Following the discontinuation of the conventional Action Research Arm Test (ARAT) import in Japan, a domestically manufactured version with identical assessment protocols but modified equipment was developed. We aimed to evaluate the psychometric properties of the newly developed ARAT and compare it with the conventional ARAT in patients with stroke.

This single-center cross-sectional study enrolled 64 patients with stroke and hemiparesis who met predefined inclusion criteria. Participants were randomly allocated to a reliability validation (n = 33) or criterion validity validation (n = 31) group. The reliability group underwent duplicate assessments with the new ARAT at 15-min intervals, with video recording for independent inter-rater evaluation. The validity group received the new and conventional ARAT assessments in randomized order. Convergent validity was assessed using Spearman correlation coefficients with Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Box and Block Test (BBT), grip strength, Motor Activity Log (MAL), and Jikei Assessment Scale for Motor Impairment in Daily Living (JASMID).

Intra-rater reliability demonstrated excellent agreement (intraclass correlation coefficient [ICC]: 0.997-1.000, 95% confidence interval [CI]: 0.995-1.000) across all subscales and total scores. Inter-rater reliability showed equally excellent agreement (ICC: 0.979-0.999, 95% CI: 0.963-0.999). Bland-Altman analysis revealed limits of agreement within clinically acceptable ranges for all measures. The new ARAT demonstrated very strong convergent validity with FMA-UE (ρ = 0.934, p < 0.001) and BBT (ρ = 0.917, p < 0.001), and moderate-to-strong correlations with grip strength (ρ = 0.683, p < 0.001), MAL subscales (ρ = 0.610-0.666, p < 0.001), and JASMID subscales (ρ = 0.806-0.808, p < 0.001).

The new ARAT demonstrates measurement properties equivalent to the conventional version with excellent reliability and strong criterion-related validity. Its robust convergent validity with established upper limb assessments supports its clinical utility for comprehensive stroke rehabilitation evaluation.

Remote patient monitoring (RPM) is recommended for hypertension control. However, less is known about short-term responses of hypertension to RPM and which program components are most important for hypertension control.

This study aimed to evaluate the association between frequency of blood pressure monitoring, nurse monitoring, and their combination and hypertension control within 3 months.

This retrospective cohort study was conducted among a convenience sample of 1464 patients with hypertension enrolled in the Brook Remote Care RPM program who sought care at any of the 68 participating primary care clinics in New York or Massachusetts, United States, between 2021 and 2023. Patients with at least 3 blood pressure measures for 70% of the weeks they were in the program were defined as having adequate readings. Brook nurses monitored patients from certain clinics, whereas clinic nurses monitored other patients. Hypertension control was defined as a weekly average blood pressure of less than 140/90 mm Hg. Generalized linear models with a binomial specification and log link were used to estimate the prevalence ratio (PR) and 95% CI of the mutually adjusted associations between adequate blood pressure readings and Brook nurse monitoring, as well as their combination with hypertension control, at 4, 8, and 12 weeks, adjusted for patient age and sex.

At weeks 4, 8, and 12, patients with adequate readings had 10% (PR=1.10, 95% CI 1.02-1.20), 12% (PR=1.12, 95% CI 1.04-1.20), and 15% (PR=1.15, 95% CI 1.07-1.24) higher prevalence of hypertension control than patients with lower frequencies of readings, respectively. Brook nurse monitoring was associated with 16% (PR=1.16, 95% CI 1.07-1.27), 6% (PR=1.06, 95% CI 0.99-1.15), and 8% (PR=1.08, 95% CI 1.00-1.16) higher prevalence of hypertension control at weeks 4, 8, and 12, respectively, compared to clinical staff monitoring. The combination of adequate readings plus Brook nurse monitoring was associated with 26% (PR=1.26, 95% CI 1.11-1.44), 17% (PR=1.17, 95% CI 1.05-1.31), and 27% (PR=1.27, 95% CI 1.12-1.43) higher prevalence of hypertension control at weeks 4, 8, and 12, respectively, compared to an inadequate number of blood pressure readings and not receiving Brook nurse monitoring.

