This study aimed to construct a predictive model for the early onset of atherosclerotic cardiovascular disease (ASCVD) by integrating oral microbiome data with traditional clinical risk factors.

A retrospective study was conducted involving participants aged 50-70 years without pre-existing ASCVD. The patients were divided into a training set and a validation set at a ratio of 7:3 by the complete randomization method. The characteristics of the oral microbiome were characterized by 16S rRNA/metagenomic sequencing. In the training set, univariate analysis and multivariate Logistic regression analysis were applied to screen predictive variables, and Random Forest (RF), Gradient Boosting (GB), and K-nearest Neighbor (KNN) were constructed. The receiver operating characteristic (ROC) curve was validated. The model performance was evaluated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

A total of 331 patients were enrolled and randomly divided into a training set (n=231) and a validation set (n=100). 40 out of 331 participants experienced major adverse cardiovascular events (MACE). Multivariate Logistic regression analysis confirmed that age, relative abundance of Fusobacterium nucleatum, Prevotella, Porphyromonas, Leptotrichia, Streptococcus and Actinomyces were significantly associated with ASCVD event risk (all P < 0.05). Three machine learning models (RF, GB, and KNN) were constructed, with the RF model achieving the highest predictive performance. The AUC values of the RF, GB, and KNN models in the training set were 0.888 (95% CI: 0.818-0.958), 0.823 (95% CI: 0.745-0.901), and 0.812 (95% CI: 0.727-0.898) respectively, and in the validation set were 0.845 (95% CI: 0.740-0.951), 0.746 (95% CI: 0.621-0.871), and 0.767 (95% CI: 0.647-0.887) respectively. Additionally, the integrated model showed significant improvements in net reclassification improvement (NRI = 0.315, P < 0.05) and integrated discrimination improvement (IDI = 0.227, P < 0.05) compared to traditional clinical models.

The integration of the oral microbiome and clinical data can improve the accuracy of the ASCVD risk prediction model, providing a novel biomarker strategy for primary cardiovascular prevention.

Venous leg ulcers (VLUs) are complex, chronic wounds that often recur after healing. The ongoing use of compression hosiery is the primary strategy to reduce the risk of VLU recurrence. However, adherence to this prophylactic treatment is low, undermining treatment effectiveness and placing a substantial burden on individuals with a history of VLUs and on healthcare systems. Understanding the factors influencing people's adherence to compression hosiery for secondary VLU prevention is essential to support approaches to promote uptake.

The study aimed to (1) draw on the Capabilities, Opportunities and Motivations of Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore factors influencing individuals' use of prophylactic compression hosiery for the secondary prevention of VLUs and (2) use the behaviour change wheel to identify intervention strategies to support the ongoing use of prophylactic compression hosiery by individuals after VLU healing.

A descriptive, interpretive qualitative study involving individuals with a history of healed VLUs. Semistructured interviews were conducted with people who had experienced healed VLUs. The interviews were guided by the COM-B model. Framework analysis was conducted using deductive coding informed by the TDF and inductive coding to capture emerging themes linked to barriers to and enablers of the target behaviour (ongoing compression use). Data management was aided by NVivo software, and coding was conducted by two researchers.

Interventions were conducted in person, by telephone or online, based on participants' preferences, at community leg clubs or in their homes, from April 2024 to January 2025.

Participants with experience of healed VLUs were recruited from three National Health Service (NHS) trusts and community leg clubs in the North of England.

A total of 15 participants were interviewed, comprising 4 males and 11 females aged between 49 and 89 years. Our analysis identified six factors that may influence individuals' use of prophylactic compression hosiery following VLU healing: knowledge, skills, environmental context and resources, emotion, social influences and beliefs about consequences. Deficits in knowledge, skills and resources, such as limited availability of prophylactic compression sizes, delays in prophylactic compression delivery and limited access to NHS services after healing, were primary barriers to people's use of compression hosiery in this context. Conversely, positive beliefs about the benefits of ongoing use of prophylactic compression hosiery were a strong enabler. Emotion and social influences were identified as both barriers and enablers: fear of recurrence and social support encouraged adherence, while stigma and negative feelings hindered it. We identified six intervention functions (education, training, persuasion, environmental restructuring, modelling and enablement) and eight linked behaviour change techniques that could be explored further to support people's ongoing use of prophylactic compression therapy. These techniques include providing information about antecedents, discussing health and emotional consequences, instruction, demonstration, rehearsal, social support, framing/reframing and vicarious reinforcement.

