搜索结果：Vascular health and risk management

Post-stroke vascular dementia (VaD) affects 20-30% of ischemic stroke survivors within the first year, yet existing prediction models lack comprehensive integration of novel blood biomarkers and validated risk stratification strategies. This study aimed to develop and temporally validate a risk-stratified prediction model incorporating clinical, neuroimaging, and serum biomarker variables. This retrospective cohort study comprised a development cohort (n = 998, 2020-2022) and temporal validation cohort (n = 249, 2023-2024). Consecutive acute ischemic stroke patients aged ≥ 18 years with available baseline magnetic resonance imaging (MRI) and 12-month follow-up were included. Candidate predictors encompassed 25 variables: demographics, vascular risk factors, stroke severity assessed by the National Institutes of Health Stroke Scale (NIHSS), neuroimaging markers (Fazekas white matter hyperintensity score, brain atrophy index [BAI]), and serum biomarkers including neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) measured by single-molecule array (Simoa). The primary outcome was incident VaD diagnosed by NINDS-AIREN criteria at 12 months. Of 1247 included patients, 354 (28.4%) developed VaD. Least absolute shrinkage and selection operator (LASSO) selected 8 predictors: age, education level, NIHSS score, Fazekas score ≥ 2, BAI, previous stroke, plasma NFL, and plasma GFAP. In the development cohort, the model demonstrated excellent discrimination (C-statistic 0.89, 95% CI 0.86-0.92) and good calibration. Bootstrap validation yielded optimism-corrected C-statistic 0.88. In temporal validation, performance remained robust (C-statistic 0.85, 95% CI 0.81-0.89). Risk stratification revealed distinct cognitive trajectories: high-risk patients (25% of cohort) exhibited 67.3% VaD incidence and steep cognitive decline (mean Montreal Cognitive Assessment [MoCA] change -6.8 points), capturing 59.3% of all VaD cases. This biomarker-enhanced prediction model demonstrates excellent discrimination and calibration for post-stroke VaD. Risk stratification effectively identifies high-risk patients for targeted interventions, providing a practical tool for precision-based clinical management.

The contribution of late-life vascular risk factors to dementia risk remains controversial. Because low blood pressure (BP) has been associated with worse clinical outcomes in frail individuals, we hypothesized hypertension, but not diabetes or smoking, is associated with higher dementia risk in robust than in frail older adults. We performed a prospective cohort analysis of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) over 11 years (2011-2022). We included all community-living White and Black participants aged 67-89 years without dementia at baseline visit 5 (2011-2013) from ARIC-NCS field centers (Jackson, Mississippi; Forsyth County, North Carolina; Washington County, Maryland; Minneapolis suburbs, Minnesota). The primary vascular risk factors measured at baseline included elevated BP (systolic BP 120-129 mm Hg and diastolic BP < 80 mm Hg), hypertension (systolic BP &#x2265; 130 mm Hg, diastolic BP &#x2265; 80 mm Hg, or use of medication for BP), diabetes (fasting glucose &#x2265;126 mg/dL, nonfasting glucose &#x2265;200 mg/dL, self-reported physician's diagnosis, or use of diabetes medication), and former and current smoking (self-reported). We defined frailty status using the Fried criteria (5 components that include low energy, low physical activity, slowness, weakness, and weight loss). We estimated cause-specific hazard ratios (HRs) of incident dementia (ascertained from in-person neuropsychological assessments, semiannual participant or informant report, or surveillance of claims from hospitalizations and death certificates) with Cox proportional hazards models including a multiplicative interaction between vascular factors and frailty. HRs of dementia were then stratified by frailty (robust [no frailty components present] vs prefrail/frail [at least 1 frailty component present]). There were 377 (15.8%) dementia cases in robust participants (n = 2,383; mean age, 74.2 years; 55.4% female) and 812 (30.0%) in prefrail/frail participants (n = 2,710; mean age 76.4 years; 61.3% female). There was a significant interaction between BP and frailty on dementia risk (p = 0.026). For robust participants, HRs were 1.03 (95% CI 0.65-1.64) for elevated BP and 1.39 (95% CI 1.00-1.94) for hypertension relative to normal BP. For prefrail/frail participants, HRs were 0.68 (95% CI 0.49-0.95) and 0.82 (95% CI 0.66-1.01), respectively. Diabetes and current smoking were associated with higher dementia risk in both robust and prefrail/frail individuals. Late-life hypertension was associated with a lower relative risk of dementia in prefrail/frail participants, but the association was positive in robust participants. BP interpretation and management to support brain health in older adults could consider age-related functional status.

