Survival with good neurological function after out-of-hospital cardiac arrest (OHCA) remains low. Extracorporeal cardiopulmonary resuscitation (eCPR) may benefit selected patients, but it is unclear how many patients in a mixed urban-rural European region would be eligible, whether regional case volumes justify dedicated eCPR programmes, and whether an in-hospital strategy after intra-arrest transport can meet a 60-minute low-flow target.

We conducted a retrospective cohort study of OHCA cases in the city and county of Göttingen, Germany (January 2015-February 2025). eCPR eligibility was assessed using a local protocol and a stricter modified ELSO definition. Eligibility was first determined at emergency medical services (EMS) arrival and then re-evaluated for three hypothetical intra-arrest transport strategies in which transport was initiated after 10, 15, or 20 minutes of on-scene conventional cardiopulmonary resuscitation (cCPR). Scene-to-hospital travel times were modelled and patients were classified according to whether they would be eligible for eCPR upon hospital arrival. A complementary analysis estimated time from collapse to hypothetical eCPR initiation under an on-scene scenario, split into simultaneous dispatch of a dedicated eCPR team (S1a) and delayed dispatch after 10 minutes of on-scene evaluation by the primary EMS team (S1b), and an in-hospital scenario following intra-arrest transport (S2), incorporating documented timing of sustained return of spontaneous circulation (ROSC).

Of 2,218 OHCA cases, 1,696 registry-documented patients were analysed (median age 71.5 years; 67.5% male; shockable rhythm 20.5%). At EMS arrival, 348 patients (20.5%) met local and 149 (8.8%) modified ELSO criteria. With transport initiated after 10/15/20 minutes of on-scene cCPR, 11.1%/9.8%/8.8% (local) and 3.8%/3.1%/2.8% (modified ELSO) would have been eligible at hospital arrival. Extrapolated regional case volume was approximately 46 (local) and 20 (modified ELSO) eligible patients per year at EMS arrival. In patients who met local eCPR criteria the number of patients with sustained ROSC exceeded those without at 13.4 minutes after EMS arrival. Median estimated time from collapse to eCPR was 37 minutes under S1a (94.8% within 60 minutes) and 54 minutes under S1b (71.6% within 60 minutes) versus 75 minutes under S2 (<1% within 60 minutes). After excluding patients with ROSC before hypothetical eCPR initiation, 47.4% (S1a) and 31.6% (S1b) in the local cohort and 36.9% (S1a) and 24.8% (S1b) in the modified ELSO cohort would both still have required and could have received on-scene eCPR within 60 minutes.

A substantial number of OHCA patients in our region met eCPR eligibility criteria, but hospital arrival did not equate to eCPR initiation. Given realistic procedural time intervals, in-hospital eCPR following intra-arrest transport rarely met the 60-minute target, whereas on-scene eCPR might have remained feasible for most eligible patients.

Primary aldosteronism (PA) is a common but frequently ignored cause of hypertension, particularly in patients with normal serum potassium and aldosterone levels.

We report the case of a 70-year-old Han Chinese man with a 20-year history of hypertension who presented with normokalemia and normal plasma aldosterone levels. Despite this, laboratory evaluation revealed suppressed direct renin concentration (DRC) and a markedly elevated aldosterone-to-renin ratio (ARR), raising suspicion for PA. Adrenal computed tomography demonstrated bilateral nodular adrenal thickening. The patient had persistently uncontrolled blood pressure despite triple antihypertensive therapy with amlodipine besylate, valsartan/hydrochlorothiazide, and bisoprolol. Spironolactone was added to the existing regimen but was subsequently discontinued due to intolerance. Treatment was then switched to finerenone, a nonsteroidal mineralocorticoid receptor antagonist. During follow-up, blood pressure was well controlled, serum potassium levels remained stable, and both plasma renin concentration and the aldosterone-to-renin ratio normalized.

This case highlights the diagnostic challenge of PA evaluation in a patient with normal-range aldosterone and suppressed renin and provides clinical experience with finerenone after intolerance to a steroidal mineralocorticoid receptor antagonist.

To investigate the association between hobby engagement and the risk of hypertension using data from the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS).

This study included 7,112 participants aged ≥ 50 years from CHARLS and 4,937 participants aged ≥ 50 years from HRS. Hobby engagement was assessed at baseline and at follow-up, and longitudinal changes in hobby engagement were analyzed. The primary outcome was incident hypertension. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were also measured. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident hypertension, and changes in SBP and DBP with hobby engagement were examined using linear mixed-effects models. Kaplan-Meier curves and subgroup analyses were performed.

