Cardiac rehabilitation (CR) is a proven, cost-effective secondary prevention intervention. Latin America and the Caribbean (LAC) bears a disproportionate burden of cardiovascular diseases yet limited CR availability. This Global Audit aimed to characterize CR coverage and delivery (access, staffing, core components, dose) in LAC, comparing findings with ICCPR's 2016 Audit and current global data.

Between May-September 2025, any phase II CR programs in all 35 LAC countries were identified through local Societies and surveyed (REDCap). Ischemic heart disease incidence was extracted from the Global Burden of Disease study 2023 estimates to reflect CR need, and juxtaposed with annual program volume data.

CR was available in 25 (71.4%) LAC countries, comprising 337 programs-a 32.2% increase from 2016. Responses were received from 255 programs in 19 (76.5%) countries with CR. Based on need, the total estimated service shortfall across the region was 635,945 patients/year, with a median of 2.9% coverage/country. Systematic CR referral was infrequent (6.3%), except in Chile. Fewer patients were paying out-of-pocket, but were paying more where they were. Using purchasing power parity, delivery costs per program were significantly lower in LAC than globally (p<.001). Multidisciplinary teams comprised 5 (median; P25-P75=3.8-7.0) members. Programs delivered 9/10 (P25-P75=7.0-10.0) core components, with patient education nearly universal, but tobacco cessation interventions-while increased from 2016-still lower than globally. Alternative model availability remained relatively unchanged from 2016 at <20%, and lower than that globally (29.5%). Total median dose was 25 sessions per supervised program, and 12/patient in alternative models.

High-quality CR persists, but system-level shortfalls limit impact.

Splenic infarction is a rare but clinically important condition that is usually associated with underlying hematological, cardiovascular, infectious, or malignant diseases. Due to its nonspecific clinical presentation, diagnosis may be delayed. This study aimed to evaluate the demographic characteristics, clinical findings, etiological factors, radiological features, treatment approaches, and outcomes of patients diagnosed with non-traumatic splenic infarction.

This retrospective study included 67 adult patients diagnosed with splenic infarction by contrast-enhanced abdominal computed tomography (CT) at Dicle University Faculty of Medicine Hospital between January 2014 and December 2023. Demographic characteristics, presenting symptoms, laboratory parameters, radiological findings, etiological factors, treatment modalities, length of hospital stay, and in-hospital mortality were evaluated.

The mean age of the patients was 50.9 ± 16.3 years, and 64.2% were male. Abdominal pain was the most common presenting symptom and was present in all patients. Hematological disorders were the most common identifiable specific etiology (31.3%), while no identifiable cause was found in 23.9% of patients. Contrast-enhanced CT established the diagnosis in all patients, whereas ultrasonography detected infarction in only 29.9% of cases. JAK2 mutation analysis was positive in 4 of 16 tested patients with hematological disorders. Conservative management was sufficient in 89.6% of patients, while 10.4% required splenectomy because of splenic rupture, hemorrhagic infarction, or splenic abscess formation. In-hospital mortality occurred in four patients (6.0%).

Splenic infarction is an uncommon clinical entity that should be considered in patients presenting with unexplained abdominal pain, particularly in the presence of hematological or systemic disorders associated with thrombotic risk. Contrast-enhanced CT remains the most reliable diagnostic modality, whereas ultrasonography has limited sensitivity. Although conservative management is effective in most patients, severe complications may necessitate surgical intervention. Early diagnosis and comprehensive etiological evaluation are essential for appropriate management and improved clinical outcomes.

Not applicable.

Near-infrared spectroscopy (NIRS) is commonly used for monitoring oxygen saturation in brain and abdominal tissues, while reports on the monitoring of local tissue oxygen saturation in limbs are very limited. This study observed the changes in limb tissue oxygen saturation index (TOI) in two infants of catheter-related venous thrombosis (CRT) and preliminarily investigated their correlation.

