Vascular cognitive impairment and dementia (VCID), a major contributor of dementia, remains underrecognized, owing to the absence of universally accepted diagnostic criteria. The VasCog Society and WSO recently released updated criteria (VasCog-2-WSO); however, their applicability is unknown yet. We aimed to evaluate these criteria in a dementia-free and stroke-free community cohort and determine their associations with vascular burden and long-term mortality.

We conducted a community-based cohort study using data from the I-Lan Longitudinal Aging Study. Adults aged 50 years or older without prior stroke or dementia underwent standardized brain MRI and comprehensive neuropsychological assessment. VCID was classified according to the VasCog-2-WSO criteria using a neuroimaging-first approach. Participants were categorized as non-VCID, preclinical VCID (with or without objective cognitive impairment), or vascular mild cognitive impairment (vaMCI). Baseline 10-year Framingham cardiovascular disease risk was assessed. The primary outcome was all-cause mortality over a mean follow-up of 9.4 years, analyzed using multivariable Cox proportional hazards and Poisson regression models.

A total of 1,236 participants (62.7 ± 8.8 years; 52.9% female) were included. Neuroimaging evidence of cerebrovascular disease was present in 19.6% of participants; 19.2% met criteria for preclinical VCID and 0.4% for vaMCI. Compared with non-VCID participants, neuroimaging-positive groups had worse cognitive performance and higher 10-year cardiovascular risk. Mortality increased across the VCID spectrum (7.4 [95% CI 5.7-9.4], 24.9 [16.0-37.1], 27.4 [18.2-39.6], and 137.9 [37.6-353.2] per 1,000 person-years). In adjusted Cox models, preclinical VCID was associated with a 1.5-1.7-fold higher mortality risk, and vaMCI with a hazard ratio of 7.2 (95% CI 2.4-21.1), with a significant graded association across the spectrum (p for trend <0.001).

The VasCog-2-WSO criteria identify a spectrum of MRI-defined vascular cognitive vulnerability associated with increased cardiovascular risk and mortality, with excess mortality risk detectable at a neuroimaging-defined preclinical stage before overt cognitive impairment. These findings support their utility for early detection and risk stratification in community settings. A key limitation is the inability to assess mixed etiologies due to the absence of genetic data and Alzheimer disease biomarkers, which limits the ability to thoroughly evaluate the VasCog-2-WSO VCID diagnostic framework.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the Middle East and Africa (MEA), with a rising incidence particularly among women. Regional factors such as limited health care access, cultural barriers, and sex-specific risk factors exacerbate this burden. Despite this, women remain significantly underrepresented in cardiovascular research, and no large-scale, multicenter prospective trials have been conducted to provide national data. To address this gap, we established the Middle East African Registry Women Cardiovascular Disease (MEA-WCVD) to create a comprehensive database on the epidemiological profile and management of heart failure (HF), atrial fibrillation (AF), ischemic heart disease (IHD), and valvular heart disease (VHD) in women.

The primary aim of this study is to compare the management of CVDs in women and men across MEA countries in accordance with current clinical practice guidelines. The study also seeks to identify gender-based disparities in health care insurance, income, and access to cardiovascular services.

The MEA-WCVD is a prospective, multicenter, observational study enrolling consecutive patients aged ≥18 years with diagnosed HF, AF, IHD, or VHD across 25 tertiary care centers. Participants provide informed consent during a single visit, and trained investigators collect sociodemographic, clinical, and treatment data via electronic case report forms. The electronic case report form captures general characteristics (age, gender, and comorbidities) and diagnosis-specific details (imaging, guideline-based therapies, and complications). Data are stored in a centralized, contract research organization-managed database (Eshmoun-Clinical Research, Tunisia). An initial 75-day enrollment phase (May 2023-July 2023) is followed by a planned 1-year follow-up for outcome analysis. Data will be analyzed using SPSS (version 25) to compare gender disparities in management and outcomes using multivariable regression and survival analyses.

