Previous studies have highlighted the relationship between socioeconomic inequalities and the general population's risk of contracting or dying from COVID-19 during the 2020-2023 pandemic. In France, socioeconomic inequalities vary across metropolitan areas; few studies have investigated whether this variation explains the spatial disparities observed in COVID-19 incidence and testing rates during the pandemic. We examined the relationship between socioeconomic profiles and these two rates across all 22 metropolitan areas in France for eight of the country's nine epidemic waves.

For each metropolitan area, we used socioeconomic variables from census data to define socioeconomic profiles through principal component clustering. We then used spatialized generalised additive mixed models to analyze associations between these profiles and both testing and incidence rates, for each epidemic wave from July 2020 to March 2023. Finally, we performed meta-regressions to study the distribution of testing and incidence rate ratios among the various socioeconomically deprived and privileged profiles within each of the 22 metropolitan areas, according to COVID-19 vaccination rate.

Testing rates were lower in socioeconomically deprived metropolitan areas than in privileged ones, except during wave 4 (July-October-2021), when testing rates were more similar. Incidence rates were higher in deprived areas (waves 2-4, July-2020 to October-2021), but this pattern reversed between waves 6-9 (March-2022 to March-2023). Meta-regressions indicated that high vaccination coverage was associated with a narrower gap in testing between deprived and privileged areas. Moreover, for each metropolitan area, the higher the level of deprivation in a zone within the deprived profile, the greater the deprived-privileged gap in under-testing.

The impact of socioeconomic inequalities on testing and incidence patterns during the COVID-19 pandemic in each metropolitan area in France was driven by the most deprived zones; this impact varied across epidemic waves. Higher vaccination rates and government health measures (lockdowns, mandatory health pass) may have reduced this variation.

The venous excess ultrasound score (VExUS) is a promising method to assess venous congestion in adults, but evidence in children is scarce. This study aimed to evaluate the feasibility, reproducibility, and clinical usefulness of VExUS in pediatric patients. We also explored whether portal venous Doppler (PVD) alone could serve as a faster alternative and assessed the role of inferior vena cava (IVC) measurements. In this prospective single-center study, 35 pediatric patients were enrolled between 2022 and 2024. Associations between clinical variables and VExUS grades at admission (VExUS-0), 24 h (VExUS-24 h), and 48 h (VExUS-48 h), as well as PVD at corresponding time points, were analyzed. The relationship between IVC diameter and VExUS was also evaluated. VExUS demonstrated perfect reproducibility (κ coefficient and intraclass correlation coefficient = 1). Patients with VExUS-0 or VExUS-24 h grades 2-3 had longer aortic cross-clamp times (p = 0.03; 0.04) and higher vasoactive-inotropic scores (p = 0.01) than those graded 0-1. A higher incidence of acute kidney injury was observed in VExUS-24 h grades 2-3 (p = 0.04). Similar associations were found with PVD. Most patients with VExUS grades 2-3 had non-dilated IVCs according to pediatric reference values.

 VExUS is a feasible, reproducible, and clinically relevant bedside tool for detecting venous congestion in children. Its association with morbidity markers suggests prognostic potential, with optimal performance 24 h after PICU admission. PVD may provide comparable information in less time, while IVC diameter appears unreliable for this purpose.

• VExUS enables bedside assessment of venous congestion and is associated with adverse outcomes in adults, particularly after cardiac surgery. • However, pediatric evidence is limited, and its clinical applicability remains uncertain.

• This study shows that VExUS is feasible, reproducible, and associated with morbidity after pediatric cardiac surgery, with the highest prognostic value at 24h. • Portal Doppler may provide comparable performance, whereas IVC diameter is is not a reliable marker of venous congestion in this population.

To estimate the short-term effect of rosuvastatin versus atorvastatin on the corrected QT interval (QTc) by emulating a published randomized controlled trial (RCT) using electronic health record (EHR) data, and to assess whether target trial emulation (TTE) can replicate RCT findings for a pharmacological safety outcome at substantially greater scale.

Retrospective cohort study emulating a target trial, reported according to the Transparent Reporting of Observational Studies Emulating a Target Trial (TARGET) guideline.

Single tertiary A teaching hospital in China, March 2012 to September 2024.

Of 619,216 cardiology hospitalizations, 165,460 new statin users with suspected coronary artery disease met all eligibility criteria. After 1:1 propensity score matching, 98,860 patients (49,430 per group) constituted the analytic cohort. All standardized mean differences were below 0.013 after matching.

The primary outcome was the change in Fridericia-corrected QT interval (ΔQTcF) from baseline to first follow-up electrocardiogram (24-72 h). Secondary outcomes included newly emerged QTc prolongation, any QTc increase, clinically significant increase (> 30 ms), severe QTc prolongation, and a composite cardiac safety endpoint. Both intention-to-treat and per-protocol effects were estimated.

