ObjectiveThis study was undertaken to systematically examine the effects of robot-assisted, task-oriented training on upper limb function and activities of daily living in patients with stroke.MethodsA systematic search was conducted across PubMed, EMBASE, SCOPUS, CINAHL, and Ovid LWW databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, including literature published from 2014 to 2025. Eligible studies were randomized controlled trials that compared an experimental group receiving robot-assisted task-oriented training with a control group undergoing conventional treatment or alternative interventions and evaluated upper limb function and activities of daily living outcomes. The Physiotherapy Evidence Database scale was used to assess the methodological quality of the literature. This systematic review was registered with the Open Science Framework (DOI: 10.17605/OSF.IO/4DT6G).ResultsTen studies were included in the analysis. Robot-assisted interventions consistently improved upper extremity motor function, particularly when implemented as an adjunct to conventional therapy or integrated with advanced technologies such as functional electrical stimulation. However, activities of daily living-related improvements varied across studies, and functional improvements were confirmed in only three studies. The effectiveness of robotic intervention depended on the intervention modality, stroke phase, and technological integration.ConclusionsRobot-assisted task-oriented training can effectively improve upper limb function in patients with stroke, and in some cases, combining it with conventional therapy may produce synergistic effects. Nevertheless, evidence regarding improvements in activities of daily living and long-term maintenance effects remains limited. Further high-quality randomized trials focusing on optimizing specific clinical dimensions and facilitating the transfer of motor recovery to activities of daily living are required.

Despite the known benefits of physical activity and diet modifications for hypertension control, adults in rural South African settings still have high levels of uncontrolled hypertension. This paper outlines an intervention that targets adjusting routine physical activity and diet practices for hypertension control in adults from rural South Africa (HYPHEN). The intervention involved a structured group education, individualised physical activity education, and individualised dietary education. We aimed to evaluate the feasibility, acceptability, and fidelity of HYPHEN for adults aged 40 years and older living with hypertension in rural South Africa. Feasibility was measured by assessing recruitment and retention rates. Acceptability was assessed through interviews after the intervention using pre-determined themes of perceived expectations, benefits, motivation, and barriers concerning the intervention. Fidelity was evaluated by intervention adherence, dosage, quality, and participant responsiveness. Participants were also asked to rate their overall satisfaction on a Likert scale out of 10. Our study demonstrated high level of feasibility, acceptability, and fidelity. Thirty participants were successfully recruited (100% of target), 28 (93%) participants were retained, and 28 (93%) provided complete data. Qualitative data demonstrated high acceptability, with participants reporting that the intervention met expectations, provided benefits, motivated continued engagement, and involved few barriers. Intervention fidelity was high with all three components carried out as planned, minor dosage adjustment, high delivery quality, and 100% participant engagement. The average rating on the Likert scale was 8.6/10 (SD = 2.55). HYPHEN is a feasible and acceptable intervention for hypertension control. Trial registration: Pan African Clinical Trial Registry (pactr.samrc.ac.za) PACTR202306662753321. Retrospectively registered on 29 June 2023.

Intracerebral hemorrhage (ICH) carries a substantial risk of early death and is frequently linked to unfavorable clinical outcomes, yet early prognostication remains challenging. The hemoglobin glycation index (HGI), which quantifies the discrepancy between measured glycosylated hemoglobin A1c(HbA1c) and the level expected based on fasting plasma glucose (FPG), has shown prognostic relevance in various clinical settings. Our objective was to investigate whether the HGI serves as a predictor of short-term mortality among individuals with ICH.

We performed a retrospective analysis utilizing data from the critical care database. We identified 1,318 adult ICH patients with available HbA1c and FPG data. HGI was defined as the difference between the observed HbA1c level and the HbA1c value predicted on the basis of admission FPG. Patients were stratified into HGI tertiles. The main outcome was 30-day all-cause mortality (90-day mortality served as a secondary endpoint). The relationship between HGI and mortality was examined using Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline analyses. Subgroup analyses were also performed.

