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For decades, the use of fibrinolytic agents in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) has been contraindicated by major clinical guidelines, mainly due to the lack of demonstrated benefit and the risk of bleeding. However, recent diagnostic advances, particularly the application of artificial intelligence to electrocardiography, now allow identification of subgroups of patients without ST-segment elevation who in fact present with acute coronary artery occlusion and may therefore require immediate reperfusion. This article weighs the potential risks and benefits of fibrinolytic therapy in NSTE-ACS and proposes specific lines of research and clinical criteria to assess the selective, research-based exploration of fibrinolysis in these patients. Specifically, this exploration concerns selected NSTE-ACS patients in whom timely angiographic evaluation or percutaneous coronary intervention (PCI) is unavailable. This article does not propose a change in clinical practice. Instead, it outlines a hypothesis-generating, research-based framework to explore whether, in highly selected circumstances and in the absence of timely PCI, fibrinolytic therapy could be studied in NSTE-ACS patients with probable acute coronary occlusion identified by advanced diagnostic tools.

ObjectiveTo identify risk factors for postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting and to develop a machine learning model for effective risk prediction.MethodsWe extracted data from the Medical Information Mart for Intensive Care-IV database for patients who underwent off-pump coronary artery bypass grafting. Eight machine learning algorithms were trained, including logistic regression, support vector machine, gradient boosting machine, neural network, eXtreme gradient boosting, adaptive boosting, light gradient boosting machine, and categorical boosting. Model performance was assessed using the area under the receiver operating characteristic curve and other relevant metrics. The best-performing model was further interpreted using Shapley additive explanations.ResultsPatients were randomly divided into a training set and a testing set at a 7:3 ratio. Models were trained on the training set, internally validated on the testing set, and externally validated using the electronic intensive care unit Collaborative Research Database. Independent predictors of postoperative acute kidney injury were age, body weight, bicarbonate, international normalized ratio, respiratory rate, and diastolic blood pressure. Among all models, categorical boosting achieved the highest performance, with an area under the receiver operating characteristic curve of 0.826 in the training set and 0.725 and 0.705 in the testing and external validation sets, respectively.ConclusionThe categorical boosting model, incorporating age, body weight, bicarbonate, international normalized ratio, respiratory rate, and diastolic blood pressure, provides a potentially valuable tool for predicting the risk of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting.

The treatment of diffuse coronary artery disease is challenging, with high rates of repeat revascularization without satisfactory treatment. We designed a prospective, single-center, single-arm study to evaluate the feasibility and safety of a new strategy for the treatment of diffuse, small-vessel coronary artery disease using a systematic combination of Scoring-balloon Angioplasty and Sirolimus-eluting balloon Angioplasty. We included patients with diffuse (lesion length ≥ 20 mm) and small vessel (diameter 1.5-2.75 mm) coronary disease. Patients with STEMI, left main stenosis, and a life expectancy of less than 24 months were excluded. The procedure strategy was scoring-balloon angioplasty (SBA), 1:1 diameter ratio with distal reference plus sirolimus-eluting balloon angioplasty (SEB) using Mozec balloon (Meril, India). From December 2022 until June 2025, 167 patients with 194 vessels were included. The mean age was 67 ± 9 years, 71% males, 92% with dyslipidemia, and 44% diabetics. The left anterior descending artery was the most frequently treated vessel (66%). The mean reference vessel diameter was 2.1 ± 0.74 mm, MLD 0.71 ± 0.31 mm, and %DS 67 ± 14%. The mean lesion length was 35 ± 15 mm. For a median clinical follow-up of 15 [8-29] months, the overall rate of MACE was 5.4%, 4.8% patients had TLR, and the total percentage of POCE was 10.2%. A novel strategy using a combination of scoring balloon angioplasty followed by sirolimus-eluting balloon inflation for the treatment of diffuse coronary artery disease yields promising angiographic and clinical outcomes.

