(1) Background: The left atrioventricular coupling index (LACI) is a novel parameter for evaluating cardiac function. This study focused on its association with major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients. (2) Methods: A retrospective cohort of AMI patients from Peking University First Hospital was enrolled. All underwent transthoracic echocardiography on admission for LACI measurement. The primary endpoint was MACE (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death). (3) Results: Among 843 AMI patients (62.07 ± 12.24 years, 77.94% male), the median LACI was 0.24 (IQR 0.18–0.33). During a median follow-up of 4.31 years, 151 patients (17.91%) developed MACE. The optimal LACI cutoff for risk stratification was 0.257. After multivariable adjustment, each standard deviation increase in LACI was associated with significantly elevated risks of MACE (HR 1.17, 95% CI 1.02–1.34), all-cause death (HR 1.19, 95% CI 1.05–1.35), cardiovascular death (HR 1.33, 95% CI 1.10–1.61), and stroke (HR 1.23, 95% CI 1.05–1.43). (4) Conclusions: LACI is an independent predictor of poor prognosis in AMI patients and may serve as a valuable tool for risk stratification in secondary prevention.

Background:The original BAMA randomized trial showed that a mobile app-based self-management digital therapeutics (DTx) intervention improved medication adherence and cardiovascular risk-factor control at 12 months in patients with coronary heart disease (CHD). Whether these early benefits are associated with favorable long-term outcomes-a potential legacy effect-remains uncertain. Methods:The BAMA pilot trial was a parallel-group, open-label, single-center randomized controlled trial in which 300 patients with CHD were assigned 1:1 to regular follow-up with or without DTx. The present study was a 12-month landmark post-trial analysis with follow-up through June 2025, corresponding to up to 8 years after randomization. Participants in the landmark cohort were analyzed according to original randomized assignment. Cox models evaluated all-cause and cardiovascular mortality, with Firth penalized Cox regression as a sparse-event sensitivity analysis. Longitudinal lipid trajectories were assessed using linear mixed-effects models based on actual measurement timing. Results:Among 290 participants who completed the 12-month visit, 289 had ascertainable post-landmark follow-up. During a median post-trial follow-up of 7.1 years, 22 participants died, including 13 from cardiovascular causes. After adjustment for baseline age and sex, original DTx assignment was associated with lower all-cause mortality (hazard ratio [HR], 0.38; 95% CI, 0.15-0.98; P=.045) and cardiovascular mortality (HR, 0.19; 95% CI, 0.04-0.87; P=.032). Firth penalized analyses yielded directionally consistent results. No significant group-by-time interactions were observed for total cholesterol, triglycerides, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol. Conclusions:Original DTx assignment was associated with lower post-landmark all-cause and cardiovascular mortality despite broadly comparable longitudinal lipid trajectories. These findings may be consistent with a potential legacy effect and warrant confirmation in larger prospective studies.

SGLT2 inhibitors (SGLT2is) improve outcomes in patients with heart failure (HF), but their effects may depend on background medical therapy. The Heart Failure Collaboratory score, which incorporates medication type and dose, may modify the benefit of SGLT2is. To evaluate the association between the scoring system and the mortality benefit of SGLT2 inhibitors in patients with heart failure. This retrospective multicenter cohort study used real-world data from the Chinese Cardiovascular Association Database–HF Center (HFC) Registry. 52 hospitals were selected with 26 HFCs and 26 NHFCs. Patients with a diagnosis of HF and one-year follow-up from July 1, 2022, to March 31, 2023, were included. The primary outcome was one-year all-cause mortality. Cox regression and multivariable fractional polynomial interaction (MFPI) models were used to assess the effect of SGLT2is on mortality risk across Heart Failure Collaboratory scores. A total of 4,077 patients (median age 70.0 years; 60.1

