Alpha-gal syndrome (AGS) is a delayed allergic reaction to red meat linked to bites of various species of ticks around the world, with the common culprits in North America identified as the Ixodes and Lone Star ticks. Most cases are asymptomatic, but some may result in mild allergic reactions or could progress to severe anaphylaxis. This report presents the case of a 64-year-old male with a history of coronary artery disease who presented with chest pain. During his hospitalization, he experienced two episodes of ventricular fibrillation (VF) with successful resuscitation. Following discharge, he continued to experience episodic palpitations, abdominal pain, nausea, vomiting, and diarrhea. An immunologist later diagnosed him with AGS and introduced the possible association of the VF events with a severe hyperacute reaction to intravenous heparin exposure, either in conjunction with or independent of the STEMI the patient was experiencing. His chronic longitudinal symptoms resolved entirely with dietary restrictions, specifically avoiding beef and porcine meat derivative products. This report highlights the importance of considering AGS in patients with unexplained allergic or periprocedural reactions following exposure to mammalian-derived products such as heparin.

Corticosteroids are commonly used in neonatal cardiac surgery to reduce inflammation. Previous studies have shown that administering methylprednisolone (MP) during the perioperative period can reduce the inflammatory response. However, the impact of MP on postoperative clinical outcomes in neonates remains unclear. Thus, this study aimed to assess the effects of MP on postoperative inflammation and clinical outcomes in neonates undergoing cardiac surgery involving cardiopulmonary bypass (CPB).

This was a prospective, non-randomized, unblinded, controlled trial in which the clinicians determined treatment assignment. A total of 86 neonates who underwent cardiac surgery with CPB between December 2020 and August 2023 were included. After induction of anesthesia, the MP group received a single dose of 30 mg/kg MP, while the placebo group received an equal volume of saline solution. Primary endpoints were plasma interleukin (IL-6, IL-8, and IL-10) and D-dimer concentrations. Composite outcomes included death, respiratory infection, cardiac arrest, need for extracorporeal membrane oxygenation, acute kidney injury, low cardiac output syndrome, and need for prolonged mechanical ventilation.

Consistent with the observed anti-inflammatory effects, MP administration was associated with significantly lower levels of proinflammatory cytokines (IL-6, IL-8) and higher levels of the anti-inflammatory cytokine (IL-10). MP did not significantly reduce the likelihood of the composite outcome (p = 0.664), with 25 patients (58.1%) in the MP group and 23 patients (53.5%) in the placebo group experiencing such outcomes. The MP group also showed a significantly lower postoperative vasoactive-inotropic score and higher postoperative procalcitonin levels and nadir mixed venous oxygen saturation during the first 24 hours. No significant differences in postoperative D-dimer, blood glucose, or insulin administration were observed between the two groups.

Prophylactic administration of 30 mg/kg MP in neonates undergoing cardiac surgery with CPB did not result in a statistically significant improvement in clinical outcomes compared with placebo. However, this intervention was associated with a reduction in the inflammatory response.

ChiCTR 2000040230, https://www.chictr.org.cn/showproj.html?proj=64716.

High-quality pediatric clinical research depends on effective and ethically robust recruitment, yet participation can be difficult for families of children with congenital heart disease (CHD), particularly in resource-constrained and culturally diverse settings. In western China, long-distance care-seeking, financial strain, family-centered decision-making, and evolving pediatric research protections may shape how caregivers understand and negotiate research participation.

We conducted a qualitative descriptive study at a tertiary pediatric referral center in western China between June and December 2025. Caregivers of children with CHD participated in one-to-one semi-structured interviews. Interviews explored practical burden, perceptions of research and treatment, therapeutic misconception, trust, child assent, and strategies to improve recruitment. Audio-recordings were transcribed verbatim, anonymized, and analyzed using qualitative content analysis.

