Optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute ICH remains uncertain. In light of new data published since the previous ESO guidelines, this update provides revised, evidence-based recommendations across 8 key clinical questions to support BP management in acute stroke. The guidelines were developed using the ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, including literature searches, systematic reviews and meta-analyses of relevant RCTs, assessment of evidence quality and formulation of specific recommendations. We advise against routine pre-hospital BP lowering in suspected stroke (moderate-certainty evidence). In AIS patients undergoing reperfusion therapy, we recommend maintaining BP < 185/110 mmHg before the bolus of intravenous thrombolysis and < 180/105 mmHg during and for 24 h after intravenous thrombolysis (low-certainty evidence) and/or mechanical thrombectomy (moderate-certainty evidence). We recommend against intensively lowering systolic BP < 140 mmHg in the first 24 h after successful mechanical thrombectomy (high-certainty evidence). Routine use of vasopressors to raise BP in AIS patients with neurological deterioration who are not treated with acute reperfusion therapies is discouraged (low-certainty evidence). In acute ICH, the net clinical benefit of intensive BP lowering remains uncertain; however, expert consensus supports early systolic BP reduction to < 140 mmHg in patients with small-to-moderate haematomas to limit haematoma expansion. Overall, the updated recommendations reaffirm the core principles of current clinical practice while providing more nuanced guidance for specific scenarios. However, the quality of evidence remains moderate to very low, limited by a lack of high-quality RCTs, methodological issues, inconsistent results and study heterogeneity. Consequently, most recommendations are weak and supported by expert consensus. These guidelines provide specific recommendations on BP thresholds and management strategies tailored to distinct acute stroke subgroups. They also highlight the ongoing uncertainty and emphasise the need for future RCTs to define optimal BP targets, timing, treatment strategies and ideal antihypertensive agents across different clinical contexts.

To assess the prognostic value of the homocysteine-to-high-density lipoprotein cholesterol (Hcy/HDL-C) ratio and the high-sensitivity C-reactive protein-to-albumin (hs-CRP/Alb) ratio as biomarkers for predicting functional outcomes in acute cerebral infarction (ACI) patients treated with recombinant tissue plasminogen activator (rt-PA).

A retrospective analysis was conducted on 204 ACI patients who received rt-PA. Patients were classified into two groups based on their functional outcomes at 3 months poststroke: good (modified Rankin scale [mRS] ≤ 2) and poor (mRS > 2). Logistic regression and restricted cubic spline (RCS) analyses were performed to evaluate the association between Hcy/HDL-C and hs-CRP/Alb ratios with functional outcomes. A predictive nomogram was developed incorporating these biomarkers, baseline NIHSS scores, and atrial fibrillation. The performance of this nomogram was compared to traditional risk models.

Elevated Hcy/HDL-C and hs-CRP/Alb ratios were identified as independent predictors of poor functional outcomes in ACI patients (p < 0.05). The nomogram, incorporating these biomarkers along with NIHSS scores and atrial fibrillation, demonstrated superior predictive performance with a C-index of 0.936 and an AUC of 0.935, outperforming traditional risk models (C-index = 0.782). Subgroup analysis revealed that Hcy/HDL-C was more predictive in patients with large-artery atherosclerosis (LAA), while hs-CRP/Alb showed stronger prognostic value in patients with cardioembolic strokes.

The Hcy/HDL-C and hs-CRP/Alb ratios serve as independent and valuable biomarkers for predicting poor outcomes in ACI patients post-rt-PA treatment. The nomogram incorporating these biomarkers provides superior prognostic accuracy and could be a useful tool for personalized risk assessment and management in ACI patients following thrombolytic therapy.

Patients with cardiovascular and chronic kidney disease (CKD) are at increased risk of adverse outcomes, calling for early monitoring of kidney function to reduce morbidity and mortality. We aimed to estimate CKD prevalence, albuminuria, kidney monitoring practices and adherence to guideline-recommended treatment in cardiology outpatients.

