Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increased risk of stroke, heart failure and mortality. While catheter ablation is increasingly used for early rhythm control, evidence on its cardiovascular outcomes in high-risk individuals with newly diagnosed AF remains limited. This study aimed to evaluate the association between catheter ablation and the risk of major adverse cardiovascular events (MACE) in high-risk patients with newly diagnosed AF using a target trial emulation design. We used the TriNetX database to identify adults with newly diagnosed AF between 1 January 2015 and 30 April 2022. Patients with prior stroke, prior cardiovascular events or valvular heart disease were excluded. Patients were assigned to ablation or non-ablation cohorts. Propensity score matching (1:1) and a landmark design with 1-year follow-up starting on Day 366 were employed. The primary outcome was MACEs. Subgroup and 2-year sensitivity analyses were performed. Among 263 329 eligible patients, 2018 (0.8%) underwent catheter ablation. After matching, each group included 2018 patients. Catheter ablation was associated with a lower risk of MACE (2.1% vs 5.0%; HR 0.420, 95% CI 0.294 to 0.600) and heart failure (HR 0.627, 95% CI 0.494 to 0.797). Findings were consistent in the sensitivity analysis and subgroup analyses. In this study, catheter ablation was associated with a lower risk of MACE and heart failure in high-risk patients with newly diagnosed AF. These findings should be interpreted in the context of the selected study population.
Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs) have shared risk factors and mechanisms. CVDs are highly prevalent in COPD patients. Additionally, the risk of suffering a cardiovascular (CV) event is increased following an exacerbation and remains elevated for months afterwards. This link between exacerbations and increased CV risk further highlights the importance of preventing exacerbations. Clinical management during and after exacerbations regarding the prevention of CV events remains to be optimised. CV events occur in patients with COPD who have not previously been diagnosed with CVD. Conventional CV risk tools have historically underestimated the risk of CV events in patients with COPD. All patients with COPD should be investigated for CVDs and markers of CV risk should be assessed at the time of COPD exacerbations. Improving survival in COPD depends on reducing the risk of exacerbations, particularly severe exacerbations, addressing identified CV risk factors and managing CVDs when identified according to guidelines.
This study seeks to investigate the relationship between pericardial fat volume and the risk of developing type 2 diabetes mellitus (T2DM) and major adverse cardiovascular events (MACE). The analysis included a cohort of 39, 125 participants from the UK Biobank. The associations between the mean estimate pericardial fat area (MEPFA), as measured by cardiac magnetic resonance imaging, and the incidence of T2DM and MACE were evaluated using multivariable Cox proportional hazards regression models and Kaplan-Meier survival curves. There were 343 occurrences of new-onset T2DM and 1, 894 occurrences of new-onset MACE over a median follow-up period of 55 months. Compared with patients with MEPFA ≤ 13.80 cm2, there was a significantly higher risk of new-onset T2DM (adjusted-HR: 2.09, 95% CI 1.38 to 3.18, P < 0.001) and MACE (adjusted-HR: 1.19, 95% CI 1.02 to 1.39, P = 0.027) in the highest MEPFA quartiles. The survival analysis further substantiated this discrepancy, with a log-rank test yielding P < 0.001. Participants exhibiting higher levels of MEPFA demonstrated poorer left ventricular morphology, systolic function, and global strain. The findings indicated that elevated MEPFA levels were significantly and independently associated with the onset of T2DM and MACE. Preliminary results suggested that increased levels of pericardial fat might enhance the predictive capability for cardio-metabolic risk.
运动训练是心脏康复计划的核心组成部分，也是心血管疾病二级预防的关键要素。尽管运动处方中的核心组成部分已经明确，包括频率、强度、时间和类型；然而，运动量的具体目标并不明晰。美国心肺康复协会（AACVPR）于2025年5月在《心肺康复与预防杂志》发表了《有氧运动量对心脏康复效果的优化策略》科学声明，该声明明确了心脏康复运动处方中的有氧运动量的具体目标，并首次确立以运动量为核心靶点的精准处方模式。本文根据该声明中的核心内容进行详细解读，期望对临床康复策略制定和应用提供可靠支持。.
