BACKGROUND Pulmonary embolism is associated with increased morbidity and mortality, yet the patient can sometimes look deceptively calm at the bedside. A normal blood pressure reading does not rule out a struggling right ventricle, and patients classified as intermediate-high-risk can deteriorate quickly. A mobile right-heart thrombus (clot-in-transit) adds another layer of urgency because embolization can be sudden and unpredictable. CASE REPORT A 45-year-old woman with a previous pulmonary embolism presented with abrupt dyspnea, tachycardia, and hypoxemia shortly after stopping apixaban. Bedside transthoracic echocardiography showed marked right ventricular dilation and a mobile right atrial thrombus consistent with clot-in-transit. Computed tomography pulmonary angiography confirmed bilateral segmental/subsegmental pulmonary embolism. Although she remained normotensive, biomarker positivity and a lactate rise suggested early hypoperfusion. After immediate anticoagulation with unfractionated heparin, the Pulmonary Embolism Response Team was activated, and, after multidisciplinary discussion, we decided to treat the patient with reduced-dose systemic alteplase (50 mg over 2 hours). The patient improved rapidly without bleeding complications and was discharged on long-term anticoagulation. She remained in excellent clinical condition at her 2-month follow-up. CONCLUSIONS This case demonstrates that in pulmonary embolism, stability is more than a blood pressure reading. The presence of right ventricular strain together with a clot-in-transit can justify immediate treatment escalation. Reduced-dose systemic thrombolysis can be a reasonable option in carefully selected patients, but decisions should remain individualized.

Air pollution remains a significant environmental and public health issue in Malaysia, with notable effects on the economy and climate. Despite long-standing monitoring systems and regulations, comprehensive assessments that combine multiple data sources with health impact analysis are still lacking. This study reviews peer-reviewed studies, haze events from 1983 to 2024, regulatory documents from the Department of Environment, Malaysia, and data from air quality monitoring stations across regions. and presents an integrated assessment of air quality across strategic and important urban, industrial, coastal, and residential areas. It analyses trends in the Air Pollutant Index and PM_2.5 levels from 2013 to 2024, and uses exposure-response models to estimate related deaths and economic impacts. Satellite data (MODIS and AERONET) help understand spatial variation and cross-border pollution. Average PM_2.5 levels ranged from 8.66-16.77 µg/m³, consistently above WHO guidelines from 2021. In 2020, PM_2.5 exposure was linked to 1.419 early deaths in four urban areas, costing about MYR 2.46 billion (USD 524 million). Population-attributable fractions ranged from 2.6-7.1%, with risk rising by 2.7-7.6% per 10 µg/m³ increase. The study identified 12 major haze events, notably in 1997 and 2015. COVID-19 restrictions temporarily reduced emissions, but levels quickly rebounded afterward. Conclusively, Malaysia's air quality issues are mainly due to transport, industry, dust, and recurring transboundary haze. Solutions include better source tracking, enhanced secondary pollutant monitoring, integrating health data more effectively, adopting advanced technologies, and aligning policies with WHO standards. Pollution effects are more pronounced in metropolitan regions due to proximity to dense sources.

Ischemic stroke is a condition characterized by the obstruction of blood flow to the brain, typically caused by a blood clot, leading to brain tissue damage and impaired neurological function. This study aims to use proteomic analysis to reveal the protein expression differences between different recovery results (meaningful recanalization [MFR] and futile recanalization [FTR]) in the recovery process of patients with ischemic stroke after thrombosis. We collected plasma samples from the healthy control (CON), MFR, and FTR groups, and used high-throughput data-independent collection (DIA) mass spectrometry for proteomic analysis. A total of 5,040 proteins were identified in the study, of which 775 were differentially expressed proteins (DEPs). The functional enrichment analysis revealed that these proteins are involved in lipid metabolism, amino acid synthesis, cell signaling regulation, and other pathways, especially between the FTR and MFR groups; the expression differences of specific proteins reflect biological differences in the recovery process. We identified 11 key DEPs, including Phospholipid Transfer Protein, Fructose-Bisphosphate Aldolase A, Alpha-Enolase 1, and Fatty Acid-Binding Protein, which may be potential biomarkers for predicting stroke recovery. This study provides new insights into the molecular mechanisms underlying recovery after ischemic stroke, particularly the molecular differences associated with distinct recovery outcomes, and identifies potential markers for personalized treatment and prognostic evaluation.

The identification and management of cardiogenic shock remain significant clinical challenges, as evidenced by persistently high mortality rates and the absence of standardized therapeutic strategies. This article provides a comprehensive overview of ongoing clinical trials in the treatment of cardiogenic shock, organized into three principal approaches aimed at improving patient outcomes: novel pharmacological therapies, optimized use of mechanical circulatory support, and advanced hemodynamic monitoring strategies. By synthesizing the available evidence, we highlight current research directions and discuss how emerging data may inform future clinical practice.

Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules. To evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and left ventricular function. This prospective case-control study was conducted at Assiut University Children's Hospital between September 2023 and August 2025. Twenty-one children with familial dyslipidemia and twenty-one age-, sex-, and BMI-matched healthy controls underwent clinical evaluation, lipid profile assessment, and transthoracic echocardiography, including measurement of epicardial fat thickness and left ventricular systolic and diastolic function according to American Society of Echocardiography guidelines. Dyslipidemic patients showed significantly higher total cholesterol (332.9 ± 222.3 mg/dL), triglycerides (391.4 ± 251.6 mg/dL), and LDL (154.3 ± 130.4 mg/dL) than controls (p < 0.001). Mixed hyperlipidemia was the most common type (47.6%). Echocardiography revealed increased epicardial fat thickness (2.88 ± 0.94 mm vs. 2.29 ± 0.57 mm; p = 0.018), larger left atrial (21.45 ± 3.86 mm; p = 0.031) and aortic diameters (17.54 ± 3.12 mm; p = 0.013). Triglyceride level was the only independent predictor of epicardial fat thickness (β = 0.437, p = 0.028).

 Echocardiography revealed increased epicardial fat thickness and early cardiac remodeling. Serum triglycerides were the only independent predictor of EFT, suggesting its key role in subclinical cardiovascular risk among dyslipidemic children.

• Epicardial adipose tissue is associated with cardiovascular risk factors in adults. • Children with primary dyslipidemia may develop early cardiac dysfunction.

• This study demonstrates a signifi cant association between epicardial adipose tissue thickness and left ventricular function in children. • It highlights the potential role of epicardial fat as an early marker of cardiac involvement in pediatric dyslipidemia.

Superficial temporal artery (STA) biopsy remains an important diagnostic investigation for giant cell (temporal) arteritis. Incisions should optimise STA exposure while avoiding the temporal branch of the facial nerve. However, the widely used Gillies incision, a 2 cm temporal incision 2.5 cm anterior and superior to the auricular helix within the hairline, has been shown to be inconsistent for STA access.

In this study of 20 hemifaces from 10 body donors (mean age 87.1; range 75-93; n = 3 females), STA branches were mapped using a Cartesian grid referenced to the anterior crus-lateral canthus axis. Four 2 cm incisions were modelled: Gillies, pre-auricular, and two novel algorithmically optimised incisions targeting frontal and parietal branches. Access was defined as incision-to-vessel distance of ≤ 0.5 cm or ≤ 1.0 cm. All donors had provided written consent for anatomical research under the Human Tissue Act 2004.

The Gillies incision accessed the frontal branch in ≤ 1.0 cm in 11/20 (55%) and ≤ 0.5 cm in 3/20 (15%); parietal access was ≤ 1.0 cm in 8/19 (42%) and ≤ 0.5 cm in 4/19 (21%). Pre-auricular incision improved access: ≤ 1.0 cm for frontal 13/20 (65%) and parietal 18/19 (94.7%) branches. Optimised frontal and parietal incisions achieved ≤ 1.0 cm access in 19/20 (95%) and 18/19 (94.7%) respectively.

Our findings suggest that the Gillies incision may not be a reliable approach for accessing the frontal or parietal branches of the STA. Pre-auricular and algorithmically optimised frontal and parietal incisions achieved high, branch-specific access but require clinical validation.

Arteriovenous fistula (AVF) failure remains a significant clinical problem for hemodialysis access. It is driven by hemodynamic changes which promote inflammatory responses leading to neointimal hyperplasia and ultimately stenosis. Perivascular wraps have proved to be a promising intervention for mitigating hemodynamics stress. However, the molecular impact of perivascular wraps on the venous wall is not fully understood. This study aims to evaluate the molecular effects of polycaprolactone (PCL) perivascular wraps and PCL wraps embedded with radiopaque bismuth nanoparticles (PCL-Bi) on the outflow vein. Chronic kidney disease (CKD) was induced in female Sprague-Dawley rats through 5/6th nephrectomy. After CKD induction, AVFs were created via end-to-side anastomosis of the external jugular vein to the common carotid artery. The AVFs were treated with either a PCL wrap, a PCL-Bi wrap, or left as unwrapped controls (n = 3 each group). The outflow veins were harvested for bulk RNA sequencing after 8 weeks. Differential expression and pathway enrichment analyses were performed to evaluate differences between the groups. Compared to the unwrapped controls, the PCL-wrapped AVFs showed significant downregulation of pathways related to vascular smooth muscle cell processes, endothelial cell processes, and cell adhesion. Conversely, pathways related to phagocytosis and lysosomal activity were upregulated, reflecting a controlled response to the bioresorbable scaffold. Few differences were observed between the PCL and PCL-Bi wrapped AVFs, demonstrating that the addition of bismuth nanoparticles does not negate the beneficial effects of the PCL scaffold.

Eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN), are severe mental health conditions affecting physical and psychosocial health. Structural gender inequality may shape the burden of EDs across sexes and regions. We analyzed Global Burden of Disease Study 2023 estimates to assess the relationship between gender inequality and ED burden in Europe. Years Lived with Disability (YLD) for AN and BN were extracted by sex and five-year age groups (10-39 years) from 1990 to 2023 across 35 countries. Gender inequality was measured using the Gender Inequality Index (GII). Mixed linear regression was applied with year, age group, sex, GII, and their interactions as fixed effects, and country and year as random intercept and slope, respectively. YLDs increased over time across most countries and age groups, with females consistently experiencing the highest burden. For AN, higher levels of GII were significantly associated with greater YLD rates in both males (β = 29.28; 95% CI: 22.2 to 36.4) and females (β = 85.3; 95% CI: 42.1 to 128.6), with a stronger effect for females. For BN, GII was inversely associated with YLDs among males (β = -645.6; 95% CI: -732.8 to -558.3), whereas a positive association was observed among females (β = 794.7; 95% CI: 659.1 to 930.2). Higher burden of AD and BN among young Europeans in more gender-equal settings coexisted with sex-specific patterns associated with increasing gender inequality, underscoring the complexity of gender-related factors and the need for gender-sensitive mental health strategies.

Chronic stroke and spinal cord injury (SCI) lead to persistent motor impairments that reduce independence and quality of life. Although rehabilitation is essential to address these challenges, the amount of therapy provided during the chronic phase remains limited, while the long-term costs of care are substantial.

The INTeRAcT (Intensive Rehabilitation Programme Integrating Advanced Technology) trial investigates a high-dose, intensive-targeted, and personalized rehabilitation program through an integrated clinical, health economic, and process evaluation.

This single-blind randomized controlled trial will include 100 adults in the chronic phase after stroke or SCI. Participants will be randomized to either the INTeRAcT intervention group (n=50) or a control group receiving usual care (n=50). The intervention group will receive 90 hours of personalized motor rehabilitation over 3 weeks, including upper and lower limb therapy, with and without technology, cardiovascular fitness training, and self-management education. Both groups then resume usual care and are followed for 9 months. Clinical assessments are performed at baseline (T0), after 3 weeks (T1, postintervention), and after 9-months follow-up (T2) by a blinded assessor. The primary outcome is independence in daily life, assessed using the Functional Independence Measure for stroke and the Spinal Cord Independence Measure for SCI. Secondary outcomes include the EQ-5D-5L, Canadian Occupational Performance Measure, Goal Attainment Scaling, Fatigue Severity Scale, and stroke-specific measures such as the Action Research Arm Test, Fugl-Meyer Assessment, 6-Minute and 10-Meter Walk-Test, and the Stroke Self-Efficacy Questionnaire. Group differences in clinical change will be analyzed using multivariate linear models. Health economic data will be collected using diaries and questionnaires, capturing direct and indirect costs. Cost-effectiveness will be assessed through a trial-based cost-utility analysis over 9 months and a Markov model over a lifetime horizon. The process evaluation follows the UK Medical Research Council framework, using mixed methods with quantitative and qualitative data from diaries, interviews, and observations, analyzed descriptively and thematically.

The funding of the project started in February 2023. Protocol version 5 (accepted March 15, 2024). Participant recruitment occurred between June 2023 and September 2024, with a total of 102 participants enrolled. Data collection ended in July 2025. Data analysis is ongoing.

This protocol outlines a randomized controlled trial integrating clinical, health economic, and process evaluations to assess a high-dose, individualized rehabilitation program. The findings will provide evidence on effectiveness, cost-effectiveness, and implementation feasibility in chronic stroke and SCI, supporting the optimization of long-term neurorehabilitation care.

Purpose To evaluate the prognostic utility of cardiac MRI parameters, particularly native T1 and extracellular volume fraction (ECV), for predicting early mortality in a preclinical model of anthracycline-induced cardiotoxicity. Materials and Methods Thirty-one Sprague-Dawley rats received weekly intravenous doxorubicin injections (2 mg/kg) for up to 12 weeks and were followed up until natural death. Cardiac MRI, including parametric mapping sequences, was performed. Myocardial histology was evaluated after death. Cox proportional hazards regression with time-dependent covariates was used to assess the association between MRI variables and early death. Results Of the 31 rats, 17 (55%) died before 12 weeks (early death group), and 14 survived to study completion. In the early death group, native T1 and ECV increased between weeks 4 and 6 (from 1210.51 msec ± 53.75 to 1368.09 msec ± 60.11 and from 17.52% ± 2.05 to 21.63% ± 2.22, respectively; both P < .001). At week 6, both parameters were higher in the early death group than in the survival group (1368.09 msec ± 60.11 vs 1243.10 msec ± 55.71, P = .003; 21.63% ± 2.22 vs 18.47% ± 2.13, P = .045). In univariable analyses, native T1 (hazard ratio, 1.01; 95% CI: 1.00, 1.01; P < .001) and ECV (hazard ratio, 1.17; 95% CI: 1.04, 1.32; P = .01) were statistically significantly associated with early death. A model combining native T1 and ECV achieved a C-index of 0.76 (95% CI: 0.64, 0.92). Conclusion Native T1 and ECV were good predictors of early mortality in rats with anthracycline-induced cardiotoxicity. Keywords: Animal Studies, MR-Imaging, Cardiac, Myocardium, Experimental Investigations Supplemental material is available for this article. © RSNA, 2026.