Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbidity. Although n-3 polyunsaturated fatty acids (PUFAs) in fish may prevent HDP, evidence from Japanese populations, particularly regarding the preconception period, remains limited. To examine associations between fish and PUFA intake before and during pregnancy and the risk of HDP using data from a nationwide Japanese birth cohort.

This analysis included 86,009 women from the Japan Environment and Children's Study. Dietary fish and n-3/n-6 PUFAs intake was assessed using a validated food-frequency questionnaire administered in early pregnancy (median gestational age, 15.0 weeks [interquartile range (IQR) 12.0-19.0]) to capture intake before pregnancy, and in mid to late pregnancy (median gestational age, 27.0 weeks [IQR 25.0-30.0]). Participants were categorized into quintiles of intake. Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for HDP, early-onset HDP (Eo-HDP < 32 weeks), and late-onset HDP (Lo-HDP ≥ 32 weeks). Missing data were addressed with multiple imputation.

In the overall population, higher fish intake before pregnancy was associated with reduced risks of Eo-HDP in the Q5 groups, whereas higher fish intake during pregnancy was associated with reduced risks of overall HDP in Q4. In analyses restricted to nulliparous women, higher pre-pregnancy fish intake was associated with a lower risk of Eo-HDP (Q4: aOR 0.57; 95% CI 0.34-0.97; p for trend = 0.02), and higher fish intake during pregnancy was associated with a lower risk of Lo-HDP (Q4: aOR 0.79; 95% CI 0.64-0.96). Total n-3 PUFA intake showed significant associations with HDP only in some analyses. Sensitivity analyses using a 34-week cutoff yielded consistent results.

Fish intake before pregnancy was associated with lower risk of Eo-HDP, whereas intake during pregnancy was linked to reduced risk of Lo-HDP. Sustained fish consumption from preconception through pregnancy may help prevent HDP and inform global nutritional guidance, including preconception care.

The Japan Environment and Children's Study, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035091 (Registration no. UMIN000030786).

Acute dizziness often leads to hospital admission because of suspected stroke. A targeted clinical examination comprising positional tests and assessment of gaze stability, nystagmus and vertical ocular misalignment is a well-documented tool for distinguishing between central and peripheral causes. The purpose of the study was to investigate whether implementation of a treatment algorithm incorporating a targeted clinical examination for acute dizziness was associated with changes in resource use, shorter hospital stays and improved diagnostic accuracy.

A retrospective analysis was conducted of all patients admitted to the Department of Neurology at Akershus University Hospital in Norway between 2015 and 2023. The study period was divided into three periods: before (2015-17), during (2018-20) and after (2021-23) implementation of the treatment algorithm. Comparisons were made of brain CT and MRI, assessment by an otolaryngologist, length of hospital stay, and the proportion of patients discharged with a specific diagnosis of dizziness before and after implementation of the algorithm.

Among patients discharged with dizziness as the primary diagnosis, there was a significant increase in the proportion undergoing CT (from 87.5% to 90.9%), while the use of MRI decreased significantly (from 34.7% to 24.5%). Assessment by an otolaryngologist decreased significantly (from 21.5% to 6.8%). There was a small, non-significant reduction in length of hospital stay, in contrast to a statistically significant increase in length of stay in the reference group. The proportion of patients discharged with a specific diagnosis of dizziness increased from 20% in the period before implementation to 34% in the period after implementation.

Implementation of a treatment algorithm incorporating a targeted clinical examination for acute dizziness in a neurology department was associated with reduced resource use (apart from a small increase in the use of CT) and improved diagnostic accuracy.

Post-stroke epilepsy (PSE) is a common and serious complication of stroke, yet simple and efficient risk assessment tools remain lacking in clinical practice. This study aimed to investigate the association between multiple core inflammation-derived indices and PSE, and to explore their potential reference value in risk stratification.

