Background: There is a lack of evidence on association between gender specific differences in obesity and cardiovascular risk after isolated surgical aortic valve replacement (AVR) and its impact on outcomes and long-term survival. The aim of this study was to assess the impact of obesity on perioperative outcomes and long-term survival after isolated AVR.
Methods: In this retrospective, single-centre study, we included all patients who underwent isolated AVR between April 2000 and December 2019 from the cardiac surgery database of the Southampton General Hospital (Patient Administration System, e-CAMIS, Yeadon, Leeds, UK). Patients with infective endocarditis, re-sternotomy, other concomitant cardiac procedures, homografts, autografts and emergency operations were excluded. Univariable regression analysis was performed to identify predictors of in-hospital mortality. Hazard ratios were calculated using a Cox proportional hazards model.
Results: Total of 2,398 patients were included in the study and two groups of patients were compared: body mass index (BMI) 25-34.9 kg/m2 (n=2,000) and BMI ≥35 kg/m2 (n=398) based on sensitivity modelling. Actuarial survival was comparable across BMI groups at 12.5and 12.7 years for BMI 25-34.9 kg/m2 and BMI ≥35 kg/m2, respectively (P=0.75 log-rank). Long-term survival was specifically worse for patients with high BMI and composite cardiovascular risk of hypertension, diabetes mellitus, and current smoking [hazard ratio (HR) 1.93, 95% confidence interval (CI): 1.45-2.58, P<0.001] and patients with moderate-to-severe patient prosthesis mismatch (PPM) (effective orifice areas index ≤0.85 cm2/m2) (HR 1.17 95% CI: 0.98-1.39, P=0.08). Median survival time for females was 11.5 years [interquartile range (IQR): 10.3-12.3 years] versus 14.2 years (IQR: 12.7-15.7 years) for males (log-rank P=0.006), although gender was not a significant predictor of long-term survival after adjusting for covariates. Moderate-severe PPM was associated with significantly worse survival in females (log-rank P<0.01), compared to males for whom this difference was not significant (log-rank P=0.21).
Conclusions: Obesity with composite risk factors (hypertension, diabetes mellitus and active smoking) is associated with adverse survival. We did not observe gender-specific differences in long-term survival among specific BMI groups of patients.
Background: In intensive care units (ICUs), managing septic shock requires maintaining adequate tissue perfusion with vasopressors, most commonly norepinephrine, while avoiding under or over-dosing that can worsen hypotension, organ injury, and adverse effects. Bedside vasopressor titration often depends on clinician judgment and simple rules, with limited tools providing individualized, time-aware guidance or early warning of impending hypotension. ChronoSynthNet aimed to create a data-driven model that learns from routine electronic health record (EHR) time-series data to personalize vasopressor therapy and anticipate deterioration. To develop and validate a dual-task deep learning model that predicts real-time norepinephrine requirements and detects hypotension early in adults with septic shock.
Methods: We performed a retrospective cohort analysis using the Medical Information Mart for Intensive Care [MIMIC-IV (2008-2019)] database. Eligible adult ICU stays met Sepsis-3 criteria, received norepinephrine, and had adequate time-series data. ChronoSynthNet integrates a shared Transformer encoder, long short-term memory (LSTM) layers, and a dynamic feature-weighting network to learn cross-variable and temporal relationships. The dataset was split 80/20 into training and internal test sets, with five-fold cross-validation on training data. Classification performance for early hypotension detection was assessed using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), precision, recall, and specificity; norepinephrine rate prediction performance was assessed using mean squared error (MSE). Ninety-five percent confidence intervals (95% CIs) were calculated for AUROC, recall, and specificity on the internal test set using bootstrap and Wilson methods.
Results: ChronoSynthNet achieved AUROC of 0.89 (95% CI: 0.836-0.938) for hypotension classification and MSE of 0.0213 (95% CI: 0.0192-0.0234) for predicting the norepinephrine infusion rate. The model demonstrated high specificity (97%, 95% CI: 96.3-98.3%) and precision (92%, 95% CI: 90.3-93.7%), with a recall of 74% (95% CI: 71.3-76.7%). Hypotension events were predicted a median of 3.5 hours in advance.
