Stroke remains a leading cause of death and disability globally, with considerable regional heterogeneity in incidence and mortality reflecting differences in classical vascular risk factors and environmental determinants. Fine particulate matter (PM2.5) is an established modifiable environmental risk factor, yet its association with regional stroke disparities remains understudied in Mediterranean European contexts. We examined regional differences in stroke hospitalization and mortality and their ecological associations with long-term air-pollution exposure across Spain's 17 autonomous communities from 2013 to 2021.

We conducted a nationwide longitudinal ecological study using aggregated stroke indicators from INCLASNS and ambient air-pollution data from MITECO. The dataset comprised 306 sex-specific region-year observations. The primary outcome was the age-standardized hospitalization rate (ASHR); secondary outcomes were CHR, CMR, ASMR, CFR, and IMI. Associations were assessed using correlation analyses, temporal trends, regional comparisons, and multivariable regression. Sex-stratified analyses were considered exploratory because pollutant concentrations were measured at the regional-year level and were not sex-specific.

Mean ASHR was 20.1 ± 5.4 per 10,000 population, with marked regional variation. PM2.5 showed the largest positive ecological correlation with ASMR among all pollutants examined (r = 0.264, p < 0.001), although the correlation remained weak. Overall pollutant-outcome correlations were weak and heterogeneous in direction. Regional variation in stroke burden was not adequately explained by the available air-pollution indicators.

PM2.5 was weakly associated with ASMR, whereas associations with hospitalization and other pollutants were small and inconsistent. These ecological findings do not support causal or individual-level inference and warrant confirmation using higher-resolution exposure and individual-level data.

Background: Carotid free-floating thrombus (CFFT) is an uncommon but clinically significant cause of transient ischemic attack and ischemic stroke, carrying a substantial risk of recurrent cerebral embolization. Despite advances in vascular imaging, the optimal management of CFFT remains controversial because available recommendations are largely based on retrospective studies, case series, and expert opinion. The present study reports a single-center experience with CFFT and provides an updated narrative review of current diagnostic and therapeutic strategies, with particular attention to the timing of intervention. Methods: A retrospective review of patients diagnosed with CFFT and managed at our institution over a 20-year period was performed. Clinical presentation, imaging findings, treatment strategy, and outcomes were analyzed. In parallel, a narrative review of the contemporary literature was conducted to summarize current evidence regarding medical management, carotid endarterectomy, endovascular techniques, hybrid approaches, and emerging concepts related to thrombus composition and maturation. Results: Five patients with symptomatic CFFT were identified. Four patients underwent carotid thromboendarterectomy, whereas one patient was managed medically with anticoagulation and antiplatelet therapy, resulting in complete thrombus resolution. Two patients experienced neurological deterioration while receiving initial anticoagulation and subsequently required urgent surgical intervention. No postoperative strokes occurred after carotid endarterectomy. Review of the literature confirmed that anticoagulation remains the cornerstone of initial therapy and achieves thrombus resolution in a substantial proportion of patients. However, recurrent neurological events continue to occur under medical treatment, while the indications and timing of invasive intervention remain poorly defined. Recent advances in high-resolution magnetic resonance imaging and optical coherence tomography suggest that thrombus age and composition may become important determinants of future treatment selection. Conclusions: CFFT represents a rare but potentially unstable vascular condition for which high-quality evidence is still lacking. Initial anticoagulation remains the most widely accepted treatment strategy, while carotid endarterectomy, endovascular thrombectomy, carotid artery stenting, and hybrid procedures may be appropriate in selected patients. Future management algorithms may ultimately move beyond a one-size-fits-all approach by incorporating thrombus biology, imaging characteristics, and individual patient risk profiles. Although this concept remains preliminary, advances in thrombus characterization may provide the foundation for more personalized treatment strategies as further clinical evidence becomes available.