The mean ΔQTcF in the rosuvastatin group was + 7.71 ms (SD 20.41) versus + 0.31 ms (SD 22.30) in the atorvastatin group, yielding a between-group difference of 7.40 ms (95% CI 7.13 to 7.67; P < 0.001). Newly emerged QTc prolongation occurred in 14.7% versus 10.5% (risk ratio 1.40, 95% CI 1.35 to 1.45). The composite cardiac safety endpoint did not differ (0.4% versus 0.5%; P = 0.24). Results were consistent across eight subgroups and six sensitivity analyses. The TTE estimate was concordant with the published RCT finding of 7.40 ms (heterogeneity P = 1.00), with a 14-fold narrower confidence interval. The negative control outcome analysis showed no residual bias.

Rosuvastatin was associated with a 7.40 ms greater short-term QTcF prolongation than atorvastatin in a cohort 212 times larger than the emulated RCT, without excess clinical cardiac events over a mean follow-up of 48 h. Target trial emulation successfully replicated the RCT finding for a short-term drug safety outcome, demonstrating the framework's value for pharmacovigilance research using routine clinical data.

The optimal timing for reinitiating antiplatelet therapy after treatment of chronic subdural hematoma (cSDH) remains uncertain, especially when middle meningeal artery embolization (MMAE) is used as an adjunct to surgery. This study evaluated the safety and outcomes of early antiplatelet reinitiation in patients undergoing combined surgical evacuation and MMAE, and compared outcomes in antiplatelet-treated patients receiving surgery with versus without MMAE. Adult cSDH patients from the TriNetX database (May 2020-May 2025) were identified using ICD-10 and RXNORM codes. Two propensity score-matched analyses were performed: (1) patients receiving surgery with adjunct MMAE, stratified by antiplatelet initiation within 30 days; and (2) antiplatelet-treated patients undergoing surgery with adjunct MMAE versus surgery alone. Outcomes included rescue surgery and 6-month mortality. After matching, early antiplatelet use in surgery + MMAE patients (n = 163 per group) was not associated with higher rescue surgery rates (OR 0.68, 95% CI 0.32-1.48) or mortality (OR 1.52, 95% CI 0.73-3.20). Among antiplatelet-treated patients, surgery + MMAE (n = 176) had similar rescue surgery rates to surgery alone (n = 176) but significantly lower mortality (10.8% vs. 21.0%; OR 0.46, 95% CI 0.25-0.83, p = 0.009). Early antiplatelet reinitiation appeared safe after cSDH evacuation with adjunct MMAE. The associated lower 6-month mortality with adjunct MMAE in antiplatelet-treated patients is observational and hypothesis-generating, and warrants prospective confirmation.

This review examines the unique cardiovascular disease patterns in older women, focusing on sex and age-specific pathophysiology, diagnostic challenges, and disparities in management. We aim to clarify how aging and hormonal transitions influence disease presentation and outcomes among women, and to identify gaps in cardiovascular care.

Emerging data demonstrate that older women are disproportionately affected by HFpEF, coronary microvascular dysfunction, atrial fibrillation, and valvular heart disease. These conditions are influenced by vascular stiffness, myocardial remodeling, and systemic inflammation and often present with atypical symptoms leading to diagnosis delays. Contemporary studies highlight persistent gaps in timely diagnosis, referral for advanced therapies, and representation in clinical trials. Increasing attention is being directed toward frailty, multimorbidity, and patient-centered care models in this population. Recognizing age and sex-specific characteristics, increasing representation of older women in clinical trials, improving equitable access to diagnostic and therapeutic resources, and aligning treatment decisions with patient priorities are critical to narrowing existing gaps and improving long-term outcomes for older women with cardiovascular disease.

The clinical data of 42 consecutive patients with extracranial carotid artery aneurysms (ECAA) who underwent surgical treatment in the Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, from January 2012 to December 2024 were retrospectively collected. Based on the Attigah classification of aneurysms, while evaluating anatomical characteristics such as bifurcation involvement, proximal and distal landing zone conditions, and parent artery tortuosity, combined with etiological risks including infection, inflammation, or trauma, individualized treatment plans were formulated. Ultimately, 36 patients underwent endovascular treatment and 6 cases underwent open surgical treatment. In the perioperative period, immediate postoperative digital subtraction angiography (DSA) or postoperative computed tomography angiography (CTA) was used to evaluate aneurysm exclusion and parent-artery patency. The patients were aged (53.3±7.3) years, including 17 females and 25 males. Among them, there were 20 true aneurysms, 19 pseudoaneurysms, and 3 dissecting aneurysms. The surgical technical success rate was 97.6% (41/42). During the perioperative period, 1 (2.2%) patient developed cranial nerve injury after open surgery. The postoperative follow-up time was (18.5±4.6) months, no deaths occurred, and 2 (4.8%) patients developed in-stent restenosis at 6 months postoperatively. Treatment of ECAA should be individualized according to etiology and anatomic characteristics, and endovascular therapy represents a relatively straightforward, safe, and effective option for ECAA.