This study involved two infants who experienced limb catheterization complicated by venous thrombosis. NIRS was employed for the continuous monitoring of TOI prior to, during, and subsequent to urokinase thrombolysis. The safe TOI range was established at 58%-68% ±2; a reduction above 20% from baseline signified an anomaly. Changes in skin color and temperature of the affected limb were simultaneously observed, and the thrombolytic effect was comprehensively assessed using vascular ultrasound. Infant 1 was diagnosed with right iliac vein thrombosis; after 144 h of thrombolytic therapy, the TOI of the affected lower limb returned to the normal range, with no abnormalities in limb skin temperature or circumference. Infant 2 involved axillary vein thrombosis near the subclavian vein; following 17 h of combined thrombolysis and anticoagulation therapy, TOI values in both upper limbs became balanced, and ultrasound follow-up revealed no residual thrombus, indicating restored venous patency.

NIRS-monitored limb tissue oxygen saturation index can indicate the local venous filling status, which may facilitate the assessment of thrombolytic efficacy and the surveillance of thrombus formation.

Chronic cerebral hypoperfusion (CCH) is an important contributor to vascular cognitive impairment and neurodegenerative disorders, characterized by neuronal injury, blood-brain barrier (BBB) disruption, neuroinflammation, mitochondrial dysfunction, and synaptic impairment. Increasing evidence suggests that the microbiota-gut-brain axis plays a crucial role in ischemic brain injury. CCH is associated with gut microbiota dysbiosis, intestinal barrier dysfunction, and reduced production of microbiota-derived short-chain fatty acids (SCFAs), which may be linked to cognitive decline through bidirectional gut-brain communication. This review summarizes the mechanisms potentially involved in CCH-related neurological damage and highlights the potential neuroprotective effects of SCFAs, including regulation of neuroinflammation, BBB integrity, mitochondrial homeostasis, neuronal apoptosis, and synaptic plasticity. Furthermore, potential microbiota-targeted therapeutic strategies, such as fecal microbiota transplantation, probiotics/prebiotics, and SCFA supplementation, are discussed. Targeting gut microbiota-derived SCFAs may represents a promising approach for improving CCH-associated cognitive impairment, although further clinical validation is required.

Frailty is highly prevalent in patients with chronic kidney disease (CKD) and is associated with increased mortality, hospitalization and disability and with poorer quality of life. Despite its prognostic importance, substantial knowledge gaps remain with regard to the optimal tools for assessing frailty in CKD settings, the extent to which frailty can be reversed through targeted interventions, and how frailty should inform decision-making between conservative kidney management and kidney replacement therapy (KRT). This consensus report provides 63 consensus statements across four domains covering the assessment of frailty, interventions aimed at targeting the modifiable contributors to frailty in patients with CKD, considerations related to conservative kidney management and KRT, and the management of stage 5 CKD in the presence of frailty. Key recommendations include the need for routine frailty screening using multi-dimensional tools; the implementation of interventions to target physical activity with a focus on resistance training, adequate dietary protein intake, medication optimization and comprehensive geriatric assessment; a frailty-informed, person-centred framework for shared decision-making that emphasizes transparent communication, goal elicitation and cultural safety; and flexible KRT delivery - including less intensive dialysis schedules, assisted home dialysis and transplant eligibility assessment - guided by serial frailty measurement. The report concludes with priority research questions and a patient partner's reflections on the co-production of consensus statements.

As frailty and cardiovascular disease are closely linked, lifestyle interventions to reduce frailty could improve cardiovascular health in at-risk individuals. Previous clinical trials have shown that exercise reduces frailty, both individually and in combination with dietary protein. Blueberries can improve vascular health and protect against cellular senescence. The objective of the study on blueberries, protein and exercise for improving frailty and cardiovascular disease (STRONG) is to determine whether a year-long treatment including blueberries, protein and exercise will reduce frailty and improve cardiovascular health in older adults of both sexes.

