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Variations in the autonomic nervous system activity during exercise therapy in patients with cardiovascular diseases may lead to adverse events. Aromatherapy may reduce these adverse events by enhancing parasympathetic nervous activity (PNA). However, the effects of aromatherapy during exercise remain relatively unknown. This study aimed to evaluate the effect of aromatherapy on autonomic nervous activity during exercise and recovery. This randomized crossover study included 20 healthy men subjected to both aroma and placebo conditions which involved rest and moderate-intensity aerobic exercise on a cycle ergometer, followed by recovery. Blood pressure, heart rate variability indices, and SpO 2 were measured during the rest, exercise, and recovery phases. Moreover, aroma preferences and emotional changes in response to the aroma were assessed. Under the placebo condition, high frequency (HF), root mean square of successive differences indices, and heart rate showed delayed recovery ( P  < 0.05). Furthermore, a moderate positive correlation was identified between aroma preference, pleasant emotions induced by aromatherapy, and the HF index ( P  < 0.05). These results indicate that aromatherapy facilitates the recovery of PNA after exercise. Furthermore, these effects were more pronounced among individuals who exhibited a stronger preference for and more positive emotions toward aromas.

The DNA damage response (DDR) plays a pivotal role in maintaining genome integrity. DNA damage and DDR activation are observed in the failing heart, however, the type of DNA damage and its role in the pathogenesis of heart failure remain elusive. Here we show the critical role of DNA single-strand break (SSB) in the pathogenesis of pressure overload-induced heart failure. Accumulation of unrepaired SSB is observed in cardiomyocytes of the failing heart. Unrepaired SSB activates DDR and increases the expression of inflammatory cytokines through NF-κB signalling. Pressure overload-induced heart failure is more severe in the mice lacking XRCC1, an essential protein for SSB repair, which is rescued by blocking DDR activation through genetic deletion of ATM, suggesting the causative role of SSB accumulation and DDR activation in the pathogenesis of heart failure. Prevention of SSB accumulation or persistent DDR activation may become a new therapeutic strategy against heart failure. DNA damage response (DDR) is activated in cardiomyocytes of the failing heart, but the type of DNA damage leading to DDR is unclear. Higo et al . show that in mice heart failure is caused in part by unrepaired DNA single-strand breaks in cardiomyocytes, which activate persistent DDR and trigger an NF-κB-dependent cardiac inflammation.

ObjectiveCardiac rehabilitation (CR) is effective in patients with acute coronary syndrome (ACS); however, CR programmes have not been fully implemented. This study aimed to reveal the current practice of outpatient CR and the dose–effect relationship of CR in real-world settings.MethodsWe performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS who underwent percutaneous coronary intervention between April 2014 and March 2018 were included. We analysed the implementation rate and dose of outpatient CR and the association between dose and outcomes.ResultsOut of 202 320 patients who underwent percutaneous coronary intervention for ACS, a total of 20 444 (10%) underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3–17), and the median (IQR) duration for each session was 60 (42–60) min. Patients were divided into four groups according to the total number of sessions (≤9 times or ≥10 times) and the duration per session (<50 min or ≥50 min). Compared with the low-number/short-duration group, the adjusted HR for all-cause mortality was 1.00 (95% CI 0.80 to 1.24, p=0.97) in the low-number/long-duration group, 0.63 (95% CI 0.46 to 0.87, p=0.005) in the high-number/short-duration group and 0.74 (95% CI 0.60 to 0.92, p=0.008) in the high-number/long-duration group, respectively.ConclusionWe found that the participation rate for outpatient CR after ACS was low and the doses of sessions vary in real-world settings. A higher number of total sessions of outpatient CR is associated with a better prognosis irrespective of the session’s duration.

Percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) undergoing hemodialysis (HD) remains challenging, with limited long-term outcome data. We investigated the long-term prognosis of ACS due to de novo coronary artery lesions and stent thrombosis (ST) in patients with and without HD. We analyzed 187 patients with ACS from the Osaka Cardiovascular Conference Long ST registry, a retrospective, multicenter registry of definite ST, and 1,856 patients with ACS due to de novo coronary artery lesions at Kansai Rosai Hospital. Patients were grouped by HD status and ACS etiology ( de novo - and ST-ACS). The primary outcome was the 6-year incidence of major adverse cardiac events (MACE) defined as a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularization, and subsequent ST. The 6-year MACE rate was highest in ST-ACS with HD, followed by de novo -ACS with HD, ST-ACS without HD, and de novo -ACS without HD (82.1 vs. 62.5 vs. 38.3 vs. 24.2%, respectively, p  < 0.001). Multivariate analysis identified HD (hazard ratio [HR]: 2.50, 95% confidence interval [CI]: 1.89–3.32, p  < 0.001) and ST-ACS (HR: 1.69, 95% CI: 1.17–2.45, p  = 0.006) as independent MACE predictors. The long-term prognoses following ACS are unfavorable in patients on HD, particularly those with ST-ACS.