Background: Atrial fibrillation (AF) is associated with oxidative stress and inflammation. Glutathione reductase (GR) and microRNA-144 (miR-144) may participate in redox-related pathways. This study aimed to evaluate relative GSR mRNA and miR-144 expression in peripheral blood samples from patients with and without AF and to explore their associations with selected clinical characteristics. Methods: This case-control study included 189 hospitalized adults: 95 without AF and 94 with AF. Clinical, anthropometric, biochemical, and echocardiographic data were collected for all participants. GSR mRNA was assessed by quantitative real-time PCR in whole blood samples, whereas circulating miR-144 expression was evaluated in serum. Group differences were assessed using nonparametric tests, correlations were evaluated using Spearman's rank correlation coefficient, and multivariable logistic regression was used to identify variables independently associated with AF. Model stability was assessed using bootstrap internal validation. Results: Relative GSR mRNA expression was significantly lower in the AF group than in controls (0.1539 vs. 0.2058, p < 0.001), whereas miR-144 expression was significantly higher in patients with AF (0.3636 vs. 0.2550, p = 0.0183). In multivariable logistic regression adjusted for clinical confounders, higher miR-144 (OR = 1.336, p = 0.048) and lower GSR (OR = 0.343, p < 0.001) expression remained associated with AF. Bootstrap internal validation supported the statistical stability of the GSR association (optimism-corrected AUC = 0.709, bootstrapped 95% CI: 0.622-0.785), whereas miR-144 showed only a more modest and less stable association (optimism-corrected AUC = 0.598, bootstrapped 95% CI: 0.519-0.684); both signals remain exploratory and do not yet support routine clinical use as diagnostic or risk-stratification biomarkers in AF. Both markers showed exploratory correlations with selected clinical and biochemical variables. Given the cross-sectional design of the study, all reported relationships should be interpreted as statistical associations rather than as evidence of causality. The observed correlations between molecular markers and clinical parameters are hypothesis-generating and warrant further investigation.

Poor sleep quality is an increasingly recognized, modifiable cardiovascular risk factor, yet data among patients with established coronary heart disease (CHD) in Central Asia are scarce. We estimated the prevalence of poor sleep quality and identified its correlates in a Kazakhstani CHD population.

In this multi-center cross-sectional study, 398 patients 6-24 months after an index coronary event were assessed for sleep quality. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI; >5 = poor). Anxiety and depression, physical activity, cognition, and clinical and socio-demographic variables were recorded. Associations were examined using logistic regression with subgroup and interaction analyses.

Poor sleep quality was reported by 147 patients (36.9%). In the adjusted model, anxiety was the only independent factor associated with poor sleep (OR 1.88, 95% CI: 1.10 to 3.23). The subgroup analysis suggested anxiety (OR 3.94) and lower education (OR 2.58) as correlates in women, whereas retirement (OR 2.27) and low physical activity (OR 2.31) were linked to poor sleep in men. A significant sex-anxiety interaction demonstrated a weaker anxiety effect in men.

More than one-third of CHD patients reported poor sleep quality, driven primarily by anxiety, with distinct sex- and age-specific determinants. Sleep and psychological screening should be integrated into secondary prevention, with personalized approaches.

Intermittent claudication is one of the most common symptoms of peripheral arterial disease. The Walking Impairment Questionnaire (WIQ) is frequently used to assess patients suffering from intermittent claudication as it measures walking distance, speed, and ability to climb stairs. Although the questionnaire has been translated and employed in different countries, no validated Polish version is available yet. The aim of this study was to translate and validate the Polish version of the WIQ.

One hundred patients with IC who qualified for endovascular treatment were enrolled. WIQ translation and clinical validation was performed. The correlations among the WIQ, the two quality of life questionnaires (VascuQol-25 and SF-36), and objective walking distances in a 6-minute walking test (6 MWT) were calculated to determine the validity.