The MEA-WCVD study was funded in April 2023, and data collection began in May 2023. As of July 2023, a total of 15,366 participants have been enrolled across 25 centers. A 1-year follow-up is expected to be completed by July 2024. Data analysis is planned to commence in July 2024, with primary results anticipated for publication in March 2025. The study aims to establish the largest registry in the MEA region for HF, AF, IHD, and VHD, providing valuable insights into demographic trends, clinical management, and adherence to current guidelines.

The MEA-WCVD registry will provide essential real-world data on the management and outcomes of the most prevalent CVDs (HF, AF, IHD, and VHD) in the MEA region. By directly comparing standard care management between men and women, this study will highlight gender disparities and inform future strategies for equitable cardiovascular care. The registry is expected to contribute to the largest contemporary cohort of patients with CVD in the region, advancing knowledge in cardiovascular epidemiology and clinical practice.

This study sought to develop and validate a predictive model integrating the Braden scale to forecast the recovery of activities of daily living (ADL) in patients with post-stroke hemiplegia. Additionally, it aimed to evaluate the effectiveness of a comprehensive rehabilitation program.

A retrospective analysis was conducted on 324 patients with hemiplegic stroke admitted to our hospital between August 2023 and August 2025. Candidate variables were selected from demographics, comorbidities, neuroimaging features, laboratory findings, early treatment, complications, Braden scale scores and ADL assessments. Patients were categorized into low and high ADL recovery groups based on the median post-treatment ADL score. A logistic regression model was developed and presented as a nomogram. Model performance was assessed using receiver operating characteristic (ROC) analysis, calibration curves, and decision curve (DCA) analysis, followed by internal validation. Additionally, in a subgroup of 82 patients who underwent comprehensive rehabilitation, detailed functional assessments including motor function, balance, walking ability, and activity of daily living (ADL) were conducted before and after intervention.

A total of 324 patients with post-stroke hemiplegia were included in the analysis. Comparative analysis between the high and low ADL recovery groups revealed that the high recovery group was significantly younger (p < 0.001) and had a higher proportion of females. This group also exhibited lower CRP levels (p = 0.003), higher albumin (ALB, p < 0.001) and cholesterol (CHOL) levels (p = 0.039), a lower rate of multi-lesion involvement (p < 0.001), a higher rate of thrombolysis (p = 0.019), a lower incidence of infection (p < 0.001), a lower rate of specific medicine intake (p = 0.021), higher baseline ADL scores at admission (p < 0.001), and higher Braden scale scores both before and after treatment (p < 0.001). Multivariable logistic regression identified sex, thrombolysis, infection incidence, and post-treatment Braden scale as independent predictors of ADL recovery. The nomogram showed excellent discrimination, with an AUC of 0.888 (95% CI: 85.4%-92.2%). At the optimal cut off value of 0.55, the model achieved a sensitivity of 84.3% and a specificity of 76.6%. In the rehabilitation subgroup (N = 82), significant post-treatment improvements were observed in motor function (upper limb p < 0.001, hand p = 0.002, lower limb p < 0.001), balance (Berg Balance Scale and Fugl-Meyer assessment; both p < 0.001), walking capability (p < 0.001), and overall performance (p < 0.001).

The findings indicate that sex, incidence of infection, thrombolysis, and the post-treatment Braden scale were independent predictors of ADL recovery. Moreover, the comprehensive rehabilitation program was associated with significant functional improvements in motor skills, balance, ADL, and walking proficiency.

Acute ischemic stroke (AIS) treatment selection requires rapid, guideline-concordant integration of clinical, imaging, and laboratory data, including therapeutic windows, contraindications, stroke severity, and imaging eligibility. This process is complex, expertise-dependent, and vulnerable to safety-critical errors.

This study aimed to develop and validate a structured multiagent large language model (LLM) framework for AIS decision support using real-world cases and to assess its accuracy, safety, auditability, and impact on physician decision-making, particularly among junior physicians and nonspecialists.