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Hypertension and dyslipidemia are major risk factors for cardiovascular disease, and effective management of these conditions is essential for reducing long-term morbidity. Mobile health (mHealth) education has emerged as a widely used strategy to enhance disease awareness and encourage lifestyle modification. This study evaluated the impact of an mHealth-based education on cardiovascular risk factors and disease awareness among individuals with hypertension. This single-arm retrospective cohort study analyzed health screening data collected in 2022 (baseline), 2023 (Phase I), and 2024 (Phase II). Participants received a series of mobile-delivered educational materials focused on hypertension and dyslipidemia, emphasizing lifestyle modification, self-management, and improved understanding of chronic disease risks. Primary outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Secondary outcomes included changes in triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and fasting blood sugar (FBS). Annual prevalence rates of hypertension and dyslipidemia were also assessed. A total of 408 participants were included in the final analysis. SBP declined from 131 mmHg (IQR: 125-138) at baseline to 130 mmHg (IQR: 124-136) in 2023 and 128 mmHg (IQR: 120-136) in 2024 (P < 0.001). DBP decreased from 84 mmHg (IQR: 81-89) to 84 mmHg (IQR: 80-89) in 2023 and 82 mmHg (IQR: 75-89) in 2024 (P < 0.001). Hypertension prevalence decreased from 27% to 23.5% and 23%, though changes were not statistically significant. TG levels significantly decreased from 141 mg/dL (IQR: 96-206) to 138 mg/dL (IQR: 91-193) and 127 mg/dL (IQR: 92-185) (P < 0.001). LDL showed a statistically significant but small reduction (127 → 128 → 126 mg/dL; P = 0.003), while HDL remained unchanged. FBS increased slightly but significantly across the study period (98 → 99 → 99 mg/dL; P = 0.01). Dyslipidemia prevalence declined modestly (45.1% → 43.6% → 43.4%) without statistical significance. This study supports the feasibility of mobile health education as a low-cost strategy for improving blood pressure and lipid control. Strengthening education program content and enhancing participant engagement may further amplify its impact on population cardiovascular health.
This review examines the unique cardiovascular disease patterns in older women, focusing on sex and age-specific pathophysiology, diagnostic challenges, and disparities in management. We aim to clarify how aging and hormonal transitions influence disease presentation and outcomes among women, and to identify gaps in cardiovascular care. Emerging data demonstrate that older women are disproportionately affected by HFpEF, coronary microvascular dysfunction, atrial fibrillation, and valvular heart disease. These conditions are influenced by vascular stiffness, myocardial remodeling, and systemic inflammation and often present with atypical symptoms leading to diagnosis delays. Contemporary studies highlight persistent gaps in timely diagnosis, referral for advanced therapies, and representation in clinical trials. Increasing attention is being directed toward frailty, multimorbidity, and patient-centered care models in this population. Recognizing age and sex-specific characteristics, increasing representation of older women in clinical trials, improving equitable access to diagnostic and therapeutic resources, and aligning treatment decisions with patient priorities are critical to narrowing existing gaps and improving long-term outcomes for older women with cardiovascular disease.
