Pulmonary drug delivery is used for local treatment of lung diseases and for systemic administration of drugs requiring rapid absorption. Drug delivery to the lungs is limited by mucociliary clearance, macrophage uptake, and short residence time of inhaled formulations. Polymer-based carrier systems have therefore been explored to improve lung retention and delivery efficiency. Chitosan, a polysaccharide obtained from chitin, is biodegradable, biocompatible, and positively charged, enabling interaction with negatively charged pulmonary mucus. When formulated as nanoparticles, chitosan allows modulation of particle size, surface charge, and drug release behavior, which are critical parameters for pulmonary deposition. Chitosan nanoparticles have been investigated for delivery of small molecules, proteins, and nucleic acids in respiratory infections, inflammatory lung diseases, and lung cancer. Reported studies demonstrate improved lung localization and sustained drug release compared with conventional formulations. This review summarizes formulation approaches used for the preparation of chitosan nanoparticles for pulmonary delivery and discusses key physicochemical factors influencing their performance. Limitations related to aerosolization behavior and formulation reproducibility are also considered.

Influenza A viruses are a significant cause of global morbidity, mortality, and economic losses. Swine are considered an important host for pandemic emergence; however, knowledge on the ecology and evolution of swine influenza viruses in relation to pig production and exchange systems is limited. The PigFluCam+ project was first initiated in 2019 as a One Health-focused research collaboration between public and animal health stakeholders in Cambodia.

The primary objectives of the project were to (1) describe the epidemiology and diversity of swine influenza A viruses (swIAVs) in the Cambodian pig sector, (2) assess the risk of zoonotic influenza transmission across different occupations, (3) characterize the pig trade network, (4) develop mathematical models of swIAV transmission to target control activities, and (5) promote in-country One Health research and surveillance. This paper presents the methods and approaches used by the project, serving as a resource for future research initiatives with similar aims.

These approaches consist of systematic sample collections and survey studies. Influenza surveillance in pigs was conducted over 2 years through repeated (monthly) cross-sectional sampling at 18 slaughterhouses across 4 provinces. Phylogenetic analysis was used to describe the diversity of swIAVs detected and was used to develop antigens for Luminex xMAP assays for screening human and pig sera. Cross-sectional surveys among actors in the pig value chain characterized pig production practices and trading networks. In parallel, a cohort study was carried out involving households with and without occupational exposure to live pigs to compare the seroprevalence of influenza A viruses among different swine-associated occupational groups.

The surveys began in 2020 and despite disruptions caused by the COVID-19 pandemic and the introduction of African Swine Fever into the region, the project has generated a wealth of data. Over 4000 pigs were sampled at slaughterhouses, and network surveys collected pig production and trading data from 379 study participants. Higher influenza A seroprevalence (960/2399, 40%) and prevalence (37/2413, 1.5%) were found among pigs from commercial farms, compared to smallholder farms (seroprevalence 8.9%, 95/1066; prevalence 0.6%, 6/1071). Duration at slaughterhouse and seroprevalence correlated positively, suggesting potential transmission after leaving the farm. A total of 997 individuals were recruited into the cohort study, with 775 consenting to provide at least 1 serum sample. Funding for the project ended in September 2025; 3 results papers and 1 PhD thesis have been published, with analysis and publication expected to be completed by the end of 2026.

This project has developed surveillance protocols and modern technologies for establishing active zoonotic disease surveillance. These efforts support the region's capability to effectively identify zoonotic pathogens and enhance the prediction and response to zoonotic outbreaks and pandemic risk associated with pig production systems in the Lower Mekong region.

Cardiovascular disease (CVD), particularly myocardial infarction (MI), remains a leading cause of morbidity and mortality worldwide. The irreversible loss of cardiomyocytes (CMs) and subsequent fibrosis following MI due to delayed or absent reperfusion are central drivers of heart failure progression. Recent evidence indicates that the adult mammalian heart retains a latent regenerative capacity, which can be reactivated under specific conditions. Therefore, stimulating endogenous cardiac regeneration represents a promising strategy to improve clinical outcomes following MI. This review summarizes a range of intervention strategies designed to wake up cardiac regeneration and promote myocardial repair in the setting of residual following myocardial injury. Key approaches examined include stimulating cardiomyocyte cell-cycle re-entry, leveraging growth factors and paracrine mediators as pro-regenerative signals, and applying cell-free vesicles and small molecule compounds. We discuss the translational progress of these strategies, drawing on evidence from large animal models and ongoing clinical trials, aiming to bridge mechanistic discoveries to future clinical applications in cardiac regenerative medicine.