This is the first study to compare outcomes for RPM patients using clinical nurse monitoring and independent staff monitoring. This study represents a contribution to the literature on clinical outcomes for RPM patients with a focus on short-term, rather than longer-term, hypertension control, evaluation of nurse monitoring conducted by Brook Health compared to clinical staff, and the joint association of monitoring frequency and Brook nurse monitoring on hypertension control. Our study findings suggest that both frequency of monitoring and specialized nurse monitoring improve hypertension control within 3 months of program enrollment. The combination of higher monitoring frequency and Brook nurse monitoring may serve as a cost-effective approach to hypertension control in high-risk populations that overcomes the limitations of clinical care staff.

Crossed cerebellar diaschisis (CCD) is a pathophysiological phenomenon in ischemic stroke (IS) that remains poorly investigated, particularly with regard to its clinical impact and the factors associated with its occurrence during the hyper-acute phase. The aim of this study was to evaluate the prevalence of CCD detected by Computed Tomography Perfusion (CTP) in patients with large vessel occlusion (LVO) ischemic stroke and to identify potential predictors of CCD occurrence and its impact on clinical outcomes.

Clinical and radiological data were collected and analyzed from 256 consecutive patients with anterior circulation LVO ischemic stroke who underwent CTP. The presence of CCD was assessed through qualitative analysis of CTP perfusion maps. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the presence of CCD, as well as to determine predictors of clinical outcome.

Perfusion alterations consistent with CCD were identified in 216 patients (84.4%). In multivariable analysis, female sex (p = 0.026) and greater supratentorial hypoperfused volume assessed on mean transit time (MTT) maps (p = 0.005) were independently associated with the presence of CCD. Although CCD was associated with a higher prevalence of unfavorable functional outcome at 3 months (mRS 3-6) in univariate analysis, it was not an independent predictor of outcome in multivariable analysis.

CCD was detected on CTP in a high proportion of patients with LVO stroke. Female sex and larger supratentorial hypoperfused volumes were independent predictors of CCD. Although correlated to functional outcome, CCD was not an independent predictor.

To compare surgical outcomes of foveal-sparing internal limiting membrane (ILM) peeling (button-hole) with conventional ILM peeling in patients with retinal arterial macroaneurysm rupture accompanied by sub-ILM hemorrhage (sub-ILMh) and subretinal hemorrhage, focusing on visual and anatomical results and postoperative macular hole formation.

A retrospective review was conducted on 42 eyes (42 patients) who underwent vitrectomy for retinal arterial macroaneurysm rupture with sub-ILMh and subretinal hemorrhage between September 2016 and December 2023. Patients were divided into two groups: conventional ILM peeling (Group 1, n = 22) and foveal-sparing ILM peeling (button-hole) (Group 2, n = 20). Subgroup analyses were performed based on macular hole presence or absence detected preoperatively or intraoperatively.

Both groups showed significant improvement in best-corrected visual acuity, with Group 1 improving from 20 to 55 ETDRS letters and Group 2 from 25 to 65 ETDRS letters (P < 0.001). Postoperative best-corrected visual acuity was significantly better in Group 2 (P = 0.039). Macular hole formation occurred in 22.7% eyes of Group 1 but not in Group 2 (P = 0.049). Subgroup analysis showed consistent benefits of the button-hole technique even after adjusting for baseline differences (P = 0.034).

Foveal-sparing ILM peeling (button-hole) has superior visual and anatomical outcomes than conventional ILM peeling, reducing postoperative macular hole incidence in patients with retinal arterial macroaneurysm rupture.

Early identification of individuals at elevated risk of cardiovascular disease and preventive treatment during childhood may reduce cardiovascular disease in adults with chronic inflammatory diseases. Children with atopic dermatitis (AD) may have elevated cardiovascular risk, but studies to date have not accounted for heterogeneity in disease activity and severity across childhood.

To evaluate whether active and more severe AD across childhood and adolescence are associated with cardiovascular risk.

This longitudinal cohort study used data collected from 1991 to 2017 for the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in the United Kingdom. Participants included children alive at 1 year with assessment of AD and at least 1 cardiovascular disease risk factor at a minimum of 1 time point. Data were analyzed November 30, 2022, to February 20, 2025.

Repeated assessments of AD activity and severity across childhood and adolescence.

The primary outcome was cardiometabolic risk scores calculated at ages 15, 17, and 24 years. Secondary outcomes included body mass index, blood pressure, and lipid profiles measured up to 12 times between ages 3 and 24 years and ultrasonography measures of subclinical atherosclerosis at ages 17 and 24 years.

