SARS-CoV-2 papain-like protease (PLpro) remains an attractive antiviral target because of its dual role in viral polyprotein processing and host immune modulation. In this study, we employed an exploratory structure-based computational workflow to identify antimicrobial peptide scaffolds with predicted PLpro-binding potential. A total of 6,615 peptides compiled from public databases were screened using protein-peptide docking, followed by molecular dynamics simulations and end-state binding energy analysis for selected complexes. Among the prioritized candidates, peptides 33,035 and 17,047 showed favorable predicted occupation of the catalytic region and persistent interactions with residues in the active-site environment. Molecular dynamics analyses suggested sustained peptide engagement within the PLpro binding region, although distinct degrees of conformational adaptation were observed across systems. MM/PBSA calculations provided additional energetic support for peptide-PLpro association in the selected complexes. In silico toxicity prediction further indicated that peptide 33,035 may require sequence optimization before translational consideration. Overall, our results identify peptide scaffolds worthy of future biochemical and antiviral validation, while reinforcing the need for experimental confirmation and further optimization before any therapeutic inference can be made.

ObjectiveTo evaluate the long-term patency outcomes of radiocephalic arteriovenous fistulas treated with percutaneous transluminal angioplasty for radial artery stenosis, with a particular focus on the clinical impact of percutaneous transluminal angioplasty-induced radial artery rupture and its endovascular management.MethodsThis single-center retrospective analysis involved all patients diagnosed with arteriovenous fistula dysfunction and radial artery stenosis who were treated with arterial percutaneous transluminal angioplasty at our department from January 2021 to September 2024. In total, 56 patients were ultimately included in the study.ResultsTechnical success was achieved in all patients. Radial artery rupture occurred in 10 of the 56 patients (17.86%) during percutaneous transluminal angioplasty and was successfully managed using prolonged low-pressure balloon inflation combined with localized external compression, without the need for covered stent implantation or surgical repair. At 1 year, primary patency rates were 40.0% in the rupture group and 39.1% in the normal group (p = 0.53), whereas the corresponding secondary patency rates were 90.0% and 87.0%, respectively (p = 0.35).ConclusionPercutaneous transluminal angioplasty is an effective treatment for radiocephalic arteriovenous fistula dysfunction caused by radial artery stenosis. Although dilation-induced radial artery rupture was relatively common in our cohort, it may be safely managed with prolonged low-pressure balloon inflation and localized compression without routine stent implantation or surgical intervention. Importantly, radial artery rupture did not appear to compromise long-term access-circuit patency. These findings apply to overall access-circuit outcomes rather than lesion-level durability. Controlled arterial rupture during percutaneous transluminal angioplasty appears to be a manageable procedural event that was not associated with worse overall access-circuit outcomes in this cohort.

This cross-sectional study aimed to compare serum Retinol-Binding Protein 4 (RBP4) levels in hypertensive and normotensive non-obese individuals. A total of 41 hypertensive and 41 normotensive subjects aged ≥40 years were enrolled. Hypertension was defined as a blood pressure (BP) of ≥140/90 mmHg, whereas normotension was defined as a BP of <120/80 mmHg in the absence of antihypertensive medication (JNC 8 criteria). Five millilitres of venous blood were collected aseptically, and serum RBP4 was measured using a Human RBP4 ELISA kit. Data were analysed using SPSS version 26 with an independent sample t-test; p ≤0.05 was considered statistically significant. Forty-six per cent of participants were male, with a mean age of 53.69 ± 9.86 years in the hypertensive and 52.41 ± 6.30 years in the normotensive group. The mean serum RBP4 was significantly higher in the hypertensive group (62.17 ± 28.22 ng/mL) than in the normotensive group (14.70 ± 5.59 ng/mL), suggesting its potential as a biomarker. Key Words: Hypertension, Normotensive, Serum Retinol-binding Protein-4, Cardiovascular diseases.