The HFA-ICOS baseline cardiovascular risk stratification framework is widely recommended to guide surveillance in patients receiving potentially cardiotoxic cancer therapies, yet real-world evidence supporting its clinical risk separation remains limited. We conducted a multicenter retrospective study of adults with HER2-positive breast cancer treated at tertiary centers from 2016 to 2023. Baseline cardiovascular risk was classified by the HFA-ICOS framework (low to very high). The primary outcome was composite cardiotoxicity, defined by a decline in left ventricular ejection fraction (LVEF), deterioration in global longitudinal strain (GLS), ECG/arrhythmia events, or elevated cardiac biomarkers. Cardiovascular risk rates and patterns were compared across categories. Discrimination and calibration were explored, with logistic regression and Kaplan-Meier analyses performed. Among 687 patients, 273 (39.7%) developed composite cardiotoxicity during follow-up. Cardiotoxicity occurred across all HFA-ICOS risk categories, with overlap in event rates and timing. Discrimination analyses showed modest performance for LVEF, GLS, ECG, and composite outcomes, with AUCs of 0.51-0.55. Sensitivity was low (0.28-0.37), while specificity was moderate (0.73-0.74). Calibration analyses indicated acceptable risk prediction. Multivariable models adjusted for age, comorbidities, baseline LVEF, prior anthracycline, and radiation therapy showed that baseline HFA-ICOS category was not independently associated with cardiotoxicity (aOR: 0.88; 95% CI: 0.56-1.37). Kaplan-Meier curves showed overlapping event-free survival across risk groups. In this real-world cohort of HER2-positive breast cancer patients, baseline HFA-ICOS stratification showed limited ability to clearly distinguish cardiotoxicity risk across categories. These findings suggest that baseline risk assessment alone may be insufficient for individualized prediction and should be complemented by dynamic, on-treatment surveillance strategies.
Objective: To investigate the impact of adding an early proactive telephone follow-up (2-4 weeks post-ablation) to routine follow-up on perioperative medication adherence, incidence of clinical outcome events, and re-consultation in patients with atrial fibrillation undergoing catheter ablation. Methods: This study employed a prospective cohort design. The intervention group included 554 patients who underwent catheter ablation for atrial fibrillation at our hospital in January 2025, receiving an additional telephone follow-up within 2-4 weeks post-ablation. The control group included 910 patients who underwent catheter ablation at our hospital in February 2025, receiving only routine first outpatient follow-up at 3 months post-ablation. The telephone follow-up content included verifying comprehension of medical orders, guiding medication administration, answering questions, assessing postoperative recovery, identifying abnormal symptoms, providing medical advice, and offering psychological support. The primary outcome measure was medication adherence at 3 months post-ablation. Secondary outcome measures included the incidence of thromboembolic events, bleeding events, and re-consultation within 3 months post-ablation. All data were statistically analyzed using SPSS 26.0; P-values<0.05 indicated statistical significance. Results: Baseline characteristics were comparable between the two groups (all P-values>0.05). Regarding medication adherence at 3 months post-ablation, the proportion of patients regularly taking anticoagulants in the intervention group (56.50%) was significantly higher than that in the control group (44.07%) (χ2=21.30, P<0.001); the proportion of patients who self-discontinued medication in the intervention group (27.26%) was significantly lower than that in the control group (41.87%) (χ2=31.78, P<0.001). For the incidence of thromboembolic and bleeding events, no statistically significant differences were observed between the two groups (all P-values>0.05). Specifically, the incidence of thromboembolic events was 1.08% (n=6) in the intervention group and 1.65% (n=15) in the control group (χ2=0.77, P=0.379); the incidence of