The identified intervention functions and behaviour change techniques provide theoretically informed insights for designing interventions to support sustained use of prophylactic compression hosiery following VLU healing. Key barriers to address include addressing gaps in individuals' knowledge about prophylactic compression therapy, prioritising posthealing VLU services, ensuring timely access to appropriately fitted compression and enhancing social support networks.

This study aims to investigate whether oral fluoroquinolone use is associated with an increased risk of aortic and mitral valve regurgitation.

A nationwide cohort study based on linked healthcare register data encompassing patient characteristics, prescription data and cases of aortic and mitral valve regurgitation.

Sweden, 2006-2018.

Study participants were adults aged 18-75 years. 794 588 courses of fluoroquinolones (88% ciprofloxacin) propensity score-matched (1:1) to an equal number of courses of penicillin V.

Aortic or mitral valve regurgitation leading to ED visit, hospitalisation or death. Cox regression was used to estimate HRs for the first incident of valve regurgitation within 120 days of treatment initiation. Subgroup and supplementary analyses included sex, age, first episode, surgery or death only, 356-day follow-up and analysis using amoxicillin as comparator drug.

There were 29 (incidence rate 0.5 per 1000 person-years) cases in the fluoroquinolone group compared with 43 (0.7 per 1000 person-years) cases in the penicillin V group during the main (1-30 days) follow-up period; corresponding to a HR 0.70 (95% CI 0.43 to 1.11). Analyses of subsequent time periods yielded results consistent with the main period: HR 1.06 (0.63-1.78) for days 31-60 and 0.90 (0.59-1.36) days 61-120. No significant differences were found in any of the subgroup- or supplementary analyses. The absolute risk difference was -17 (95% CI -33 to 6) cases of valve regurgitation per 1 000 000 courses of fluoroquinolones.

In a nationwide cohort study, there was no statistical support for an increase in the risk of mitral or aortic valve regurgitation associated with oral fluoroquinolone use.

Multimorbidity, defined as two or more chronic medical conditions, leads to the use of multiple medicines, including for cardiovascular conditions. This is associated with frailty and an increased risk of medication-related harm. Hospitalised adults have higher rates of multimorbidity and frailty compared with non-hospitalised adults. The aim of this study was to examine the use of medicines for hypertension, ischaemic heart disease and atrial fibrillation among patients with multimorbidity and frailty, who are generally not well represented in clinical trials.

A cross-sectional study was performed of adults aged ≥45 years with inpatient admissions during an 18-month period. Regular medications prescribed at discharge and coding data were obtained from the electronic medical record and hospital datasets.

The prevalence of multimorbidity (using coded chronic medical conditions or the RxRisk pharmaceutical comorbidity index), frailty (using hospital frailty risk score) and polypharmacy (defined as ≥5 medicines) were calculated. The uptake of medicines recommended by the Australian Therapeutic Guidelines for patients with coded hypertension, ischaemic heart disease and atrial fibrillation was also assessed.

Two large acute care, teaching hospitals in Adelaide, South Australia.

23 980 unique patients were identified.

69% (n=16 637) of patients had multimorbidity using the coding definition compared with 94% (n=22 620) using the pharmaceutical comorbidity score. 81% (n=19 366) had polypharmacy and 46% (n=11 091) had frailty. More than 85% of patients with hypertension were taking an antihypertensive. More than 75% of patients with ischaemic heart disease were taking an antithrombotic or a lipid-lowering agent and more than 50% were taking an agent acting on the renin-angiotensin system. Over 70% of patients with atrial fibrillation without a contraindication to anticoagulation were taking an anticoagulant. Patients with multimorbidity were 11-51% more likely to be taking an antihypertensive, antithrombotic or lipid-lowering medicine for the respective cardiovascular conditions, whereas those with frailty were 31-48% less likely to be taking guideline-directed medicines for all conditions studied.

Over two-thirds of hospitalised patients with these cardiovascular conditions were taking at least one guideline-directed medicine. Medication use was generally more common in multimorbidity and less common in frailty. Outcomes studies are needed to quantify the risks and benefits of cardiovascular medicines in these patients.