We developed a multiagent LLM framework that used structured outputs and guideline-based reasoning to generate treatment recommendations (intravenous thrombolysis, endovascular thrombectomy, standard medical therapy, or non-AIS, or nonstroke) and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. The framework was evaluated using multicenter retrospective real-world cases from 2 hospitals collected between January 2018 and March 2025, prospective cases from February to May 2025, and literature-derived challenging cases from PubMed between January 2024 and January 2025. Performance was assessed against clinical reference standards. Safety was assessed using omission and hallucination event rates, instruction adherence, and 5-point clinical safety ratings. In a prospective physician study, physicians with different seniority and specialty backgrounds made AIS treatment and TOAST classification decisions with and without LLM support. Physician-case decision-level outcomes were analyzed using a binomial generalized linear mixed-effects model accounting for physician and case effects.

The final analysis included 1055 group A cases, 721 group B cases, 144 literature-derived group C cases, and 161 prospectively collected group D cases. Across representative Baichuan, Qwen, DeepSeek, and GPT models, the multiagent framework consistently improved treatment recommendation accuracy. Model-level accuracy ranges increased from 0.546-0.737 to 0.687-0.851 in group A, from 0.587-0.698 to 0.671-0.813 in group B, and from 0.507-0.646 to 0.667-0.750 in group C. TOAST classification improved overall, with cohort-level variation. Across evaluated models, the multiagent framework increased the mean clinical safety score from 3.70 to 4.01 and reduced mean hallucination and omission rates from 33.6% to 20.6% and from 38.5% to 24.5%, respectively. In the prospective physician study, LLM support increased treatment decision accuracy from 73.1% to 88.6% (odds ratio 2.86, 95% CI, 2.27-3.60; P<.001). Accuracy gains were largest among junior and nonspecialist physicians, including junior specialists (0.667 to 0.833), junior nonspecialists (0.600 to 0.846), and senior nonspecialists (0.667 to 0.850). TOAST classification performance also improved (odds ratio 3.63, 95% CI 2.85-4.64; P<.001).

A structured multiagent framework improved LLM performance with average improvements of 18.9% in AIS treatment recommendation and TOAST classification, while producing more structured, auditable outputs with higher safety ratings. It was associated with higher physician decision accuracy, with larger gains among less-experienced physicians, suggesting the potential to narrow expertise-related decision accuracy gaps. Prospective multicenter studies are needed to assess effects on workflow and clinical outcomes.

Current immunosuppressive treatment is used for autoimmune, inflammatory, malignant, transplant-related, and other chronic conditions that may carry elevated cerebrovascular burden. Nationally representative evidence on current immunosuppressive treatment status and self-reported lifetime stroke history remains limited. This cross-sectional study used pooled 2023-2024 National Health Interview Survey Adult Sample data. The analytic sample included adults aged 18 years or older with valid survey weights and complete data on exposure, outcome, and selected covariates. The exposure was current self-reported use of medications that weaken the immune system. The outcome was self-reported lifetime stroke history. Survey-weighted logistic regression estimated odds ratios and 95% confidence intervals, accounting for National Health Interview Survey stratification, clustering, and adjusted sampling weights. The final analytic sample included 60,026 adults, representing approximately 250 million United States adults. The weighted prevalence of current immunosuppressive treatment was 4.6%. Stroke history was more common among adults receiving immunosuppressive treatment than among those not receiving treatment (6.0% versus 2.8%). In unadjusted analysis, immunosuppressive treatment was associated with higher odds of stroke history (odds ratio 2.24, 95% confidence interval 1.86-2.70, p < 0.001). After full adjustment for age, sex, race/ethnicity, hypertension, diabetes, smoking status, coronary heart disease, and income-to-poverty category, the association persisted (adjusted odds ratio 1.71, 95% confidence interval 1.40-2.08, p < 0.001). Current immunosuppressive treatment status, likely reflecting both medication exposure and underlying disease burden, was associated with higher odds of self-reported lifetime stroke history among United States adults. Because of the cross-sectional design, broad exposure definition, self-reported outcome, and potential confounding by indication, these findings should be interpreted as an association rather than evidence of causation.

