Background and Objectives: This study aimed to investigate the association between circulating monocyte subset profiles and carotid artery stenosis (CAS) severity and to examine their relationships with inflammatory and atherosclerosis-related parameters. Materials and Methods: This cross-sectional study included 73 adult patients who underwent carotid Doppler ultrasonography. Participants were classified according to internal CAS severity as <50% (n = 44) or ≥50% (n = 29). Monocyte subsets were analyzed using flow cytometry and categorized as classical (CD14++CD16-), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) monocytes. Serum MCP-1 concentrations were measured using an enzyme-linked immunosorbent assay. Clinical characteristics, biochemical parameters, inflammatory indices, and carotid intima-media thickness (cIMT) were compared between the groups. Multivariate logistic regression analyses were performed to identify independent associations with significant stenosis. Results: Patients with CAS ≥50% exhibited significantly higher classical monocyte percentages and lower non-classical monocyte percentages than those with CAS < 50% (p = 0.044 and p = 0.027, respectively). Intermediate monocyte percentages did not differ significantly between the groups. Significant stenosis was also associated with a higher white blood cell count, neutrophil count, systemic inflammatory response index, fibrinogen, and HbA1c levels. Non-classical monocyte percentages showed a significant inverse correlation with cIMT (r = -0.320, p = 0.006). In a multivariable model adjusted for age, sex, and systolic blood pressure, lower non-classical monocyte percentage was associated with significant CAS (OR 0.872, 95% CI 0.765-0.994; p = 0.040). However, this association was no longer statistically significant after further adjustment for fibrinogen, neutrophil count, and HbA1c, whereas fibrinogen remained independently associated with significant CAS. Conclusions: Lower circulating non-classical monocyte percentages were associated with significant CAS and inversely correlated with cIMT and inflammatory markers. However, the attenuation of this association after adjusting for inflammatory parameters suggests that monocyte subset distribution should be interpreted within the broader inflammatory context that accompanies advanced carotid atherosclerosis.

Background and Objectives: Air plethysmography (APG), also referred to as pulse volume recording, provides a physiological assessment of lower-extremity perfusion, but its role in contemporary surveillance after peripheral arterial revascularization remains uncertain. This prospective study aimed to evaluate the ability of APG to monitor hemodynamic recovery and predict procedural failure after open and endovascular interventions. Materials and Methods: Consecutive patients undergoing infrainguinal revascularization for symptomatic peripheral arterial disease were prospectively enrolled and followed for 24 months. Standardized clinical assessment, ankle-brachial index, Duplex ultrasonography, and APG were performed preoperatively and at 1, 6, 12, and 24 months. Longitudinal hemodynamic changes, diagnostic accuracy for restenosis, patency, and predictors of procedural failure were analyzed. Results: A total of 120 patients were included, of whom 108 (90.0%) completed a 24-month follow-up. Mean pulse volume amplitude increased from 5.8 ± 2.3 mm preoperatively to 14.6 ± 4.1 mm at one month (p < 0.001) and remained significantly improved throughout follow-up. Systolic upstroke time decreased from 192 ± 31 to 128 ± 24 ms (p < 0.001), while waveform morphology also improved substantially. Longitudinal analysis demonstrated a significant effect of time (p < 0.001) and group-by-time interaction (p = 0.031). Among secondary outcomes, APG deterioration preceded fulfillment of the predefined Duplex criteria for significant restenosis in 26 of 34 failures, with a mean observed interval of 3.8 ± 1.2 months. A ≥25% reduction in pulse volume amplitude showed good discrimination for restenosis, while APG deterioration was independently associated with procedural failure (HR = 2.80, 95% CI 1.65-5.37; p < 0.001). Conclusions: APG is a reproducible, non-invasive surveillance adjunct that objectively reflects hemodynamic recovery and may identify physiological deterioration before fulfillment of predefined Duplex criteria for significant restenosis. These findings support further evaluation of APG as a complementary physiological modality within structured surveillance following lower-extremity revascularization.