Conclusions: ChronoSynthNet demonstrated strong performance in early hypotension detection and norepinephrine dose forecasting in ICU patients with septic shock. These findings support its potential role in aiding real-time vasopressor titration and early recognition of hemodynamic instability; prospective multicenter validation is needed before clinical deployment.
Background: Vascular calcification (VC) is a common high-risk factor for cardiovascular disease and is mainly caused by the deposition of calcium (Ca2+), phosphorus, and other minerals on the walls of arteries and veins; however, its specific pathogenic mechanism is still unclear. The aim of the present study was to explore the effect of large-conductance calcium and voltage-activated potassium (BK) channels in regulating VC.
Methods: In this study, primary vascular smooth muscle cells (VSMCs) isolated from the rat or murine thoracic aorta were treated with calcifying media and NS1619 and 3-methyladenine (3-MA) and divided into the following five groups: (I) the control group; (II) the control + NS1619 group; (III) the calcify group; (IV) the calcify + NS1619 group; (V) the calcify + NS1619+3-MA group. Twelve male C57BL/6 mice (20-25 g) were treated with vitamin D and NS1619 and divided into the following four groups: (I) the control group; (II) the vitamin D model group; (III) the vitamin D +5 mg/kg NS1619 group; and (IV) the vitamin D +10 mg/kg NS1619 group. Gene expression, protein expression and the size and concentration of MVs were tested by quantitative polymerase chain reaction (qPCR), Western blot (WB), immunohistochemistry and nanoparticle tracking analysis (NTA), respectively.
Results: We found that BK channels regulate VC. BK channel downregulation was observed in samples from animal and cell models of VC. Both the application of the BK channel agonist NS1619 and BK overexpression modulated the expression of Runt-related transcription factor 2 (Runx2) and alpha-smooth muscle actin (α-SMA) by suppressing matrix vesicles (MVs) formation and secretion, consequently improving VC in VSMCs. However, intervention with the autophagy inhibitor 3-MA appeared to regulate the secretion of MVs and simultaneously weakened the therapeutic effect of NS1619 on calcification.
Conclusions: Although our experimental sample size is small, we still speculate that BK channel agonists might inhibit the secretion of MVs by activating autophagy, thereby alleviating VC. BK channels may be applied in clinical practice and become a potential target for treating VC.
Background: The safety of administering vasopressors through peripheral venous catheters (PVCs) remains controversial, primarily due to concerns regarding extravasation, thrombosis, and catheter-related infections. This study aimed to systematically summarize the prevalence of these complications through a meta-analysis.
Methods: The PubMed, Excerpta Medical Database (Embase), Cochrane Library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Wanfang (WF), Chinese Science and Technology Journal Database (VIP), and China Biology Medicine disc (CBMdisc) databases were systematically searched (from database establishment 16 August 2025) to retrieve pertinent articles, and study quality was rated via the Joanna Briggs Institute (JBI) scale and Newcastle-Ottawa Scale (NOS). The data analysis was conducted using the meta package in R, and random/fixed-effects models were applied to combine the complication rates based on heterogeneity. Sensitivity and subgroup analyses were also carried out.
Results: A total of 19 studies comprising 6,852 patients across 10 counties, including Sweden, the USA, and China, were encompassed in the meta-analysis, with the majority being intensive care unit (ICU) patients. The overall rates of extravasation, thrombosis, and infection were 1.43% [95% confidence interval (CI): 0.72-2.32%; I2=71%], 1.47% (95% CI: 0.32-3.18%; I2=86%), and 0.72% (95% CI: 0.14-1.60%; I2=63%), respectively. The subgroup analysis peripherally inserted central catheters (PICCs) carried a higher risk of thrombosis, while midline catheters (MCs) had the lowest risk of extravasation. In relation to the catheter-related infection risks, PVCs showed the lowest incidence, whereas PICCs had the highest. Limited direct comparative evidence indicated no statistically significant differences between PVCs and central venous catheters (CVCs).
Conclusions: Under standardized procedures, PVCs may be a viable option for vasopressor infusion, particularly MCs, which showed the lowest risk of extravasation. Caution is warranted with PICCs due to the potential risk of thrombosis, while traditional PVCs should be limited to short-term or emergency use. Future well-designed studies with standardized definitions are needed to strengthen the reliability and clinical applicability of the evidence.