Objective: To investigate the impact of adding an early proactive telephone follow-up (2-4 weeks post-ablation) to routine follow-up on perioperative medication adherence, incidence of clinical outcome events, and re-consultation in patients with atrial fibrillation undergoing catheter ablation. Methods: This study employed a prospective cohort design. The intervention group included 554 patients who underwent catheter ablation for atrial fibrillation at our hospital in January 2025, receiving an additional telephone follow-up within 2-4 weeks post-ablation. The control group included 910 patients who underwent catheter ablation at our hospital in February 2025, receiving only routine first outpatient follow-up at 3 months post-ablation. The telephone follow-up content included verifying comprehension of medical orders, guiding medication administration, answering questions, assessing postoperative recovery, identifying abnormal symptoms, providing medical advice, and offering psychological support. The primary outcome measure was medication adherence at 3 months post-ablation. Secondary outcome measures included the incidence of thromboembolic events, bleeding events, and re-consultation within 3 months post-ablation. All data were statistically analyzed using SPSS 26.0; P-values<0.05 indicated statistical significance. Results: Baseline characteristics were comparable between the two groups (all P-values>0.05). Regarding medication adherence at 3 months post-ablation, the proportion of patients regularly taking anticoagulants in the intervention group (56.50%) was significantly higher than that in the control group (44.07%) (χ²=21.30, P<0.001); the proportion of patients who self-discontinued medication in the intervention group (27.26%) was significantly lower than that in the control group (41.87%) (χ²=31.78, P<0.001). For the incidence of thromboembolic and bleeding events, no statistically significant differences were observed between the two groups (all P-values>0.05). Specifically, the incidence of thromboembolic events was 1.08% (n=6) in the intervention group and 1.65% (n=15) in the control group (χ²=0.77, P=0.379); the incidence of bleeding events was 0.18% (n=1) and 0.22% (n=2), respectively (χ²=0.19, P=0.664). The overall incidence of any thromboembolic or bleeding event was 1.26% (n=7) and 1.76% (n=16), respectively, and this difference was not statistically significant (χ²=0.54, P=0.460). Regarding re-consultation, the incidence of outpatient visits due to cardiovascular disease was significantly lower in the intervention group (2.53%, n=14) than in the control group (6.81%, n=62) (χ²=12.84, P<0.001). No statistically significant differences were observed between the two groups for emergency visits due to cardiovascular disease (χ²<0.01,P=0.975), hospitalization due to cardiovascular disease (χ²<0.01,P=0.985), or re-consultation/hospitalization for any reason (χ²=0.95, P=0.329). Conclusion: Early proactive telephone follow-up can significantly improve perioperative medication adherence in patients with atrial fibrillation undergoing catheter ablation and effectively reduce postoperative outpatient visits. This simple and feasible intervention has positive clinical application value for improving short-term patient outcomes and optimizing medical resource allocation.

Objective: To analyze the diagnostic and therapeutic characteristics of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with predominantly nasal symptoms. Methods: Clinical data of 10 patients (4 males and 6 females, aged 24-73 years) with AAV with predominantly nasal symptoms who were treated in the Second Hospital of Shanxi Medical University from January 2019 to January 2025 were collected and retrospectively analyzed with regard to clinical manifestations, endoscopy, imaging, laboratory examination, pathohistology, treatment and prognosis of the patients. Descriptive statistical methods were used for analysis. Results: Nasal symptoms such as nasal congestion, pus and dry crusts and pulmonary manifestations such as cough and pulmonary nodules were present in all 10 patients; most of them were accompanied by multifocal involvement of the head and neck (9/10) and systemic inflammatory prodromal manifestations such as intermittent fever and polyarticular pain (9/10). Nasal endoscopy showed congestion, erosion, and increased secretion of the nasal mucosa, and in severe cases, perforation of the nasal septum was seen (3/10). Sinus CT showed thickening of nasal and sinus mucosa, bone hyperplasia, and even progressive bone destruction and paranasal sinus granuloma formation (2/10). Laboratory tests showed ANCA positivity in 9 cases and negativity in 1. Six patients were treated with nasal surgery and 5 had postoperative outbreaks. Ten patients were treated with systemic glucocorticoid combined with immunosuppressant or monoclonal antibody after diagnosis, and all of them went into remission. During follow-up, 6 cases relapsed and all 10 cases survived. Conclusions: For patients with refractory nasal symptoms and inflammatory precursor manifestations (combined with other extra-nasal systems), who have poor responses to conventional treatment, AAV should be considered. Early ANCA testing, histopathological examination and multidisciplinary team combined diagnosis and treatment should be performed to improve patient prognosis.