Background Artificial light at night (LAN) pollution is a growing public health concern. However, there has been limited epidemiological research on the LAN-lung cancer mortality links. Evidence from large cohorts and causal inference approaches is far more limited. Methods We included 476,328 individuals from 35 randomly selected communities in southern China. A satellite-based approach was used to assess LAN exposure, which was assigned to participants based on their home address. The LAN-lung cancer mortality connections were investigated using marginal structural Cox proportional hazards regression models with inverse probability weightings. The modification effects of sociodemographics on the above relationships were also assessed. Results During a median follow-up of 9.0 years, the incidence of lung cancer mortality was 6.43 per 10,000 person-years. We found a hazard ratio (HR) of 1.055 [95 ​% confidence interval (CI): 1.010–1.102] for lung cancer mortality following each 10 ​nW/cm2/sr increase in long-term LAN exposure. Further stratified analyses revealed that those <65 years, males, and those with primary school and below were more vulnerable to LAN exposure. The LAN-lung cancer mortality relationship was significant in those <65 years (HR ​= ​1.132, 95 %CI: 1.047–1.224) but not in those ≥65 years (HR ​= ​1.041, 95 %CI: 0.984–1.101). The HR for male participants was 1.105 (95 %CI: 1.044–1.169), while the HR for females was 1.033 (95 %CI: 0.958–1.113). A significant positive association was observed only among those with primary school and below. Discussion This large cohort study suggests that long-term LAN exposure was linked to increased lung cancer mortality, particularly in certain vulnerable populations.

Cardiovascular disease (CVD) is a leading threat to long-term health in cancer survivors. This study aimed to evaluate whether integrating genetic risk with the composite cardiovascular health metric, the Life's Essential 8 (LE8) score, can improve primary prevention and guide personalized survivorship care in this population. We conducted a retrospective cohort study including 21,751 cancer survivors and 87,004 matched non-cancer controls from the UK Biobank. For each participant, a LE8 score, encompassing eight CVD-related factors (diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose, and non-high-density lipoprotein cholesterol), and a polygenic risk score (PRS) for coronary artery disease (CAD) were calculated. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident risk of CAD across LE8 (or individual LE8 components) and PRS levels and to examine their potential interactions. A higher LE8 score and a lower PRS were independently associated with reduced CAD risk in cancer survivors. Participants with a high LE8 score and low PRS had the lowest CAD risk (HR 0.22; 95% CI, 0.09 0.53) when compared with those with a low LE8 score and high PRS. Similar patterns were observed in matched controls who had a lower CAD incidence rate. Associations between optimal blood lipid levels (as defined in the LE8 score) seemed to be more pronounced in individuals with high PRS, although it did not reach statistical significance among cancer survivors (p for interaction with PRS = 0.14 and 0.011, respectively, in cancer survivors and matched controls). Subgroup analyses showed consistent associations between LE8 score and CAD risk in breast, prostate, colorectal, and malignant skin cancer survivors, but not in those with lymphoma or hematologic malignancies. Furthermore, the association between LE8 score and CAD risk was stronger 5-10 years after cancer diagnosis and among younger cancer survivors aged under 55 years. Both a higher LE8 score and lower PRS for CAD were independently associated with substantially reduced risk of incident CAD.

Breast cancer is the most common malignancy in women. Ultrasound plays a critical role in dense breasts, and BI-RADS provides a standardized framework for lesion assessment. However, conventional reports may suffer from variability. Deep learning and large language models (LLMs) show promise in automated report generation. We propose a workflow integrating deep learning with GPT-4o for structured breast ultrasound reports. We retrospectively collected 2,243 ultrasound images from 362 patients (BI-RADS 4B, 4C, 5; 2019–2024). The proposed BreastViT model, a VisionEncoderDecoderModel (pretrained: nlpconnect/vit-gpt2-image-captioning), was compared against three baseline architectures: CNN-Transformer (R2Gen), CNN-Attention-LSTM, and CNN-RNN. Generated texts were refined by GPT-4o for language optimization and terminology standardization. An external validation set (49 cases, Oct–Dec 2024) compared three outputs: GPT-4o alone, BreastViT outputs, and BreastViT + GPT-4o. Internally, BreastViT achieved a best BLEU of 0.9187 and loss of 0.1277. GPT-4o refinement markedly improved fluency and structure. In external validation, GPT-4o alone produced natural language but occasional image inconsistencies; BreastViT outputs captured key findings but lacked structure; the combined approach yielded the best accuracy, completeness, and terminological consistency. In blinded radiologist evaluation, the BreastViT + GPT-4o reports were rated highest for structural integrity and terminology standardization. In the external validation, a blinded evaluation was conducted by three senior radiologists. The intraclass correlation coefficient (ICC) demonstrated excellent inter-rater reliability (ICC = 0.8808; 95