Mortality was significantly greater among individuals in the lowest HGI tertile than among those in the highest tertile (30.18% vs 17.24% at 30-day mortality, p < 0.001; 33.64% vs 22.07% at 90-day mortality, p < 0.001). Multivariable Cox regression showed that higher HGI was an independent predictor of reduced mortality risk. The adjusted hazard ratio(HR) for 30-day mortality was 0.84 (95% CI 0.75-0.93), for 90-day mortality was 0.86(95% CI: 0.79-0.95) in fully adjusted models. Restricted cubic spline (RCS) analysis demonstrated an L-shaped association, with inflection points identified at HGI values of 0.692 for 30-day mortality and 0.472 for 90-day mortality, respectively. Below these thresholds, each one-unit increase in HGI corresponded to a 47.7% reduction in 30-day mortality risk and a 40.4% reduction in 90-day mortality risk, respectively. The association between HGI and mortality was consistent across most subgroups, with a significant interaction by diabetes status (p for interaction < 0.05), indicating the predictive value of HGI was more pronounced in patients with diabetes.

An L-shaped association exists between HGI and short-term mortality in ICH patients, with low HGI indicating substantially higher risk and holds potential as a novel prognostic indicator for facilitating early risk stratification in patients with acute ICH.

Isolated distal deep vein thrombosis (IDDVT) is common, yet tools for predicting poor recanalization remain limited. We aimed to develop and compare machine learning models for predicting poor recanalization in patients with IDDVT and to identify the most informative predictors.

A total of 1600 patients with IDDVT were retrospectively enrolled. The dataset was randomly divided into a development set (n = 1280) and an independent test set (n = 320) using stratified sampling. Six predictive models were developed and compared: logistic regression (LR), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and a Voting Ensemble. Model training and hyperparameter tuning were performed in the development set using five-fold stratified cross-validation, and optimal classification thresholds were determined using the Youden index. Model performance was evaluated by discrimination, calibration, and classification metrics, with 95% confidence intervals estimated by bootstrap resampling (10,000 iterations). SHAP analysis was applied to interpret the final model.

In the independent test set, all models showed acceptable to strong discrimination, with AUC values ranging from 0.808 to 0.908. XGBoost achieved the best overall performance, with an optimal threshold of 0.183, an AUC of 0.908 (95% CI, 0.855-0.952), a Brier score of 0.077 (95% CI, 0.058-0.096), an accuracy of 0.900 (95% CI, 0.866-0.931), a precision of 0.650 (95% CI, 0.529-0.767), a recall of 0.803 (95% CI, 0.686-0.906), an F1-score of 0.717 (95% CI, 0.615-0.806), and a specificity of 0.918 (95% CI, 0.884-0.950). The calibration intercept and slope of the XGBoost model were 0.149 (95% CI, -0.192 to 0.454) and 1.410 (95% CI, 1.098-1.809), respectively, indicating acceptable overall calibration. SHAP analysis identified D-dimer rate, provoking-factor-related variables, anticoagulant use, and age group as the most influential predictors.

Among six candidate models, XGBoost showed the best overall performance for predicting poor recanalization in patients with IDDVT. This study establishes an interpretable machine learning-based prediction framework focused specifically on poor recanalization in IDDVT and highlights the contribution of dynamic laboratory information, particularly D-dimer rate. The model may support early risk stratification and individualized follow-up planning, but external validation is required before routine clinical implementation.