Although coronary endarterectomy performed for diffuse coronary artery disease is known to increase early postoperative morbidity, its effects on mid-term myocardial functional recovery remain controversial. Therefore, this study aimed to examine changes in preoperative and sixth-month postoperative left ventricular ejection fraction, as assessed by echocardiography, in patients undergoing single or multiple coronary endarterectomy concomitantly with coronary artery bypass grafting. A total of 151 patients who underwent coronary artery bypass grafting with concomitant coronary endarterectomy, performed by experienced surgical teams between 2023 and 2025, were included in this retrospective, multicenter cohort study. Early morbidity and mortality were evaluated in the entire cohort of 151 patients, whereas the mid-term changes in echocardiographic left ventricular ejection fraction were examined in the remaining 138 patients after exclusion of the 13 patients who died in the early postoperative period. Recovery dynamics were analyzed according to the number of target vessels undergoing endarterectomy and aortic cross-clamp times. Endarterectomy was performed on a total of 298 target lesions (mean 1.97 per patient) in the 151 patients included in the study, and multiple vessel endarterectomy was performed in 58.3% of the cases. The mean preoperative left ventricular ejection fraction was 46.6% &#xb1; 9.9%, and a clinically significant relative improvement of 16.8% was observed by the end of the sixth postoperative month (p < 0.001). Although multiple endarterectomy procedures and prolonged cross-clamp time tended to increase early morbidity, including postoperative atrial fibrillation and bleeding, no statistically significant difference was detected compared with single procedures (p > 0.05, p = 0.388). In particular, complete revascularization of the left anterior descending artery territory was identified as the strongest predictor of functional recovery. Although coronary endarterectomy carries early risks related to increased surgical surface area and prolonged ischemia, it is associated with significant and sustained improvement in mid-term left ventricular functions among surviving patients, likely through reverse remodeling resulting from complete resolution of myocardial hibernation in the ischemic myocardium.

Coronary calcification is a prevalent pathology and strong cardiovascular indicator. However, its progression drivers remain poorly defined. With limited clinical samples, it is unclear if simple traditional machine learning can effectively predict progression, challenging risk assessment and individualized treatment. We assembled a serial CCTA dataset of 2,579 patients from West China Hospital. Using Random Forest, Gradient Boosting Decision Trees, XGBoost, and Logistic Regression with SHAP analysis, we identified key features of coronary artery calcification progression and built predictive models, then compared them with traditional clinical models. The Random Forest (RF) model achieved an AUC of 0.81 (95% CI: 0.78-0.84) vs. 0.64 (0.59-0.68) for the traditional model. Baseline CACS, plaque burden, and other CCTA features were key predictors, with critical thresholds determined. A coronary artery calcification progression prediction score (CACPPS) was derived to quantify personalized progression risk. The RF model also showed acceptable calibration (Brier score&#x2009;=&#x2009;0.169; Hosmer-Lemeshow p&#x2009;=&#x2009;0.415), favorable decision-curve net benefit, and an optimal CACPPS threshold of 0.566. In patients with suspected or confirmed CAD, a traditional yet interpretable machine learning model can predict CACS progression and generate CACPPS to support treatment decisions and dynamic individualized management, mitigating black-box concerns through indirect interpretability.

Coronary artery disease (CAD) is a major global cause of morbidity and mortality, and population ageing is reshaping its clinical phenotype, disease trajectory, and therapeutic complexity. Chronological age alone cannot explain the heterogeneity of CAD outcomes in older individuals, highlighting the need to integrate biological ageing into cardiovascular disease research and management. Cellular senescence, characterised by stable cell-cycle arrest, metabolic reprogramming, and acquisition of a senescence-associated secretory phenotype (SASP), provides a mechanistic bridge between ageing and CAD. Senescent endothelial cells, vascular smooth muscle cells, immune cells, fibroblasts, and cardiomyocytes contribute to endothelial dysfunction, chronic inflammation, plaque instability, impaired myocardial stress tolerance, and adverse remodelling. Conversely, CAD-related stressors, including atherosclerotic injury, disturbed flow, myocardial ischaemia and ischaemia-reperfusion injury, can induce local senescence programmes and propagate inflammatory or extracellular-vesicle-mediated signalling beyond the initial injury site. However, whether CAD directly accelerates whole-organism biological ageing remains less established. In this review, we examine cellular senescence as a bidirectional but context-dependent interface between ageing and CAD. We summarise cell-type-specific senescence programmes in vascular and myocardial compartments, compare the strength of evidence for major molecular pathways, and discuss senescence-targeted therapies. We emphasise that senolytic and senomorphic strategies remain largely preclinical in cardiovascular disease and that their translation will require careful attention to disease stage, treatment timing, cell specificity and patient stratification. This framework may help refine ageing-informed approaches to CAD prevention, diagnosis and therapy.