Correlations were observed among all WIQ domains, as well as between the total WIQ score and both initial claudication distance (InCD) and maximum walking distance (MWD), across all domains and 6 MWT parameters. The WIQ correlated with all domains of both VascuQol and SF-36. Test-retest reliability, as measured using the ICC, was 0.90. The internal consistency determined using Cronbach's alpha was 0.94 for the total WIQ score.

This study demonstrates that the Polish version of the WIQ, using the European metric system, is a reliable and clinically relevant tool for assessing walking impairment in patients with intermittent claudication.

Background: Caregiver burden represents a multidimensional syndrome influenced by patient-related, relational, and contextual factors in neurological disorders. Although stroke, Parkinson's disease (PD), and Alzheimer's disease (AD) differ in clinical trajectory, comparative analyses of caregiver risk profiles across these conditions remain limited. Objective: This study aimed to identify sociodemographic, cognitive, and dyadic factors associated with caregiver burden in a clinical cohort, and to investigate their value for caregiver risk stratification using supervised machine learning models. Methods: In this monocentric observational cohort study, 113 patient-caregiver dyads (79 stroke, 19 PD, 15 AD) were consecutively enrolled in a neurorehabilitation setting. Patients underwent cognitive assessment with the Montreal Cognitive Assessment (MoCA), while caregivers completed the Caregiver Burden Inventory (CBI), which was considered the primary outcome measure. Caregiver burden was dichotomized into mild versus moderate-to-severe burden using established CBI cutoff thresholds. Group comparisons, correlation analyses (false discovery rate-corrected), and supervised machine learning models (logistic regression, random forest, AdaBoost, support-vector machine, naïve Bayes, and CatBoost) were performed using 5-fold stratified cross-validation repeated 10 times. Results: Disease-specific burden patterns emerged. Stroke caregivers reported higher time-dependent burden, whereas AD caregivers showed greater emotional burden (p < 0.05). No significant differences were observed in total CBI scores across groups. Lower MoCA scores were moderately associated with higher total and time-dependent burden (r up to -0.49, p < 0.001), particularly when interacting with advanced patient age. Machine learning models showed moderate performance, with AdaBoost achieving the highest accuracy (75.8%) and logistic regression and CatBoost the highest area under the receiver-operating-characteristic curve (AUC = 0.80). The most influential predictors were the age × MoCA interaction, MoCA score alone, and patient-caregiver gender concordance. Cognitive impairment, especially in older patients, and dyadic gender concordance emerged as central risk factors. Conclusions: Multidimensional assessment and early risk stratification, potentially supported by machine learning tools, may improve identification of vulnerable caregivers and guide tailored interventions.

Recurrent event data arise frequently in many clinical and observational studies. In this article, we propose a Cox-Aalen rate model to analyze recurrent event data with a terminal event, where the covariate effects are additive, time-varying, and dependent on a latent variable nonparametrically. The association between recurrent and terminal events is fully nonparametric, and a proportional hazards model is specified for the terminal event. To estimate the model parameters, an estimating equation approach is developed and kernel-smoothing techniques are employed to estimate the conditional expectations in the estimating equation. The asymptotic properties of the proposed estimators are derived, and the finite sample performance is evaluated through simulation studies. An application to medical cost data for chronic heart failure patients is presented.

The C-reactive protein-albumin-lymphocyte (CALLY) index, a novel composite marker derived from lymphocyte count, serum albumin, and C-reactive protein (CRP) levels, is commonly used to assess nutritional and inflammatory status. However, existing studies have not clarified the association between the CALLY index and prognosis in patients with chronic inflammatory airway diseases (CIADs). This study aims to elucidate the relationship between the CALLY index and the risks of all-cause and cardiovascular mortality among CIAD patients in the United States.