Background and Objectives: Echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) in hypertrophic cardiomyopathy (HCM) is challenging, as conventional parameters correlate poorly with left ventricular filling pressure. Emerging evidence suggests that left atrial (LA) strain is associated with atrial fibrillation (AF). This study aimed to compare LA reservoir strain (LASr)-based and conventional LVDD grading, evaluate associations between LA strain and clinical and echocardiographic parameters, and explore its relationship with AF. Materials and Methods: This retrospective cross-sectional single-center study included 109 adult HCM patients with comprehensive echocardiographic data. LVDD was graded using conventional echocardiographic parameters and LASr-based thresholds (≥35% (grade 0), ≥24% to <35% (grade 1), ≥19% to <24% (grade 2), and <19% (grade 3)). Results: LASr-based grading revealed a significantly greater prevalence of advanced LVDD compared with conventional assessment (grade 3: 39% vs. 3%, p < 0.001), with poor intermethod agreement (κ = 0.07). Overall, approximately 45% of patients were reclassified into higher LVDD grades using LASr, particularly among nonobstructive HCM patients. Higher LASr-based LVDD grades were associated with worse conventional diastolic indices, reduced biventricular strain parameters, and higher natriuretic peptide levels. Reduced LA reservoir and conduit strain were independently associated with documented AF after adjustment for age, LA volume index, and left ventricular mass index. Conclusions: LASr provides additional information on diastolic dysfunction in HCM patients and is associated with documented AF. LASr-based grading assigned more patients to advanced LVDD grades than conventional assessment. The observed association with AF requires prospective validation before LA strain can be used for risk stratification.

Background and Objectives: Conjunctival hyperemia is common with netarsudil, but redness may not reflect the overall patient experience when treatment burden is reduced. We evaluated ocular surface symptoms, objective redness, tear-film parameters, intraocular pressure (IOP), and treatment preference after a routine-care switch from twice-daily fixed dorzolamide/timolol to once-daily netarsudil 0.02%, while continuing latanoprost. Materials and Methods: This prospective, single-center observational cohort included 30 consecutive adults with primary open-angle glaucoma or ocular hypertension and controlled IOP. Outcomes were assessed at baseline and months 1 and 2. The primary outcome was the Ocular Surface Disease Index (OSDI). Continuous eye-level outcomes were analyzed using mixed-effects models accounting for fellow-eye and repeated-measures correlation; grade ≥ 2 hyperemia was analyzed using participant-clustered logistic regression. Results: Twenty-seven participants (54 eyes) completed evaluable 2-month follow-up. Median OSDI decreased from 7.50 at baseline to 6.25 at month 1 and 5.00 at month 2 (Friedman p = 0.0015). The mean baseline-to-month 2 change was -2.95 points (95% CI, -4.80 to -1.10), and 6/27 participants (22.2%) improved by at least 7 points. Serle grade ≥ 2 hyperemia increased from 7.4% of eyes at baseline to 51.9% at month 1 and 44.4% at month 2. Estimated mean bulbar redness index increased from 1.57 to 2.14 (p < 0.0001), tear meniscus height increased modestly, and non-invasive keratograph break-up time showed no significant longitudinal change. Estimated mean IOP changed from 14.50 to 13.65 mmHg (p = 0.0083), with no eye showing an increase of at least 4 mmHg. Burning improved after multiplicity adjustment, and 17/27 participants with available month-2 preference data (63.0%) preferred netarsudil. Conclusions: The switch was associated with modest OSDI improvement and maintained short-term IOP control despite increased objective redness. Patient preference appeared to reflect factors beyond redness alone.