To analyze the interplay between family history of type 2 diabetes (T2D) and cardiovascular health (CVH) in relation to T2D onset age and subsequent cardiovascular disease (CVD) risk. A total of 79&#x2009;831 participants were included to investigate the association between family history and T2D onset age. Then, 7387 diagnosed T2D patients were 1:1 matched with non-T2D individuals to analyze the association of T2D onset age with subsequent CVD risk. The benefit of good CVH was further assessed. Stratified Cox regression and conditional Cox regression were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Family history was associated with younger T2D onset, with an approximately 2.4-year earlier onset of T2D, which further increased the subsequent risk of CVD. Compared with individuals without family history, those with family history had HRs (95% CIs) of 3.911 (3.041, 5.032), 3.785 (3.385, 4.233), 3.627 (3.340, 3.938), 3.465 (3.189, 3.764), and 3.169 (2.787, 3.603) for T2D onset at <&#x2009;40, 40-50, 50-60, 60-70, and &#x2265;&#x2009;70&#x2009;years old, respectively (Pinteraction&#x2009;=&#x2009;0.007). Among individuals with family history, HR (95% CI) for incident CVD was 3.598 (1.372, 9.433) for those diagnosed T2D <&#x2009;50&#x2009;years compared with those without T2D, while the HR (95% CI) was 2.336 (1.232, 4.428) among those without family history. However, high CVH could mitigate risk of young-onset T2D, and could further decrease CVD risk after their T2D diagnosis. Having family history of T2D increased susceptibility to young-onset T2D and subsequent CVD risks, while ideal CVH could counteract these risks, highlighting the necessity of early screening and intervention.

The relationship between Neuromyelitis optica spectrum disorder (NMOSD) and specific cardiovascular outcomes, particularly macrovascular events such as peripheral artery disease (PAD) and venous thromboembolism (VTE), has not been examined in a population-based study. The current study investigated the association between NMOSD and the risks of PAD and VTE. This retrospective cohort study used data from the Taiwan National Health Insurance Research Database. Patients with new-onset NMOSD between 2003 and 2020. Patients with previous PAD or VTE were excluded. Each patient was matched to five general patients for comparison using propensity score matching. In total, the study included 2,027 patients with NMOSD and 10,135 matched general population controls. A Cox proportional hazards model was used to investigate PAD and VTE risk, with relevant variables controlled for. NMOSD was stratified by severity to further verify the association between disease severity and macrovascular event risk. The control variables considered in this study were sex, age, insured salary, urbanization, Charlson comorbidity index (CCI), and related comorbidities. The average follow-up of all participants was 7.01 person-years. After adjustments for relevant variables, patients with NMOSD had significantly higher risks of PAD (adjusted hazard ratio [aHR] = 1.40; 95% confidence interval [CI]: 1.02-1.92) and VTE (aHR = 4.81; 95% CI: 3.08-7.52). The risk of vascular events was strongly associated with disease severity. Severe NMOSD was associated with markedly increased risks of PAD (aHR = 2.26; 95% CI: 1.41-3.61) and VTE (aHR = 11.69; 95% CI: 6.86-19.90), whereas mild and moderate disease did not significantly increase PAD risk. NMOSD is a significant risk factor for PAD and VTE. These findings highlight the importance of proactive vascular risk assessment and preventive management in patients with NMOSD.