In this retrospective case-control study, we extracted data from hospitalized stroke patients at Hefei Second People's Hospital between January 2018 and December 2025 from the electronic medical record system. A 1:1 propensity score matching method was used to balance confounding factors including sex, age, and underlying diseases. Ultimately, 317 PSE patients (case group) and 317 stroke patients without PSE (control group) were included. Routine hematological parameters collected within 24 h of admission were used to calculate six inflammatory indices: the systemic immune-inflammation index (SIRI), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (DNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-platelet ratio (NPR), and neutrophil-monocyte-to-lymphocyte ratio (NMLR). Multivariable logistic regression models were employed to analyze the association between inflammatory indices and PSE risk, and nonlinear relationships and threshold effects were also explored. The discriminative ability and incremental value of each inflammatory index were assessed using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Subgroup analyses were conducted to verify the stability of the results.

This study showed that for each one-standard-deviation increase in SIRI, the risk of PSE increased by 172% (OR = 2.72, FDR-adjusted p < 0.001). Quartile-stratified analysis revealed a clear dose-response relationship (trend p < 0.001). Similarly, the strength of association for SIRI was superior to that of other inflammation-derived indices. Compared with the other inflammatory indices, SIRI demonstrated relatively better discriminative ability in ROC analysis (AUC = 0.693, 95% CI: 0.654-0.732), NRI, and DCA. Restricted cubic spline regression and E-value analysis further supported the robustness of this association, and subgroup analyses indicated consistency across different subgroups.

Systemic immune-inflammation index showed a relatively strong association with PSE risk and moderate discriminative ability in the stroke population, and may serve as an auxiliary reference indicator for early risk stratification of post-stroke epilepsy. However, its clinical utility requires further validation in prospective cohort studies.

This study aimed to evaluate the predictive value of C1q (complement activation regulatory factor) for the occurrence of postoperative delirium (POD) following surgery for acute aortic dissection.

We prospectively included patients undergoing surgery for aortic dissection. Serum levels of C1q were measured preoperatively and on the first postoperative day. POD was assessed daily postoperatively using the confusion assessment method (CAM) or the confusion assessment method for the intensive care unit (CAM-ICU) for patients in the intensive care unit (ICU). Statistical analyses included the Pearson correlation coefficient and multivariate logistic regression to evaluate the association between C1q levels and POD.

A total of 67 patients were enrolled in the study. Serum C1q levels were significantly higher in the Delirium group compared to the non-Delirium group both preoperatively and postoperatively. Univariate logistic analysis revealed that preoperative serum C1q levels were predictive of POD (OR = 1.379, 95% CI = 1.176-1.683, p < 0.001). The area under the curve (AUC) for preoperative serum C1q was 0.788 (95% CI = 0.671-0.880).

C1q is a potential biomarker for predicting POD in patients undergoing aortic dissection surgery. These findings suggest that C1q may be valuable for early diagnose and intervention strategies for POD.

To develop a smartphone application (Conjunctiva VD) that objectively quantifies bulbar conjunctival hyperemia by estimating the conjunctival vessel density (VD) within a user-defined region of interest (ROI).

A total of 100 conjunctival images from 2 public datasets were analyzed. An external imaging technician selected images meeting predefined quality criteria and delineated an inferior bulbar conjunctival ROI within the app. After ROI selection, the application automatically resized each ROI to 2100 × 1800 pixels and performed on-device vessel segmentation using a fixed computer-vision pipeline to compute the VD (%). Three expert ophthalmologists independently graded hyperemia on the technician-defined ROI using the scale (0-4) and provided a subjective percentage estimate of the VD. The inter-rater agreement (the quadratic-weighted κ for Efron grading and the intraclass correlation coefficient for the subjective VD) and associations between the VDs and the expert assessments (Spearman's ρ) were evaluated.

The inter-rater agreement was high for the Efron grading (quadratic-weighted κ = 0.854-0.885), with a similarly high reliability for the subjective VD estimation (intraclass correlation coefficient = 0.910; 95% confidence interval, 0.877-0.935). The application-derived VD correlated strongly with Efron grades across graders (Spearman's ρ = 0.780-0.807; all P < 0.001) and with the expert-estimated VD (ρ = 0.814-0.843; all P < 0.001).

A lightweight smartphone application can provide an objective VD metric that shows a strong association with an expert clinical assessment of conjunctival hyperemia.

A portable, widely available smartphone-based tool for objective hyperemia quantification may lower barriers to point-of-care use and enable scalable applications in outpatient triage, longitudinal monitoring, and teleophthalmology.

