Adequate tissue oxygenation is essential for effective skin wound healing. Hypoxia contributes to impaired healing and chronic wound formation. Obstructive sleep apnea (OSA) affects nearly one billion adults worldwide, and up to 80% of cases remain undiagnosed. OSA causes intermittent hypoxia (IH), with repetitive cycles of oxygen desaturation and reoxygenation during sleep. The molecular pathways activated by IH differ from those induced by acute and chronic hypoxia. We propose that OSA may contribute to impaired wound healing in two ways. Indirectly, by promoting comorbidities such as diabetes, hypertension, and obesity. Directly, through IH and its effects at the cellular and tissue level.

PubMed/MEDLINE, Scopus, and Web of Science were searched through August 2026 for preclinical and clinical studies on OSA, IH, and wound healing.

To our knowledge, this is the first review to integrate cellular mechanisms, preclinical evidence, and clinical data on this topic. We describe the IH-driven mechanisms that may contribute to impaired wound healing, including reduced antioxidant capacity, sustained inflammation, sympathetic activation, and endothelial dysfunction. Preclinical evidence is limited and mostly derives from in vitro scratch assays. It shows that IH delays wound closure, downregulates HIF-2α and VEGF, and shifts macrophages toward a pro-inflammatory phenotype. Clinical data are also limited and heterogeneous. In diabetic foot ulcers, high OSA risk doubled the risk of poor healing. Improved ulcer healing after CPAP has been described only in a small case series.

Given its high prevalence and underdiagnosis, OSA may be an overlooked and potentially modifiable factor in impaired wound healing.

Refractory hepatic hydrothorax (HH) is the persistent accumulation of pleural effusion secondary to portal hypertension, in the absence of cardiopulmonary or pleural etiology. It is diagnosed in patients with cirrhosis and it is a diagnosis of exclusion. Initial management consists of diuretics and sodium restriction, with a success rate of 75-80%; the remainder progress to refractory HH. Diaphragmatic plication via thoracoscopy combined with chemical pleurodesis has emerged as a therapeutic alternative to improve quality of life and reduce hospitalizations.

A 64-year-old woman with cirrhosis due to primary biliary cholangitis, Child-Pugh B (9 points), MELD 3.0: 15 points (bilirubin 1.7 mg/dL, INR 1.0, creatinine 1.3 mg/dL, sodium 140 mEq/L, albumin 2.0 g/dL). The patient presented with pleuritic pain, dyspnea mMRC IV, and transudative pleural effusion. Diuretic therapy with propranolol, furosemide, and spironolactone was administered, along with sodium restriction (80-90 mEq/day) and fluid restriction (< 2 L/day), without improvement and with symptom progression. A diagnosis of refractory HH was made, and thoracoscopic diaphragmatic plication with chemical pleurodesis was performed, resulting in a reduction of the effusion and clinical improvement. 6 months later, there was no clinical or radiological recurrence.

Diaphragmatic plication closes defects that communicate between the abdominal and pleural cavities, reducing the pleuroperitoneal gradient. Chemical pleurodesis induces pleural adhesion and obliteration of the space. The combination of both techniques increases therapeutic effectiveness.

During the 2024-2025 influenza season in Auvergne-Rhône-Alpes, France, a genetically distinct cluster of A(H3N2) viruses within subclade J.2.2 was found to be significantly overrepresented in hospitalized patients compared with community patients. Circulating mainly in November and December 2024, this genetically distinct cluster harboured HA1:G62R and S145N mutations, both linked to immune escape, as well as P239Q, located near key antigenic sites and warranting further investigation. The findings highlight the importance of monitoring influenza genome diversity in both hospital and community settings to identify emerging genetically distinct clusters with potential for increased severity.