Coronary artery bypass grafting (CABG) is among the most commonly performed cardiac surgical procedures worldwide and frequently requires perioperative blood transfusion. Acute normovolaemic haemodilution (ANH) is a simple and economical strategy that aims to reduce the need for allogeneic blood transfusion. A systematic review was conducted between October 2024 and August 2025 and analysed randomised controlled trials comparing ANH with conventional transfusion practices in patients undergoing coronary bypass surgery. Eighteen studies were evaluated for outcomes such as transfusion rates, blood loss, coagulation profiles, myocardial protection, postoperative complications, and cost-effectiveness. ANH reduced the need for allogeneic blood transfusion without affecting haemodynamic stability or postoperative recovery. Moderate improvements were observed in coagulation preservation and myocardial protection, although the certainty of evidence varied across outcomes. Further large-scale trials are required to establish standardised ANH protocols and clarify long-term clinical outcomes. Key Words: Acute normovolaemic haemodilution, Coronary artery bypass grafting, Blood conservation, Allogeneic transfusion.

To explore the association between comprehensive geriatric assessment (CGA)-related projects and indicators of heart failure with preserved ejection fraction (HFpEF) in hospitalised older adults, and to evaluate their predictive value for HFpEF risk.

An observational study. Place and Duration of the Study: Department of Geriatrics, Mindong Hospital Affiliated to Fujian Medical University, Mindong, China, from July to December 2024.

A total of 134 patients aged ≥60 years who received standard CGA were included in the single-centre cross-sectional analysis. The CGA protocol was used to evaluate frailty using the FRAIL scale, sarcopenia risk using the SARC-CalF score, nutritional status, cognitive function, basic activities of daily living, and fall risk. Patients were divided into the HFpEF group (n = 50) and the heart failure without preserved ejection fraction (non-HFpEF) group (n = 84) according to clinical diagnosis. Statistical methods included initial univariate screening, variable selection using Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis to evaluate diagnostic performance.

Patients with HFpEF were older, had a higher burden of polypharmacy, and had higher FRAIL scores than those in the non-HFpEF group (all p <0.05). In the adjusted multivariate analysis, both FRAIL and SARC-CalF scores were independently associated with HFpEF. The odds ratio for the FRAIL score was 3.68 (95% CI, 1.83-8.39), while the odds ratio for the SARC-CalF score was 1.47 (95% CI, 1.21-1.86). ROC analysis shows that the prediction utility of the two tools is relatively strong. The AUC for the FRAIL scale is 0.88, whereas the AUC for the SARC-CalF scale is 0.89. The optimal diagnostic thresholds are 1.5 points (indicating pre-frailty) and 11 points.

The SARC-CalF and FRAIL scales are sensitive for identifying high-risk older adults with HFpEF. Their combined use improves predictive specificity and accuracy compared with either scale alone. This dual-scale approach may provide a practical and efficient preliminary screening tool for HFpEF in geriatric care.

HFpEF, Comprehensive geriatric assessment, Aged, Frailty, Pre-frailty, Sarcopenia.

BACKGROUND Cerebral venous thrombosis (CVT) is an uncommon form of stroke with highly variable clinical manifestations. Although headache and focal neurological deficits are typical presenting features, isolated psychiatric symptoms as an initial manifestation are exceptionally rare and may substantially delay diagnosis. CVT most commonly affects young adults and women with identifiable prothrombotic risk factors. CASE REPORT We report the case of a 37-year-old previously healthy woman with no identifiable thrombotic risk factors who presented with acute behavioral disturbances characterized by insomnia, agitation, emotional lability, and aggressive behavior. There was no history of prior psychiatric illness. Initial investigations, including brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and infectious workup, were unremarkable, with no evidence of structural abnormalities on early neuroimaging. She was admitted with a working diagnosis of acute polymorphic psychotic disorder and started on psychiatric treatment. Six days later, she developed sudden loss of consciousness followed by generalized tonic-clonic seizures, prompting urgent neuroimaging. Imaging revealed a right high-parietal intracerebral hemorrhage, and subsequent venous imaging confirmed CVT involving the superficial superior cerebral vein. The patient was treated with antiepileptic therapy and anticoagulation, leading to gradual neurological and psychiatric improvement. CONCLUSIONS This case highlights an unusual presentation of CVT with isolated psychiatric manifestations, absence of classical risk factors, and initially normal neuroimaging findings, all of which contributed to delayed diagnosis. Abrupt neurological deterioration can occur despite non-specific early investigations. Early consideration of cerebral venous imaging may be warranted in atypical acute psychiatric presentations to avoid delayed diagnosis and potentially life-threatening complications.