To evaluate emergency patient care from a chronophysiological perspective, examining circadian variations in symptom presentations and physiological parameters.Single-centre retrospective analysis.

SETTING: Department of Emergency Medicine, Clinical Centre, University of Pécs, Hungary (August 2022 to August 2023).

Patient data including symptom categories, time of presentation (divided into eight 3-hour intervals), sex and age were collected. A total of 32 977 patient records were analysed. Symptoms were classified using the International Classification of Diseases, 10th Revision. For hypertension, random proportionally stratified sampling was performed (n=120).

Primary outcomes were the circadian distribution of emergency presentations across 14 symptom categories and their variation by time of day, age and sex. Secondary outcomes included diurnal variation in hypertension-related cases, examining blood pressure, pulse rate, triage time and medication use.

Cardiovascular cases peaked between 09:00 and 12:00 (p<0.001), toxicological emergencies between 18:00 and 21:00 (p<0.001) and endocrine-metabolic cases between 12:00 and 15:00 (p<0.001). In hypertensive patients, the lowest systolic pressure occurred between 12:00 and 15:00 (p=0.037). More patients presented on weekdays than weekends (p=0.013).

Symptom presentations in emergency care follow distinct circadian patterns, highlighting the influence of biological rhythms on clinical demand. Recognition of these temporal trends may support more effective ED scheduling and resource allocation.

High blood pressure (BP) in obese populations poses significant cardiovascular risks, yet the comparative effectiveness of various weight loss interventions on BP remains unclear. This systematic review and network meta-analysis (NMA) aims to assess the comparative effectiveness of weight loss interventions in overweight/obese adults with prehypertension/hypertension on BP change and adverse events (AEs).

A systematic review and Bayesian NMA of randomised controlled trials of weight loss interventions in overweight/obese patients with prehypertension/hypertension will be conducted. PubMed, EMBASE and the Cochrane library (CENTRAL) and relevant references will be searched up to June 2025. Primary outcomes are changes in systolic and diastolic BP; secondary outcomes include AEs, body weight reduction (kg) and quality of life. Study selection, data extraction and methodological quality assessment using Cochrane risk of bias (RoB) 2.0 will be performed by independent two authors. A Bayesian NMA will be conducted using BUGSnet, with surface under the cumulative ranking curve to rank interventions. Subgroup analyses will explore heterogeneity by baseline BP severity, intervention duration and comorbidities, and sensitivity analyses will be performed for robustness of the results by RoB and sample size.

Ethical approval is not required for this systematic review as it will involve analysis of data only from previously published studies. The results will be disseminated through presentations at international conferences and publication in peer-reviewed journals.

CRD42022376688.

To explore experiences of healthcare providers, stroke survivors and caregivers on stroke transitional care delivery at a tertiary hospital in Tanzania.

A qualitative descriptive design with a phenomenological approach was used. Colaizzi's thematic analysis was conducted using Dedoose software to identify significant information that describes the transitional care experiences of the study participants.

This study was conducted in the internal medicine and outpatient departments of a tertiary hospital in Tanzania.

15 triads of healthcare providers, stroke survivors and caregivers were purposively recruited to participate in semi-structured in-depth interviews between June and September 2024.

The analysis identified four themes: communication and exchange of information, involvement of patients and caregivers in transitional care, coordination of transitional care and experiences with changing care setting. Effective communication and information exchange among healthcare providers, survivors and caregivers ensured that survivors and their caregivers were well informed about the care process, clinical condition, prognosis and transitional care needs. A collaborative care approach enabled survivors and caregivers to actively participate in care, decision-making and discharge planning during hospital-to-home transition. Coordination of care was equally important during hospital-to-home transition as it provided survivors with home-care instructions and opportunities for follow-up care. However, miscommunication among the healthcare team, insufficient information exchange, inadequate discharge planning, poor social support and lack of care coordination prevented smooth hospital-to-home transition leading to a crisis at home.

The experiences of healthcare providers, patients and caregivers during stroke transitional care in Tanzania highlight achievements and key areas for improvement. Hospital-to-home transition is often characterised by uncertainty and emotional strain, emphasising the need for effective communication, involving patients and caregivers in care, as well as coordinating transitional care to address medical and psychosocial needs of survivors and their caregivers during and after discharge.