Lithium carbonate has a narrow therapeutic window for the treatment of manic episodes and is mainly excreted via the kidneys. Hypertension may impair lithium clearance, although evidence from relevant studies is insufficient. Based on previous research on the association between hypertension and the lithium concentration-to-dose (C/D) ratio, this study further performed a large-sample stratified analysis to evaluate the independent effects of hypertension on steady-state lithium pharmacokinetics, C/D ratio, rate of achieving therapeutic lithium levels, and risk of lithium toxicity in patients with mania.

A single-center retrospective cohort study was performed, enrolling 210 patients with mania, who were assigned to a hypertension group (n = 90) or a non-hypertension group (n = 120). The t-test, chi-square test, and multiple linear regression were used to evaluate the relevant parameters.

There was no significant difference in the mean daily dose of lithium carbonate between the two groups. However, the hypertension group had significantly higher steady-state serum lithium concentrations and C/D ratios than the non-hypertension group (p < 0.001). The rate of achieving therapeutic lithium levels in the hypertension group was only 42.22%, markedly lower than the 65.83% in the non-hypertension group, while the incidence of lithium toxicity was 11.11% in the hypertension group, significantly higher than the 2.50% in the control group. Multiple regression analysis confirmed that hypertension (β = 0.215), age, and daily dose were independent influencing factors for the C/D ratio, with elderly hypertensive patients showing a more pronounced increase in the C/D ratio. The type of antihypertensive medication did not affect lithium metabolism.

Hypertension can reduce renal lithium excretion and elevate both the C/D ratio and the risk of toxicity; therefore, in clinical practice, the initial lithium dose should be reduced and therapeutic drug monitoring should be intensified for patients with comorbid hypertension, while elderly patients should receive stratified management with lower serum concentration ranges.

Formal criteria and evidence-based guidelines commonly frame healthcare prioritisation, yet everyday prioritisation often occurs in organisational 'grey zones' where competing values coexist. Drawing on interviews with clinicians in two Norwegian cardiology wards, we examine how prioritisation is justified and enacted under institutional pluralism and moral ambiguity. Using Boltanski and Thévenot's framework of 'orders of worth', we show how clinicians develop discretionary compromises: situated adjustments that combine competing evaluative principles into hybrid justifications, making contested decisions actionable and morally defensible. Instead of switching between institutional logics, clinicians blend professionalism, managerialism, and economic rationality into 'good enough' moral narratives that uphold discretion and authority under constraint. These compromises rely on ethical decoupling, whereby conflicting moral concerns are acknowledged but temporarily set aside to enable action. By explaining how legitimacy is created through context-dependent justification, the article contributes to debates on valuation, professional change, and moral agency, while highlighting the often invisible moral labour of healthcare prioritisation.

Despite being a life-threatening condition that may rupture without prior symptoms-potentially resulting in sudden death-comprehensive research on its global burden remains limited. This study was conducted to estimate the global burden and associated risk factors of aortic aneurysms and to project future trends through to 2050.

Data on aortic aneurysms were extracted from the Global Burden of Disease Study 2021, encompassing 204 countries and territories from 1990 to 2021. An aortic aneurysm was defined as a full-thickness dilation of the aorta, including both abdominal and thoracic types. The study stratified the burden by geographical region, age, year, sex, and Socio-demographic Index (SDI). Additionally, attributable risk factors were analyzed, and projections for the burden of aortic aneurysms in 2050 were generated using scenario modelling. These models evaluated the potential impact of eliminating smoking, dietary risks, and high body mass index among adults through improved behavioral and metabolic risk management.