Background: Hereditary angioedema (HAE) is a rare, potentially life-threatening disorder characterized by recurrent edema of the extremities, abdomen, face, larynx, trunk, and genital region. It follows an autosomal dominant inheritance pattern and affects both sexes equally; however, attacks may occur more frequently and with greater severity in women due to hormonal factors. Aims: The aim of this study was to evaluate the impact of hormonal changes on HAE attacks in women and to determine how different reproductive stages and hormonal exposures affect attack frequency and course. Methods: In this retrospective descriptive cohort study, 36 postpubertal women with HAE were evaluated to assess the effects of reproductive factors, including menstruation, oral contraceptive use, pregnancy, delivery, lactation, and menopause, on attack frequency and disease activity. Results: Thirty patients had type I and six had type II HAE. The mean age at diagnosis was 23.5 years, with a mean diagnostic delay of 12.6 years. Menstruation triggered attacks in 52.8% of the patients. Among 26 patients with 94 pregnancies, 21.2% ended in spontaneous abortion, and 73.1% had at least one child diagnosed with HAE. During pregnancy, attack frequency increased in 30.6%, decreased in 27.7%, and was unchanged in 41.7%. Attacks occurred within 48 hours postpartum in six deliveries, and three patients reported increased attacks during lactation. After menopause, attacks increased in 25%, decreased in 33.3%, and were unchanged in 41.7%. Conclusion: Hormonal and reproductive life stages influence disease activity in women with HAE, although the direction and magnitude of these effects vary among individuals. The marked delay in diagnosis observed in this cohort suggests that many women experience pregnancies without disease-specific management. Earlier recognition of HAE and individualized treatment approaches may improve care during hormonally dynamic periods.

Background: Hereditary angioedema is a rare bradykinin-mediated disorder characterized by recurrent, unpredictable swelling attacks that can substantially impair quality of life. Objective: The objectives were to describe attack triggers reported during the previous 4 weeks, compare the clinical impact of emotional and physical and/or organic triggers on attack outcomes, Angioedema Control Test (AECT) based disease control, and quality of life; and, secondarily, to examine the associations of the attack burden with the AECT and Angioedema Quality of Life (AE-QoL) Questionnaire scores. Methods: This single-center retrospective cross-sectional study included 50 adults with type I or type II hereditary angioedema followed up between January 2019 and October 2025. Data extracted from medical records included the number of attacks during the preceding 4 weeks, characteristics of the most severe attack, trigger category, disease control assessed by the AECT, and quality of life assessed by the AE-QoL Questionnaire. Triggers were grouped as emotional (stress/sadness) or physical/organic (trauma, infection, physical exertion, hormonal/metabolic). Results: The median age was 40.5 years, 54% of the patients were women, the median diagnostic delay was 16.5 years, and 82% had a positive family history of hereditary angioedema. Emotional stress was the most commonly reported trigger of the most severe attack (60%). No significant differences were observed between emotional and physical/organic trigger groups in attack frequency, duration or severity of the most severe attack, emergency department visits, AECT-based disease control, or quality-of-life scores (all p > 0.05). Attack frequency was negatively correlated with AECT-based disease control (r = -0.631; p < 0.001) and positively correlated with quality-of-life impairment (r = 0.428; p = 0.002), with the strongest association in the fear/shame domain (r = 0.500; p < 0.001). AECT-based disease control was strongly inversely correlated with quality-of-life impairment (r = -0.734; p < 0.001). Conclusion: Emotional stress was the most frequently reported trigger of recent hereditary angioedema attacks. Although clinical outcomes did not differ according to trigger type, a higher attack frequency was associated with poorer AECT-based disease control and worse quality of life.

Accurate electrocardiogram (ECG) interpretation for acute coronary occlusion is a critical, time-sensitive task in emergency care. The field is increasingly shifting from the ST-segment elevation myocardial infarction paradigm to the broader concept of occlusion myocardial infarction (OMI). This study compared the diagnostic accuracy of a dedicated occlusion-detection deep neural network, Queen of Hearts (QoH), two general-purpose multimodal large language models (LLMs), and emergency physicians for ECG-based OMI detection. Response consistency and confidence calibration of the LLMs were also evaluated.