Super large-bore aspiration catheters have emerged as promising tools for endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). The Route 92 Reperfusion System utilizes super large-bore catheters with specialized delivery mechanisms to maximize first-pass effect (FPE) and reperfusion rates. To evaluate the efficacy and safety of the Route 92 super large bore reperfusion System in treating AIS-LVO. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched five databases from inception through December 2025. Studies evaluating Route 92 Reperfusion System outcomes in AIS-LVO patients were included. Primary outcomes were FPE and functional independence (modified Rankin Scale (mRS) 0-2). Secondary outcomes included successful reperfusion (modified thrombolysis in cerebral infarction (mTICI) scores), symptomatic intracranial hemorrhage (sICH), mortality, and adverse events. Random-effects models were used for all analyses. Seven studies comprising 490 patients were included. In comparative analyses, Route 92 (0.088") demonstrated significantly higher FPE rates (risk difference (RD): 0.18, number needed to treat (NNT) = 6, p = 0.001) and near-complete reperfusion (RD: 0.23, NNT = 4, p = 0.0005) compared to other techniques. Single-arm analyses showed 56% achieved FPE, 94% achieved near-complete to complete reperfusion, and 43% achieved functional independence at follow-up. The system demonstrated favorable safety with 3% sICH rate and 20% mortality. National Institutes of Health Stroke Scale (NIHSS) scores improved significantly (mean difference (MD): -9.55, p < 0.00001). The Route 92 Reperfusion System achieves high rates of FPE and successful reperfusion with acceptable safety profiles. Future RCTs is warranted to support these findings.

Beneficial effects of sialic acid on cognition have been most often seen in cognitive development in infant models, whereas the relevant evidence from ageing population studies remains limited. We aimed to investigate the associations of dietary sialic acids and their subtypes (Neu5Ac and Neu5Gc) with the incident dementia in a large prospective study.

A total of 210,796 middle-aged and older participants from UK Biobank were included in this study. Dietary sialic acids intake was estimated using repeated 24-h dietary recall questionnaires. Cox proportional hazards models were used to evaluate the association of sialic acid and its subtypes with dementia risk.

During a mean follow-up of 10.9 years, 2469 incident all-cause dementia were recorded, of which 1077 were Alzheimer's disease (AD), and 454 were vascular dementia (VaD). Compared with participants in the lowest quartile (median intake: 25.12 mg/d), participants in the third quartile of total sialic acids (median intake: 56.46 mg/d) were associated with a 18% lower risk of all-cause dementia (HR 0.82; 95% CI 0.73-0.92) and a 31% lower risk of VaD (HR 0.69; 95%CI 0.53-0.91), respectively. Similar associations were observed for Neu5Ac and Neu5Gc, respectively. After mutual adjustment, the association of Neu5Gc with all-cause dementia or VaD risk remained unchanged, whereas the association of Neu5Ac with dementia risk became non-significant after adjusting for Neu5Gc.

Our findings suggest a potential non-linear protective association between total sialic acid and risk of all-cause dementia and VaD.

The assessment of cardiovascular care in Brazil is challenged by the country's vast territory and the large volume of data. Business Intelligence (BI) tools may enhance the visualization and utilization of such information to support public health decision-making.

To demonstrate the practical application of the interactive dashboard iCardio in analyzing regional inequalities in high-complexity cardiovascular care in Brazil.

Descriptive study based on secondary data made available by the iCardio dashboard, which integrates healthcare information from the Brazilian Unified Health System (SUS). Variables from 2019 were analyzed by region, considering service volume, mortality rates, hospital readmissions, and patient travel distance.

Analyses of cardiovascular surgery and interventional cardiology procedures indicated that the Southeast region exhibited the lowest mortality rates (in-hospital: 5.65%, 30 days after procedure: 5.73%, and 30 days after discharge: 6.77%). The North had the highest mortality rates (in-hospital: 7.56%, within 30 days after the procedure: 7.7%, and within 30 days after discharge: 8.7%). The South and Central-West regions registered the highest readmission rates within 30 days after the procedure (9.79% and 10.3%, respectively) and within 30 days after discharge (11.7% and 11.97%, respectively). The South also presented the highest standardized procedure rate (10.54), nearly double that of the Southeast (6.02). The Northeast showed the longest mean patient travel distance (94.59 km).

The use of BI through the iCardio dashboard enables rapid and accessible analysis of healthcare data, with the potential to inform evidence-based decision-making, optimize resource allocation, and identify regional disparities in cardiovascular care.

The cardiovascular impact of earthquakes remains poorly understood, particularly regarding subclinical vascular diseases in women. This study examined the association between seismic exposure and the progression of carotid atherosclerosis in northern Chinese adults.

A totally of 7,412 individuals were enrolled, including survivors of the 1976 Tangshan earthquake (magnitude 7.8) and unexposed controls. Carotid atherosclerosis was assessed using bilateral ultrasonography. Multivariate logistic regression accounted for sociodemographic, clinical, and lifestyle covariates.