The subcohort included 9281 children, of whom 4669 (50.31%) were male. The analysis included 1001 participants (10.79%) 3 years of age, 908 (9.78%) 4 years, 838 (9.03%) 5 years, 6352 (68.44%) 7 years, 6205 (66.86%) 10 years, 5629 (60.65%) 11 years, 4968 (53.53%) 13 years, 3502 (37.73%) 15 years, 4738 (51.05%) 17 years, and 3626 (39.07%) 24 years of age. The prevalence of active AD varied by age and ranged from 13.10% to 21.58% at ages 3 through 18 years. Among participants with AD, 3.52% to 6.85% reported moderate or severe disease at each age. Multivariable linear regression models did not reveal associations between active AD and most cardiovascular risk factors; only 2 associations between AD and low-density lipoprotein cholesterol levels were found with P < .05, but they differed in the directionality of association at ages 3 and 10 years (mean difference, -0.33 [95% CI, -0.58 to -0.07] SDs for 3 years vs 0.14 [95% CI, 0.03-0.24] SDs at 10 years). There was no consistent evidence for dose-response effects by AD severity. There were also no associations between patterns of more active and severe AD across childhood with subclinical atherosclerosis.

In a population-based UK cohort of children and adolescents followed up into early adulthood, AD, including more active and severe disease over time, was not associated with increases in markers of cardiovascular risk. This finding suggests that systematic screening of all children with AD is unlikely to improve identification of early cardiovascular risk.

The precise and consistent identification of fetal cardiac structures and functional flows is essential for the early diagnosis of congenital heart defects (CHDs), yet interobserver variability remains a significant challenge in clinical practice. Although fetal cardiac magnetic resonance imaging (MRI) has emerged as a valuable adjunct in selected cases, its routine use remains limited by long acquisition times, motion artifacts, and restricted availability in many centers. This underscores the need to optimize ultrasound-based techniques that can reduce reliance on MRI while still providing comprehensive and reproducible fetal cardiac assessment. This article presents a study investigating the reliability of a layered imaging approach combined with standardized B-mode and color Doppler ultrasound protocols to improve interobserver agreement in image interpretation among experts in fetal echocardiography.

A dataset comprising 209 B-mode and 205 color Doppler recordings acquired during midgestational anomaly scans (mean gestational age: 21.2 weeks) was systematically evaluated by five expert supervisors. Interobserver agreement was quantified using the prevalence-adjusted bias-adjusted kappa (PABAK) coefficient. To evaluate consistency across anatomical layers, one-way ANOVA was employed, followed by post hoc analysis where applicable.

Most anatomical structures and functional features were consistently identified across observers, certain structures posed challenges, likely owing to their smaller size, lower visibility, or greater variability in presentation.

By integrating structured imaging sequences with advanced statistical methodologies, this study explored the potential of improving diagnostic accuracy and standardization in fetal cardiac assessments, offering insights into the development of more reliable protocols for clinical applications and future research.

Cryofibrinogen-associated glomerulonephritis (CryoFiGN) is a rare, diagnostically challenging cause of nephrotic syndrome, and its clinical presentation can vary considerably. Herein, we report the case of a 76-year-old man who presented with nephrotic syndrome; biopsy showed a C3-dominant membranoproliferative pattern of injury. Electron microscopy revealed organised subendothelial microtubular deposits (40-80 nm), confirming CryoFiGN, despite inconclusive results on mass spectrometry. The patient progressed to end-stage kidney disease and later developed systemic vasculitis with skin ulcers and gastrointestinal bleeding. CryoFiGN may initially manifest as a renal-limited disease and evolve into systemic vasculitis. Electron microscopy is pivotal for diagnosis when proteomic analysis is inconclusive and long-term surveillance is warranted.

Cardiovascular diseases (CVD) in Chile are profoundly shaped by place-based determinants of diet. This study examines the association between food deserts-areas with structurally limited access to nutritious, affordable food-and population-level cardiovascular risk across Chile's three largest metropolitan areas (Santiago, Valparaíso, Concepción).

We constructed a geospatial food desert index combining OpenStreetMap-derived retail accessibility with census information, and linked it to georeferenced cardiovascular health records. To overcome the limitations of global models that assume spatial stationarity, we applied Multiscale Geographically Weighted Regression (MGWR) to allow coefficients to vary across space and to recover variable-specific process scales.