Rescue stenting (RS) is increasingly used for intracranial artery stenosis-related large vessel occlusion (ICAS-LVO), but optimal patient selection remains uncertain. We investigated the baseline and procedural factors associated with receiving RS and whether they modified the association between RS and clinical outcome.This retrospective multicenter study included patients with middle cerebral artery (MCA) ICAS-LVO treated with mechanical thrombectomy (MT) alone or MT followed by RS. Baseline and procedural characteristics associated with receiving RS were identified using multivariable logistic regression and incorporated into inverse probability of treatment weighting models to assess treatment-effect heterogeneity for the 90-day modified Rankin Scale score.Among 264 patients, 193 received RS and 71 MT alone. MT failure, severe stenosis (> 75%), and higher baseline Alberta Stroke Program Early CT Score (ASPECTS) were independently associated with receiving RS. Both MT failure (interaction OR 0.28, 95% CI 0.10-0.83; p for interaction = 0.02) and severe stenosis (interaction OR 0.13, 95% CI 0.03-0.53; p for interaction = 0.004) significantly modified the association between RS and clinical outcome, whereas baseline ASPECTS did not. Within the MT failure subgroup, a significant interaction between severe stenosis and ASPECTS was observed (interaction OR 0.08, 95% CI 0.02-0.38; p for interaction = 0.002), suggesting a more favorable association between RS and outcome at higher ASPECTS values in patients with severe stenosis.In MCA ICAS-LVO, RS may be associated with more favorable outcomes in patients with MT failure, particularly in the presence of severe residual stenosis and preserved ASPECTS. These findings support a more selective approach to RS and warrant prospective validation.

Intracranial pressure (ICP) monitoring is a cornerstone of the management of patients with acute brain injury. External ventricular drains (EVDs) and intraparenchymal pressure sensors are the two most widely used invasive monitoring modalities. Although both techniques are routinely employed in neurocritical care, discrepancies between simultaneously recorded ICP values may occur because of technical limitations, sensor drift, or physiological intracranial pressuregradients. In this study, we evaluated dual ICP monitoring using EVD and intraparenchymal pressure sensor. The primary objective was to assess the frequency of signal mismatches. The secondary objective was to identify associations with patient diagnosis and device type. This was a single-center, retrospective observational study, from July 2013 to January 2015 and from December 2017 to April 2019. We included ICU patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (aSAH). All patients had dual ICP monitoring with an intraparenchymal pressure sensor and an EVD. Paired ICP measurements were collected every three hours during a 15-day observation period. Three categories of discordance were analyzed: E1: absolute difference > 6 mmHg between EVD and intraparenchymal measurements E2 : EVD-positive / intraparenchymal-negative threshold discordance (EVD > 20 mmHg and intraparenchymal ICP < 20 mmHg) E3: intraparenchymal-positive / EVD-negative threshold discordance (intraparenchymal ICP > 20 mmHg and EVD < 20 mmHg). A total of 313 patients (169 traumatic brain injury and 144 aneurysmalsubarachnoid hemorrhage) were included, providing 22,294 valid paired ICP measurements. Overall, 84% (n = 267) of patients experienced at least one E1 event, whereas 15.7% (n = 49) experienced at least one E2 event and 28.1% (n = 88) at least one E3 event. Agreement between ventricular and intraparenchymal measurements remained acceptable across pathologies and device types. However, discordances occurred more frequently during episodes of intracranial hypertension. Discordance between ventricular and intraparenchymal ICP measurements was not uncommon in this cohort of neurocritical care patients. These findings underscore the complexity of ICP interpretation and highlight the limitations inherent to all invasive monitoring techniques. Although dual monitoring may help identify discordant measurements in selected situations, the clinical significance of these discrepancies and their impact on patient management and outcomes remain to be established.

The consumption of ultra-processed foods (UPFs) has increased globally. This study comprehensively investigated the impact of consuming UPFs on the risk of major chronic diseases in adults.

A systematic search identified prospective cohort studies up to April 2026 on consumption of UPFs and major chronic outcomes. Consumption of UPFs was assessed by food frequency questionnaires (FFQs), 24-hour recalls, or dietary history.

Adults (≥18 years) without restriction to specific clinical conditions at baseline.

