcranial Doppler ultrasound (c-TCD) is a commonly used, noninvasive method for the detection of RLS. In this study, we explored the application of a modified Valsalva blowing device for the diagnosis of RLS using c-TCD.

The data of 805 patients with high clinical suspicion of PFO, who underwent c-TCD at Shaanxi Provincial People's Hospital between January and October 2024, were collected and analyzed. All 805 patients first completed resting-state c-TCD, followed by c-TCD using the traditional Valsalva maneuver and the modified Valsalva blowing device in random order. The RLS detection rate and shunting extent of the two methods were compared.

The detection rate using the traditional Valsalva maneuver was 395 RLS-positive patients (49.1%), but it increased significantly when using the modified Valsalva blowing device (475 positive patients, 59%, P < 0.01). In addition, the diagnosis of the shunting extent differed significantly between the traditional Valsalva maneuver and the modified Valsalva blowing device (P < 0.01).

The modified Valsalva device has higher sensitivity in the diagnosis of RLS than the traditional Valsalva maneuver, especially for higher grade shunting severity. It can be used as an alternative to the traditional Valsalva maneuver in c-TCD screening, particularly in patients who have difficulty performing the traditional Valsalva maneuver.

Osteoarthritis (OA) is a degenerative joint disorder characterized by cartilage degradation and subchondral bone alterations. As current OA treatment mainly focuses on damaged cartilage repair, novel therapeutic strategies targeting microenvironmental instability and chondrocyte dysfunction are needed. This study investigated the therapeutic potential of platelet-derived growth factor (PDGF)-BB, delivered via sodium hyaluronate (SH), in modulating OA chondrocyte microstructure and cytoskeletal dynamics. Utilizing a high-throughput 3D chondrogenic organoid model, we simulated the in vivo cartilage microenvironment to assess the sustained efficacy of PDGF-BB. In vitro and in vivo analyses demonstrated that PDGF-BB significantly stabilized the hypoxic cartilage microenvironment by suppressing F-actin formation and chondrocyte dedifferentiation. Mechanistically, PDGF-BB exerted its effects through oxygen-dependent regulation of HIF-1α/SCIN signaling and inhibition of the RhoA/ROCK pathway, thereby preserving chondrocyte phenotype and extracellular matrix integrity. Furthermore, SH-mediated PDGF-BB delivery extended therapeutic duration, reducing injection frequency while maintaining comparable efficacy to PDGF-BB alone. These findings highlight the role of PDGF-BB in microenvironmental stabilization and indicate SH as an effective delivery vehicle for prolonged OA management. Our findings provide a foundation for clinical translation of PDGF-based therapies, emphasizing combination strategies to optimize treatment outcomes in degenerative joint diseases.

Dongfeng Gu and colleagues review community based cohort studies in China, finding strategies to improve the quality and scale of these studies in China and beyond

Central retinal artery occlusion (CRAO) represents a critical ophthalmological emergency characterized by sudden, painless monocular vision loss and requires immediate intervention within emergency department settings. This narrative review examines the current evidence regarding CRAO management, emphasizing its pathophysiology, risk factors, clinical presentation, diagnostic approaches, and therapeutic interventions. The condition's complex etiology encompasses both embolic and inflammatory processes, with significant associations to cardiovascular risk factors and systemic diseases. Despite its critical nature, CRAO management faces substantial challenges, including delayed patient presentation, limited therapeutic windows, and the absence of universally accepted treatment protocols. Current diagnostic approaches incorporate traditional fundoscopic examination alongside emerging technologies such as point-of-care ultrasound and optical coherence tomography. While conventional management strategies include ocular massage, intraocular pressure reduction, and systemic therapies, their efficacy remains limited by insufficient evidence from randomized controlled trials. Emerging therapeutic approaches, including targeted thrombolysis, hyperbaric oxygen therapy, and novel surgical interventions, show promise but require further investigation. The review emphasizes the importance of a multidisciplinary approach involving emergency medicine, ophthalmology, and neurology specialists to optimize patient outcomes. Future directions highlight the potential of artificial intelligence-assisted diagnostics, standardized "eye stroke" protocols, and ongoing research into novel therapeutic interventions. Success in addressing these challenges requires continued investigation through rigorous clinical trials, improved public awareness regarding CRAO symptoms, and enhanced emergency department protocols to facilitate rapid diagnosis and treatment initiation.