The menopause transition marks a period of accelerated cardiovascular risk in women, highlighting the importance of opportunistic screening and intervention in midlife primary care. This article summarises current evidence linking menopause with cardiovascular disease (CVD) and appropriate interventions, including lifestyle optimisation and menopausal hormone therapy (MHT). The midlife acceleration of CVD risk is driven by distinct cardiometabolic and vascular changes, with ovarian ageing independently associated with adverse lipid profiles, fat redistribution, vascular dysfunction and metabolic syndrome. Early, premature, surgical and symptomatic menopause further amplifies risk. Lifestyle optimisation and lipid-lowering therapy remain powerful strategies to mitigate these changes. MHT, although not recommended solely for primary or secondary CVD prevention, may be offered for symptom management and bone protection in appropriately selected women, and in cases of premature, early or surgical menopause. Midlife consultations provide a unique window for general practitioners to opportunistically risk stratify, initiate preventive measures and support informed MHT decision making, thereby shaping long-term cardiovascular trajectories.

Stroke is the second leading cause of death globally. While daily toothbrushing is widely promoted for oral hygiene, the preventive impact of adjunctive oral hygiene practices, such as dental flossing and interdental brushing, on stroke risk remains unclear. This study aimed to investigate the association between comprehensive oral hygiene behaviors and the risk of stroke. We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance Service-Health Screening cohort. A total of 98,866 adults aged &#x2265;40 years who underwent both general and oral health examinations during 2009-2010 were included. Participants were followed from January 2011 to December 2019. Individuals with pre-existing cardiovascular disease, death before baseline, or missing data were excluded. Oral hygiene behaviors, including daily toothbrushing frequency and weekly use of dental floss and interdental brushes, were self-reported. The primary outcome was incident stroke requiring hospitalization for &#x2265;2 days and was classified as total, ischemic, or hemorrhagic stroke according to diagnostic codes. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). During follow-up, participants with favorable oral hygiene behaviors showed a lower risk of stroke compared with those with poor oral hygiene practices. In multivariable-adjusted analyses, individuals who brushed their teeth at least twice daily and regularly used dental floss and interdental brushes had a 23% lower risk of ischemic stroke (adjusted hazard ratio [aHR] 0.77, 95% CI 0.63-0.94). A significant dose-response relationship was observed across categories of oral hygiene behaviors. Frequent toothbrushing combined with regular use of dental floss and interdental brushes was associated with a reduced risk of ischemic stroke. These findings suggest that comprehensive oral hygiene practices may provide additional benefits for stroke prevention. Comprehensive oral hygiene behaviors, including regular toothbrushing, dental flossing, and interdental brushing, may contribute to stroke prevention beyond conventional vascular risk factor management. Promoting adjunctive oral hygiene practices could represent a simple, accessible, and population-based strategy for reducing ischemic stroke risk in middle-aged and older adults.

Cardiovascular diseases remain the leading cause of global mortality, and growing evidence shows that regular exercise is one of the most effective non-pharmacological strategies to prevent and modify their progression. Exercise exerts its benefits on the cardiovascular system in multiple ways. It improves lipid metabolism by lowering LDL-cholesterol, reducing triglycerides, and increasing HDL-cholesterol, which provides a protective function by slowing atherosclerotic plaque development. Exercise also reduces chronic inflammation by lowering circulating inflammatory markers and shifting immune cells toward anti-inflammatory profiles. In addition, regular physical activity enhances autonomic balance, increases heart rate variability, and supports healthier blood pressure regulation. Mitochondrial function and antioxidant capacity improve with exercise, helping to reduce oxidative stress and support overall cardiac health. Exercise further influences vascular and metabolic health through epigenetic mechanisms, myokine release, and favorable changes in the gut microbiome. These molecular and systemic adaptations translate into meaningful clinical benefits, including improved recovery after myocardial infarction, better heart failure management, and a reduced risk of ischemic and hemorrhagic stroke. Overall, regular physical activity is a powerful and accessible tool for reducing cardiovascular disease risk and promoting long-term health.