This investigation included 4128 patients with CIAD from the National Health and Nutrition Examination Survey (NHANES, 1999-2010). The CALLY index was measured only at baseline. We employed weighted Cox proportional hazards regression models to assess the association between the CALLY index and risks of all-cause and cardiovascular mortality across three progressively adjusted models. To evaluate potential nonlinear dose-response relationships, we applied restricted cubic spline (RCS) models. Additionally, subgroup analyses and sensitivity analyses were conducted to verify the robustness of our findings.

Multivariable-adjusted Model 3 demonstrated that, compared with the lowest quartile, the highest CALLY index quartile showed a significant inverse association with both all-cause and cardiovascular mortality, with corresponding HRs of 0.36 (95% CI: 0.27-0.47) and 0.33 (95% CI: 0.21-0.51), respectively (both p  < 0.05).

The CALLY index showed a significant inverse association with all-cause and cardiovascular mortality among U.S. adults with CIAD, suggesting its potential value as a prognostic tool for risk stratification in this group.

Chronic internal carotid artery occlusion (CICAO) with contralateral stenosis confers high stroke risk, particularly when thrombocytopenia complicates dual antiplatelet therapy (DAPT). We report a single case of staged carotid revascularization in which a stent retriever was used as a temporary distal protection device during CICAO recanalization after hematologic optimization.

A 69-year-old woman with chronic hepatitis B-related thrombocytopenia (20-68 × 10⁹/L) presented with progressive imbalance (NIHSS 3, mRS 2). Imaging revealed bilateral parieto-occipital infarcts, chronic left ICA occlusion, and severe right ICA stenosis (80% North American Symptomatic Carotid Endarterectomy Trial (NASCET)). After eltrombopag therapy increased platelet counts to >300 × 10⁹/L, DAPT was initiated. Revascularization was performed in two stages: right ICA stenting with distal filter protection, followed 14 days later by left CICAO recanalization using a Catch Mini stent retriever (Balt, Montmorency, France) as temporary embolic protection and dual-stent reconstruction (proximal Wallstent (Boston Scientific, Marlborough, MA, USA) and distal braided Leo+ stent (Balt, Montmorency, France)). Both procedures were completed without periprocedural complications. At 6 months, CTA demonstrated distal re-occlusion of the cavernous (C4) segment; however, the patient remained clinically stable (NIHSS 0) without recurrent ischemic events.

The stent retriever-assisted approach was technically feasible in this single carefully selected patient and may offer a solution to the inherent limitation of conventional embolic protection devices in CICAO recanalization; however, its protective efficacy cannot be established without post-procedural imaging, which was not obtained in this case.

To explore the prevalence and associated factors of cognitive frailty in older adults with heart failure.

A systematic review and meta-analysis.

We systematically searched China National Knowledge Infrastructure (CNKI), Wanfang Data, the VIP Database, SinoMed, PubMed, Web of Science, Embase, the Cochrane Library and Scopus from their inception to March 30, 2026.

A total of 22 studies involving 8,892 older adults with heart failure were included. The meta-analysis showed that the pooled prevalence of cognitive frailty in older adults with heart failure was 32% (95% CI: 27%-37%). Descriptive stratified analyses yielded pooled prevalence estimates of 37% in women and 31% in men. According to New York Heart Association functional classification, the corresponding estimates were 44% among patients classified as class IV and 28% among those classified as classes II-III.The prevalence was also higher in patients with comorbid chronic obstructive pulmonary disease (46%) and coronary heart disease (31%). Older age was associated with higher odds of cognitive frailty (adjusted OR = 1.12, 95% CI 1.06-1.18). Depression was also associated with higher odds, whereas exercise and intellectual activity were associated with lower odds.

Cognitive frailty appears to be common among older adults with heart failure, although prevalence estimates vary across populations and assessment approaches. Older age and depression were associated with higher odds of cognitive frailty, whereas exercise and intellectual activity were associated with lower odds. These findings support early screening and comprehensive assessment, while the observed associations should not be interpreted as causal because the available evidence was predominantly observational and cross-sectional.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261360024, PROSPERO, identifier CRD420261360024.