In 2021, there were an estimated 153.93 thousand (95% uncertainty interval [UI], 138.41-165.74) deaths globally due to aortic aneurysm. From 1990 to 2021, the global age-standardized mortality rate (ASMR) decreased from 2.54 (95% UI, 2.35-2.69) to 1.86 (1.67-2.00), and the age-standardized years of life lost rates declined from 48.79 (46.01-51.80) to 36.54 (33.52-39.46) per 100,000 population. While regions with higher SDI exhibited a sharp decline, the burden remained significant in both high (ASMR, 2.87 [95% UI, 2.51-3.06]) and high-middle (1.79 [1.66-1.92]) SDI areas. Conversely, regions with lower SDI demonstrated an increasing trend. Males consistently exhibited a higher burden than females, and burden increased with age. Tobacco use and high systolic blood pressure were identified as the predominant risk factors for aortic aneurysm-related mortality. Specifically, tobacco use was a more significant risk factor in males, while high systolic blood pressure was more prominent in females. Projections suggest that the global ASMR for aortic aneurysm will remain stable under the reference scenario in 2022 (1.87 [95% UI, 1.67-2.02]) and 2050 (1.44 [1.23-1.70]). However, improved behavioral and metabolic risk management could substantially reduce rates to 0.84 (0.71-0.99) by 2050.

The findings demonstrate a global decline in the burden of aortic aneurysms, though pronounced regional differences persist. Effective management strategies must be tailored to account for healthcare infrastructure, socioeconomic status, and risk factors unique to each geographical region.

Non-ischaemic left ventricular (LV) scar is increasingly recognized in athletes with preserved left ventricular ejection fraction (LVEF) and may represent a substrate for malignant ventricular arrhythmias. The role of electrophysiological study (EPS) with programmed ventricular stimulation (PVS) for risk stratification in this population remains unclear. This study aimed to evaluate the prognostic value of inducibility at EPS in symptomatic athletes with non-ischaemic LV scar and preserved LVEF.

We prospectively enrolled 72 consecutive athletes (mean age 48.9 ± 13.1 years; 66.7% male) with documented non-ischaemic LV scar, preserved LVEF (≥50%), and arrhythmic symptoms (tachycardic palpitations, syncope/presyncope, and/or exercise-related ventricular arrhythmias) undergoing EPS. Inducibility was defined as sustained ventricular arrhythmias during PVS. The primary endpoint was the occurrence of major arrhythmic events (MAE), including sudden cardiac death, sustained ventricular tachycardia/ventricular fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Twenty-three athletes (31.9%) were inducible (EPS+), while 49 (68.1%) were non-inducible (EPS-). Baseline characteristics were largely comparable between groups, although QRS duration was longer in inducible athletes (104.6 ± 15.2 ms vs. 95.5 ± 14.3 ms; P = 0.019). Twenty-three inducible athletes underwent ICD implantation (18 transvenous and 5 subcutaneous devices), whereas 16 non-inducible athletes received an implantable loop recorder. During a median follow-up of 42 months, 11 major arrhythmic events occurred. Nine events occurred among inducible athletes and consisted of sustained ventricular arrhythmias (monomorphic VT, polymorphic VT, or ventricular fibrillation) successfully terminated by appropriate ICD therapy, whereas two major arrhythmic events occurred among non-inducible athletes and required successful resuscitation followed by ICD implantation. No arrhythmic deaths occurred during follow-up. Event-free survival at 50 months was 40.6% in inducible athletes and 95.9% in non-inducible athletes (log-rank P < 0.001).

In symptomatic athletes with non-ischaemic LV scar and preserved LVEF, inducibility at EPS identifies a subgroup at higher risk of MAE, whereas non-inducibility is associated with a low event rate. EPS may represent a useful adjunctive tool for arrhythmic risk stratification in athletes, particularly in those without conventional high-risk features.

This guideline (GL) provides an overview of the management of dyslipidaemia based on international guidelines and new evidence from studies published up to June 2026. The GL focuses on primary care and takes into account the specific characteristics of the Swiss healthcare system. Lipid-lowering therapy should be risk-adapted, with the current 2025/2026 AGLA, ESC/EAS, and ACC/AHA dyslipidaemia GLs recommending a target-based treatment strategy. Our GL presents a structured approach to cardiovascular risk stratification and supports clinicians in selecting the most appropriate risk prediction model for individual patients. Risk modifiers - including family history, ethnicity, comorbidities, biomarkers, and lipoprotein(a) - should be considered in addition to traditional cardiovascular risk factors. In addition to lifestyle optimization, statins remain the first-line treatment. If the required LDL-C reduction is not achieved with statins alone, Ezetimibe, bempedoic acid, and PCSK9 inhibitors should be added sequentially.