Thematic saturation was reached after 22 interviews. Four overarching themes were identified: (1) families' real-world constraints and the costs of research participation; (2) cognitive biases and tensions surrounding therapeutic misconception; (3) trust anchors and views on assent, insurance, and institutional protection under a changing policy context; and (4) strategies for optimizing recruitment. Caregivers commonly weighed research participation against treatment-related burdens, especially travel distance, accommodation costs, wage loss, and repeated hospital visits. Decisions were further shaped by collective family decision-making, culturally mediated concerns about bodily integrity, confusion between research and individualized treatment, and strong reliance on physician recommendation. Participation was generally more acceptable when procedures were non-invasive or integrated into routine care, whereas extra venipuncture was often resisted. Caregivers also emphasized the value of plain-language, visual, dialect-adapted, and child-friendly communication.

Caregivers' decisions about pediatric clinical research participation in western China are shaped by structural disadvantage, family-centered norms, therapeutic misconception, and trust in physicians and institutions. Recruitment should reduce burden, improve comprehension, support family communication, and accommodate children's developing role in research decisions.

To determine whether admission Berg Balance Scale score independently predicts independent walking on discharge after adjustment for major confounders, and to derive subtype-specific optimal cut-off values for ischaemic and haemorrhagic stroke.

Multicentre retrospective cohort study.

A total of 565 stroke patients (316 ischaemic, 249 haemorrhagic) admitted to 3 inpatient rehabilitation centres in the Republic of Korea.

Multivariable logistic regression was used to evaluate the independent predictive value of the Berg Balance Scale. Optimal cut-off values were derived using receiver operating characteristic curve analysis and the Youden index. Bootstrap internal validation, calibration analysis, and decision curve analysis were performed.

Admission Berg Balance Scale was a significant independent predictor of independent walking (adjusted odds ratio 1.053, 95% confidence interval 1.030-1.076). The difference in discriminative ability between the Berg Balance Scale only and multivariable models was not statistically significant (p = 0.097). The overall optimal cut-off was 24 points; subtype-specific cut-offs were 33 for ischaemic and 12 for haemorrhagic stroke.

The Berg Balance Scale has different optimal cut-off values by stroke subtype and, as a standalone assessment, maintains discriminative ability equivalent to a multivariable model, providing clinical evidence for subtype-specific precision rehabilitation strategies.

The diseases of circulatory system continue to occupy leading positions in structure of morbidity and mortality of population, remaining one of key public health problems. The purpose of the study is to investigate dynamics of primary morbidity and prevalence of diseases of circulatory system by main nosological forms among adult and adolescent population of the Kyrgyz Republic in 2018-2024. The study used official data from the Center for E-Health Care that was analyzed using retrospective, statistical and comparative analytical methods. It was found that indicators of primary morbidity and prevalence were characterized by pronounced variability with greatest increase in 2022, against the background of decrease in 2020-2021, that may be due to changes in availability of medical care in period of COVID-19 pandemic. The highest levels of morbidity and prevalence were found for hypertension, coronary heart disease and cerebrovascular diseases. Some nosologies, including myocardial infarction and other peripheral vascular diseases, demonstrated sharp increase in indicators, suggesting changes in disease detection and health care seeking behavior of population. The obtained results confirm necessity to improve system of monitoring, prevention and early detection of cardiovascular diseases, especially among high-risk groups.

BACKGROUND MicroRNAs (miRNAs) are important post-transcriptional regulators of gene expression and have emerged as potential biomarkers of cardiovascular and renal diseases. Resistant arterial hypertension (RAH) is frequently associated with chronic kidney disease (CKD) and microalbuminuria, reflecting early microvascular damage. However, the relationship between microRNA expression and microalbuminuria in patients with RAH remains insufficiently researched. This study aimed to evaluate the expression of selected miRNAs in patients with RAH, with and without CKD, and to assess their association with urinary albumin excretion. MATERIAL AND METHODS This cross-sectional study included 115 patients with RAH, of whom 42 (36.5%) had coexisting CKD. The expression levels of 11 selected miRNAs were assessed in peripheral blood mononuclear cells using quantitative real-time polymerase chain reaction. Urinary albumin-to-creatinine ratio (UACR) was used to assess albuminuria. Correlations between microRNA expression and UACR were analyzed using Spearman's rank correlation. RESULTS In patients with RAH and microalbuminuria, a statistically significant positive correlation was observed between hsa-miR-133a expression and UACR (Spearman's r=0.38, P=0.024, n=35). No significant correlations were found between urinary albumin excretion and other analyzed microRNAs or in patients without microalbuminuria. CONCLUSIONS Expression of hsa-miR-133a was associated with urinary albumin excretion in patients with RAH and microalbuminuria. The findings suggest that hsa-miR-133a may be a potential noninvasive biomarker of microalbuminuria and early renal microvascular injury in a high-risk hypertensive population; however, further longitudinal studies are required to clarify the prognostic value and clinical utility of miR-133a in this patient population.