The MGWR results indicate pronounced spatial non-stationarity in the food desert-CVD association. The relationship is predominantly positive across Gran Valparaíso, predominantly negative in Gran Concepción, and highly mixed within Gran Santiago, evidencing divergent local mechanisms rather than a single national pattern.

The observed heterogeneity undermines "one-size-fits-all" national interventions and supports place-sensitive, equity-oriented strategies. Policy implications include territorially tailored food-retail regulation and primary-care outreach, co-designed with local actors, with MGWR providing a critical analytic basis for actionable, context-specific public health planning.

People from Bangladeshi and Nepalese origin living in Australia experience a disproportionate burden of chronic diseases, such as diabetes and cardiovascular diseases. Although preventive services are essential to reduce the burden of chronic diseases, existing evidence indicates that these communities encounter unique migration, socioeconomic and health system-level challenges that impede their access to existing preventive services in Australia. The present study therefore explored the barriers and facilitators to accessing preventive care services among people of Bangladeshi and Nepalese origin living in Sydney, Australia.

This qualitative study was conducted within a constructivist paradigm, which recognizes that realities are constructed through participants' lived experiences. Six focus group discussions (FGDs) and 22 in-depth interviews (IDIs) were conducted between August 2024 and January 2025 with people of Bangladeshi and Nepalese origin living in Sydney, Australia. FGDs and IDIs were conducted in participants' native language, transcribed verbatim, translated into English and thematically analysed. The identifed barriers and facilitators to accessing preventive services were organized across multiple levels using the socio-ecological framework.

Several barriers and facilitators relevant to the contextual experience of people from Bangladeshi and Nepalese backgrounds were identified across multiple levels of the socioecological framework. At the individual level, key barriers included cultural and religious perceptions, limited health literacy and low awareness of available preventive care services. Interpersonal barriers included limited English language proficiency, inadequate availabilty of translated health education materials and interpreter services, and limited cultural understanding among health care providers. Community-level barriers comprised chronic disease-related stigma and low level of community engagement. At the institutional and policy levels, barriers included limited culturally tailored support services and infrequent public transport to health care facilities. Conversely, facilitators across these levels included self-awareness and personal ownership of health, knowledge of available preventive services, peer support network, cultural and linguistic competence of health care providers, the use of digital and social media for health information dissemination, and the supportive role of community organisations.

These findings suggest the need for implementing multi-level, culturally tailored, community-led interventions that leverage existing community and social engagement platforms to ensure equitable access to available preventive services for chronic diseases among these disadvantaged population groups in Australia.

Study participants contributed to research by sharing their lived experiences of accessing preventive services for chronic diseases. The shared linguistic and cultural backgrounds between the researchers and participants helped rapport-building and supported in-depth exploration of the complex factors influencing access to preventive care. Participants provided valuable insights through participating in IDIs or FGDs, which formed the basis of the study findings. However, participants were not directly involved in the study design or conduct of the study, data analysis or interpretation or manuscript preparation.

The frequency, characteristics, and relationship with performance of arrhythmias occurring during high-intensity exercise in Thoroughbred racehorses remain poorly understood.

Describe the frequency, characteristics, and association with subsequent race performance of arrhythmias occurring during intense exercise.

Seventy-one racehorses competing in races sanctioned by the Hong Kong Jockey Club.

Risk-based case-control study. Single-lead ECGs were recorded during high-intensity trials using wearable devices. Ectopic depolarizations identified during warm-up, maximal exercise, and fast and slow recovery were characterized by frequency and morphology. Horses with ECG recordings obtained before a race were included. Race performance was classified as poor (finishing in the last 3 positions) or good (finishing in the first 3 positions). Associations between ECG variables and race performance were assessed using odds ratios.

A total of 405 ECGs were recorded within 21 days before 1 or more race starts (82 poor- and 142 good-performance starts). Arrhythmias were detected in 73% and 81% of ECGs preceding good and poor performances, respectively. Ectopic beats during maximal exercise occurred in 57% of ECGs before good and in 70% before poor performances. The odds of performing poorly increased with each additional ectopic beat (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.04-1.28; P = .01), and horses with any ectopic beat were nearly twice as likely to underperform (OR, 1.8; 95% CI, 0.86-3.81; P = .02).

Ectopic beats are common and adversely associated with athletic performance. Electrocardiographic monitoring during intense exertion might enable detection of clinically important arrhythmias.