Background: Hemoptysis is a prevalent symptom among patients with respiratory diseases, and those experiencing hemoptysis from non-bronchial artery sources are particularly susceptible to recurrence following treatment. This study aimed to evaluate the therapeutic effect of angiogram computed tomography (Angio-CT) on bronchial artery embolization (BAE) in patients with non-bronchial systemic arteries (NBSA).
Methods: This retrospective study included a total of 100 patients experiencing hemoptysis due to various etiologies between January 2020 and June 2024 in Huazhong University of Science and Technology Tongji Medical College Affiliated Union Hospital. The patients were divided into two groups: BAE treatment combined with Angio-CT group (n=60); Conventional BAE treatment group (n=40). A total of 26 and 14 patients in each group experienced hemoptysis attributed to NBSA. Clinical data were recorded, including age, gender, volume of hemoptysis, etc. Hemoptysis-free survival and overall survival were illustrated using Kaplan-Meier curves. The log-rank test was used to assess the differences in hemoptysis-free survival and overall survival between the two groups.
Results: Technical success was achieved in all patients. There were no statistical differences in clinical success rate (90.0% vs. 91.7%, P=0.78). The difference in recurrence rates between the two patient groups is statistically significant (11.7% vs. 27.5%, P=0.04). And among patients with NBSA, the Angio-CT group exhibited a higher recurrence rate without hemoptysis compared to the traditional BAE group (P=0.04). In contrast, there was no significant difference in recurrence rates between the two groups of patients without NBSA (P=0.68).
Conclusions: The application of Angio-CT in guiding the treatment of NBSA-related hemoptysis offers superior clinical outcomes compared to conventional approaches. These findings could provide valuable evidence for refining therapeutic strategies, ultimately improving patient management in hemoptysis cases.
Background and objective: Atrial fibrillation (AF) is an independent risk factor for ischemic stroke and systemic thromboembolism. Oral anticoagulation (OAC) effectively reduces stroke risk but also increases bleeding risk. Current clinical risk scores for bleeding in AF patients have only modest predictive ability and overlapping stroke and bleeding risk factors complicate treatment decisions. This narrative review aims to review and evaluate current evidence on biomarkers that can predict bleeding risk in AF patients on OAC and assess their integration into risk-scoring systems to guide more personalised clinical decision-making.
Methods: This narrative review summarises data from major clinical trials and cohort studies evaluating bleeding-related biomarkers in AF patients on OAC, including growth differentiation factor 15 (GDF-15), high-sensitivity cardiac troponin (hs-cTn), N-terminal prohormone-brain natriuretic peptide (NT-pro-BNP), interleukin-6 (IL-6), von Willebrand factor (vWF), cystatin C, and D-dimer. The prognostic value of these biomarkers, their role in risk scores (e.g., ABC-bleeding), and their ability to improve predictive accuracy were examined.
Key content and findings: In recent years, several biomarkers have shown promise in predicting bleeding risk in patients with AF on OAC. GDF-15 has consistently emerged as a strong independent marker of significant bleeding and mortality, validated in trials such as Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY), Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE), and Edoxaban Versus Warfarin in Patients with Atrial Fibrillation trial (ENGAGE AF-TIMI 48). hs-cTn and D-dimer levels are also independently associated with an increased bleeding risk and have been included in the ABC-bleeding score, which has shown superior predictive ability compared to traditional scores, such as HAS-BLED. Biomarkers such as cystatin C, which reflects renal dysfunction, vWF, and IL-6 have demonstrated associations with adverse outcomes, although their predictive abilities vary. The inclusion of these biomarkers in clinical tools has improved bleeding risk prediction. Although trials and cost-effectiveness models suggest clinical benefit, further real-world validation is required to confirm their place in everyday clinical practice.
Conclusions: Several biomarkers have demonstrated the ability to predict bleeding risk in patients with AF. Risk-scoring systems that incorporate biomarkers have improved the prediction of bleeding events. More accurate identification of patients at higher risk of bleeding allows clinicians and patients to better balance the risks of bleeding versus stroke in the setting of AF and create individualised care plans to lower the overall rate of both stroke and bleeding.
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