BACKGROUND:Nasopharyngeal carcinoma (NPC) is a prevalent malignant tumor in East Asia, particularly impacting China. The association between multiple constituents of fine particulate matter (PM2.5) and the survival time of NPC patients remains unclear, which poses a challenge for targeted public health interventions. METHODS:An accelerated failure-time model with a 12-year cohort design was used to analyze the impact of long-term PM2.5 and its constituents on the survival time of 1492 NPC patients. Restricted cubic splines (RCS) functions and stratification analyses were conducted to identify the exposure-response curve and vulnerable subgroups, respectively. RESULTS:PM2.5 and its constituents were significantly associated with reduced survival time in NPC patients. For per interquartile range (IQR) increase in concentrations, the time ratio changing percentage (TRCP) ranged from -28.8 % to -33.6 % for PM2.5, -34.7 % to -39.6 % for black carbon (BC), -13.6 % to -17.4 % for nitrate (NO3-), -21.9 % to -26.6 % for ammonium (NH4+), -29.5 % to -35.5 % for organic matter (OM), and -31.5 % to -36.2 % for sulfate (SO42-). The exposure-response relationship exhibited a nonlinear trend, with a steep slope at lower concentrations. Furthermore, females, patients with lower monocyte levels, and those with a drinking history faced a higher risk of reduced survival time. CONCLUSIONS:The study reveals the urgent need for environmental regulations to mitigate PM2.5 and its constituents, particularly BC. The evidence of accelerated loss of survivorship is crucial for establishing air quality guidelines concerning PM constituents and formulating public health interventions and protective measures for high-risk NPC patients.

Background: This study investigated the value of trimethylamine oxide (TMAO) and its precursors in secondary prevention for patients with acute myocardial infarction (AMI). Methods: We retrospectively enrolled patients diagnosed with AMI. The associations of TMAO and its precursors with endpoint events were estimated by Cox proportional hazards models. Results: During a median follow-up of 6.4 years, 319 (32.0%) major adverse cardiovascular event (MACE) occurred in the 996 patients enrolled. After adjusting for traditional risk factors, the risk of MACE, cardiac death, and recurrent MI increased by 28% (HR 1.28, 95% CI 1.10-1.49), 44% (HR 1.44, 95% CI 1.12-1.84), and 27% (HR 1.27, 95% CI 1.04-1.55), respectively, per one increment in ln-transformed TMAO. After adjustment for the levels of its precursors, the relationship between TMAO and MACE was still significant. Choline was associated with MACEs, all-cause mortality, cardiac death, and risk of recurrent MI after adjusting for the levels of the remaining metabolites, in addition to traditional risk factors. The overall ability to predict all-cause mortality was better for the choline model than for the TMAO model (continuous NRI 0.185, p = 0.007; IDI 0.030, p = 0.020). Mediation effect analysis showed that the mediating effect of TMAO on choline and the risk of all-cause mortality was 11.39% (95% CI 0.0209-0.2200, p = 0.016), suggesting the existence of a choline activity pathway that is independent of the TMAO pathway. Conclusions: TMAO and choline were associated with an increased risk of MACE in patients with AMI, and choline had better predictive power.

Background Wearables satisfactorily detect atrial fibrillation (AF) longer than 1 hour. Our study aims to evaluate smartwatch performances for long-term AF monitoring, including AF with short durations. Methods This prospective study enrolled AF patients from 2020 to 2023. Diagnostic efficacy of the Amazfit smartwatch, with AF-identifying algorithms from photoplethysmography (PPG) and single-lead electrocardiogram (ECG), was compared with a 7-day Holter. Primary analysis included smartwatch diagnostics to identify AF longer than 5 minutes. Secondary analyses evaluated smartwatch performances under different settings and compared AF burdens between the smartwatch and Holter. Results The study analyzed 72 patients (48 males, mean age 65.4 ± 8.5) with 914 AF episodes lasting 834.7 hours, including 142 longer-than-5-minute AF episodes. Smartwatch recording time was 8927.6 hours. By individual, sensitivities and specificities of AF longer than 5 minutes were 100.0% and 83.7% for PPG and 89.7% and 67.4% for the ECG algorithm. Positive and negative predictive values were 94.9% and 99.9% for PPG and 77.6% and 99.8% for ECG. Optimal AF durations to be identified by PPG and ECG algorithms were 1.358 and 16.708 minutes. Smartwatch performances varied across AF durations and between day-time and night-time. Strong correlations (PPG: ρ = 0.877; ECG: ρ = 0.769) and excellent agreements (PPG: ICC = 0.976; ECG: ICC = 0.927) were found between AF burdens calculated from smartwatch and Holter. Conclusions Compared with long-term Holter, the wearable smartwatch had satisfying qualitative and quantitative diagnostic performances for continuous AF monitoring. Susceptibility to false positives led to modest specificity. Smartwatch performances were affected by AF durations and time periods. Registration ChiCTR2000040035.