In baseline analyses, participants with hobby engagement had a significantly lower risk of developing hypertension compared to non-engaged participants in both CHARLS (HR = 0.84, 95% CI: 0.76,0.93) and HRS (HR = 0.86, 95% CI: 0.78,0.96) after full adjustment. In longitudinal analyses of hobby engagement patterns, persistent hobby engagement had the greatest protective effect in both cohorts compared with persistent hobby non-engagement in CHARLS (HR = 0.77, 95% CI: 0.68,0.88) and HRS (HR = 0.83, 95% CI: 0.73,0.95), respectively. Hobby engagement was associated with reductions in SBP (-0.52 mmHg per year) and DBP (-0.24 mmHg per year) over time in CHARLS. However, this effect was not observed in HRS.

Hobby engagement is a significant protective factor against hypertension, with stronger benefits observed among individuals who maintained their hobby engagement over time. These findings support the integration of hobby-based interventions into public health strategies for preventing hypertension in middle-aged and older populations.

Adrenal insufficiency (AI) is a rare but potentially life-threatening cause of perioperative hemodynamic instability characterized by an inadequate cortisol response to physiological stress.

We report a case of a 77-year-old woman undergoing oblique lumbar interbody fusion who developed profound intraoperative hypotension refractory to fluid resuscitation and multiple vasopressors. Notably, she had a history of corticosteroid therapy for rheumatoid arthritis that had been discontinued nearly 3 decades earlier. She also exhibited extreme skin fragility.

AI was clinically suspected based on persistent vasopressor-resistant hypotension, a remote history of corticosteroid therapy, and extreme skin fragility.

Suspecting AI, intravenous hydrocortisone was administered postoperatively, resulting in rapid hemodynamic stabilization and subsequent weaning of vasopressors.

Pre- and postoperative biochemical testing was inconclusive for definitive AI. However, the clinical presentation and dramatic response to steroid administration strongly suggested surgical stress-related AI. The patient was discharged without any complications.

This case underscores the importance of maintaining a high index of suspicion for AI in patients with unexplained, vasopressor-resistant hypotension, even those with a remote history of corticosteroid use, as timely empirical treatment can be life-saving.

Hypertension remains one of the leading modifiable risk factors for cardiovascular disease and premature mortality worldwide. Blood pressure (BP) management is particularly challenging in patients with coexisting type 2 diabetes (T2D), chronic kidney disease (CKD), or heart failure (HF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have become an integral component of contemporary cardiorenal therapy and have consistently demonstrated additional BP-lowering effects across diverse clinical settings. This narrative review synthesizes the current clinical evidence regarding the antihypertensive effects of dapagliflozin and summarizes the biological mechanisms that may contribute to these effects, including osmotic diuresis and natriuresis, weight reduction, modulation of the sympathetic nervous system, enhanced uric acid excretion, and attenuation of oxidative stress, inflammation, and vascular dysfunction. Across clinical studies, reductions in systolic BP (SBP) generally exceed those in diastolic BP (DBP), although the physiological basis underlying this differential response remains incompletely understood. Dapagliflozin has demonstrated good tolerability and antihypertensive effects in clinical applications, its long-term use may be limited by the risk of genital infections. Collectively, the available evidence supports dapagliflozin as a cardiorenal therapeutic agent that may provide additional BP-lowering benefits in patients with hypertension and concomitant T2D, CKD, or HF, rather than as a substitute for conventional antihypertensive therapy. Future hypertension-focused clinical studies are warranted to further define its role in hypertension management.

Diabetic macular edema (DME) is a common microvascular complication of diabetes and a major cause of vision impairment. Intravitreal vascular endothelial growth factor (VEGF) inhibitors remain the gold standard for its management. However, the high cost and limited accessibility of reference anti-VEGF agents have driven growing interest in biosimilars-biologic therapies designed to match the efficacy, safety, and immunogenicity of their reference products. Following the expiration of patents for agents such as aflibercept and ranibizumab, several biosimilars have been developed, approved, and introduced into clinical practice. Evidence from real-world studies-including RE-ENACT2 (REal-life assessmENt of safety And effeCTiveness of Razumab) and REAR-RD2 (REal-world observational study to evaluate the risk factors in the management of REtinal Diseases-2)-as well as randomized clinical trials such as INSIGHT and CT-P42 has demonstrated clinical equivalence between these biosimilars and their reference anti-VEGF counterparts in the treatment of DME. This article provides an updated overview of the current evidence base, recent advances in regulatory pathways, and ongoing challenges in integrating biosimilars into routine DME management.

Type 2 long QT syndrome (LQT2) increases the risk of cardiac arrest and sudden death due to reduced rapid delayed rectifier potassium currents (IKr) in the heart. Caused by loss-of-function genetic variants in the hERG K⁺ channel, LQT2 might benefit from variant-targeted therapy approaches. T1019PfsX38 and Q1070X are LQT2-causing variants reported in Oman and Saudi Arabia. Although nonsense-mediated mRNA decay (NMD) has been proposed to contribute to reduced expression of these truncating variants, it remains unclear whether residual mutant hERG channel function can be pharmacologically enhanced. We used the patch-clamp technique and examined the effects of the hERG potentiator NS1643 on wild-type-, T1019PfsX38- and Q1070X-hERG channels expressed in HEK293 cells. We started by assessing the response of these variants under the influence of a ventricular action potential clamp protocol, then used additional protocols to elucidate the drug's mechanism of action. NS1643 [10 µM] enhanced the repolarization currents in wild-type-, T1019PfsX38- and Q1070X-expressing cells. Its effect was associated with accelerated activation rates and a negative shift in the voltage dependence of activation. In addition, NS1643 suppressed fast deactivation transitions. We conclude that the functions of T1019PfsX38- and Q1070X-hERG channels can be augmented by hERG potentiators if NMD is incomplete, which may facilitate the development of a mechanism-based rescue approach.

