Introduction: Acute subdural hematoma (aSDH) represents one of the most lethal and debilitating forms of traumatic brain injury (TBI) encountered in neurosurgical emergency settings, carrying high mortality rates and severe long-term functional deficits. Historically, the timing of surgical decompression has been considered a critical modifiable prognostic factor. However, contemporary evidence regarding the relationship between time to surgery and clinical outcomes remains inconsistent. This systematic review and meta-analysis evaluates the impact of surgical timing on mortality and functional status in adult patients undergoing evacuation for acute subdural hematoma. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines and registered in PROSPERO. A database search was performed across PubMed, Scopus, Embase and Web of Science for relevant studies published between 2009 and 2026. Peer-reviewed cohort studies and clinical trials including adults (>18 years) with CT- or MRI-confirmed aSDH were included. Data extraction focused on baseline characteristics, surgical timing thresholds, and primary outcomes of mortality and functional status assessed using the Glasgow Outcome Scale (GOS). Methodological quality was assessed using the Newcastle-Ottawa Scale. Relative risks (RR) and risk differences (RD) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: The search identified 1815 records, of which six studies, including 926 patients, met the inclusion criteria. Meta-analysis found no statistically significant association between time to surgery and mortality (RR 1.01, 95% CI [0.69, 1.48], p = 0.96; RD -0.02, 95% CI [-0.19, 0.15]). High statistical heterogeneity was observed (I² = 80%) across the included cohorts. Most studies indicated that patients who underwent rapid neurosurgical intervention frequently presented with significantly worse baseline neurological status, which acts as a primary confounding factor and drives poorer prognostic trends. Conclusions: While historical paradigms emphasize a 4h period for subdural hematoma evacuation, our meta-analysis indicates that a straightforward linear relationship between time to intervention and improved survival or functional outcome is absent in contemporary clinical studies. Surgical timing thresholds must be interpreted cautiously, as the decision-making process is heavily guided by clinical triage bias, where rapidly deteriorating patients are prioritized for urgent decompression. Crude timing thresholds do not reflect a lack of causal benefit of early intervention but rather highlight the profound confounding by indication embedded in contemporary neurotrauma literature. Future multicenter investigations adjusting for admission severity, pupillary reactivity, associated intracranial pathology and other confounding factors are crucial to isolate the true prognostic value of surgical timing in aSDH.

Background: Neonatal open-heart surgery induces profound oxidative stress, yet its perioperative dynamics remain incompletely characterized. This study quantified urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane as markers of oxidative damage, and plasma α₁-microglobulin (A1M) as an endogenous antioxidant, while exploring the influence of pre- and intraoperative factors. Methods: In a prospective cohort of 40 term neonates with critical congenital heart defects undergoing open-heart surgery, serial urinary and plasma samples were collected perioperatively. Biomarker concentrations were analyzed using mixed-effects regression models to assess associations with postnatal age, sex, preoperative oxygenation, oxygen surge at bypass initiation, and cell-free hemoglobin in the prime solution. Results: Urinary 8-OHdG and 8-isoprostane increased following bypass separation; 8-OHdG remained elevated through postoperative days 0-2, while 8-isoprostane returned toward baseline by day 1. Plasma A1M declined at bypass initiation, recovered to preoperative levels at separation, and rose thereafter. Females exhibited higher A1M concentrations throughout. Longer time to surgery was associated with greater preoperative oxidative stress, and lower preoperative arterial pO₂ correlated with increased 8-isoprostane at bypass separation. No statistically significant associations were identified between intraoperative variables and biomarker levels, although the study was designed to be a hypothesis generating study and not powered to detect modest intraoperative effects. Conclusions: This exploratory study delineates distinct perioperative trajectories of oxidative stress and antioxidant response in neonates undergoing open-heart surgery, with surgical timing, preoperative hypoxemia, and sex emerging as relevant associations. No statistically significant associations were identified between intraoperative variables and biomarker levels; however, the study was hypothesis-generating in design and not powered to detect modest intraoperative effects.