bleeding events was 0.18% (n=1) and 0.22% (n=2), respectively (χ2=0.19, P=0.664). The overall incidence of any thromboembolic or bleeding event was 1.26% (n=7) and 1.76% (n=16), respectively, and this difference was not statistically significant (χ2=0.54, P=0.460). Regarding re-consultation, the incidence of outpatient visits due to cardiovascular disease was significantly lower in the intervention group (2.53%, n=14) than in the control group (6.81%, n=62) (χ2=12.84, P<0.001). No statistically significant differences were observed between the two groups for emergency visits due to cardiovascular disease (χ2<0.01,P=0.975), hospitalization due to cardiovascular disease (χ2<0.01,P=0.985), or re-consultation/hospitalization for any reason (χ2=0.95, P=0.329). Conclusion: Early proactive telephone follow-up can significantly improve perioperative medication adherence in patients with atrial fibrillation undergoing catheter ablation and effectively reduce postoperative outpatient visits. This simple and feasible intervention has positive clinical application value for improving short-term patient outcomes and optimizing medical resource allocation. 目的： 探讨在常规随访基础上，对择期手术房颤患者在术后早期（2~4周）增加1次主动电话随访，对其围术期药物依从性、临床结局事件发生率及再就诊情况的影响。 方法： 本研究采用前瞻性队列研究设计。纳入2025年1月在北京安贞医院接受房颤择期手术的554例患者作为干预组，在术后2~4周内接受1次额外的电话随访；纳入2025年2月在北京安贞医院接受择期手术的910例患者作为对照组，仅接受常规的术后3个月首次门诊随访。电话随访内容包括核实医嘱理解、指导药物服用、解答疑问、评估术后恢复情况、识别异常症状并提供就医指导、进行心理支持等。主要结局指标为术后3个月药物依从性，次要结局指标包括术后3个月内血栓栓塞事件、出血事件及再就诊情况。所有数据采用SPSS 26.0进行统计分析，以P<0.05为差异有统计学意义。 结果： 两组患者基线资料均衡可比（均P>0.05）。在术后3个月药物依从性方面，干预组仍规律服用抗凝药物的患者比例显著高于对照组（56.50%比44.07%，χ2=21.30，P<0.001）；干预组自行停药比例显著低于对照组（27.26%比41.87%，χ2=31.78，P<0.001）。在血栓栓塞和出血事件发生率方面，两组间差异均无统计学意义（均P>0.05），其中血栓栓塞事件发生率在干预组为1.08%（6例），对照组为1.65%（15例）（χ2=0.77，P=0.379）；出血事件干预组为0.18%（1例），对照组为0.22%（2例）（χ2=0.19，P=0.664）；任意血栓栓塞或出血事件的发生率在干预组为1.26%（7例），对照组为1.76%（16例），差异均无统计学意义（χ2=0.54，P=0.460）。在再就诊情况方面，因心血管疾病门诊就诊的发生率中，干预组（2.53%，14例）显著低于对照组（6.81%，62例）（χ2=12.84，P<0.001），因心血管疾病急诊就诊（χ2<0.01，P=0.975）、因心血管疾病住院（χ2<0.01，P=0.985）以及任意原因再就诊/住院（χ2=0.95，P=0.329），两组间差异均无统计学意义。 结论： 早期主动电话随访能够显著提高择期手术房颤患者的围术期药物依从性，并减少心血管相关门诊就诊次数。这一简便易行的干预措施，对改善患者短期结局、优化医疗资源配置具有积极的临床应用价值。.
Aortic stenosis leads to adverse left ventricular remodeling; aortic valve replacement (AVR) remains the cornerstone of management. We evaluated clinical and echocardiographic outcomes with renin-angiotensin system inhibitor (RASi) use in patients undergoing AVR. Five electronic databases were systematically queried for studies comparing outcomes with and without RASi post-AVR. Outcomes were pooled using random-effects models to calculate risk ratios (RRs), mean differences, and standardized mean differences with 95% confidence intervals. Outcomes of interest included all-cause and cardiovascular mortality, heart failure, myocardial infarction, stroke/TIA, arrhythmias, pacemaker requirement, acute kidney injury, and echocardiographic parameters. Seventeen studies (16 observational, 1 RCT) including 44,935 patients [RASi: 20,723; no RASi: 24,212] were included. RASi use was associated with significantly reduced all-cause mortality (RR: 0.74; 95% CI: 0.65-0.83; p < 0.0001) and cardiovascular mortality (RR: 0.65; 95% CI: 0.49-0.85; p = 0.002), consistent across TAVR and SAVR subgroups. No significant differences were observed for heart failure, myocardial infarction, stroke, or pacemaker requirement. RASi did not increase acute kidney injury (p = 0.08) or major bleeding (p = 0.67). Echocardiographic outcomes, including peak aortic valve velocity and LV mass index, showed no significant differences between groups. In predominantly observational studies, RASi use following AVR is associated with lower all-cause and cardiovascular mortality without increasing major adverse clinical events. Survival benefits were not accompanied by consistent echocardiographic improvements. Given substantial heterogeneity and residual confounding inherent to observational data, prospective randomized trials are needed to confirm these associations. Meta-analysis of 17 studies shows survival benefit with ACEI/ARB in the patients undergoing TAVR/SAVR, with no significant differences in HF, MI, stroke/TIA, AF, pacemaker, or echo outcomes.