How the shape characterization of the concentration-response relationships between particulate matter (PM) and all-cause mortality influences life expectancy (LE) gains remains unclear. Based on the Pearl River Cohort, the 2021 World Health Organization air quality guidelines, and an integrated comparative risk assessment framework, we identified sigmodal relationships between PM2.5, all-cause mortality, and LE reduction. A 10-unit increase in PM2.5 was associated with an excess mortality risk of 31.2% (95% uncertainty interval: 27.6-35.0%). Reducing PM2.5 to the guideline threshold of 5 mu g/m3 could prevent 0.193 (0.175-0.212) million deaths, contributing to a 4.07-year (3.60-4.52) average LE gain. In contrast, PM2.5 reductions by 5.6% and 10% resulted in smaller LE gains of 0.33 (0.28-0.38) and 0.58 (0.49-0.67) years, respectively. These findings highlight the importance of accounting for the nonlinear relationship in air pollution control and provide essential incentives for tailoring sustainable plans to enhance population longevity.

Breast cancer is the most common malignant tumor in women; breast ultrasound is crucial for its diagnosis, but its accuracy and standardization (especially in BI-RADS application) are operator-dependent. Peking University Third Hospital faced challenges related to suboptimal ultrasound reporting compliance and excessively high positive predictive value (PPV) of BI-RADS 4 A lesions. This study aimed to evaluate the effectiveness of the Plan-Do-Check-Act (PDCA) cycle as a management tool in postgraduate medical education to bridge this skill gap. A retrospective study was conducted in a multi-campus academic institution. Throughout 2024, an educational intervention based on the PDCA cycle was implemented. Key educational outcome metrics, including BI-RADS categorization rate, reporting compliance rate, ultrasonographic-pathologic concordance rate, and PPV, were compared between the pre-PDCA and post-PDCA groups. The reporting compliance rate significantly increased from 87.18

Noonan syndrome with multiple lentigines (NSML) is a rare autosomal dominant disorder, primarily caused by variants in the PTPN11 gene. Characterized by multiple lentigines, hypertelorism, short stature, and hearing loss, its common cardiac manifestations include pulmonary stenosis, hypertrophic cardiomyopathy (HCM), atrial septal defect, and left-sided heart lesions. We report a 58-year-old female diagnosed with NSML presenting with bilateral atrial and ventricular chamber enlargement and atrial fibrillation, which are uncommon cardiac phenotypes of NSML.

Treatment effects of anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in coronary artery disease (CAD) had conflicting results. The study aims to evaluate efficacy and safety outcomes of treatments inhibiting this pathway. Cochrane Library, Embase, Pubmed, and ClinicalTrials.gov were searched for randomized controlled trials evaluating therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in CAD patients. Relative risks (RR) with 95

Fine particulate matter (PM2.5) pollution threatens urban sustainability. Few cohort studies have assessed hypertension risks linked to lagged and cumulative exposure to PM2.5 components. Using data from a cohort study of 36,271 individuals in South China (2015-2020), we examined the individual associations between timevarying PM2.5 and six components (NO3- , SO42- , BC, CL-, NH4+, and OM) with hypertension hospitalization through Cox proportional hazards regression. Mixed associations of simultaneous exposure to these components were analyzed at lag 0, lag 1, lag 2, lag 0-1, and lag 0-2 years using quantile-based g-computation models. Individual-effect analysis revealed strong associations, with each quantile increase in CL-, NH4+, SO42- , and NO3 linked to 17 %-32 % higher hypertension risks across different time windows. Co-exposure to PM2.5 components at different lag times increased hospital admissions for overall hypertension, with hazard ratios (95 % confidence intervals) of 1.151 (1.136-1.166), 1.221 (1.205-1.238), 1.257 (1.241-1.273), 1.087 (1.073-1.101), and 1.197 (1.182-1.212). Secondary water-soluble ions (NO3- , SO42- , NH4+, CL-) were major contributors. Increased susceptibility was observed among those under 45, men, individuals with lower education, unhealthy weight, or limited green space exposure. These findings highlight the lagged and cumulative impacts of simultaneous exposure to PM2.5 component on hypertension.