The prognostic utility of the atherogenic index of plasma (AIP) in patients with coronary artery disease (CAD) and chronic kidney disease (CKD) remains unclear. Therefore, this study aimed to evaluate the association between AIP and long-term outcomes in patients with CAD and stage 2-5 CKD. This retrospective study included 1816 patients with angiographically confirmed CAD and stage 2-5 CKD treated at a tertiary center between January 2019 and June 2023. The AIP was calculated as log10 (TG/HDL-C). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), including cardiac death, non-fatal myocardial infarction (MI), non-fatal stroke, and ischemia-driven revascularization. Patients were stratified into high- and low-AIP groups according to the optimal receiver operating characteristic (ROC) curve-derived cutoff value (0.148). The association between the AIP and incidence of MACCEs was primarily evaluated in the overall cohort using multivariable Cox regression. To minimize the influence of confounding and improve comparability between groups, Kaplan-Meier analysis and model performance metrics, including the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI), were also assessed. MACCEs occurred in 379 patients (20.9%). High AIP independently predicted increased risk of MACCEs (adjusted hazard ratio (HR): 1.95; 95% confidence interval (CI): 1.45-2.63; p < 0.001). Specifically, the high-AIP group showed a significantly elevated risk of cardiac death (HR: 2.07; 95% CI: 1.13-3.80; p = 0.019), non-fatal MI (HR: 1.97; 95% CI: 1.02-3.78; p = 0.043), and ischemia-driven revascularization (HR: 2.97; 95% CI: 1.76-5.02; p < 0.001). Incorporation of AIP values into the established Global Registry of Acute Coronary Events (GRACE) risk model improved predictive accuracy (C-statistic: 0.624 to 0.679; NRI = 0.139; p = 0.01; IDI = 0.037; p < 0.001) with an optimal AIP cutoff of 0.148 for predicting-MACCEs. AIP is an independent predictor of adverse long-term outcomes in patients with CAD and stage 2-5 CKD. Integration of the AIP into existing risk models significantly enhances risk stratification and facilitates the identification of high-risk individuals for personalized management.

While cognitive impairment is prevalent in patients with coronary artery disease (CAD), its prognostic significance in stable CAD patients remains unclear. In this prospective cohort study of 6,130 stable CAD patients, baseline cognitive function was assessed using Montreal Cognitive Assessment (MoCA). The primary outcome was major adverse cardiovascular events (MACE), including all-cause death, nonfatal myocardial infarction, and nonfatal stroke. Unplanned revascularization was specified as a secondary outcome. Kaplan-Meier survival analysis and Cox regression were used to assess the prognostic impact of cognitive impairment. The robustness of the findings was tested via subgroup analyses and sensitivity analyses. Over a median follow-up of 549 days, 123 (2.0%) patients experienced a MACE, and 315 (5.1%) underwent unplanned revascularization. Patients in the MACE group had significantly lower baseline cognitive function. Worse cognitive function was observed in older adults, females, individuals with lower educational attainment, and those with cardiometabolic risk factors. Patients with cognitive impairment had a significantly higher incidence of MACE (log-rank p = 0.001). In contrast, no significant difference was observed in the incidence of unplanned revascularization (log-rank p = 0.791). After multivariable adjustment, cognitive impairment remained an independent predictor of MACE (HR = 1.58, 95% CI: 1.06-2.37, p = 0.026). Sensitivity analyses confirmed the robustness of primary findings. In subgroup analyses, cognitive impairment showed a consistent trend toward increased MACE risk across all strata, with the notable exception of the subgroup with low-density lipoprotein cholesterol < 1.8 mmol/l. Baseline cognitive impairment is an independent predictor of MACE in stable CAD patients.