Takotsubo Syndrome (TS) is a cardiac condition that mimics myocardial infarction (MI). Long-term readmission data remain limited. Previous studies in other conditions suggest that socioeconomic factors, such as low income and unemployment, may influence readmission rates, but this has not been explored in TS. This study aims to investigate the risk factors of one-year readmissions in TS patients and the impact of socioeconomic factors, comparing results with matched individuals from the general population and those with MI. Methods A nationwide cohort study was conducted using national registers. Patients discharged alive from Danish hospitals with an incident TS diagnosis between 2008 and 2018 were identified through the Danish National Patient Registry. Each TS patient was matched with four individuals from the general population and patients with MI by sex and age. In the analyses of one-year readmission of TS, we included socioeconomic factors such as cohabitation, labor market attachment, education, family income psychological distress, and comorbidities. Results A total of 1022 individuals with TS were identified, with a median age of 70 years (IQR 61-77), and 89% were women. Compared to the general population, TS patients had higher rates of cardiovascular comorbidities, respiratory diseases, and psychotropic medication use, but fewer cardiac conditions except for heart failure in the MI population. TS patients were more likely to receive incapacity pensions, have basic education, and belong to the lowest income percentile compared to the general population. In the first year, (36%) of TS patients were readmitted, compared to 4% in the general population and 44% in the MI group. The most common causes of readmission in the TS cohort were cardiac (27%), 'other' conditions (22%), and respiratory (20%).Readmission rates were higher among TS patients in vulnerable socioeconomic groups compared to the general population: 37% vs 6% for those in the lowest income percentile, 42% vs 6 % for those with basic education, and 37% vs 4% for those on incapacity pension, but overall lower compared to the MI population. Most readmissions occurred within the first two months. The two lowest income quintiles, vocational/high school and below and living alone all predicted readmission. The lowest income had a Hazard Ratio of 1.64 and 95% confidence intervals of 1.01-2.69. Conclusion Although TS patients exhibit a disadvantaged socioeconomic profile and a substantial comorbidity burden, our analyses suggest that socioeconomic factors are associated with readmission risk, with part of this association potentially mediated through comorbidity burden. These findings indicate that, even in healthcare systems with free access such as Denmark's, socioeconomic inequalities may remain relevant for readmission risk in TS patients.

Myocardial dysfunction is a major determinant of mortality after cardiac arrest, yet the molecular events driving post-resuscitation injury remain incompletely understood. Nitric oxide (NO) has been proposed as a cardioprotective adjunct during extracorporeal life support (ECLS), but its mechanistic impact on myocardial recovery is unclear. We investigated whether NO supplementation during ECLS modulates oxidative stress, metabolic pathways, and apoptotic signaling in the post-cardiac arrest heart.

Male Sprague Dawley rats underwent hypothermic cardiac arrest followed by ECLS resuscitation with or without NO supplementation (20 ppm). Myocardial tissue was analyzed using bulk RNA sequencing, quantitative RT-PCR, oxidative stress assays (MDA, 3-nitrotyrosine, total oxidant/antioxidant status), and TUNEL staining to characterize pathway-level alterations.

NO supplementation markedly increased cardiomyocyte apoptosis (46%±3 vs. 27%±2; p < 0.0001). Transcriptomic profiling revealed > 550 differentially expressed genes, highlighting upregulation of inflammatory and apoptotic cascades (MAPK, TNF, NF-κB, proteasome/TLR pathways) and profound suppression of metabolic programs essential for myocardial recovery, including fatty acid oxidation, branched-chain amino acid metabolism, and oxidative phosphorylation. NO induced a striking oxidative-nitrosative imbalance, with elevated MDA, 3-nitrotyrosine, and total oxidant status and reduced total antioxidant capacity, resulting in a threefold increase in the oxidative stress index.

NO administration during ECLS drives a coordinated oxidative-inflammatory-apoptotic response and disrupts metabolic pathways necessary for myocardial recovery, suggesting a mechanistic basis for worsened post-arrest myocardial injury. These findings have direct implications for optimizing resuscitation strategies in human ECLS and may inform future therapeutic modulation of NO signaling.

Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs) have shared risk factors and mechanisms. CVDs are highly prevalent in COPD patients. Additionally, the risk of suffering a cardiovascular (CV) event is increased following an exacerbation and remains elevated for months afterwards. This link between exacerbations and increased CV risk further highlights the importance of preventing exacerbations. Clinical management during and after exacerbations regarding the prevention of CV events remains to be optimised. CV events occur in patients with COPD who have not previously been diagnosed with CVD. Conventional CV risk tools have historically underestimated the risk of CV events in patients with COPD. All patients with COPD should be investigated for CVDs and markers of CV risk should be assessed at the time of COPD exacerbations. Improving survival in COPD depends on reducing the risk of exacerbations, particularly severe exacerbations, addressing identified CV risk factors and managing CVDs when identified according to guidelines.