Chronic kidney disease (CKD) is associated with increased mortality, however, the impact of troponin-defined myocardial injury within this population remains poorly understood. This study aimed to investigate the associations between troponin-defined myocardial injury and long-term mortality in CKD patients.

This observational study analyzed 22,772,953 weighted records of adult CKD patients from National Health and Nutrition Examination Survey (1999-2004) databases. Myocardial injury was defined by at least one elevated high-sensitivity troponin (hs-cTn) assay, present in 26.6% of the cohort. Cox regression models adjusted for baseline characteristics and comorbidities were used to assess the associations between troponin-defined myocardial injury and all-cause and cardiovascular mortality. Sensitivity analyses excluding patients with known cardiovascular disease (CVD) were performed to evaluate the robustness of the findings.

Patients with troponin-defined myocardial injury were older and had a higher prevalence of CVD, hypertension, diabetes, as well as a lower estimated glomerular filtration rate (eGFR), compared with those without troponin-defined myocardial injury. Over a median follow-up of 11.6 years, survival was significantly worse among patients with troponin-defined myocardial injury at 1, 5, 10, and 15 years. The adjusted hazard ratios (aHR) for all-cause mortality and cardiovascular mortality in patients with troponin-defined myocardial injury were 1.81 (95% CI 1.51-2.17) and 2.03 (95% CI 1.47-2.79), respectively. Sensitivity analysis excluding records with pre-existing CVD showed similar trends, with an aHR of 1.86 (95% CI 1.56-2.21) for all-cause mortality and 2.44 (95% CI 1.83-3.24) for cardiovascular mortality.

As a marker for troponin-defined myocardial injury, hs-cTns were independently associated with worse long-term survival among CKD patients. However, the observational design precludes causal inference, and single time-point troponin measurements limit the assessment of dynamic changes in myocardial injury.

Overdose and cardiovascular disease are both leading causes of emergency medical services (EMS) activation. The objective of this study was to identify differential patterns in cardiac EMS activations by age and explore whether suspected overdose activity influenced these differences.

EMS activations data were obtained using emsCharts software for Washington County, Pennsylvania, from 2017 through 2023. Poisson point process model (PPM) regression analyses were conducted to estimate the cardiac EMS activation per unit area, as a function of age and suspected overdose, adjusting for population size.

PPM regression analyses identified significant differences in EMS cardiac activations for people aged 18 to 45 years compared with people older than 45 years (β = -1.83, SE = 0.020, 95% CI = -1.86 to -1.79). EMS activations increased as population size increased (β = 0.21, SE = 0.001, 95% CI = 0.21 to 0.22). Analysis also identified significant differences in EMS activation per unit area for age groupings, depending on local suspected overdose activity (interaction term) (β = 0.02, SE = 0.001, 95% CI = 0.01 to 0.02). Likelihood-ratio tests indicated that using suspected overdose activity as an effect modifier on age-dependent cardiac EMS activations improved model fit (deviance = 228.12, df = 1, P < .001).

The community-level occurrence of cardiac emergencies differs by age group, with younger adults experiencing more cardiovascular disease in neighborhoods with higher suspected overdose activity. This nuance is key to developing age-appropriate public health intervention materials to lessen early onset cardiovascular disease illness and death.