This cross-sectional study included 196 patients from a cardiology outpatient clinic in Svendborg, Denmark. Blood and urine samples were analysed for the estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio and secondary markers of kidney impairment, in accordance with international guidelines. Medical history, risk factors and demographic information were obtained from a questionnaire. Regular CKD monitoring (≥ 1 ×/year) and nephroprotective drug use were evaluated.

The prevalence of CKD was 50.5%, and 20.9% of patients were categorised with a high or very high CKD risk. In patients with CKD, 23.2% had albuminuria despite normal eGFR, 22.2% had secondary markers of kidney impairment, and only 15.2% were aware of having reduced kidney function. Regular kidney monitoring was lacking in 33.7% of patients, and 64.3% of patients with CKD did not receive the recommended treatment.

The prevalence of CKD was high in cardiology outpatients. Limited awareness of kidney function, in combination with infrequent screening of CKD, led to inadequate prescription of nephroprotective drugs.

Funded by the Cardiovascular Research Unit, Odense University Hospital Svendborg.

Not relevant.

Acute appendicitis is a common surgical emergency, but accurate diagnosis remains challenging. Despite the 2020 World Society of Emergency Surgery Jerusalem guidelines recommending structured imaging pathways, including ultrasound and selective computed tomography, clinical assessment remains the primary diagnostic tool in Denmark. Contemporary practice emphasises rapid assessment, with imaging reserved for older or borderline cases. We hypothesised that reliance on clinical assessment alone contributes to a high number of negative appendectomies, particularly in young adults.

We conducted a single-centre retrospective cohort study of adults (> 18 years) undergoing surgery for suspected appendicitis at a tertiary university hospital in Denmark between January 2021 and December 2023. Data were extracted from electronic medical records and analysed in Stata 19.5.

Among 613 patients, 522 had histologically confirmed appendicitis, yielding an overall negative appendectomy rate (NAR) of 14.9%. Patients without preoperative imaging (n = 279) had a NAR of 24.4%, compared with 6.9% among those who underwent preoperative imaging (n = 334).

Reliance on clinical assessment alone results in a substantial number of unnecessary operations. Preoperative imaging significantly reduces NAR (p less-than 0.001), supporting broader adoption of guideline-based diagnostic strategies to improve diagnostic accuracy and optimise resource utilisation.

None.

Not relevant.

The Danish RETROSHOCK registry has provided valuable insights into patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) and their clinical trajectories. However, continuously updating the registry through manual chart review is time-consuming.

Electronic medical records were retrieved from patients admitted to Odense University Hospital from 2018 to 2022, assigned an ICD-10 code suggestive of AMICS. A random sample of 100 consecutive patients was selected for testing the AI-assisted chart review. The AI tool was a natural language processing model identifying AMICS-related keywords. Electronic medical records were initially screened using AI-assisted chart review, with time recorded until AMICS diagnosis or exclusion due to an alternative diagnosis. One week later, a manual chart review was performed. AI-assisted and manual screening times were compared using the Wilcoxon signed-rank test.

AI-assisted chart review identified the same 26 AMICS patients as manual review (Cohen's kappa = 1). Median manual inclusion time was 2:20 minutes, compared with 1:16 minutes with AI-assisted chart review (p less-than 0.001). Median manual exclusion time was 2:45 minutes, and AI-assisted exclusion was 0:59 minutes (p less-than 0.001).

AI-assisted chart review significantly reduced screening time for including AMICS patients in the RETROSHOCK registry and excluding non-eligible patients, while preserving diagnostic accuracy.

The RETROSHOCK database is supported by Johnson and Johnson Med Tech and the Novo Nordic Foundation.

Not relevant.