Extradural anterior clinoidectomy is increasingly used to improve exposure and proximal vascular control in aneurysm surgery, but its isolated effect on an otherwise uncompromised optic nerve remains unclear. To evaluate the functional, structural, and electrophysiological impact of EAC with optic canal unroofing in patients without preoperative optic nerve compression or optic canal pathology. We conducted this single-center study included 16 adults who underwent no-drill extradural anterior clinoidectomy (EAC) during microsurgical clipping of ruptured aneurysms (January 2023-December 2024). Patients with visual or optic pathway pathology were excluded. Postoperative assessment (6-12 months) included visual acuity, automated perimetry (visual field index, VFI), OCT-derived retinal nerve fiber layer (RNFL) thickness, and visual evoked potentials (P100 latency). Eyes were compared using paired tests, with repeated-measures ANOVA for quadrant-based ΔRNFL. Visual acuity was preserved in all patients. Global RNFL thickness was similar in ipsilateral and contralateral eyes (95.8 ± 12.7 vs. 99.2 ± 18.6 μm; p = 0.230). Quadrant ΔRNFL varied by quadrant, but no pairwise differences remained after correction, with a trend toward greater thinning in the superior quadrant. VFI was similar (p = 0.7); one patient had inferior nasal quadrantanopia and two had mild blind-spot enlargement. P100 latency was comparable (114.8 ± 9.7 ms vs. 113.8 ± 8.9 ms; p = 0.223). No major EAC-related neurovascular complications were observed. Extradural anterior clinoidectomy was not associated with statistically significant optic nerve impairment, although visual field changes occurred in 3/16 patients (18.75%) with a trend toward superior RNFL thinning.

Lung transplantation is the definitive therapy for end-stage respiratory diseases. To expand the donor lung pool, ex vivo lung perfusion (EVLP) has been developed for the assessment of marginal donor lungs. However, current evaluation methods remain limited. This study aimed to develop non-invasive imaging and monitoring techniques for the quantitative and early assessment of pulmonary function during EVLP. Three novel approaches were established: (1) lung thermography during the initial reperfusion period to assess pulmonary function, (2) optical oxygen saturation (SaO₂) imaging to assess pulmonary oxygenation, and (3) real-time lung weight measurement as an early indicator of transplant suitability. Lung thermography revealed that lung surface temperature at 8 min after shunt closure was significantly lower in non-suitable cases than in suitable cases (25.1 ± 0.6 °C vs. 27.8 ± 1.2 °C, P < 0.01). Optical SaO₂ imaging demonstrated a strong correlation between lower lobe SaO₂ calculated from SaO₂ imaging and PaO₂/FiO₂ (P/F) ratio in the lower pulmonary vein (R = 0.855, P < 0.01), with SaO₂ being significantly lower in non-suitable cases. Real-time lung weight measurement showed that lung weight gain increased significantly after 40 min in non-suitable cases compared with suitable cases (51.6 ± 46.0 g vs. -8.8 ± 25.7 g, P < 0.01). These three approaches proved effective for the quantitative and early assessment of pulmonary function during EVLP. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2024 (Vol. 53, No. 3, pp. 216-220).

Rare-variant association studies typically perform gene-level tests in which coding variants are filtered (or 'masked') and aggregated based on functional annotation and allele frequency. Through a systematic literature review, we cataloged 664 masks used across 234 studies and found that masking strategies (that is, sets of masks) rarely repeat across studies and are rarely justified. To quantify their impact on association results, we applied all previously employed strategies to 54 traits within 189,947 UK Biobank exomes. Here we find that the number of significant associations greatly depends on the masking strategy (ranging from 58 to 2,523 associations), which is a key reason for the modest overlap (<30%) of associations between separate published analyses of this dataset. We empirically determine masking strategies with high discovery power for low-frequency and rare variant gene-level associations across numerous datasets and traits, and we use these to explore the impact of other factors on burden test results. These findings offer a baseline strategy in burden tests to increase study power and replicability, addressing one source of inconsistency in previous studies.