Background: Asymptomatic atrial fibrillation (AF) represents a substantial proportion of diagnosed AF cases; however, its prognostic implications remain controversial. This study aimed to compare clinical characteristics, treatment strategies, and outcomes between asymptomatic and symptomatic AF patients in a contemporary real-world registry. Methods: This observational subanalysis included 997 patients from the prospective multicenter REGUEIFA registry with 2-year follow-up. Patients were classified as asymptomatic if they had a baseline European Heart Rhythm Association (EHRA) score of I. Clinical characteristics, therapeutic strategies, and the incidence of a composite endpoint including cardiovascular death, stroke, major bleeding, or worsening heart failure were analyzed. Results: Overall, 33.7% of patients were asymptomatic. Compared with symptomatic patients, asymptomatic patients had a lower prevalence of heart failure, hypertension, and cardiomyopathy, lower CHA₂DS₂-VASc scores, and a higher prevalence of preserved left ventricular ejection fraction. Rhythm control strategies were less frequently used in asymptomatic patients (58.33% vs. 65.96%; p = 0.018), despite similar arrhythmia recurrence rates after treatment (p = 0.490). The incidence of the composite endpoint was lower in asymptomatic patients (8.39 [6.53-10.78] vs. 12.12 [10.43-14.09] per 100 person-years; p = 0.013), mainly driven by lower cardiovascular mortality. No significant differences were observed in stroke, major bleeding, worsening heart failure, or all-cause mortality. In multivariable analysis adjusted for clinically relevant covariates, symptomatic patients exhibited a higher incidence of the composite endpoint. Conclusions: In this contemporary real-world registry, asymptomatic AF patients exhibited a lower burden of cardiovascular comorbidities and lower cardiovascular mortality than symptomatic patients, while rates of stroke, heart failure worsening, major bleeding, and arrhythmia recurrence were similar. These findings suggest that prognosis is influenced predominantly by baseline comorbidity burden, and the independent contribution of symptom status itself, although statistically significant, appears modest and should be interpreted with caution given the observational design.

Background/Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) is a major cause of neurodevelopmental diseases. In a previous retrospective study, we revealed that the levels of the soluble form of lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) are linked to HIE severity. We conducted a prospective investigation to evaluate the association between sLOX-1 levels and HIE severity using the Sarnat staging system, as well as a multicenter study to assess neurodevelopmental sequelae in the short term. Methods: A total of 193 infants were enrolled in the study between April 2018 and March 2021. We divided the infants into groups as follows: infants without HIE were assigned to a normal control group, and those with HIE to mild, moderate, and severe HIE groups. We measured 191 samples, excluding three participants. The distribution of 191 participants was as follows: 88 normal samples of 50 umbilical cord (UC) arteries and 38 venous blood samples (control; CTL), as well as 103 HIE samples of 34 mild, 55 moderate, and 14 severe HIE samples. All the plasma samples were collected until 6 h after birth. Results: The mean sLOX-1 value in the CTL group was 613 pg/mL (IQR: 474-925 pg/mL) and that in the UC group was 497 pg/mL (IQR: 337-693 pg/mL), with no significant difference (p = 0.136). The mean sLOX-1 value in the mild HIE group was 1030 pg/mL (IQR: 658-1547 pg/mL), 1026 pg/mL (IQR: 710-2051 pg/mL) in the moderate HIE group, and 1444 pg/mL (IQR: 766-3927 pg/mL) in the severe HIE group. There were significant differences between the CTL and HIE groups (p = 0.006) and between the CTL and mild HIE groups (p < 0.05), but not between the mild HIE and the moderate and severe HIE groups (p = 0.088). The other blood markers exhibited no correlation with Sarnat severity. Interestingly, blood sLOX-1 levels increased with Sarnat severity. Conclusions: The results of this study indicated that sLOX-1 level was correlated with Sarnat severity. Moreover, early assessment of sLOX-1 level may be useful for deciding whether to induce therapeutic hypothermia and/or other treatments, and sLOX-1 may serve as a short-term outcome biomarker of HIE.

Hypertrophic cardiomyopathy (HCM) is a common inherited myocardial disorder and a leading cause of sudden cardiac death (SCD) across all age groups. Accurate risk stratification remains a clinical challenge, as conventional algorithms fail to fully capture the heterogeneous arrhythmic substrate of the disease. In recent years, cardiac imaging has emerged as a pivotal tool for refining SCD prediction by providing detailed structural, functional, and tissue-characterisation data. This review offers a comprehensive synthesis of imaging-derived predictors of SCD in HCM. We examine established echocardiographic markers, including maximal left ventricular wall thickness, left ventricular ejection fraction and left ventricular outflow tract obstruction, together with advanced cardiovascular magnetic resonance parameters such as late gadolinium enhancement and apical aneurysm detection. In addition, we discuss the emerging role of extracellular volume expansion, quantitative mapping techniques, and strain abnormalities within the framework of contemporary risk stratification models. By bridging imaging biomarkers with underlying pathophysiological mechanisms, this review highlights current evidence, limitations, and future directions to improve precision in SCD risk assessment in HCM.