Stroke remains a leading cause of death and long-term disability worldwide, making prevention strategies a global health priority. Emerging technologies-including artificial intelligence (AI), wearable devices, digital health applications, and drone-assisted emergency systems-are increasingly being explored to improve stroke prevention and early management. In primary prevention, machine learning models can identify individuals at high risk of stroke using clinical and behavioral data with high reported predictive accuracy, although most models are derived from retrospective, single-center datasets and still require prospective external validation. Digital devices and wearable technologies enable continuous monitoring of cardiovascular risk factors and support behavioral interventions aimed at reducing vascular risk. In secondary prevention, AI-based tools are being developed to predict stroke recurrence, identify modifiable risk factors, and detect patients at risk of poor medication adherence. In the acute setting, AI-assisted neuroimaging platforms are already integrated into clinical and telestroke workflows, supporting rapid triage and treatment decisions. In parallel, drone-based emergency systems may contribute to improved outcomes by reducing prehospital delays and facilitating telemedicine-based triage in remote or resource-limited settings, although current evidence is derived largely from out-of-hospital cardiac arrest pathways rather than stroke-specific trials. Although advanced neurotechnological systems capable of real-time neurophysiological monitoring and closed-loop neuromodulation exist in other neurological disorders, their role in stroke prevention remains largely theoretical. Overall, these technologies offer promising opportunities to reshape the continuum of stroke prevention and care, but further validation, integration into clinical workflows, and evidence of real-world effectiveness are required before widespread implementation.

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality for people living in the Middle East and North Africa (MENA) region. Accumulation of modifiable ASCVD risk factors such as hypertension, type 2 diabetes mellitus (T2DM), dyslipidemia, smoking, obesity, and physical inactivity leads to a higher magnitude of ASCVD burden. Metabolic syndrome (MetS) is a fundamental clinical factor associated with increased incidence and mortality of ASCVD. This study aimed to assess the prevalence and clinical profiles of MetS among Middle Eastern patients with ASCVD using a newly proposed definition incorporating six modifiable risk factors. We used data from the Jordan absence of standard modifiable risk factors (SMuRF-Less) study, to evaluate demographic, clinical, and laboratory characteristics along with the presence and co-existence of six modifiable risk factors between ASCVD patients with and without MetS. A total of 5540 patients with ASCVD (mean age 57.13 &#xb1; 12.31 years) were included. MetS status was available for 1,016 patients, of whom 434 (42.7%) met the criteria for MetS. Patients with MetS were more likely to be aged 46-65 years and had a higher prevalence of hypertension, dyslipidemia (notably hypertriglyceridemia and low HDL levels), T2DM, obesity, and physical inactivity. Additionally, MetS patients showed higher rates of heart failure, chronic kidney disease, obstructive sleep apnea, lower educational levels, higher smoking prevalence, and lack of health insurance. Nearly half of ASCVD patients in this Middle Eastern cohort had MetS. In regions with a high burden of cardiovascular risk factors, effective ASCVD prevention strategies should prioritize early detection and comprehensive management of MetS through control of modifiable risk factors and the establishment of dedicated MetS clinics. : NCT06199869.

Exposure to hydrocarbons, including polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs), represents an escalating public health concern. These compounds induce systemic inflammation, oxidative stress, and endothelial dysfunction, driving cardiovascular disease (CVD) pathogenesis. This systematic review evaluates the association between hydrocarbon exposure and CVD risk, focusing on specific metabolite biomarkers. A comprehensive search of PubMed, Embase, and Web of Science was conducted up to June 10, 2025. Observational studies evaluating correlations between hydrocarbon exposure and CVD outcomes-including coronary heart disease (CHD), stroke, and myocardial infarction (MI)-were selected for narrative synthesis. Eleven studies met the inclusion criteria. Included studies were of moderate to high quality with a low overall risk of bias. The PAH metabolites 1-hydroxynaphthalene (6 studies), 2-hydroxynaphthalene (7 studies), 2-hydroxyfluorene (6 studies), 3-hydroxyfluorene (5 studies), and 1-hydroxypyrene (5 studies) were consistently associated with elevated risks of CHD, stroke, and MI. Similarly, exposure to BTEX components (benzene, toluene, ethylbenzene, and xylene) evaluated in one study significantly correlated with heightened CVD incidence. These associations appeared more pronounced in highly exposed populations, particularly occupational cohorts, although effect sizes varied across studies because of study design differences and residual confounding factors such as smoking. Overall, the available evidence suggests an association between hydrocarbon exposure and increased CVD risk. Further prospective longitudinal studies are needed to confirm these findings and clarify the underlying toxicological mechanisms.