Syndromic craniosynostosis is characterized by premature fusion of one or more cranial sutures, often in association with multisystem anomalies affecting the airway, cardiovascular, musculoskeletal, and neurodevelopmental systems. Variants in genes such as TWIST1 contribute to phenotypic heterogeneity and may influence surgical timing, risk stratification, and long-term craniofacial planning. We present a severe syndromic craniosynostosis phenotype associated with a previously undescribed TWIST1 variant and discuss perioperative considerations of staged cranial vault reconstruction. We report a female infant with craniofacial dysmorphism and multisuture craniosynostosis with complete fusion of the bilateral coronal sutures and widening of the sagittal and metopic sutures. Her phenotype included hypertelorism, frontal bossing, exophthalmos, micrognathia, microtia with aural atresia, cleft palate, and limb anomalies. Additional comorbidities included cardiovascular, respiratory, and feeding abnormalities. Genetic testing revealed a novel TWIST1 missense variant (c.423C > G; p.Asp141Glu), not previously reported in population databases or associated with TWIST1-related disease. Due to progressive dysmorphology and worsening orbital proptosis, early strip craniectomy was performed to permit brain-driven anterior vault expansion. At 8.8 months, PVDO with virtual surgical planning was performed to improve intracranial volume and cranial morphology. The postoperative course was complicated by respiratory failure, cardiac arrest, intracranial abscess, and pseudomeningocele requiring surgical management. This case highlights the expanding genotypic and phenotypic variability associated with TWIST1 alterations. It emphasizes the need for ongoing genetic investigation to delineate pathogenic variants, improve prognostication, and refine surgical planning in complex craniosynostosis.
The "physical activity health paradox" posits that physical activity done during work (occupational physical activity [OPA]) may not yield the health benefits consistently observed for leisure-time physical activity (LTPA) and, in some cases, may be harmful. Given the broad implications for such a paradox, which contradicts current public health guidelines for physical activity, we conducted a narrative, non-systematic review to discuss the current epidemiological and mechanistic evidence on the topic to inform opportunities for research and practice moving forward. Epidemiological evidence shows that LTPA is reliably protective against mortality and cardiovascular disease, whereas OPA has mixed or adverse associations. Several recent meta-analyses found higher all-cause mortality risk among men with high vs low OPA and found LTPA to potentially mitigate this OPA risk. Studies with device-measured OPA further highlight potential heterogeneity by OPA task and context. These conclusions remain limited by low quality evidence due to heterogeneous OPA exposure measurements, referent group selection, challenges in study design, and varied confounder adjustments. Mechanistically, four interrelated pathways that may explain the observed presence of a paradox have been proposed and preliminarily tested: (1) acute cardiovascular strain catalyzed by long-duration OPA with little recovery; (2) downstream vascular changes such as greater arterial stiffness, blunted baroreflex sensitivity, and maladaptive cardiac remodeling from chronic OPA exposure; (3) systemic inflammation associated with high OPA levels; and (4) modifiers such as low cardiorespiratory fitness and high psychosocial stress amplifying strain, inflammation, and risk. Current evidence is limited by reliance on cross-sectional or between-subject designs, crude OPA classification, and limited mechanistic interventions. Unlike the clear benefits from LTPA, research findings examining the health effects of OPA remain mixed. While uncertainty remains, the balance of evidence suggests that OPA is less beneficial to health than LTPA which should be considered in public health messaging. Advancing the field will require multidimensional OPA exposure assessment, rigorous study designs, and evaluation of mechanism-driven outcomes to clarify causal pathways and identify feasible intervention targets to promote health in workers with physically demanding jobs.