Fibrosis is a pathological process characterized by the abnormal deposition of connective tissue across multiple organ systems. Given the high prevalence of fibrotic diseases and the limited availability of clinical treatment options, it has emerged as a major challenge in contemporary medicine. Chronic inflammation is widely recognized as a common pathological basis of various fibrotic disorders. In fibrosis progression, CCR2 acts as a critical signaling hub, initiating cascade reactions and contributing to the formation of a complex regulatory network. Studies have demonstrated that in most organ fibrotic processes, CCR2 primarily exerts pro-fibrotic effect by recruiting inflammatory monocytes, activating fibroblasts, and promoting extracellular matrix deposition. However, the function of CCR2 is not unidimensional. It may also play a regulatory role in promoting fibrosis regression under specific tissue and pathological contexts. CCR2 signaling exhibits dual regulatory properties at different stages of liver fibrosis. CCR2 promotes injury in the early phase, while participating in fibrosis reversal by mediating macrophage transition toward a reparative phenotype and facilitating extracellular matrix degradation. This stage-dependent behavior suggests that inappropriate timing of intervention may disrupt repair process, and the functional redundancy of the chemokine system may trigger compensatory adaptations. Together, these factors constitute the core translational challenges facing CCR2-targeted therapeutic strategies. This article systematically reviews the complex regulatory network and pivotal role of CCR2 signaling in fibrosis progression, summarizes the latest advances in the diagnosis and treatment of clinically relevant fibrotic diseases associated with this pathway, analyzes the specific challenges in translating CCR2-targeted therapies into clinical practice, and outlines future research directions.

Inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices as well as practical and political issues restrict the global applicability of currently available guidelines. There is a need for universal recommen- dations that address the unique challenges faced by patients and healthcare providers worldwide. Our iCARDIO Alliance Global Implementation Guidelines emphasize the incorporation of novel therapies, while integrating standard of care with the most up-to-date evidence to enable clinicians to optimize patient care. This document is about heart failure (HF), including acute and chronic heart failure, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies. Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged. Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients. Such "economic adjustment" recommendations aim to provide guidance for situations when "Resources are somewhat limited" or when "Resources are severely limited". Hence, this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.

This study investigated the pathological characteristics and risk factors of early cardiovascular disease (CVD) associated with rheumatoid arthritis (RA) using a collagen-induced arthritis (CIA) rat model.

A total of 120 SPF-grade male SD rats were used. Following CIA induction, echocardiography, histopathology, molecular biology, and lipid profile analysis were employed to dynamically monitor cardiac function, structural changes, and lipid profiles across disease stages (D0-D112) .

Sequential progression of cardiac dysfunction: Echocardiography revealed a significant decrease in the mitral valve E/A ratio (MVE/A) starting from D84 (P<0.05), indicating diastolic impairment preceding systolic dysfunction.Myocardial structural abnormalities: The heart-to-body weight ratio (HW/BW) in CIA rats was significantly higher than that in the control group starting from day 84 (*P < 0.01), indicating cardiac hypertrophy. Masson staining revealed progressive myocardial fibrosis with increasing collagen deposition from D56. Abnormal lipid profiles and biomarkers: LDL-C significantly increased from D84 to D112 (*P<0.01), while OX-LDL rose from D98 to D112 (P<0.05); B-type natriuretic peptide (BNP) significantly increased at D112 (*P<0.01), indicating heart failure risk. Negative atherosclerosis findings: No plaque formation was detected in the Oil Red O staining of the aorta and coronary arteries. While macroscopic atherosclerotic plaques were not apparent, microvascular endothelial dysfunction may play a role in the early stages of cardiovascular disease (CVD) .

Cardiovascular lesions in CIA rats exhibit sequential progression: diastolic dysfunction and myocardial fibrosis emerge first (from D56), followed by systolic dysfunction (from D98), accompanied by lipid metabolism disorders driven by LDL-C and OX-LDL. This model provides an experimental basis for studying the mechanisms of RA-associated cardiac lesions and early intervention.