Cardiac surgery is an effective treatment for cardiovascular diseases but is associated with significant risks. Limited patient knowledge during the perioperative period may negatively affect outcomes.

To map the knowledge gaps among patients with heart diseases in the perioperative context of cardiac surgery.

Scoping review developed based on the guidelines of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR).

Evidence selection was conducted between August and September 2025 through searches in the MEDLINE, CINAHL, BDENF, Web of Science, Scopus, LILACS, CAPES Theses and Dissertations Portal, Theses Canada, RCAAP, BDTD, and Trove.

The inclusion criteria comprised studies in Portuguese, English, and Spanish involving individuals aged 18 years or older, with no time restriction, addressing patients' knowledge about their health condition in the perioperative period of cardiac surgery. Studies unavailable in full text, restricted-access documents, and opinion articles were excluded. Data extraction was based on predefined variables, and the information was analyzed using descriptive statistics.

Six studies were included in the final sample, predominantly journal articles with a quantitative approach, originating from Brazil, published in Portuguese, and covering the period from 2012 to 2024. Patients' knowledge was found to be deficient mainly regarding the risks and potential complications of cardiac surgery, how the surgical procedure is performed, the specific type of cardiac surgery to be undertaken, the possibility of engaging in physical activity after surgery, and care related to the surgical wound.

Patients' knowledge presents gaps in several aspects related to the perioperative period of cardiac surgery, and that health education interventions are essential to address this issue.

This scoping review identifies critical knowledge gaps among cardiac surgery patients in the perioperative period, underscoring the need for targeted nursing-led health education to improve patient safety, recovery, and evidence-based cardiovascular care.

Cutibacterium acnes, traditionally considered a contaminant, is increasingly recognized as a relevant pathogen of prosthetic valve endocarditis, particularly in men. It is hypothesized that intraoperative transfer from incised hair follicles at the sternal wound margin occurs despite current standard disinfection protocols.

To evaluate whether additional intraoperative hygiene measures reduce surgical site contamination with C acnes during cardiac surgery.

This multicenter, parallel-group, blinded randomized clinical trial was conducted from October 28, 2024, to March 3, 2025, at 1 university hospital and 1 university-affiliated teaching hospital in Munich, Germany. Participants were male patients undergoing first-time cardiac surgery. Patients and laboratory personnel were blinded to group assignments. The analysis was based on a per-protocol design. Six patients were excluded after randomization due to incorrect sampling (n = 4) or incorrectly performed intervention procedures (n = 2).

The intervention group received additional hygiene measures after sternotomy, including changing outer gloves, disinfecting sternal wound margins with iodine, and covering them with sterile absorption pads. The control group received usual care, which included a glove change after sternotomy without additional skin margin treatment.

The primary outcome was perioperative C acnes contamination, measured by the number of culture-positive swabs, amount of growth on agar, and pathogen identification via matrix-assisted laser desorption-ionization time of flight mass spectrometry.

Among 124 male patients (mean [SD] age, 68.5 [9.9] years) included in the analysis, C acnes was detected significantly less frequently in the intervention group (9 of 62 [14.5%]) compared with the control group (38 of 62 [61.3%]; risk ratio [RR], 0.24 [95% CI, 0.13-0.45]; P < .001), representing a relative risk reduction of 76%. Regarding growth intensity in the pericardium, the intervention group showed 100% negative or thioglycolate-only growth, whereas 27 patients (43.5%) in the control group exhibited agar growth (1+ to 3+). Overall bacterial contamination was similarly reduced (10 of 62 [16.1%] vs 44 of 62 [71.0%]; RR, 0.23 [95% CI, 0.13-0.41]; P < .001). Chest hair density was identified as a risk factor for contamination (odds ratio, 1.16 [95% CI, 1.02-1.31]; P = .02).