ObjectivesTo analyze the global stroke burden attributable to household air pollution (HAP) using Global Burden of Disease (GBD) 2021 data, examine its spatiotemporal patterns from 1990-2021, and project future trends through 2040.Study designRetrospective analysis using GBD data with future projections.MethodsAnalysis of age-standardized rates, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to HAP-related stroke across 204 countries. The linear regression model examined global time trends. Cluster analysis investigated the patterns of disease burden changes across GBD regions. The Nordpred model projected trends up to 2040.ResultsIn 2021, HAP caused 1.23 million stroke deaths and 26.78 million DALYs globally. From 1990-2021, age-standardized death rates (EAPC = -0.37), DALY rates (EAPC = -0.20), and YLL rates (EAPC = -0.30) decreased, while YLD rates increased (EAPC = 1.11). Males showed a higher burden than females, with peak rates in the 80-84 age group. Middle-SDI regions had the highest age-standardized rates, with East Asia recording the largest absolute numbers. South and East Asia showed significant increases, while Western Europe, Eastern Europe, and High-income North America showed the greatest declines. Predictions using the Nordpred model indicated rising absolute numbers of deaths (to 1.79 million), DALYs (to 34.76 million), YLDs (to 3.29 million), and YLLs (to 31.39 million), with males consistently bearing a higher burden, though ASRs are expected to decline for both sexes.ConclusionsOur findings suggest that regions with higher economic development and greater adoption of clean energy are associated with lower HAP-related stroke burden, possibly through improvements in indoor air quality. The observed regional and gender disparities emphasize the need for targeted interventions, particularly in less developed regions and among high-risk groups such as men and older adults.

While studies reported the impact of particulate matter (PM2.5) on lung cancer mortality, evidence for PM2.5 constituents remains limited. We collected data from a cohort of 182,009 participants enrolled during 2013-2015 until 2020 in Guangzhou, China. We explored the impact of individual PM2.5 constituents on lung cancer mortality using marginal structural Cox proportional hazard models, an established causal inference approach, and evaluated their joint effect using quantile-based g-computation. Results were stratified by demographics and lifestyle behaviors. We observed significant associations between PM2.5 constituents and lung cancer mortality, with hazard ratios (HRs) of 1.967 (95 % confidence interval: 1.410-2.744) per interquartile range increase in ammonium (NH4+) concentration, 1.633 (1.327-2.010) for nitrate (NO3-), 1.622 (1.173-2.241) for black carbon (BC), and 1.539 (1.202-1.970) for organic matters (OM). The HR of lung cancer mortality following each decile increase across all 6 PM2.5 constituents was 1.435 (1.347-1.523), with NH4+ contributing 35.1 % to the impact of overall PM2.5, followed by Cl- (19.3 %), SO42-(17.6 %), BC (14.7 %), and OM (13.2 %). Older adults, males, and smokers showed greater lung cancer mortality following PM2.5 constituents exposure than their counterparts. Our findings unveiled potential causal links between long-term PM2.5 constituents exposure and lung cancer mortality, particularly pronounced for certain constituents and among certain subgroups.

Background Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF). Epidemiological data regarding HF in patients with AF are lacking. We describe the epidemiology, clinical features, treatment strategies, and in‐hospital outcomes in patients with AF and HF. Methods and Results Patients with HF and nonvalvular AF in the Improving Care for Cardiovascular Disease in China‐AF cohort from February 2015 to December 2019 were included. Patients were stratified by left ventricular ejection fraction into HF with reduced EF, HF with mildly reduced EF, and HF with preserved EF groups. The primary outcome was the occurrence of hospitalization for major adverse cardiovascular events, including death, cardiogenic shock, cardiac arrest, and stroke. Overall, 16 562 patients with AF and HF were included (mean age: 72.35±11.07 years; 46.1% female). HF with preserved EF (63.1%) accounted for the largest proportion, followed by HF with mildly reduced EF (19.0%) and HF with reduced EF (17.9%). Different HF subtypes in patients with AF had unique baseline demographic and clinical characteristics after multinomial logistic regression analysis. Compared with the HF with preserved EF group, hospitalization for major adverse cardiovascular events was increased in the HF with mildly reduced EF group (odds ratio=1.55 [95% CI, 1.18–2.03]) and HF with reduced EF group (odds ratio 1.60 [95% CI, 1.21–2.13]) after adjusting for confounders. Conclusions In this large Chinese AF registry, the distribution of HF differed from the non‐AF population. Patients with AF with different types of HF have unique demographic and clinical characteristics. Occurrence rates of in‐hospital outcomes were higher in patients with HF with mildly reduced EF and patients with HF with reduced EF compared with the HF with preserved EF group. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT02309398.