Patient and public involvement (PPI) in pricing and reimbursement (P&R) procedures is increasingly recognized as essential for strengthening the quality, legitimacy, and patient-centredness of healthcare decision-making. However, implementation remains heterogeneous across countries and data on concrete practices, barriers, and enablers are fragmented. This study aimed to map international approaches to PPI in P&R procedures and identify barriers and enablers to meaningful involvement.

A mixed-methods design was applied, combining a scoping literature review complemented by qualitative research. The scoping literature review was conducted following PRISMA-ScR guidance to identify scientific publications on PPI in P&R procedures. Semi-structured interviews and focus group discussions were conducted with industry experts, policymakers, assessors, and patient organisations. A descriptive, narrative, and thematic analysis integrating findings across data sources identified recurring patterns, cross-country similarities and differences, and diverse stakeholders' perspectives.

The literature and stakeholder perspectives revealed that PPI remains uneven and inconsistently implemented in P&R procedures across healthcare systems, though overall trends point towards more structured participation and partnership. Barriers include: (i) resource constraints, (ii) unclear value and impact of PPI, (iii) conflict of interest and confidentiality concerns, (iv) recruitment challenges, (v) concerns about representativeness and diversity, (vi) complexity of P&R terminology and processes, (vii) methodological gaps, (viii) limited experience with PPI, and (ix) competing workloads. Across countries, stakeholders identified a shared set of enabling conditions necessary for meaningful involvement: (i) clear institutional commitment and leadership, (ii) dedicated resources, time, and experience-building with explicit definition of roles, expectations, and scope of influence, (iii) transparency and systematic feedback for two-way communication, (iv) methodological rigour and evaluation frameworks for capturing and reporting experiential evidence, (v) inclusivity and representativeness with diverse participation opportunities, and (vi) capacity building for both patients and the public, as well as P&R agencies.

While PPI in P&R procedures remains uneven across countries, there is a clear shift towards more structured participation. Meaningful and sustainable involvement requires the integration of structural, organisational, procedural, technical, and financial enablers. When these enablers are aligned and mutually reinforcing, PPI can become a substantive driver of more patient-centred, transparent, and socially accountable P&R decision-making.

The changes in local renin-angiotensin system (RAS), independent of systemic RAS, are suggested to play a role in the pathophysiology of chronic kidney disease (CKD). This study aimed to investigate RAS molecules in children with predialysis CKD and to evaluate their relationship with echocardiographic parameters.

The patients with predialysis CKD (n = 37) and control group (n = 48) were included. Angiotensin-A, angiotensin-2, angiotensin converting enzyme (ACE)-1, ACE-2, angiotensin 1-7 and alamandin levels were determined by ELISA. Echocardiography was performed with M-mode, pulsed wave Doppler, tissue Doppler, and speckle tracking strain.

Serum angiotensin peptide levels were similar between patients and controls. Urinary angiotensin peptides were lower in patients and were positively correlated with glomerular filtration rate (p < 0.001 for each). Urinary angiotensin peptides were lower and serum angiotensin-2 and angiotensin 1-7 were higher in patients without hypertension compared to controls (p < 0.05). Serum ACE-2 was lower in patients with hypertension (p < 0.05). Urinary angiotensin peptides and serum angiotensin-A were lower in CKD with hypertension compared to healthy children (p < 0.05). In logistic regression analysis, hypertension was negatively correlated with urinary angiotensin peptides. Serum angiotensin-A was negatively and angiotensin-2 was positively correlated with hypertension (p < 0.05). Mitral lateral E was positively correlated with serum alamandin and ACE-2 (p < 0.05). Tricuspid E/A correlated with serum alamandin, angiotensin-A, ACE-1 and ACE-2 levels (p < 0.05). Tricuspid lateral S was negatively correlated with urinary alamandin and urinary angiotensin-A (p < 0.05).

Circulating and local RAS molecules may play a role in renal dysfunction, hypertension, and echocardiographic alteration in children with predialysis CKD.