Adults with inflammatory bowel disease (IBD) demonstrate a high prevalence of obesity, metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiometabolic comorbidities. Cardiovascular disease (CVD) is a leading cause of mortality in IBD. This review examines cardiometabolic and obesity screening, and management within IBD models of care to optimise chronic disease management. Obesity prevalence in IBD has increased to 40%. Chronic systemic inflammation driven by visceral adiposity, proinflammatory cytokine production, insulin resistance and vascular endothelial dysfunction represent a unifying mechanism linking IBD, MASLD and CVD. Proactive management of cardiometabolic risk is not prioritised within traditional IBD service models. Therapeutic approaches to manage obesity and lower CVD risk in this cohort with concurrent optimisation of IBD control include dietary and lifestyle intervention through to anti-obesity pharmacotherapy and bariatric procedures. Integrated multidisciplinary models of care that leverage existing infrastructure and shared-care partnerships with primary care, proactive risk identification and management strategies should be adopted within specialist IBD services. As obesity, MASLD and CVD emerge as major contributors of morbidity and mortality in IBD, failure to systematically address cardiometabolic risk represents a critical gap in contemporary IBD care. Embedding proactive screening and multidisciplinary management within existing IBD infrastructure offers immediate actionable opportunity to improve long-term outcomes beyond inflammatory control.

Hyperglycaemia is common in intensive care unit (ICU) patients and blood glucose management practices likely vary, but there are limited contemporary data on ICU doctors' and nurses' preferences. We conducted an international online survey of ICU doctors and nurses. The 16-question survey covered respondent characteristics, glucose management practices, perceived challenges with intermittent point of care (iPOC) glucose monitoring and continuous glucose monitoring (CGM), and preferences for a future trial on CGM versus usual care. Data were reported descriptively for all respondents and stratified by profession. We received 1424 responses from 12 countries, of which 63% were from nurses. The overall response rate was 36% and the highest proportion of missing data for any question was 9%. Most respondents (92%) reported that their ICU had a glucose management protocol. The median reported insulin initiation threshold was blood glucose of 10&#x2009;mmol/L. Long-acting insulin was reported to be used occasionally by 68% of respondents. As needed pro re nata insulin was reported as most often given subcutaneously (43%) or intravenously (25%). Overall, 61% of ICU nurses reported concerns related to iPOC use versus 53% among ICU doctors (concerns among nurses versus doctors included risk of hypoglycaemia in 41% vs. 28%; risk of hyperglycaemia in 28% vs. 16%; patient discomfort in 26% vs. 27%). Overall, 75% of respondents never used CGM and 18% of ICU nurses reported concerns related to CGM use versus 22% of ICU doctors (accuracy and reliability in 14% vs. 18%; calibration and maintenance in 9% versus 16%; patient discomfort in 5% vs. 6%, respectively). Most respondents (89%) supported a randomised trial on CGM versus usual care in ICU and 68% preferred an intervention arm with a specific CGM-treatment protocol. Glucose management preferences varied among ICU staff, particularly in the administration of as needed doses and long-acting insulin. ICU nurses appeared more concerned about iPOC use than ICU doctors. The concerns about use of CGM appeared less common than concerns about iPOC. Most nurses and doctors would support a randomised trial on CGM versus usual care for glucose management in ICU and reported a preference for CGM to be used with a specific treatment protocol. This international survey highlights substantial professional differences and heterogeneity in ICU glucose management practices, particularly regarding as-needed and long-acting insulin use. Nurses expressed greater concern than doctors about intermittentpoint point-of-care glucose monitoring, especially the risks of hypoglycaemia and hyperglycaemia. Although continuous glucose monitoring was rarely used, it was viewed favourably overall, with broad support for a future protocolised randomised CGM trial.