In this randomized clinical trial of 124 male patients undergoing cardiac surgery, additional intraoperative hygiene measures targeting the wound margin significantly reduced C acnes transfer to the surgical site. These simple, low-cost strategies should be considered for implementation in standard surgical protocols to potentially prevent prosthetic valve endocarditis.

German Clinical Trials Register: DRKS00035169.

Ginsenoside Rg1, a key bioactive component of Panax ginseng, is recognized for its cardiovascular protective effects, yet its role in modulating platelet activation under high shear stress remains incompletely understood. This study aimed to systematically evaluate the in vitro effects and underlying mechanisms of Rg1 on platelet aggregation under high shear stress using a microfluidic chip system. In this study, blood flow environments at venous (300 s^-1), arterial (1500 s^-1), and pathological arterial (5000 s^-1) shear rates were simulated using microfluidic chips. The effects of Rg1 (0-1000 μM) on platelet aggregation and activation were assessed via fluorescence imaging, flow cytometry (measuring P-selectin and GP IIb/IIIa activation), and Western blot analysis of intracellular signaling pathways. Coagulation parameters (APTT, PT, TT) and blood compatibility were also evaluated. Our results showed that Rg1 concentration-dependently inhibited platelet aggregation across all tested shear rates, showing particularly pronounced suppression under high shear stress (5000 s^-1). Mechanistically, Rg1 significantly reduced P-selectin expression and GP IIb/IIIa activation. Western blot analysis revealed that Rg1 exerted its antiplatelet effects primarily by suppressing the PI3K/AKT and ERK1/2 signaling pathways and enhancing VASP phosphorylation, while exhibiting limited direct inhibitory effects on the Syk/PLCγ2 pathway. Notably, Rg1 did not significantly alter standard coagulation parameters or cause hemolysis within the tested concentration range. In conclusion, ginsenoside Rg1 demonstrated potent concentration-dependent inhibition of platelet activation and aggregation under high shear stress in this in vitro study. Its mechanism involves the multi-target modulation of key intracellular signaling pathways (PI3K/AKT, ERK1/2, and PKG/VASP). Furthermore, Rg1 exhibited favorable blood compatibility without impairing coagulation function in vitro. These findings suggest that Rg1 is a promising candidate warranting further preclinical investigation for targeted intervention in arterial thrombosis, although its therapeutic efficacy and safety require validation in vivo.

Blood homocysteine (Hcy) concentrations have become a sensitive predictor of the development of cardiovascular disease. Few studies have reported the relationship between plasma vitamin E and Hcy. We aim to conduct an sex- and age-stratified investigation of the association between vitamin E status and Hcy concentrations in a large nationwide sample in China.

We conducted a cross-sectional study including 15,842 Chinese adults. The exposure variable was plasma vitamin E. The outcome variables included Hcy concentrations and hyperhomocysteinemia. Multiple linear models and multivariable logistic regression were performed to evaluate the relation between plasma vitamin E and Hcy. Restricted cubic spline was conducted to examine the non-linear relationship.

In men, the association between plasma vitamin E and Hcy concentrations suggested an approximately U-shaped pattern (p for nonlinearity < 0.001). Compared with men aged < 65 years with plasma vitamin E concentrations of 8.5-15.9 µg/mL, those with concentrations below 8.5 µg/mL or above 15.9 µg/mL had higher odds of hyperhomocysteinemia (OR: 1.33 (1.10,1.60), p = 0.002; OR: 1.77 (1.25, 2.50), p = 0.001, respectively). In men ≥ 65 years old, plasma vitamin E < 8.4 µg/mL was not significantly associated with hyperhomocysteinemia (OR: 1.06(0.86,1.30), p = 0.589). Among women, age-stratified spline curves generally suggested an L-shaped pattern, with higher plasma vitamin E concentrations associated with lower Hcy concentrations, followed by a plateau in the association.

Sex-specific associations between plasma vitamin E and Hcy concentrations or hyperhomocysteinemia were found. The spline analyses suggested an approximately U-shaped pattern in men and an L-shaped pattern in women. In contrast to the sex-specific patterns, the association between vitamin E and Hcy were generally consistent across age groups.