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the consensus statement on the management of type 2 diabetes in nonpregnant adults, published since 2006 and last updated in 2022. The target audience is the multidisciplinary health care team providing diabetes care in the U.S. and Europe. A systematic examination of publications since 2022 informed new recommendations. This update has broadened the focus from the management of hyperglycemia to the holistic management of type 2 diabetes and its risk of associated multiple long-term conditions. Fundamental aspects of diabetes care include promoting healthy lifestyle behaviors (healthy eating, 24-h physical behaviors including sleep, and avoiding tobacco and substance use), alongside the provision of psychological support and weight management interventions. For the management of people living with type 2 diabetes, earlier use, potentially from diagnosis, of sodium-glucose cotransporter 2 (SGLT2) inhibitors and/or glucagon-like peptide 1 (GLP-1)-based therapies to offer organ protection and improve long-term outcomes in type 2 diabetes is advocated. Furthermore, earlier combination use of SGLT2 inhibitors and GLP-1-based therapies should be considered in people with concomitant cardiovascular disease, chronic kidney disease, and heart failure. Finally, the ability to transform outcomes for people living with type 2 diabetes is within our grasp through the consistent, equitable, and systematic implementation of strategies and therapies that are already available.

Noonan syndrome (NS) is a multisystem RASopathy marked by characteristic facies, congenital heart disease, short stature, and variable neurodevelopmental and systemic complications. Although molecular and clinical knowledge has advanced, evidence-based clinical guidance in Japan has been limited. A multidisciplinary committee in pediatric endocrinology, clinical genetics, and pediatric cardiology developed consensus guidelines on diagnosis, comorbidity assessment, treatment, and transitional care. Clinical questions were defined, and the literature published through March 2024 was systematically reviewed. Evidence was graded in partial accordance with the Minds Clinical Practice Guideline Development Manual 2020 and the GRADE framework, with expert consensus supplementing areas of limited evidence. External review included patient groups and academic societies, and the guideline was approved in 2025. The guideline recommends expanding diagnostic panels to include LZTR1, SOS2, MRAS, RRAS, and RRAS2 in addition to established genes. It advises comprehensive childhood assessment for tumor predisposition, coagulation abnormalities, hearing and ophthalmologic problems, neurodevelopmental features, and endocrine and cardiovascular complications, with strong emphasis on cardiac evaluation. Growth hormone therapy is recommended for short stature with careful monitoring for malignancy risk. MEK inhibitors may help selected patients with refractory hypertrophic cardiomyopathy or lymphatic abnormalities. Lifelong multidisciplinary surveillance and structured transition to adult care are strongly emphasized.

A steady increase in the number of grandparent caregivers - accelerated by recent trends such as children orphaned by the COVID-19 pandemic or the opioid crisis - magnifies the importance of addressing cardiovascular disease (CVD) risk in that already at high-risk group. However, few efforts have directly addressed the specific cardiac health needs of grandparent primary caregivers (or custodial grandparents). In this paper, we describe the research protocol for the Rural Caregiver Heart Health Education (RICHH) intervention for implementation with grandparent caregivers (RICHH-GP) study funded by the National Institute of Heart, Lung, and Blood. This study will tailor an existing CVD risk reduction intervention (RICHH) for implementation with grandparent primary caregivers and then test the modified design for feasibility, acceptability, and preliminary efficacy. The expected outcome of RICHH-GP is to establish the groundwork for an expanded future clinical trial in which we will test effectiveness with a longer follow-up and with increased inclusivity of participants from marginalized populations. The specific aims are: 1) modify the RICHH intervention to target custodial grandparents from a variety of backgrounds; 2) employ the tailored intervention and assess its feasibility and acceptability via a 2-arm randomized controlled trial; 3) test the preliminary efficacy of RICHH-GP based on measures of CVD risk (physical activity, dietary intake, nicotine exposure, sleep, body mass index, lipids, blood pressure, and HbA1c), self-management behaviors, and depressive symptoms at 4- and 6-months compared to baseline and; 4) (exploratory) examine the proximal impact of the RICHH-GP intervention on CVD risk and depressive symptoms on a subsample of grandchildren of the grandparent participants. The ultimate objectives of this work are to prevent CVD-related morbidity and mortality and overall physical decline, improve psychological well-being among grandparent caregivers, and foster a more heart-healthy environment in grandfamilies.