Pulmonary embolism (PE) is the third leading cause of cardiovascular death globally and continues to carry high rates of morbdity and mortality despite advances in therapy. While risk stratification helps guide treatment for both low- and high-risk patients, optimal management of intermediate-risk PE remains unclear. Although contemporary AHA/ACC guidelines introduce more granular clinical categories to better define risk and guide treatment selection within this heterogeneous population, uncertainty persists. Systemic fibrinolysis poses bleeding risks, whereas anticoagulation alone may not be sufficient to prevent clinical deterioration. Catheter-based approaches, such as ultrasound-assisted catheter-directed thrombolysis (UACDT), have therefore emerged as potential options that deliver lower-dose fibrinolytics directly into the pulmonary arteries. However, much of the existing literature combines UACDT with other catheter-based interventions, making it difficult to isolate its specific contribution. The data are also heterogeneous, limiting cross-study comparisons. This review summarizes the current evidence, influential clinical trials, and ongoing studies on UACDT, with a focus on its therapeutic potential, safety considerations, limitations, and evolving role in the management of intermediate-risk PE. A literature search was conducted using PubMed, Embase, and ClinicalTrials.gov from inception through early 2026, with supplementary searches performed using Google Scholar. A pulmonary embolism occurs when a blood clot blocks the vessels between the heart and the lungs, preventing the heart from pumping blood to the lungs and the lungs from receiving blood from the heart. There is a wide range of severity. Some patients are very stable and can be treated with standard blood-thinning medications alone; these patients are low risk. Other patients are high risk; they are extremely sick and require urgent therapies to remove the clot from vessels, relieve stress on the heart, and restore oxygen to the lungs. The patients in between are intermediate-risk, and their treatment is less straightforward. For these patients, blood thinners alone may not be enough, but the stronger therapies can make them bleed extensively (sometimes into their brain).One option for this group is ultrasound-assisted catheter-directed thrombolysis, or UACDT. An experienced doctor places a small tube into the lung vessels to deliver medication that breaks up the clot; the device also uses ultrasound waves (&#x201c;vibrations&#x201d;) to disrupt the links holding the clot together. The idea is to reduce strain on the heart and repair blood flow while using less medication that causes bleeding.The evidence for this therapy is inconsistent and can be difficult to apply in real-world settings. In this paper, we evaluated the research on UACDT. We found that UACDT can work for some patients but is not necessarily better than other treatments. More research is needed to better clarify the outcomes of this treatment.

Early hospital discharge has shifted complex care to domestic settings, increasing the risk of Healthcare-Associated Infections (HAIs). This review evaluates home care HAI prevalence, risk factors, and preventive challenges. Following PRISMA guidelines, a systematic search identified original studies on adult home care patients. Methodological quality was assessed using the RTI Item Bank and MMAT. Ten studies were included in the narrative synthesis. Findings suggest that the overall prevalence of HAIs in the home care setting varies widely depending on reporting criteria and specific populations, also highlighting a critical epidemiological shift. In fact, up to 56% of home-managed HAIs were imported from previous hospitalizations thus actively introducing Multidrug-Resistant Organisms (MDROs)&#x2014;such as ESBL-producing E. coli and Clostridium difficile&#x2014;into the community setting. The prolonged use of invasive medical devices (e.g., urinary catheters, implantable ports), combined with severe chronic comorbidities like dementia, diabetes, and hypoalbuminemia, strongly amplifies infection risks. Furthermore, adherence to standard Infection Prevention and Control (IPC) protocols is frequently hindered by structural barriers, including a lack of cleanliness (85.4%) and space (77.1%). In this unregulated setting, the capability and education of informal caregivers act as primary determinants of infection outcomes. The home care environment is increasingly vulnerable to severe HAIs. Mitigating these risks requires the development of setting-specific IPC guidelines and the formal integration of caregiver education into public health policies. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024594811, identifier PROSPERO (CRD42024594811).