In managing ECMO, preventing thrombus formation and hemolysis is crucial. While centrifugal pumps are increasingly used in pediatric ECMO, pumps designed for low flow range are not approved in Japan. Thus, centrifugal pumps for adults are used in pediatric ECMO cases. This increases the risk of thrombus formation in the enlarged flow paths before and after the centrifugal pump. To prevent thrombus formation in the ECMO circuit, it is necessary not only to appropriately optimize the dosage of anticoagulants but also to pay meticulous attention to circuit configuration. Furthermore, using centrifugal pumps at low flow rates increases shear stress on the blood, making hemolysis significantly more likely to occur in pediatric cases compared to adult cases. To reduce the incidence of hemolysis, it is necessary to use centrifugal pumps designed for low flow range. However, given the current situation where such centrifugal pumps are not approved in Japan, we must proceed with the understanding that hemolysis is more likely to occur in pediatric ECMO cases using centrifugal pumps. Moving forward, to reduce complications and improve outcomes in pediatric ECMO, the development of pediatric ECMO systems, including centrifugal pumps optimized for low-flow range, is required.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), an autosomal dominant cerebrovascular disorder caused by NOTCH3 variants. Although more than 400 NOTCH3 variants have been reported, exon 20 variants remain rare, and clinical characterization is limited. We report a 39-year-old Chinese male with recurrent lacunar infarctions involving the brainstem, basal ganglia, and corona radiata. He had right-sided hemiplegia and cognitive deficits, without dizziness, headache, dysphagia, or dysarthria. His mother and maternal uncle had a history of ischemic stroke. Genetic testing identified a heterozygous NOTCH3 c.3313G > T (p.Gly1105Cys) variant in exon 20 (NM_000435.3), classified as likely pathogenic according to the American College of Medical Genetics and Genomics (ACMG) criteria. Alongside adjusted medications for secondary stroke prevention, he received acupuncture and physical rehabilitation, followed by an improvement in mood and motor function. We also reviewed NOTCH3 exon 20 variants and found marked phenotypic heterogeneity across variants and populations. Migraine appears less frequent among Chinese carriers than in Western cohorts, whereas cognitive impairment may occur relatively early. Radiologically, temporal pole white matter hyperintensities were absent in our patient and other Chinese carriers of NOTCH3 variants in epidermal growth factor-like repeat (EGFr) domain 28, but reported in some with domain 27 variants. Although p.Gly1105Cys is located in a low-risk EGFr domain according to recent domain-based stratification models, our patient developed early-onset recurrent stroke, highlighting individual clinical variability. This case provides a detailed clinical and imaging description of CADASIL associated with NOTCH3 c.3313G > T (p.Gly1105Cys) and expands understanding of genotype-phenotype correlations among exon 20 variants.

Hypertension is the leading modifiable risk factor for cardiovascular diseases and affects over 1.3 billion adults. The renin-angiotensin and kallikrein-kinin systems (RAS and KKS) are critical in regulating blood pressure (BP). Clinically, the RAS and KKS have gained renewed importance, especially due to the discovery of the non-canonical vasodilative RAS pathway. Thus, for their clinical use, clarity on their measurement and reference ranges is essential. This systematic review aimed to synthesise the reported baseline circulating concentrations of RAS and KKS peptides, and the pre-analytical and analytical methods used in measuing them, in normotensive and untreated hypertensive adults. It adhered to PRISMA guidelines and synthesised data from 27 of 2864 retrieved studies that met the inclusion criteria. Reported peptide concentrations varied widely, ranging from 0.06-81.85 × 10³ fmol/mL. However, there was substantial heterogeneity across included studies in sample collection procedures, protease inhibitor use for peptide stabilisation, participant clinical phenotyping, BP reporting, and analytical methods. Reported levels of several RAS and KKS peptides were generally lower in hypertensive cohorts than in normotensive cohorts; however, these differences should be interpreted cautiously given the small number of hypertensive studies, incomplete BP reporting, and substantial heterogeneity across all included studies. Current evidence is insufficient to establish reference ranges for RAS and KKS peptides. This review emphasises the need for standardisation of sampling protocols, comprehensive peptide stabilisation, consistent clinical phenotyping, and robust analytical methods before RAS and KKS peptides can be used as clinical markers and their therapeutic potential identified.