Understanding how emotional processes arise from interactions between the brain and heart is crucial for advancing integrated approaches to cardiovascular and mental health. Wearable technologies offer new opportunities to objectively evaluate this heart - brain relationship in real time. This narrative review examines studies evaluating emotional states using smart wearable devices used in cardiology. A literature search was conducted across PubMed, Web of Science, Cochrane Library, and Scopus, focusing on the past decade. From 2205 identified records, 9 studies were included. Both single-parameter (e.g. heart rate variability) and multi-parameter devices were analyzed to determine their effectiveness in detecting emotional states and supporting holistic cardiac health management. Wearable devices represent a promising tool for linking emotional and cardiovascular dynamics, with single-parameter systems currently offering more reliable signal interpretation. Further research is needed to refine multi-parameter integration and enhance personalized, emotion-informed cardiac care.
Interest in ayahuasca and its main component, N,N-Dimethyltryptamine (DMT), has currently moved from historical and experimental use into modern clinical development. Yet, current evidence is fragmented, and systematic mapping of trial methods and design choices remains limited. We therefore systematically examined registered interventional trials of DMT, ayahuasca, and DMT combined with harmine on ClinicalTrials.gov, identifying 26 eligible trial registers for review. We extracted and harmonized trial characteristics, participant eligibility and enrollment patterns, design features, administration routes, and registered outcomes, and linked completed registrations to associated publications. The registry landscape expanded after 2020-2021 and was dominated by early-stage development, with most trials in phase I and more than half listed as completed at the time of extraction. Trials were primarily DMT-only and most often sponsored by academic or hospital institutions. Eligibility criteria were conservative, emphasizing medically and psychiatrically healthy adult cohorts and extensive cardiovascular and psychiatric exclusions. Accordingly, primary outcomes prioritized acute safety and physiological monitoring, alongside structured characterization of the subjective and altered-states profile, while disorder-specific symptom endpoints were less commonly prioritized as primary objectives. Publications linked to included trials largely reflect this early-stage focus, describing controlled administration, tolerability limits, route and formulation refinement, and initial mechanistic readouts. A smaller set of publications from depression-focused trials provides preliminary evidence of potential clinical effects, supporting further controlled replication and broader disorder-focused development. Overall, registered trials indicate an active and maturing field that has generated foundational safety and regimen knowledge, but remains constrained by a limited number of indication-specific programs beyond depression.
Apart from observational studies, anecdotal reports can offer evidence that an event is causally linked to one or more drugs and then could contribute to a better assessment of a drug's benefit-risk ratio. These reports based on temporality and dechallenge/rechallenge data have a real value and help to make safety decision. The aim of our study was to describe the characteristics of positive rechallenge cases of adverse drug reactions (ADRs) reported to the Toulouse Pharmacovigilance Center (TPC), without restricting our analysis to any specific type of ADR or drug class. We described the drug class most commonly involved in the occurrence of serious ADRs following drug rechallenge. Retrospective study using data from the Toulouse Pharmacovigilance Database from 1st January 2022 until 31st December 2024. All cases of vaccines-induced ADRs were excluded. A descriptive analysis was done for demographic data, nature of ADRs and outcome, suspected drugs. Furthermore, the cases reported by the Department of Allergology for patients who underwent allergological investigation following a suspected hypersensitivity reaction were analyzed separately. Among the 8,196 ADR reports, 2,256 cases vaccine-related cases were excluded. Of the remaining 5,940 cases, 325 (5.5%) met the criteria for a positive rechallenge. The median age of patients was 57 years [35-72], mean 53.6 (±22.9) years and the sex ratio was 1.44. The outcome was fatal in three cases. The most drug class (more than 20 fold) involved in positive rechallenge cases was antineoplasic agents (n=105) and immunosuppressants (n=51), drugs of nervous system (n=95), systemic anti-infective agents (n=83), and cardiovascular drugs (n=54). A total of 187 cases concerned positive rechallenge for hypersensitivity reactions after allergological investigations. Case reports containing dechallenge/rechallenge data could be considerable value for improving knowledge to support optimal drug use, particularly in situations where no alternative is available. This preliminary study limited to the data of one pharmacovigilance center could be extended in national level.