Cardiometabolic diseases are strongly socially patterned, with individuals of lower socioeconomic position experiencing a disproportionate burden of metabolic disorders. Obesity has been proposed as a potential explanatory factor that may partly account for the association between social disadvantage and adverse cardiometabolic profiles. This study aimed to evaluate whether obesity may partly explain the observed associations between socioeconomic position and multiple cardiometabolic outcomes.

A cross-sectional study was conducted in 3108 working-age adults undergoing occupational health examinations in the Balearic Islands, Spain. Socioeconomic position was assessed using educational attainment and occupational category. Cardiometabolic outcomes included obesity, FLI-defined probable steatotic liver disease (FLI ≥ 60), insulin resistance, atherogenic risk, and metabolic syndrome. Multivariable logistic regression models with sequential adjustment were performed. Additional models evaluated attenuation after inclusion of obesity. Mediation analyses were conducted using bootstrapping methods.

A clear socioeconomic gradient was observed across all cardiometabolic outcomes, with higher prevalence among individuals with lower educational attainment (p for trend < 0.001). In fully adjusted models, lower educational level remained significantly associated with obesity (OR 1.61; 95% CI 1.18-2.21), whereas associations with the remaining cardiometabolic outcomes were substantially attenuated after adjustment. Inclusion of obesity reduced effect estimates for FLI-defined probable steatotic liver disease (FLI ≥ 60), insulin resistance, atherogenic risk, and metabolic syndrome by approximately 53-72%. Exploratory mediation analyses suggested that obesity was associated with approximately 28% attenuation of the association with estimated steatotic liver disease risk and 8% attenuation of the association with insulin resistance.

Socioeconomic inequalities in cardiometabolic risk were evident across multiple metabolic domains. Obesity was associated with substantial attenuation of several downstream cardiometabolic associations and may represent an important explanatory factor associated with the observed socioeconomic differences in metabolic health, particularly for estimated steatotic liver disease risk. However, the magnitude of these associations varied across outcomes, and the cross-sectional design precludes causal interpretation. These findings support the importance of addressing obesity within its broader social context as a potential strategy to reduce metabolic health inequalities among employed working-age adults.

Pectus excavatum (PEX) is the most common congenital chest wall deformity and may result in cardiac compression and arrhythmias. The relationship between structural severity and exercise-induced electrocardiographic (ECG) abnormalities in pediatric patients remains unclear.

We performed a retrospective study of patients aged 10-19 years that underwent standardized preoperative evaluation for PEX between 2015 and 2021, including ECG, transthoracic echocardiography (TTE), computed tomography (CT), and cardiopulmonary exercise testing (CPET). PEX severity was assessed using the Haller index (HI), while right ventricular (RV) compression was evaluated on CT. Tricuspid valve annular size (TVAS) on TTE was used as a surrogate marker of RV compression. Exercise-induced ECG abnormalities, including premature ventricular complexes (PVCs), were analyzed and correlated with HI, RV compression, and TVAS.

Among 124 patients (85% male; median age 15 years), 33% exhibited exercise-induced ECG abnormalities, most commonly PVCs (24% overall). PVC occurrence was not associated with Haller index severity (p = 0.35) but was significantly associated with RV compression on CT (92.6% vs. 62.1%, OR 7.64, p = 0.02). Patients with ECG abnormalities had significantly smaller TVAS compared to those without (1.98 ± 0.31 cm vs. 2.09 ± 0.33 cm, p = 0.04). Although PVCs were more frequent in patients with TVAS z-score ≤ -2.0, this did not reach statistical significance.

Exercise-induced ventricular ectopy in pediatric PEX is associated with right ventricular compression rather than structural severity as defined by HI. Echocardiographic measures such as TVAS may serve as noninvasive markers of clinically significant compression. These findings highlight the importance of cardiac-thoracic relationships in predicting arrhythmic risk and suggest a potential for reversibility with surgical correction.