Background and Objectives: Systemic inflammation and nutritional impairment may influence outcomes after permanent pacemaker implantation, but the prognostic value of composite indices in degenerative complete atrioventricular block remains unclear. We evaluated the associations of routinely available inflammatory and nutritional indices with long-term all-cause mortality in this population. Materials and Methods: This retrospective, single-center study included 272 patients who underwent permanent pacemaker implantation for isolated complete atrioventricular block attributed to degenerative conduction system disease between August 2020 and July 2024. Baseline laboratory values were used to calculate the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value. The primary endpoint was all-cause mortality during follow-up. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis, and independent associations were evaluated using multivariable Cox regression. Results: During a mean follow-up of 27.8 ± 16.6 months, 69 patients (25.4%) died. Compared with survivors, non-survivors were older and had lower hemoglobin, lymphocyte count, albumin, estimated glomerular filtration rate, GNRI, LMR, and PNI values, whereas C-reactive protein, NLR, and SIRI values were higher. PNI had the numerically highest AUC for mortality prediction (AUC: 0.720, 95% CI: 0.648-0.793; p < 0.001), corresponding to moderate discriminatory performance, whereas GNRI showed fair discrimination (AUC: 0.677, 95% CI: 0.589-0.766; p < 0.001). In multivariable Cox regression, PNI remained independently associated with mortality (HR: 0.945, 95% CI: 0.909-0.982; p = 0.004). Conclusions: Among the evaluated inflammatory and nutritional indices, PNI demonstrated the numerically highest discriminatory performance and remained independently associated with long-term all-cause mortality. PNI may therefore serve as a readily available adjunct to clinical risk stratification in patients undergoing permanent pacemaker implantation for degenerative complete atrioventricular block; however, external validation is required.

Background and Objectives: Iron deficiency (ID) is common in heart failure with reduced ejection fraction (HFrEF) and is associated with adverse clinical outcomes. Although intravenous ferric carboxymaltose (FCM) improves functional status, its effects on ventricular electrophysiological indices remain incompletely characterized. This study evaluated short-term changes in the corrected index of cardiac electrophysiological balance (iCEBc) and conventional electrocardiographic repolarization parameters after FCM administration. Materials and Methods: This retrospective single-center pre-post study included 92 clinically stable patients with HFrEF and ID who received intravenous FCM. Standard 12-lead electrocardiograms and laboratory parameters were evaluated at baseline and 30 ± 5 days after treatment. The primary outcome was the within-patient change in iCEBc, while secondary outcomes included conventional ventricular repolarization indices. Results: Following FCM treatment, ferritin, transferrin saturation, and hemoglobin increased significantly (all p < 0.001). iCEBc decreased significantly (4.33 ± 1.04 vs. 4.04 ± 0.82, p = 0.016). Significant reductions were also observed in QTc, JTc, JT, Tp-e, Tp-e/QT, Tp-e/QTc, frontal QRS-T angle, and QT, whereas QRS duration remained unchanged. Changes in iron indices were not associated with changes in iCEBc. Conclusions: In this uncontrolled pre-post cohort, intravenous FCM was associated with favorable short-term changes in several electrocardiographic repolarization indices. However, because anemia correction occurred concurrently and no control group or clinical arrhythmic outcomes were available, these findings should be considered exploratory and hypothesis-generating rather than evidence of an antiarrhythmic effect.

Background and Objectives: brain arteriovenous malformations (AVMs) are a leading cause of spontaneous intracranial hemorrhage in children and carry a disproportionately high lifetime hemorrhagic risk. Materials and Methods: We retrospectively analyzed clinical, morphological, and surgical factors associated with functional outcome in 30 consecutive pediatric patients (≤18 years) who underwent microsurgical AVM resection at a single tertiary neurosurgical center between January 2015 and December 2025. Results: Functional status was assessed with the modified Rankin Scale (mRS) at hospital discharge and at 6-9 months of follow-up; the Wilcoxon signed-rank test, Mann-Whitney U test, Fisher's exact test, Spearman correlation, and univariable logistic regression were used for analysis. Complete resection on early postoperative CT angiography was documented in all 30 patients (100%). The proportion with a favorable outcome (mRS 0-2) improved significantly from 50.0% at discharge to 76.7% at follow-up (p < 0.0001); 80.8% of survivors improved by at least one mRS point, and none deteriorated. In univariable analysis, the variable most strongly associated with poor outcome was intraventricular hemorrhage (IVH; odds ratio [OR] 28.5, 95% CI 2.65-306.6; p = 0.002); the wide confidence interval reflects the small number of events and precludes a precise estimate of effect size. Lower admission Glasgow Coma Scale (GCS) score (p = 0.0006), higher Supplemented Spetzler-Martin (S-M) grade (p = 0.019), and postoperative complications (p = 0.016) were likewise associated with poor outcome. Because these associations are univariable and unadjusted for confounding, they should be regarded as exploratory and hypothesis-generating rather than as independent predictors. All four deaths occurred in malformations in eloquent locations (p = 0.037). Microsurgical resection achieved complete resection on early postoperative CT angiography in all patients; however, functional recovery appeared to be associated primarily with the severity of the initial hemorrhagic insult-particularly IVH-and with lesion complexity rather than with the achievement of angiographic resection alone. Conclusions: Given the small, surgically selected cohort and the limited follow-up, these findings require confirmation in larger multicenter studies.