To investigate the associations of device-measured sedentary behaviour (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with incident symptomatic peripheral artery disease (PAD). Cohort study. A community-based volunteer sample recruited across the United Kingdom. A total of 87,490 adults without cardiovascular disease who had valid wrist-worn accelerometer data and met the study eligibility criteria. Not applicable. Incident symptomatic PAD identified during follow-up. Over a median follow-up of 7.9 years, 569 participants developed symptomatic PAD. Participants in the highest SB tertile had a 43% increased risk of symptomatic PAD [hazard ratio (HR): 1.43, 95% confidence interval (CI): 1.16 to 1.76] compared to those in the lowest tertile. In contrast, higher MVPA was associated with lower symptomatic PAD risk, whereas LPA showed no significant association. All behaviours showed a significant nonlinear association with symptomatic PAD (all P-non-linear <0.05). Joint analysis revealed the lowest symptomatic PAD risk among participants with both low SB and high MVPA, with no significant interaction observed. Isotemporal substitution analyses suggested that replacing SB with MVPA was associated with the greatest estimated reduction in symptomatic PAD risk. Higher SB is independently associated with higher symptomatic PAD risk, whereas greater MVPA was associated with lower risk. These findings underscore the potential importance of considering both MVPA promotion and sedentary time reduction in future PAD prevention.

Pulmonary artery pressure (PAP) monitors provide ambulatory hemodynamic assessment of patients with chronic heart failure (HF). The current analysis was designed to determine whether baseline systolic, diastolic, and mean PAPs and changes in PAPs from baseline to 6 months each were independent predictors of a heart failure hospitalization (HFH) within 2 years. Retrospective analysis of CardioMEMS data from 4 studies including CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes) (n = 550), GUIDE-HF (Hemodynamic-GUIDEed Management of Heart Failure) (n = 2,358), US PAS (CardioMEMS HF System Post Approval Study) (n = 1,200), and MEMS-HF (CardioMEMS Monitoring Study for Heart Failure) (n = 234) included all enrolled patients regardless of treatment assignment (N = 4,342), reduced ejection fraction (<50%) (n = 2,562), and preserved ejection fraction (&#x2265;50%) (n = 1,454). Relationships between baseline pressure (averaged over 14 days after implantation) and change in pressure from baseline to 6 months (averaged over 14 days just before the 6-month time point) and HFH risk were evaluated over a 2-year follow-up. Baseline diastolic PAP was an independent predictor of HFH (HR: 1.043 [95% CI: 1.035-1.050]; P < 0.0001). Change in diastolic PAP (baseline to 6 months, assessed as a continuous variable) was an independent predictor of HFH (landmark analysis; HR: 1.047 [95% CI: 1.035-1.0506]; P < 0.0001). A decrease or increase of >2 mm Hg in diastolic PAP (baseline to 6 months, assessed as categorical variable) compared with no change predicted a 16.1% decrease and 50.1% increase in HFH (P < 0.0001). Results were comparable for systolic and mean PAPs and for patients with HF with reduced ejection fraction and HF with preserved ejection fraction. Baseline PAP and change in PAP from baseline to 6 months (systolic, diastolic, and mean) were independent predictors of HFH within 2 years. Current and previous data from 4 studies using CardioMEMS indicate that PAP is an independent predictor of both mortality and HFH.

Obstructive sleep apnea (OSA) promotes endothelial activation and a prothrombotic milieu through intermittent hypoxia, oxidative stress, and systemic inflammation, mechanisms closely linked to atherosclerosis progression. The vascular effects of continuous positive airway pressure (CPAP) therapy in patients with established coronary artery disease (CAD) remain incompletely understood. To evaluate the longitudinal effects of CPAP treatment on endothelial adhesion molecules and fibrinolytic balance in patients with CAD and OSA. In this randomized controlled analysis from the RICCADSA trial, 210 revascularized CAD patients with moderate-to-severe OSA were assigned to CPAP (n&#x202f;=&#x202f;104) or no-CPAP (n&#x202f;=&#x202f;106) and had available biomarker measurements at baseline and 12&#x202f;months. Circulating intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and plasminogen activator inhibitor-1 (PAI-1) were assessed. Linear mixed-effects models were used to examine longitudinal changes and time-by-treatment interactions adjusted for cardiometabolic covariates. For ICAM-1, no significant time-by-treatment interaction was observed. For PAI-1, a borderline time-by-treatment interaction suggested a numerically smaller increase in the CPAP group compared with no-CPAP (p&#x202f;=&#x202f;0.09). CPAP treatment was associated with a significantly greater reduction in VCAM-1 over time compared with no-CPAP (time-by-treatment interaction p&#x202f;=&#x202f;0.045 in adjusted models). CPAP treatment was associated with selective modulation of vascular biomarkers in patients with CAD and OSA, characterized by attenuation of endothelial activation reflected by reduced VCAM-1 levels, while fibrinolytic imbalance appeared largely resistant to intervention. These findings support pathway-specific vascular responses to CPAP and provide mechanistic insight into residual atherosclerotic risk in this high-risk population.