Fifty-one prospective cohort studies involving 8 819 894 participants were included. Consumption of UPFs was associated with cardiovascular events (Hazard Ratio (HR) 1.24, 95% Confidence Interval (CI) 1.14 to 1.36), cancer (HR 1.12, 95% CI 1.04 to 1.21), obesity/overweight (HR 1.23, 95% CI 1.17 to 1.30), metabolic syndrome (MetS)/diabetes (HR 1.24, 95% CI 1.08 to 1.42), depression/anxiety (HR 1.27, 95% CI 1.15 to 1.40), digestive diseases (HR 1.31, 95% CI 1.16 to 1.48) and all-cause mortality (HR 1.18, 95% CI 1.10 to 1.26). Dose-response analyses showed each additional 100 g/day associated with higher risks of cardiovascular events (HR 1.14, 95% CI 1.06 to 1.22), cancer (HR 1.04, 95% CI 1.02 to 1.06), all-cause mortality (HR 1.03, 95% CI 1.02 to 1.05), and MetS/diabetes (HR 1.02, 95% CI 1.01 to 1.04).

Consuming UPFs was associated with higher risks of multiple chronic diseases and all-cause mortality with low or moderate evidence. Reducing dietary intake of UPFs may therefore be relevant for chronic disease prevention.

CRD42023421092.

Out-of-hospital cardiac arrest (OHCA) treatment often requires multiple defibrillatory shocks due to failed defibrillation or refibrillation. The complete nature of refractory ventricular fibrillation (VF) is unknown, as many studies do not consider shocks delivered by lay rescuers prior to the arrival of basic life support (BLS)/advanced life support (ALS) when quantifying refractory VF. ERC guidelines define refractory VF as continuous VF after three consecutive shocks, not differentiating between patients who refibrillate and those with shock-resistant VF (three consecutive failed shocks) which may contribute to this variation in reported incidence. There are some differences in treatment recommendations for patients who refibrillate and those with shock-resistant VF. Therefore, understanding the number of shocks delivered by lay-rescuers with public access defibrillators (PADs) and the patient's response to them prior to BLS/ALS arrival may inform treatment strategies.

ECG data collected retrospectively from OHCAs treated by lay-rescuers using PADs were analysed. Cardiac rhythm, shock success, refibrillation, time to refibrillation and presence of shock-resistant VF (three consecutive failed shocks) were determined by two investigators.

Data were available for 1459 patients receiving at least one shock. Refibrillation occurred in 498 (34.1%) patients. The median number of refibrillations per patient was 1 (IQR 1, 2). Median time to refibrillation was 29.8 s. Three consecutive shocks were observed in 231 of the 1459 (15.8%) patients, 11 patients (4.8% of 231 patients) had shock-resistant VF.

When treated by lay-rescuers with PADs, refibrillation occurrence is lower than that reported for patients treated by BLS/ALS. However, aligned with BLS/ALS studies, in lay-rescuer treated OHCA, refibrillation typically occurs within the first 30 s following a successful shock. Therefore, patients who refibrillate are typically in VF for an additional 1.5 min before receiving a subsequent shock for PADs with a 2 min cardiopulmonary resuscitation (CPR) cycle. This finding emphasises the need for investigation into optimal CPR duration for patients requiring multiple shocks.

This study sought to characterise the demographics, arrest characteristics, clinical outcomes and ED access variables for out-of-hospital cardiac arrest (OHCA) presentations to the Victorian Heart Hospital (VHH), Australia's first dedicated cardiac hospital.

A retrospective audit of OHCA presentations to the VHH Cardiac Emergency Department from June 2024 to June 2025 was undertaken. Survival to hospital discharge was the primary outcome. Categorical variables associated with survival were assessed using Fisher's exact test with odds ratios; continuous variables associated with survival were assessed by Mann-Whitney U test.

One hundred and twenty-one patients were included; 70.2% male, median age 66 years (IQR 59-75). Shockable rhythms accounted for 61.2% of presentations and prehospital ROSC was documented in 92.6%. The primary outcome of survival to hospital discharge was 50.4% and 30-day survival was 40.0%. Shockable rhythm (OR 3.46, 95% CI 1.55-7.73), cardiac aetiology (OR 3.40, 95% CI 1.32-8.74) and prehospital ROSC (OR 9.23, 95% CI 1.12-76.3) were significant categorical variables associated with survival. Interhospital transfer was required in 24.0% of patients primarily due to a noncardiac aetiology of arrest requiring continuity of care at an affiliated centre.