STRONG is a pragmatic randomised controlled trial 1 year in length with an additional year of follow-up. We will recruit 240 adults aged ≥65 years (120 females and 120 males) in Nova Scotia, Canada. Participants will be randomly assigned to the STRONG intervention group (1 cup of blueberries/day, 30 g of protein powder/day and three 60-min multimodal exercise sessions with an exercise physiologist/week) or the control group (usual care). Measured outcomes will include changes in frailty (eg, frailty scores, balance, falls, changes in life-space, social engagement), cardiovascular disease risk factors (eg, blood pressure, lipid profile, Framingham risk score), cardiovascular health (eg, 6-min walk test, cardiac function measures), inflammatory markers, physical fitness, diet quality and health-related quality of life. All measures will be collected at baseline and 12 months, with many also repeated at the 3-, 6-, 9- and 24-month time points.

This study has received approval from the Nova Scotia Health Research Ethics Board (ROMEO #1031656) and is being conducted according to Consolidated Standards of Reporting Trials (CONSORT) and Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The findings will be disseminated through peer-reviewed publications, academic and community presentations, lay materials on our research team websites and social media and summaries/briefings to stakeholders that will be directed toward registered dietitians, exercise physiologists and clinicians.

NCT06693271.

Occlusive myocardial infarction (OMI) frequently presents without ST-elevation (NST-OMI) after return of spontaneous circulation (ROSC), complicating triage decisions. Aim of this study was to (i) characterise the distribution of NST-OMI patterns post-ROSC and (ii) determine whether quantitative ECG features are associated with survival.

In this retrospective single-centre analysis, the first post-ROSC ECG of cardiac arrest survivors admitted to a tertiary ICU (2020-2025) was evaluated for STEMI and NST-OMI patterns and for quantitative intervals (PQ, PR, P-wave, QRS, QTc). Coronary angiography (CAG) served as the reference standard for OMI.

Of 214 patients, 101 had CAG-confirmed OMI, wherein left-main equivalent and Smith-modified Sgarbossa criteria were the most prevalent NST-OMI patterns (each 8%), followed by Aslanger pattern (5%), lateral OMI, shark-fin sign and hyperacute t-wave (each 4%). NST-OMI patterns were more prevalent both overall (35% vs. 24%) and among CAG-confirmed OMI cases (48% vs. 44%) yet underwent CAG less frequently (78% vs. 98%; p=0.002), with the highest 30-day mortality among NST-OMI patients not undergoing CAG (75%; p=0.005). Regarding ECG features, non-survivors had longer PR-segment (74 vs. 57ms; p=0.008) and QRS-duration (130 vs. 108ms; p=0.003), and shorter P-wave duration (105 vs. 108ms; p=0.027). After multivariable adjustment, PR-segment prolongation was independently associated with reduced 30-day survival (aOR 0.977 [0.956-0.998]; p=0.032).

On the first post-ROSC ECG, angiographically confirmed occlusion concentrated around a small number of NST-OMI morphologies - findings of crucial importance for identification and appropriate management. PR-segment prolongation predicted reduced 30-day survival - indicating prognostic information beyond ischaemia detection.

Berberine is a phytochemical that has been shown to prevent a spectrum of serious ailments, to slow aging, and to extend lifespans and health spans of animals, demonstrating its pleiotropic effectiveness. Like sulforaphane, metformin, resveratrol, and many other phytochemicals, berberine suppresses the expression of critical etiological factors-particularly oxidative stress, inflammation, and cellular damage-involved in the progression of many diseases (e.g., diabetes, cardiovascular diseases, cancers, and neurodegenerative disorders) and the aging process. Since the salutary responses elicited by many phytochemicals have already been reported to be biphasic and hormetic, this study examined whether berberine and its salutary responses are mediated by hormesis. To address these questions, it was necessary to mine data from across the biomedical research literature, utilize anti-biasing data-selection criteria, and apply conservative statistical methods to evaluate, identify, and validate the occurrence of a biphasic hormetic response. Results show berberine, at low nontoxic doses and/or concentrations, routinely induces responses across a broad range of biological models and medical endpoints that are not only hormetic (biphasic) and salutary but of biomedical/clinical importance. This study is the first to report that the many pleiotropic and beneficial effects induced by berberine are clearly hormetic. These results underscore the positive relationship between a strong experimental design and the likelihood of eliciting an hormetic response. This means that the experimental endpoints, the sample sizes, and the numbers, ranges, and temporal spacings of applied doses must be judiciously selected to increase the likelihood of inducing an unambiguous hormetic response.