Postoperative pulmonary exercises are crucial for recovery after coronary artery bypass grafting (CABG). However, traditional face-to-face education often fails to translate into sustained patient adherence. While continuous educational support is essential throughout hospitalization and post-discharge, mobile-based platforms offer a promising, accessible avenue to bridge this gap. This study explored the perspectives of post-CABG patients and healthcare professionals (HCPs) on the requirements for a mobile-based educational intervention to guide its development. This is a descriptive qualitative study conducted at a Malaysian public tertiary cardiac center between January and March 2025. Using purposive sampling, 12 patients with CABG and 14 HCPs from cardiothoracic surgery and rehabilitation medicine departments were recruited. Data were collected via face-to-face, semi-structured interviews and analyzed using inductive content analysis. Three key themes were identified: (1) the need for supportive education throughout the care continuum, (2) high readiness to adopt mobile-based learning, and (3) the importance of application usability and personalization. Both patients and HCPs valued continuous education and were receptive to a mobile-based solution. Participants preferred video-based demonstrations, multilingual content, and a user-friendly interface to enhance engagement. A mobile application may be a feasible and preferred platform for supplementing routine education on post-CABG pulmonary exercises. Despite concerns regarding age and digital literacy, stakeholders supported its real-world implementation to evaluate its potential to enhance patient engagement and foster self-directed recovery.

The growing prevalence and severity of diffuse coronary artery disease (dCAD) necessitate the utilization of appropriate stenting techniques to ensure complete target lesion coverage. In clinical settings where overlapping stents are the norm, there is inconclusive evidence to determine whether using stents of the same identity produces better outcomes compared to stents that differ in material characteristics. We conducted a retrospective observational cohort study at two high-volume, tertiary cardiac care centers in India to determine the safety and efficacy of homogeneous overlapping stents (HOSTs) and heterogeneous overlapping stents (HESTs) in patients with dCAD undergoing percutaneous coronary intervention (PCI). Patients were stratified into complex and non-complex subgroups based on pre-specified clinical and angiographic criteria. Out of 12,920 interventions that were performed during the study period (January 2016 to December 2023), 972 procedures utilized overlapping stent strategies, of which 935 cases met the inclusion and exclusion criteria. HOSTs were used in 795 patients, while HESTs were used in 140 patients. To account for imbalances in the study population, inverse probability of treatment weighting (IPTW) was applied following propensity score adjustment via logistic regression modeling. During a mean follow-up of 2.5 years, occurrence of major adverse cardiovascular events (MACE) was comparable between HOST and HEST groups in the unadjusted (odds ratio [OR] 0.91, 95% confidence interval [CI]: 0.59-1.42, p&#x2009;=&#x2009;0.67), as well as adjusted population (OR 1.05, 95% CI: 0.69-1.61, p&#x2009;=&#x2009;0.81). Similar trends were observed in the complexity-stratified populations, with no evidence of benefit or harm associated with either stenting strategy. Overlapping heterogeneous stents yield similar clinical outcomes as homogeneous stents, regardless of procedural complexity, suggesting that operators may use a "mix-and-match" strategy when ideal stent pairings are not feasible.