Diabetic foot disease remains one of the leading preventable causes of hospitalization, limb loss, and premature mortality. It is important to understand temporal changes in disease severity and outcomes in order to establish gaps in prevention and acute management. The present study reported on the hospital burden, amputation patterns, and mortality trends of diabetic foot patients over a decade. This is a retrospective analysis of 500 patients admitted for diabetic foot complications from 2015 to 2024. The records were reviewed for demographic profile, ulcer grade, severity of infection, co-morbidities, length of stay, surgical interventions, and mortality. The amputation was classified into minor or major, while mortality was analyzed at two stages: during hospitalization and within 30&#x202f;days. Annual trends were studied to assess the changes in clinical presentation and outcomes. Diabetic foot complication admissions gradually increased year by year, with later years recording more severe grades of ulcers and high infection burden. Major amputations formed a consistent proportion of the surgical cases, though a slight decline was recorded after 2021. Overall mortality remained similar throughout the study period but was higher among those presenting with sepsis, advanced peripheral arterial disease, or chronic renal impairment. The hospital burden remained high, reflected in prolonged lengths of stay and multiple readmissions. The 10-year pattern demonstrates persistent clinical severity at presentation, continued reliance on major amputations, and stable but meaningful mortality in diabetic foot patients. The findings stress the need for stronger preventive care, earlier referral, and community-level screening strategies to reduce advanced disease and improve survival.

Foot-related conditions are a leading cause of all hospitalisations and amputations worldwide. Half of these foot-related hospitalisations are in people without diabetes. Yet, few studies seem to have explored risk factors for foot-related hospitalisations in populations with or without diabetes. This study aimed to systematically review studies investigating risk factors for hospitalisations caused by any foot-related conditions amongst any general community-dwelling adult populations (with or without diabetes). PubMed and Embase databases were searched for studies related to risk factors, foot-related conditions and hospitalisations published since 1st January 2000. Search results were screened for eligibility by two independent authors. Risk of bias was assessed using the Quality in Prognostic Studies tool, and data were extracted using a customised data extraction tool. Fourteen studies from 7824 screened studies were included. Twelve studies investigated diabetes populations and two general (with and without diabetes) populations. All 14 studies investigated only for foot disease-related hospitalisation outcomes. Seven studies were rated as low risk of bias. Twenty-two independent risk factors were reported, including eight reported both in multiple studies and low risk of bias studies. Those eight risk factors were being male, having diabetes, increased HbA1c, insulin management, chronic kidney disease, peripheral neuropathy, peripheral artery disease and no footcare within 12&#xa0;months. This review suggests that the common risk factors for foot disease-related hospitalisations are being male, having diabetes, chronic kidney disease, peripheral neuropathy, peripheral artery disease and lack of footcare, particularly in diabetes populations. There were no studies investigating hospitalisations for other foot-related conditions and few in nondiabetes populations.