In this selected postresuscitation OHCA cohort, survival to hospital discharge was 50.4%, with high rates of prehospital ROSC, shockable rhythm and witnessed arrest. These findings should not be interpreted as evidence of superiority over population-based OHCA cohorts. ED access variables, including a 24.0% interhospital transfer rate, represent novel system-level findings warranting prospective investigation.

Hypertensive disorders of pregnancy (HDP) are associated with maternal and neonatal morbidity. Although delivery is the definitive treatment, antihypertensive agents are often prescribed to control blood pressure to facilitate safe prolongation of pregnancy. International guidelines vary in their treatment recommendations and preferences for methyldopa, labetalol and nifedipine. Within the field of HDP, randomised trials are often underpowered and observational studies are limited in causal inference due to confounding. Therefore, we propose a target trial emulation with hospital-based electronic health record (EHR) data to compare methyldopa, labetalol and nifedipine in pregnancies complicated by HDP, focusing on maternal and perinatal outcomes.

We will emulate a target trial by using multicentre EHR data of four university and two non-university hospitals in the Netherlands covering the period from 2006 to 2025, although data availability varied across hospitals. With algorithm-based data extraction, we will collect EHR data from patients with an obstetric diagnosis-treatment code and a prescription of methyldopa, labetalol or nifedipine during pregnancy. Time zero between patients will be aligned to minimise the risk of immortal time bias. Therefore, patients will be stratified into gestational age groups at treatment initiation. Primary outcomes include severe hypertension and severe small for gestational age (SGA) below the third percentile. Secondary maternal outcomes include the development of pre-eclampsia, haemolysis, elevated liver enzymes and low platelets syndrome, acute kidney injury, maternal intensive care unit (ICU) admission, mortality and mode of delivery. Secondary perinatal outcomes include birth weight, SGA below the 10th percentile, fetal growth restriction (diagnosed based on ultrasound data), gestational age, preterm birth <37 and <34 weeks, Apgar score, neonatal ICU admission, neonatal hypoglycaemia and perinatal mortality. Weighted multivariable mixed-effects logistic or linear regression models will be used, depending on the outcome.

The Medical Research Ethics Committee of the University Medical Centre Utrecht (NedMec, 23-092/DB) confirmed that formal ethical approval was not required. Study findings will be disseminated through publication in peer-reviewed scientific journals.

Stroke is a leading cause of disability in Malaysia, often resulting in cognitive impairments such as reduced attention and processing speed. Music-based interventions have demonstrated potential in engaging neural networks associated with cognitive functions while home-based rehabilitation offers improved accessibility and adherence. This study aims to evaluate the feasibility and acceptability of a home-based music rehabilitation programme targeting attention and processing speed after stroke while obtaining preliminary estimates of cognitive outcomes to inform a future definitive trial.

This parallel-group feasibility randomised controlled trial will recruit 44 stroke survivors from a tertiary rehabilitation centre. Participants will be randomly allocated (1:1) to either a 4-week home-based music rehabilitation programme (40-minute sessions, five times per week) or standard care. Primary outcomes are recruitment, retention, intervention adherence, participant acceptability, intervention fidelity, completeness of outcome data and adverse events. Secondary exploratory outcomes include cognitive performance assessed using the Test of Everyday Attention, Trail Making Test (A and B), Stroop Test and Digit Span Test. Assessments will be conducted at baseline, postintervention (4 weeks) and 3-month follow-up. Feasibility outcomes will be summarised descriptively using frequencies, proportions and 95% CIs. Exploratory cognitive outcomes will be analysed using mixed-effects models where appropriate, while qualitative interview data will be analysed thematically.

The study has been approved by the UMMC Medical Research Ethics Committee 20251223-16042.

NCT07522463.