Psoriasis is associated with elevated cardiovascular risk, partly mediated through dyslipidemia and the interleukin-23/Th17 inflammatory axis. Interleukin-17A (IL-17A) inhibitors demonstrate superior dermatologic efficacy, but their effects on lipid metabolism remain controversial. Most previous studies analyzed lipid changes at the population level without stratifying by baseline lipid phenotypes. This study aimed to evaluate the phenotype-specific effects of IL-17A inhibitors on lipid profiles and identify risk factors for dyslipidemia in moderate-to-severe plaque psoriasis. This retrospective cohort study included 353 patients with moderate-to-severe plaque psoriasis (body surface area [BSA] ≥ 3%) treated with IL-17A inhibitors (secukinumab or ixekizumab) for one year. Patients were stratified into five mutually exclusive lipid phenotypes according to the 2023 Chinese guidelines for lipid management. Multivariable logistic regression identified independent risk factors for dyslipidemia. Lipid changes were assessed using paired tests with Benjamini-Hochberg false discovery rate (FDR) correction. Sensitivity analyses were performed in the BSA ≥ 10% subgroup (n = 274). Dyslipidemia was present in 72.2% of patients, with mixed dyslipidemia (26.1%) and hypertriglyceridemia (21.2%) being predominant. BMI ≥ 28 kg/m² (OR = 3.35, 95% CI 1.79-6.28, P < 0.001) and male sex (OR = 2.37, 95% CI 1.40-4.01, P = 0.001) were independent risk factors. Phenotype-specific effects were observed: mixed dyslipidemia patients showed significant reductions in TC (0.47 mmol/L), TG (0.46 mmol/L), and LDL-C (0.18 mmol/L) (all FDR-adjusted P ≤ 0.010); hypercholesterolemia patients demonstrated reductions in TC (0.49 mmol/L) and LDL-C (0.43 mmol/L) (both FDR-adjusted P < 0.001). Among 110 patients with baseline LDL-C ≥ 3.4 mmol/L, 31.0% achieved LDL-C < 3.4 mmol/L. Hypertriglyceridemia patients showed no significant changes after FDR adjustment. Isolated low HDL-C patients exhibited modest increases in HDL-C and LDL-C. Normal lipid patients experienced mild increases in TG and LDL-C within normal ranges. Psoriasis Area and Severity Index (PASI) improvement showed no correlation with lipid changes (all FDR-adjusted P > 0.05). Sensitivity analyses confirmed the robustness of all primary findings. IL-17A inhibitors exert heterogeneous, phenotype-dependent effects on lipid metabolism. Patients with elevated baseline cholesterol may derive dual dermatologic and cardiometabolic benefits, while those with normal lipids require monitoring for modest unfavorable changes. These findings support phenotype-guided treatment selection and individualized lipid monitoring strategies.
This study evaluated the performance of three large language models, including ChatGPT-4o, ChatGPT-5, and Gemini 2.5 Flash, on 532 Persian multiple-choice questions from the 2025 Iranian surgical subspecialty board examinations. Questions spanned five domains: Pediatric, Cardiovascular, Vascular and Endovascular, Thoracic, and Plastic & Reconstructive Surgery. Using standardized prompts, we assessed overall accuracy, variation across subspecialties and question types, and the effect of question length. Gemini 2.5 Flash and ChatGPT-5 achieved higher accuracy (73.9% and 73.3%) than ChatGPT-4o (68.2%). Agreement with the official key was substantial for Gemini 2.5 Flash (κ = 0.651) and ChatGPT-5 (κ = 0.642), and moderate to substantial for ChatGPT-4o (κ = 0.575). Model performance was stable across subspecialties, but all three showed lower accuracy on surgical technique questions compared with clinical scenarios or basic science items. Question length did not affect ChatGPT-5 or Gemini 2.5 Flash, while longer stems reduced ChatGPT-4o's performance. These findings indicate that newer LLMs provide measurable improvements in surgical question answering, though lower performance on surgical technique items supports cautious integration and further multimodal development.