Binocular diplopia is a distressing clinical condition that prompts clinicians to investigate underlying etiologies, particularly cranial nerve (CN) III, IV, or VI palsies. These may arise from microvascular ischemia, inflammation, trauma, compression, or neuromuscular junction disorders. This study aims to explore the association factors of these three ocular motor cranial nerve palsies and to compare their respective all-cause mortality rates using the real-world TriNetX Clinical Research Database (TriNetX CRD). TriNetX is a global federated administrative database with real-time updates of electronic medical records (EMRs). We used the US Collaborative Network within the TriNetX platform to establish the patient cohorts. This network contains electronic health record data from more than 100&#xa0;million patients across 68 US healthcare organizations (HCOs). This study utilized TriNetX platform to analyze the demographics and associated factors of ocular motor cranial nerve palsies, including diabetes, hypertension, acute myocardial infarction (AMI), overweight status, blood glucose and lipid profiles, body mass index (BMI), and history of brain aneurysm surgery, through intergroup comparisons using paired t-tests. All-cause mortality was assessed using Cox proportional hazards modeling and Kaplan-Meier survival analysis. The average age at presentation was 63, 57, and 60 years for CN III, IV, and VI palsies, respectively, with a slight male predominance. CN VI palsy was the most common, followed by CN IV and CN III palsies. CN III and CN VI palsy cohorts were more commonly associated with diabetes, hypertension, AMI, overweight, and brain aneurysm surgery, suggesting a microvascular or compressive etiology. In contrast, the CN IV palsy cohort was younger and more similar to the general population in clinical and laboratory characteristics. Regarding all-cause mortality, the CN III palsy cohort had the poorest survival, followed closely by the CN VI group, while the CN IV group exhibited the most favorable survival outcome. This study confirmed that CN VI palsy is the most frequent cause of ocular motor nerve palsy leading to binocular diplopia. Notably, CN III and VI palsies shared similar vascular and compressive association factors, while CN IV palsy appeared to be more frequently linked to congenital or traumatic origins. These differences were reflected in the mortality analysis, where CN III palsy showed the worst prognosis, CN VI a slightly better but comparable pattern, and CN IV the best survival outcome. Using the TriNetX CRD, this study delineated the demographic profiles, associated clinical factors, and survival outcomes of patients with ocular motor cranial nerve palsies. The typical demographic was males in their late 50s to early 60s, with CN VI being the most frequently affected nerve. CN III and VI palsies were more often associated with microvascular and compressive conditions, which correlated with higher mortality. Conversely, CN IV palsy was associated with a younger population and more benign clinical profiles, reflected in better survival outcomes.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent metabolic disorder linked to increased all-cause and cardiovascular mortality. While accelerated biological aging is a known risk factor for age-related diseases, its role in MASLD remains unclear. This study explores the association between biological aging and hospital-diagnosed MASLD and investigates the potential mediating effects of biological aging on lifestyle-MASLD relationships. Data were from the UK Biobank, and the biological age was estimated by PhenoAge and Klemera-Doubal method age (KDMAge). The association between biological aging and hospital-diagnosed MASLD (defined as hospital admission or death) was estimated using Cox regression. Biological aging acceleration was defined as positive residuals obtained from regressing biological age on chronological age. Mediation analyses were used to assess the potential mediating role of biological aging in the relationships between lifestyle and hospital-diagnosed MASLD. Among 247,444 participants, 3,254 developed hospital-diagnosed MASLD during a median follow-up of 13.7 years. Accelerated biological aging was significantly associated with hospital-diagnosed MASLD with hazard ratios of 1.46 (95% confidence interval, 1.35, 1.57) for PhenoAge acceleration and 1.35 (1.19, 1.53) for KDMAge acceleration. In mediation analyses, PhenoAge acceleration significantly accounted for the associations between four unhealthy lifestyle factors (smoking, drinking, poor diet, and low physical activity) and MASLD, with mediation proportions ranging from 11.4% to 25.5%, and the strongest effect observed for smoking. In contrast, KDMAge acceleration showed minimal mediation effects (&#x2264;2%). Accelerated biological aging was associated with hospital-diagnosed MASLD and may partially mediate the associations between unhealthy lifestyles and hospital-diagnosed MASLD. These findings support the potential relevance of biological aging in MASLD risk stratification and prevention.

The incidence of pediatric venous thromboembolism (VTE) has increased due to increased health care complexity, improved diagnostic techniques, and greater clinical awareness. Most episodes are associated with iatrogenic risk factors, particularly the use of central venous catheters, and occur in vulnerable populations such as neonates or children with cancer, congenital heart disease, and/or short bowel syndrome. To review special clinical scenarios of pediatric VTE and propose a practical approach to support decision-making in complex clinical settings. Narrative review focused on clinical practice, addressing pathophysiological features, diagnosis, treatment, and follow-up, integrating recent guideline recommendations, observational case series, and clinical experience reports. In neonatology, developmental hemostasis, bleeding risk, and pharmacokinetics influence the indication, selection, and monitoring of anticoagulation therapy. The review discusses umbilical venous catheter-associated thrombosis, neonatal purpura fulminans, and renal and portal vein thrombosis, highlighting the criteria for anticoagulation and/or thrombolysis and the need for long-term follow-up to detect sequelae. In children with cancer, congenital heart disease, or short bowel syndrome, VTE is multifactorial and frequently catheter-related, requiring therapeutic adjustments (eg, thrombocytopenia, invasive procedures, preservation of vascular access). We summarize the current strategies for anticoagulation-including the emerging role of direct oral anticoagulants, with caution in selected subgroups-and thrombolysis. In special pediatric populations, VTE requires individualized and multidisciplinary management. Disease severity, residual risk, and the need to balance bleeding and thrombosis should guide decisions regarding treatment intensity/duration as well as prophylaxis, with emphasis on organ preservation, maintenance of venous capital, and prevention of long-term complications.