Coronary microvascular dysfunction (CMD) represents a key pathological mechanism in patients with ischemia and non-obstructive coronary artery disease (INOCA). Structural and functional abnormalities of the left heart are associated with poor prognosis. The aim of this study was to evaluate the imaging features of early left-heart remodeling associated with CMD in patients with INOCA, including structural and functional changes. A total of 74 patients underwent coronary computed tomography angiography (CCTA) and invasive physiological assessment. They were classified into two groups: the CMD group (index of microcirculatory resistance (IMR) >25 or coronary flow reserve (CFR) <2.0, n = 36) and the control group (n = 38). Structural parameters included left ventricular mass (LVM), left ventricular mid-diastolic volume (LVMDV), left ventricular mid-systolic volume (LVMSV), left atrial mid-diastolic volume (LAMDV), and left atrial mid-systolic volume (LAMSV), all of which were indexed to body surface area (LVMi, LVMDVi, LVMSVi, LAMDVi, and LAMSVi, respectively). The concentricity index (CI) and left ventricular mid-diastolic wall thickness (LVMDWT) were also evaluated. Functional parameters included LAMDV, LAMSV, the diastolic expansion (DE) index, and left ventricular ejection fraction (LVEF). The CMD group showed significantly higher values for LVMi, LVMDVi, LVMSV, LVMSVi, LAMDV, LAMDVi, LAMSV, and LAMSVi than the control group (p = 0.023, 0.018, 0.025, 0.017, 0.003, 0.002, <0.001, <0.001, respectively). No significant differences were found in the absolute values of LVM, LVMDV, CI, LVMDWT, DE, or LVEF (p = 0.113, 0.080, 0.868, 0.879, 0.406, 0.289, respectively). Multivariable logistic regression analysis revealed that higher LAMSVi (adjusted odds ratio (OR) [AOR] = 1.129, 95% confidence interval (CI) 1.052-1.211, p < 0.001), LAMDVi (AOR = 1.133, 95% CI 1.048-1.225, p = 0.002), LVMi (AOR = 1.072, 95% CI 1.020-1.127, p = 0.006), LVMDVi (AOR = 1.069, 95% CI 1.015-1.126, p = 0.012), and LVMSVi (AOR = 1.084, 95% CI 1.007-1.168, p = 0.032) were independently associated with CMD status in adjusted logistic regression models. These principal multivariable associations remained significant after correction for false discovery rate (all Q <0.05). CMD was associated with adverse left-heart remodeling, as manifested by myocardial hypertrophy, eccentric left ventricular remodeling, atrial dilation, and indices suggestive of early diastolic alterations.

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Sex-based differences in treatment response to neuroprotective strategies during endovascular treatment (EVT) for acute ischemic stroke remain poorly understood. This study aimed to evaluate sex-specific effects of methylprednisolone on outcomes after EVT for acute ischemic stroke due to large vessel occlusion. Secondary analysis of the MARVEL (Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke) randomized controlled trial. We compared outcomes following methylprednisolone versus placebo, stratified by sex. We also compared outcomes between women and men receiving methylprednisolone. The primary outcome was defined as the 90-day modified Rankin Scale score (mRS) ordinal shift. Secondary outcomes included mRS score of 0-4, 0-3, 0-2, 0-1 at 90 days. Safety outcomes included mortality within 90 days and symptomatic intracranial hemorrhage (sICH) within 48 hours. This study included 1680 patients (49.9% methylprednisolone, 56.7% men). Stratified by sex, among men, the methylprednisolone group was more likely to have a primary outcome compared with placebo [adjusted OR (aOR) 1.26 (1.00-1.59), P = 0.047] and reduce mortality (P < 0.01) and sICH (P = 0.031); among women, the primary outcome was similar between two treatment arms (P = 0.66), with similar findings for the safety outcomes. Additionally, stratified by different treatment arms, no significant difference was found in the primary outcome between men and women treated with methylprednisolone (P = 0.31) and placebo (P = 0.68). In this exploratory analysis, methylprednisolone appeared to be associated with better clinical outcomes in men compared with placebo. Nevertheless, the interaction between treatment and sex was not statistically significant. Furthermore, among patients receiving methylprednisolone, clinical outcomes did not differ significantly between men and women. ChiCTR.org.cn Identifier: ChiCTR2100051729. This study looked at whether an anti-inflammatory drug called methylprednisolone has different effects in men and women who had a severe stroke caused by a large blood clot in a brain artery and underwent a procedure called endovascular treatment to remove the clot. The research was based on data from a large clinical trial that included 1,680 patients. About half received methylprednisolone and the other half received a placebo. The researchers compared outcomes between men and women who received the drug versus placebo, and also directly compared men and women who received the drug. The results showed that among men, those who received methylprednisolone had better recovery of daily functions 90 days after the stroke compared to men who received placebo. They also had lower rates of death and symptomatic bleeding in the brain. Among women, however, there was no significant difference in recovery between those who received methylprednisolone and those who received placebo. When researchers directly compared men and women who both received methylprednisolone, their recovery outcomes were not significantly different. In summary, this study suggests that methylprednisolone may be more helpful for recovery in men with this type of stroke, while the benefit in women was less clear. These findings indicate that sex may be an important factor to consider when using this medication in future stroke treatment.