Among females, earthquake exposure was associated with significantly higher atherosclerosis prevalence (44.9% vs. 33.1% in males), with elevated adjusted odds ( OR = 2.32, 95% CI: 1.78-3.02, P < 0.001). No significant association was observed in males after full adjustment. In women, CVD risk increased twofold (95% CI: 1.66-2.55, P < 0.001), with gradients by age (≥ 65 years: HR = 3.98, P < 0.001), education (elementary: HR = 4.00, P < 0.001), and income (low-income: HR = 2.74, P < 0.001). Proximity to the epicenter further amplified the CVD risk (log-rank P < 0.0001).

Seismic exposure independently predicts accelerated carotid atherosclerosis and cardiovascular risk in women, underscoring the need to elucidate sex-specific mechanisms and develop targeted interventions for post-disaster populations.

Dyslipidemia has been linked to increased arterial stiffness. However, few studies have comprehensively assessed the cumulative effects of lipid profiles on arterial stiffness.

Based on the initial recruitment of 7,134 participants from the China-PAR cohort, we finally included 6,717 participants with up to four repeated lipid measurements between baseline (1998-2008) and the most recent follow-up (2018-2020). Cumulative exposure to total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and remnant cholesterol (RC) was estimated using the area under the curve method. Arterial stiffness was measured in 2018-2020 using the arterial pressure-volume index (API) and the arterial velocity-pulse index (AVI), which reflect the stiffness of peripheral and central arteries, respectively.

Participants (mean age: 51.4 ± 10.3 years) included 2,598 men (38.68%), with a mean cumulative lipid exposure duration of 14.02 years. Cumulative TG, HDL-C, and RC were significantly associated with API levels, with adjusted β s (95% confidence intervals [ CIs]) of 2.31 (1.53, 3.08), -1.14 (-2.24, -0.04), and 2.39 (1.52, 3.25), respectively, for the highest quartile compared with the lowest quartile. Restricted cubic splines showed nonlinear associations of cumulative TG and RC with API and a linear association for HDL-C (all P < 0.05). For AVI, only cumulative HDL-C showed a significant inverse association, with an adjusted β (95% CI) of -1.16 (-2.12, -0.21) for the highest quartile, and a nonlinear association was observed ( P < 0.05).

Long-term cumulative TG and RC were associated with increased peripheral arterial stiffness but not central arterial stiffness, and cumulative HDL-C was negatively associated with both peripheral and central arterial stiffness. These findings underscore the importance of long-term TG and RC control along with maintaining adequate HDL-C levels.

To investigate the joint effect of free fatty acid (FFA) and the triglyceride-glucose (TyG) index on the prognosis of overweight and obese coronary artery disease (CAD) patients.

A total of 5,887 patients were enrolled in this study. Restricted cubic spline analyses were used to assess the dose-response relationship of FFA and TyG with major adverse cardiovascular and cerebrovascular events (MACCE). Mediation analysis was used to examine whether TyG mediated the association between FFA and MACCE. Kaplan-Meier survival curves were used to compare the cumulative incidence of events. Multivariable Cox models were used to explore the independent association between Low-/High-FFA and Low-/High-TyG on outcomes.

FFA and TyG were independent predictors of MACCE. TyG mediated 10.7% of the association between FFA and MACCE. Patients with high FFA and TyG levels exhibited a markedly higher MACCE risk (adjusted hazard ratio: 1.951, 95% confidence interval: 1.533-2.484; P < 0.001), with a significant interaction between FFA and TyG. Among patients with elevated FFA levels, MACCE increased progressively across higher TyG tertiles ( P for trend = 0.001).

FFA and the TyG index independently predict adverse outcomes in overweight or obese CAD patients, with the TyG index mediating the relationship between FFA and MACCE. Their combined assessment enhances the risk stratification in this population.

Polypharmacy in patients with cardiovascular disease occurs frequently across the age spectrum and can lead to inappropriate prescribing and adverse outcomes. Despite polypharmacy being a known problem for decades, there is limited guidance describing how to manage polypharmacy in patients with cardiovascular disease, including when and how to initiate deprescribing strategies. Although polypharmacy can occur at any age, studies often focus on older adults. The prevalence and consequences of polypharmacy, coupled with current gaps in the deprescribing literature, highlight the need for a scientific statement focused on deprescribing in all patients with cardiovascular disease. Deprescribing can improve outcomes and can apply to both cardiovascular and noncardiovascular drugs because both contribute to polypharmacy and poor outcomes associated with inappropriate prescribing in patients with cardiovascular disease. This scientific statement reviews the consequences of polypharmacy in patients with cardiovascular disease and provides tailored deprescribing strategies across the life span, with an emphasis on the unique considerations in pediatric, adult, and older adult populations. These strategies include observing clinical cues and triggers, using validated deprescribing tools, engaging in shared decision-making, and leveraging the roles of all members of the health care team to address barriers to deprescribing. Last, this scientific statement highlights current challenges related to polypharmacy and deprescribing and suggests some strategies to address them.