Although Valsalva maneuver (VM) remains the guideline-directed emergent treatment for supraventricular tachycardia (SVT), its success rate remains suboptimal.

To assess the efficacy of a novel handheld Valsalva assist device, which can assist in achieving and maintaining target intrathoracic pressures, in improving sinus rhythm restoration rates in patients with SVT.

This single-center, open-label randomized clinical trial conducted at Beijing Anzhen Hospital randomized patients with SVT (aged 16-80 years, enrolled between April 2022 and April 2023) undergoing electrophysiological study at a tertiary hospital. Data analysis was completed from January 2024 to January 2025.

Participants received either device-assisted VM (n = 106) or standard VM (n = 106) during induced SVT.

The primary outcome was immediate cardioversion success (12-lead electrocardiogram-confirmed sinus rhythm within 1 minute) postintervention by intention-to-treat analysis.

A total of 212 patients were randomized, among whom 210 completed the randomly assigned VM and were included in the primary analysis (106 in the standard VM group and 104 in the device-assisted VM group). Mean (SD) patient age was 48.4 (14.0) years, and 114 patients (54.8%) were female. After 2 VMs, 67 of 106 participants in the VM with device assist group (63.2%) vs 31 of 106 participants in the standard VM group (29.2%) converted to sinus rhythm within 1 minute (odds ratio, 4.16; 95% CI, 2.36-7.47; P < .001).

Per the results of this randomized clinical trial, the handheld Valsalva assist device significantly enhances VM effectiveness, providing a potentially implementable solution for SVT management.

ClinicalTrials.gov Identifier: NCT06622772.

Patient awareness extends beyond factual knowledge, encompassing emotional and cognitive engagement with the disease. As in other chronic diseases, it plays a critical role in asthma management. A comprehensive, validated tool for assessing this multifaceted construct in patients with asthma has been lacking. This study aimed to develop and validate the Asthma Awareness Questionnaire (AAQ) within the framework of the Mild/Moderate Asthma Network of Italy (MANI) study, a real-world, prospective, longitudinal cohort study involving adults diagnosed with mild-to-moderate asthma according to Global Initiative for Asthma (GINA) 2020 criteria.

The questionnaire was developed through a Delphi process involving clinicians and patients. Psychometric properties (scale dimensions, internal validity, construct validity, and reliability) were explored, as well as the total and domain level of awareness.

Starting from an initial list of 39 items, the Delphi process led to a provisional 22-item version. A total of 149 participants completed the AAQ at baseline and 6-month follow-up visit. Exploratory and confirmatory factor analyses supported a three-factor structure-agency, knowledge, and acceptance-with the exclusion of four items. Internal consistency (Cronbach's α = 0.78), construct validity (assessed through correlations with established patient-reported outcome measures), and test-retest reliability (ICC = 0.723) were assessed. Awareness levels were suboptimal overall (mean total score ≈ 60/100), with knowledge scores nearing the 80/100 threshold, while agency and acceptance lagged.

The AAQ is a psychometrically sound instrument that captures the multidimensional nature of asthma awareness. Its use may guide future interventions aimed at improving patient self-management. Further validation in broader clinical settings is warranted.

ClinicalTrials.gov identifier, NCT12345678.

This study investigates the changes in serum miRNA-210 expression at different stages of spontaneous intracerebral hemorrhage (sICH) and their clinical significance.

Twenty patients with sICH and admitted to the Neurosurgery Department of the Affiliated Hospital of Beihua University between August 2022 and January 2023 were selected for this study. Venous blood samples were collected on Day 1 (within 12 hours) and Day 7 after disease onset. Serum miRNA-210 expression was quantified using quantitative reverse transcription polymerase chain reaction (qRT-PCR).

Serum miRNA-210 levels on Day 7 (31.5775 ± 0.13242) were significantly lower than on Day 1 (31.6865 ± 0.1654) in patients with sICH. Results of a paired t-test analysis showed a t value of 2.268, p = 0.035 (p < 0.05).

In this study, differences in serum miRNA-210 expression at different stages of sICH were found to be significant. Changes in miRNA-210 levels may serve as potential biomarkers for disease progression, providing insights for clinical management.