We report the case of a 33-year-old male mountaineer, presenting with chest pain, severe headache, dyspnea, and lower extremity edema, on his first expedition to Paraw mountain located in Kermanshah Province. His condition involved a complex thrombotic presentation, including both venous and arterial events, such as a myocardial infarction due to stenosis of the left main coronary artery, which we believe to be a coincidental pathology. His neurological symptom includes headache, vomiting, and slight drowsiness associated with chest pain, which were evaluated alongside confirmatory testing for protein C-S deficiency. Physical examination revealed right lower extremity edema, respiratory distress (RR = 34), and mid-drowsiness. Chest X ray showed lung congestion. A history of recurrent thrombophlebitis, along with the current myocardial infarction, raised suspicion of a thrombophilic state. The final diagnosis of these complications was confirmed to have protein C-S deficiency based on laboratory tests performed during the acute phase. However, the hereditary nature of this deficiency remains unconfirmed as no genetic testing or family screening was undertaken. The patient underwent coronary artery bypass grafting of left anterior descending artery (LAD) and LCX associated with anticoagulant therapy, and his neurologic sign and symptom and lower extremity deep vein thrombosis recovered uneventfully.

To what extent does multiple birth mediate the association between fertility treatment and congenital anomalies? Multiple birth explained only a modest proportion of the increased risk of congenital anomalies associated with fertility treatment, suggesting that most of the excess risk is independent of multiple birth. Fertility treatments have been associated with an increased risk of congenital anomalies. Because fertility treatment also increases the probability of multiple birth, it remains unclear whether the observed increase in congenital anomalies is attributable to treatment itself, multiple gestation, or underlying infertility. Population-based cohort study of all live and stillbirths delivered &#x2265;22 weeks' gestation from 2006 to 2021 among women with a history of infertility diagnosis in Ontario, Canada. Data were obtained from administrative health records routinely collected within a universal healthcare system for epidemiological surveillance. Exposure was defined as (1) infertility without fertility treatment, (2) ovulation induction (OI) or IUI, and (3) IVF or ICSI. Congenital anomalies were categorized as (1) any anomaly, (2) organ system, and (3) specific anomalies. Modified Poisson regression models generated adjusted relative risks (aRR). For statistically significant aRR > 1, causal mediation was used to decompose the total effect into direct and mediated effects to estimate proportion mediated by multiple birth. There were 274&#xa0;893 births included in the cohort, of which 229&#xa0;932 (83.6%) occurred among women with infertility who did not receive fertility treatment, 20&#xa0;525 (7.5%) after OI/IUI, and 24&#xa0;536 (8.9%) after IVF/ICSI. Multiple birth rates were 2.3%, 7.2%, and 13.3%, respectively. Compared with infertility without treatment, the aRR of any anomaly was 1.11 (95% CI 1.05-1.17) after OI/IUI and 1.28 (95% CI 1.22-1.34) after IVF/ICSI. Mediation analyses demonstrated that multiple birth accounted for only a minority of the excess risk, although the proportion mediated varied by anomaly type. The greatest mediation was observed for pulmonary artery stenosis, where multiple birth explained 33.9% of the association after OI/IUI and 44.4% after IVF/ICSI. As with all studies using administrative health data, our findings are subject to potential misclassification of infertility status based on billing codes, particularly when consultations do not reflect a confirmed diagnosis, as well as residual confounding from unmeasured factors.&#x2002;. This study suggests that multiple birth explains only part of the increased risk of congenital anomalies observed after fertility treatment. While continued efforts to decrease multiple pregnancy remain important, future research should focus on disentangling the contribution of specific infertility diagnoses and treatment-related factors to the risk of congenital anomalies. This study was funded by grant MFM-146444 from the Canadian Institutes of Health Research Institute of Human Development, Child & Youth Health, Clinician-Investigator Teams in Obstetrics and Maternal-Fetal Medicine. Bailey Milne received funding for this project from the Queen's University Dean's Doctoral Award. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from &#xa9;Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by CIHI, the Ontario Ministry of Health, and the Better Outcomes Registry & Network ('BORN'), part of the Children's Hospital of Eastern Ontario. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The authors have nothing to disclose. N/A.