Background: The Langendorff isolated heart model remains one of the most widely used experimental platforms for cardiovascular research. However, conventional bubble oxygenation is associated with several limitations, including inefficient gas utilization and incompatibility with protein-containing perfusates due to excessive foam formation. The present study evaluated whether membrane oxygenation could improve myocardial preservation and facilitate the use of a protein-enriched perfusion solution in a constant-pressure Langendorff system. Methods: A total of 48 male Wistar rats were allocated to six experimental groups (n = 8 per group). In the first experimental series, myocardial performance was compared between a conventional bubble oxygenator, a Terumo CAPIOX^® FX05 membrane oxygenator, and a Novalung iLA membrane oxygenator. In the second series, standard Krebs-Henseleit buffer was compared with a bovine serum albumin-enriched perfusate under membrane oxygenation. Hemodynamic parameters, coronary flow, and perfusate pH were assessed throughout a 180 min ischemia-reperfusion protocol. Results: Both membrane oxygenators demonstrated significantly improved myocardial preservation compared with the conventional bubble oxygenator, as evidenced by superior systolic and diastolic function, enhanced coronary flow, and improved overall cardiac performance. No significant differences were observed between the two membrane oxygenators. Membrane oxygenation additionally enabled stable supplementation of the perfusate with bovine serum albumin, which resulted in further improvements in ventricular function and coronary perfusion. Perfusate pH remained comparable among groups. Furthermore, membrane oxygenation reduced Carbozen consumption by approximately 33%, increasing the number of experiments that could be performed using a standard gas cylinder. Conclusions: The present findings suggest that membrane oxygenation may represent a simple and effective refinement of the Langendorff isolated heart model. Beyond improving myocardial preservation, it enables the use of protein-enriched perfusates and substantially reduces gas consumption. These findings support the incorporation of membrane oxygenation into modern Langendorff systems and provide a foundation for the development of more physiologically relevant isolated organ perfusion models.

Background/Objectives: This study aimed to evaluate longitudinal changes in physical and cognitive function in individuals with chronic stroke over five years and to explore factors associated with long-term outcomes. Methods: This ambispective cohort study included individuals with chronic stroke who had participated in a previous cross-sectional study conducted between 2018 and 2019. Assessments were performed at baseline and five-year follow-up (2023-2024). Primary outcomes were physical function, assessed using the six-minute walk test (6MWT), comfortable and fast gait speeds measured by the ten-meter walk test (10MWT), and cognitive function, assessed using the Mini-Mental State Examination (MMSE). Results: Thirty-two individuals participated (mean age 63.5 ± 10.3 years; median time since stroke 7.0 years). The six-minute walk distance declined by 22% (263.7 to 206.8 m, p < 0.001), whereas no significant changes were observed in gait speed or cognitive function. Age, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline values of the 6MWT and 10MWT, and nutritional status (Mini Nutritional Assessment-Short Form; MNA-SF) showed associations with physical outcomes. For cognitive outcomes, baseline NIHSS score, baseline MMSE score, MNA-SF score, and education level showed associations. However, sensitivity analyses suggested that the associations involving MNA-SF and education level were not robust. Conclusions: Physical function declines over five years in individuals with chronic stroke, highlighting the importance of long-term follow-up. While global cognition (MMSE) remained stable, domain-specific declines cannot be ruled out. Baseline stroke severity, nutritional status, and initial functional and cognitive performance may be associated with long-term outcomes.

BMI is widely used for obesity classification, yet it does not adequately reflect adiposity distribution and related metabolic risk. Normal-weight obesity (NWO), defined as excess adiposity despite normal BMI, has emerged as a clinically relevant phenotype associated with increased cardiometabolic risk. However, its prevalence and implications in young populations remain insufficiently characterized.

To evaluate the prevalence of normal-weight obesity and its association with cardiometabolic risk markers in a cohort of young adults undergoing occupational health assessments.

A cross-sectional study was conducted in 12,874 adults aged 22-30 years undergoing routine occupational health assessments. NWO was defined using a strict criterion (normal BMI with a waist-to-height ratio ≥ 0.5) and an expanded definition including additional adiposity markers derived from body fat percentage and visceral fat estimates. Anthropometric, adiposity-related, biochemical, and lifestyle data were collected using standardized protocols. Multivariable logistic regression models adjusted for age and sex were used to assess associations between NWO and cardiometabolic risk markers.

Among individuals with normal BMI (n = 9290), the prevalence of NWO was 1.79% (n = 166) using the strict definition and 2.30% (n = 214) with the expanded definition. Compared with metabolically healthy normal-weight individuals, those with NWO exhibited higher triglycerides, fasting glucose, and atherogenic lipid indices, along with lower HDL cholesterol (all p < 0.05). In multivariable analyses, NWO was independently associated with elevated triglycerides (OR 4.99; 95% CI 2.90-8.58), an unfavorable triglyceride-to-HDL ratio (OR 7.44; 95% CI 5.19-10.65), and impaired fasting glucose (OR 3.87; 95% CI 2.19-6.82). Associations were consistent across sensitivity and sex-stratified analyses.

Normal-weight obesity is present in a measurable proportion of young adults and is associated with an unfavorable cardiometabolic profile despite normal BMI. The triglyceride-to-HDL ratio was consistently associated with normal-weight obesity and showed marked differences across adiposity-defined phenotypes. These findings highlight the limitations of BMI-based classification alone and suggest that additional anthropometric and metabolic markers may help identify individuals with less favorable cardiometabolic characteristics.