Remnant cholesterol (RC) is a known contributor to cardiovascular disease, but its role in gestational diabetes mellitus (GDM) remains insufficiently characterized. To examine the association between first-trimester RC levels and GDM risk, and to quantify the mediating effects of prepregnancy body mass index (BMI) and insulin sensitivity. This prospective cohort study included 877 pregnant women in Southeastern China. RC was calculated from first-trimester fasting lipid profiles. GDM was diagnosed via a 75 g oral glucose tolerance test at 24 to 28 weeks. Binary logistic regression, restricted cubic splines, and serial mediation models were employed for analysis. Among all participants, 160 (18.2%) developed GDM. After full adjustment for confounders, women in the highest quartile of first-trimester RC had a significantly higher risk of GDM (odds ratio = 2.850, 95% CI: 1.679-4.836) compared with those in the lowest quartile. A significant positive dose-response relationship was observed (P for overall < .001). Serial mediation analysis indicated that the association between RC and GDM was partially mediated through the sequential pathway of prepregnancy BMI → Matsuda index, accounting for 13.50% of the total effect. RC also showed modest predictive performance for GDM (area under the curve = 0.673) compared with conventional lipid parameters. Elevated first-trimester RC is independently associated with increased GDM risk. This association is partially mediated by prepregnancy BMI and subsequent insulin resistance. Measuring RC in early pregnancy may improve the identification of women at high risk for GDM.
The association between oral health and frailty has been established. This study aimed to examine the association between masticatory function (assessed by functional tooth units (FTU) and edentulism), and frailty status with mortality risk among frail individuals. Data from National Health and Nutrition Examination Survey (NHANES) and China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Masticatory function was assessed using FTU and edentulism. Frailty was defined using a 49-item and 32-item index in NHANES and CHARLS respectively. Multivariate logistic regression and Cox proportional hazards models, and restricted cubic spline analyses were used to examine associations between mastication, frailty, and mortality. Sensitivity analyses were conducted. The prevalence of frailty was 29.97% and 10.66% in NHANES and CHARLS respectively. Individuals having FTU of 10-12 showed a 24% lower risk of frailty compared to those with FTU of 0-3 in NHANES, and edentulism had 88% higher risk in CHARLS. Among frail participants, higher FTU scores were linked to lower all-cause (HR = 0.73, 95% CI: 0.60-0.89) and cancer-related mortality (HR = 0.51, 95% CI: 0.33-0.80), but not cardiovascular mortality in NHANES, and edentulism had 56% higher mortality in CHARLS. The association between FTU and frailty was linear, subgroups and sensitivity analyses confirmed robustness. Better masticatory function, as indicated by higher FTU, is associated with lower frailty prevalence and improved survival among frail individuals, while edentulism linked to higher prevalence and mortality. These findings emphasize the importance of maintaining functional dentition and oral rehabilitation in geriatric care.
Arterial stiffness is a key marker of vascular aging. We compared the prognostic performance of brachial-ankle pulse wave velocity (baPWV) and estimated PWV (ePWV) for major adverse cardiovascular events (MACE). We retrospectively analyzed adults aged 40-75 years who underwent baPWV at a tertiary center (n = 9521). ePWV was computed from age and mean blood pressure. The primary endpoint was MACE (cardiac death, non-fatal myocardial infarction, coronary revascularization, non-fatal ischemic stroke). During a median follow-up of 3.77 years, 271 MACEs occurred (2.8%). Multivariable Cox regression models showed that higher arterial stiffness by both baPWV and ePWV was independently associated with increased MACE risk (P < 0.05 for each). Consistently, baPWV identified stepwise increases in risk from lower to higher categories and produced larger effect estimates. However, ePWV retained independent prognostic value but with a weaker gradient. With dichotomized cutoffs, C-index values were similar for baPWV and ePWV (0.736 vs. 0.728; P = 0.323). When participants were stratified into tertiles, baPWV showed superior discrimination, yielding a higher C-index than ePWV (0.755 vs. 0.729; P = 0.033) and clearer separation of Kaplan-Meier curves across risk strata. These findings indicate that both measures add information beyond traditional risk factors, but baPWV provides stronger risk stratification, particularly when risk is partitioned into multiple levels. ePWV remains a practical alternative in settings where device-based testing is not feasible.