This retrospective diagnostic accuracy study used 36 twelve-lead ECGs from patients referred for emergent coronary angiography, including 24 with angiographically confirmed acute coronary occlusion and 12 without. Five emergency medicine specialists, five emergency medicine residents, and two LLMs, ChatGPT 5.2 and Gemini 3 Pro, interpreted all ECGs under a standardized moderate-risk acute coronary syndrome scenario. The same ECGs were submitted to QoH. Each LLM evaluated the set five times in separate sessions, whereas QoH was queried once because it provides deterministic output. In the primary head-to-head analysis, each interpreter or interpreter group contributed a single decision per ECG. Areas under the curve (AUCs) were compared using the DeLong test, binary metrics using the exact McNemar test, and reliability using Fleiss' kappa.

QoH showed the highest discrimination for OMI (AUC 0.96), followed by ChatGPT (0.81) and Gemini (0.62). QoH also achieved the highest sensitivity (95.8%, missing one of 24 occlusions) and accuracy (86.1%), with significantly higher sensitivity than emergency specialists (p = 0.016). Among physicians, specialists performed best (accuracy 75.0%; sensitivity 66.7%; specificity 91.7%). ChatGPT showed high specificity (91.7%) but low sensitivity (54.2%), whereas Gemini performed least well overall (accuracy 55.6%). The LLMs produced variable interpretations across repeated queries (Fleiss' kappa 0.24-0.49), and Gemini showed marked overconfidence (Brier score 0.40).

In this OMI-focused study, QoH showed the highest discrimination and sensitivity for acute coronary occlusion. General-purpose LLMs showed clinically important limitations and do not currently support autonomous OMI diagnosis. These findings support further evaluation of task-specific models for ECG-based occlusion detection and suggest, at most, an adjunctive, human-supervised role for current general-purpose LLMs.

Endovascular treatment of unruptured intracranial aneurysms requires anesthetic strategies that maintain cerebral perfusion and hemodynamic stability while avoiding increases in intracranial pressure (ICP). Optic nerve sheath diameter (ONSD) measured by ultrasonography is commonly used as a noninvasive surrogate marker of ICP. This study compared propofol and propofol-ketamine anesthesia with respect to perioperative ONSD, cerebral oxygenation, and hemodynamic parameters during endovascular aneurysm procedures.

In this prospective, randomized, single-center, observer-blinded trial, 40 adults undergoing elective endovascular treatment of unruptured intracranial aneurysms were allocated to a propofol group (P, n = 20) or a propofol-ketamine group (KP, n = 20). Standardized anesthetic protocols and ventilation targeting normocapnia were used in both groups. ONSD, regional cerebral oxygen saturation (rSO₂), bispectral index (BIS), and hemodynamic variables were recorded at predefined perioperative time points. The primary outcome was the temporal change in mean ONSD. Mean ONSD was analyzed using a linear mixed-effects model including group, time, and group × time interaction. Secondary longitudinal outcomes were analyzed using exploratory mixed-effects models.

Baseline demographic and clinical characteristics were comparable between groups. Total propofol consumption was significantly lower in the KP group, whereas remifentanil use showed a non-significant trend toward reduction. In the primary mixed-effects analysis, the group × time interaction for mean ONSD was not statistically significant, indicating that the temporal trajectory of ONSD did not differ between groups. The main effect of group was also not significant, whereas the main effect of time was significant. Exploratory analyses of secondary longitudinal outcomes showed significant group × time interactions for selected hemodynamic, ventilation-related, anesthetic depth, and cerebral oxygenation parameters, including DBP, MAP, EtCO₂, BIS, and mean rSO₂. Heart rate and SpO₂ trajectories were comparable between groups.

In this small randomized cohort of patients undergoing elective endovascular treatment of unruptured intracranial aneurysms, propofol and propofol-ketamine anesthesia showed comparable ONSD trajectories over time. The propofol-ketamine regimen was associated with reduced propofol consumption and exploratory evidence of differential perioperative hemodynamic and cerebral oxygenation profiles. However, the study was not powered to evaluate safety outcomes or rare adverse events. Larger neurosurgical trials are required before firm conclusions regarding safety and clinical feasibility can be drawn.

The study was registered at ClinicalTrials.gov (identifier NCT07542015) on April 14, 2026. Retrospectively registered.