Identification of populations eligible for lung cancer screening (LCS) is a priority question in this field. The primary objective of this study was to quantify lung cancer prevalence after a first round of LCS among patients with history of atheromatous cardiovascular disease (aCVD) and tobacco exposure.

We performed a prospective bi-centric descriptive quantification of lung cancer prevalence among patients aged 45-75 years old with minimal history of 10 years of daily smoking and aCVD who underwent a chest computed tomography (CT) in an intend to screen. We also described lung cancer stage at diagnosis and treatments, we evaluated the eligibility of our population to the National Lung Screening Trial (NLST) and the Dutch-Belgian randomized controlled trial (NELSON) and described main quality metrics of LCS clinical path.

Among 505 participants who underwent a chest CT 159/505 (31%) did not met NLST nor NELSON eligibility criteria, 19/505 (3.8%) participants presented a positive screening. We diagnosed 16 cancers in 15 patients resulting in a LC prevalence of 2.97% (15/505). Among 16 lung cancers, 11 were stage I or II (75%). All patients with lung cancer received specific treatments including 12 surgeries alone, 2 surgeries with adjuvant systemic therapy, 1 radiation with systemic therapy and one systemic therapy alone; there was no postoperative severe morbidity (i.e. Clavien Dindo ≥ 3).

Our exploratory descriptive prospective study suggests that age 45-75 years-old, daily smoking for 10 years and aCVD may be evaluated in future studies as additional LCS eligibility criteria to existing LCS eligibility criteria.

Degenerative diseases impose a growing global health burden, whereas currently available therapies remain limited by adverse effects, drug resistance, and variable clinical efficacy. This critical narrative review used a structured, database-informed search of PubMed, Scopus, and ScienceDirect to identify original studies integrating metabolomics-based chemical profiling, chemometric analysis, and disease-relevant bioactivity assessment. Searches were conducted in January 2026 without publication-date restrictions. A total of 416 records were identified during the literature-identification process, of which 19 studies were retained for critical narrative synthesis. Across neurodegenerative, cardiovascular, diabetes-related, cancer-related, and hepatic conditions, LC-MS- and GC-MS-based metabolomics were used to differentiate samples with varying bioactivity levels, integrate chemical profiles with bioactivity data, and prioritize candidate features associated with biological responses. Alkaloids, triterpene saponins, phenolics, flavonoids, and essential-oil constituents were identified as putative bioactivity-related markers, with selected candidates receiving additional in vitro, ex vivo, or in silico support. Among the included studies, cardiovascular investigations demonstrated the strongest methodological rigor, particularly through the use of quality-control samples, reported chemometric validation, quantitative confirmation, and multilevel bioactivity testing. In contrast, studies in neurodegenerative, diabetic-related, cancer-related, and hepatic contexts were frequently limited by incomplete quality-control reporting, insufficient chemometric-validation information, uncertain risks of model overfitting, and limited functional confirmation of candidate markers. Overall, metabolomics provides a valuable decision-support framework for natural-product-based drug discovery. Its translational value, however, depends on standardized experimental design, robust quality-control procedures, transparent chemometric validation, biologically guided variable selection, and layered confirmation of candidate bioactivity-related markers.