Background and Objectives: Poor sleep quality and gut microbiota dysbiosis are independently associated with cognitive decline, yet their effects on cognition in heart failure (HF) patients remain unexamined. To assess the independent associations of sleep quality and gut microbiota diversity with cognition in patients with HF. Methods: This exploratory/pilot cross-sectional study enrolled adults with chronic stable HF from an outpatient cardiology clinic. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and Montreal Cognitive Assessment (MoCA). Fecal samples were analyzed for gut microbiota composition, including Shannon diversity and Simpson indices. Multivariable linear regression analysis of MoCA scores with sleep quality and alpha diversity (Shannon index) as primary exposures, adjusted for age, sex, and left ventricular ejection fraction (LVEF) was conducted. Results: Of 59 enrolled patients (mean age 73.3 ± 10.8 years; 72.7% male; 86.4% White), 40 provided fecal samples. Analysis of microbiota data revealed a composition dominated by Bacillota (63.7%). In multivariable regressions, poor sleep quality was independently associated with lower MoCA scores (β = -3.01 to -3.88, p < 0.01). Similarly, Shannon diversity was also associated with lower MoCA (β = -3.45, p < 0.05). Beta-diversity analyses showed no consistent association between overall microbial community composition and cognition. No significant interactions between microbiota diversity and sleep variables were identified (all p > 0.20). Conclusions: Sleep quality and gut microbiota alpha diversity are independently associated with cognitive function in HF. Microbial pathways favoring short-chain fatty acid production align with better sleep, while lipopolysaccharide-related pathways associate with poorer sleep and cognition.

Background and Objectives: Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1INH) is a rare autosomal dominant disorder caused by mutations in the SERPING1 gene and is characterized by considerable clinical variability among affected individuals. Although genotype-phenotype correlations have been reported, data from populations with high consanguinity rates remain limited. Therefore, this study aimed to construct pedigrees of HAE-C1INH families harboring SERPING1 mutations and to investigate whether mutation type is associated with phenotypic characteristics, particularly age at disease onset and C1 inhibitor functional activity. Materials and Methods: Eleven HAE-C1INH probands and their families were followed up at the Allergy and Immunology Department of Internal Medicine, Ege University Faculty of Medicine. Of the 295 family members identified through pedigree construction, 109 had symptoms compatible with HAE-C1INH, and 53 of these symptomatic individuals had both a confirmed SERPING1 genetic result and an available C1-INH functional measurement. Pedigrees were created using the Progeny Pedigree Drawing Software (Progeny Genetics LLC, Delray Beach, FL, USA). Demographic data, disease characteristics, C1-INH function levels, and SERPING1 mutation types were obtained from patient files. Results: A total of 295 individuals (151 males and 144 females) from 11 HAE-C1INH families were identified through pedigree construction. The analytical cohort comprised 53 symptomatic individuals, of whom 7 (13.2%) were homozygous for the variant. Among heterozygous patients (n = 46), 27 (58.7%) had missense mutations, 7 (15.2%) had nonsense mutations, 7 (15.2%) had large deletions, and 5 (10.9%) had frameshift deletion mutations. Patients carrying missense mutations had significantly higher median C1-INH functional activity (28.5%) than those with other mutation types (14.1%) (p = 0.026), and the median age of disease onset was significantly later in the missense group (20 years) than in the non-missense group (8 years) (p < 0.001). Annual HAE attack frequency was also lower in the missense group (median, 12 vs. 48 attacks per year; p = 0.009). Conclusions: Exploratory individual-level analyses showed higher residual C1-INH functional activity and later symptom onset among individuals carrying missense SERPING1 variants than among those carrying pooled non-missense loss-of-function variants. However, familial clustering and the small number of independent families limit the strength and generalizability of these findings.