It remains unknown whether the recent trend of short dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy can simply be applied to patients undergoing complex percutaneous coronary intervention (PCI). We performed a systematic review and meta-analysis to evaluate P2Y12 inhibitor monotherapy vs. conventional DAPT in patients undergoing complex PCI and non-complex PCI (PROSPERO: CRD42022335723). Primary endpoint was the 1-year Net Adverse Clinical Event (NACE). Among 5,323 screened studies, six randomized trials fulfilled the eligibility criteria. A total of 10,588 complex PCI patients (5,269 vs. 5,319 patients) and 25,618 non-complex PCI patients (12,820 vs 12,798 patients) were randomly assigned to P2Y12 inhibitor monotherapy vs. conventional DAPT. In complex PCI patients, P2Y12 inhibitor monotherapy was associated with a lower risk of NACE than conventional DAPT [Odds ratio (OR) 0.76, 95% confidence interval (CI) 0.63–0.91, P = 0.003], whereas in non-complex PCI patients, P2Y12 inhibitor monotherapy was associated with a trend toward lowering the risk of NACE (OR 0.86, 95% CI 0.72–1.02, P = 0.09). This meta-analysis across randomized trials demonstrated that a strategy of short DAPT followed by P2Y12 inhibitor monotherapy reduces the risk of 1-year NACE in patients undergoing complex PCI.

Progressive Fibrosing Interstitial Lung Disease (PF-ILD) is a severe phenotype of Interstitial Lung Disease (ILD) with a poor prognosis, typically requiring prolonged clinical observation and multiple CT examinations for diagnosis. Such requirements delay early detection and treatment initiation. To enable earlier identification of PF-ILD, we propose ILD-Slider, a parameter-efficient and lightweight deep learning framework that enables accurate PF-ILD identification from a limited number of CT slices. ILD-Slider introduces anatomy-based position markers (PMs) to guide the selection of representative slices (RSs). A PM extractor, trained via a multi-class classification model, achieves high PM detection accuracy despite severe class imbalance by leveraging a peak slice mining (PSM)-based strategy. Using the PM extractor, we automatically select three, five, or nine RSs per case, substantially reducing computational cost while maintaining diagnostic accuracy. The selected RSs are then processed by a slice-level 3D Adapter (Slider) for PF-ILD identification. Experiments on 613 cases from The University of Osaka Hospital (UOH) and the National Hospital Organization Osaka Toneyama Medical Center (OTMC) demonstrate the effectiveness of ILD-Slider, achieving an AUPRC of 0.790 (AUROC 0.847) using only five automatically extracted RSs. ILD-Slider further validates the feasibility of diagnosing PF-ILD from non-contiguous slices, which is particularly valuable for real-world and public datasets where contiguous volumes are often unavailable. These results highlight ILD-Slider as a practical and efficient solution for early PF-ILD identification.

Background:Radiology reports are usually written in a free-text format, which makes it challenging to reuse the reports.Objective:For secondary use, we developed a 2-stage deep learning system for extracting clinical information and converting it into a structured format.Methods:Our system mainly consists of 2 deep learning modules: entity extraction and relation extraction. For each module, state-of-the-art deep learning models were applied. We trained and evaluated the models using 1040 in-house Japanese computed tomography (CT) reports annotated by medical experts. We also evaluated the performance of the entire pipeline of our system. In addition, the ratio of annotated entities in the reports was measured to validate the coverage of the clinical information with our information model.Results:The microaveragedF1-scores of our best-performing model for entity extraction and relation extraction were 96.1% and 97.4%, respectively. The microaveragedF1-score of the 2-stage system, which is a measure of the performance of the entire pipeline of our system, was 91.9%. Our system showed encouraging results for the conversion of free-text radiology reports into a structured format. The coverage of clinical information in the reports was 96.2% (6595/6853).Conclusions:Our 2-stage deep system can extract clinical information from chest and abdomen CT reports accurately and comprehensively.

Background There is a lack of recent data reflecting the actual use of sodium-glucose cotransporter-2 (SGLT2) inhibitors for heart failure (HF) and type 2 diabetes (DM) in the superaged society. The present study investigated the association between the use of SGLT2 inhibitors and one-year prognosis in patients hospitalized across a broad spectrum of HF patients with DM in the superaged society using the Nationwide Electric Health Database in Japan. Methods The patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2019. A cohort of 2,277 users of SGLT2 inhibitors and 41,410 users of the active comparator, dipeptidyl peptidase-4 (DPP4) inhibitors were compared. A propensity score-matched cohort study of 2,101 users of each inhibitor was also conducted. A multivariable multilevel mixed-effects survival model was conducted with adjustments, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Results Among 300,398 patients discharged with HF in 4,176 hospitals, 216,016 (71.9%) were 75 years or older, and 60,999 (20.3%) took antidiabetic medications. Among them, the patients treated with SGLT2 inhibitors were younger and had a more severe status than those treated with DPP4 inhibitors. Kaplan–Meier analysis showed that patients treated with SGLT2 inhibitors had a lower mortality risk and HF readmission. In propensity-matched cohorts, SGLT2 inhibitor use was associated with a lower risk of mortality and HF readmission than DPP-4 inhibitor use (HR [95% CI]; 0.70 [0.56, 0.89] and 0.52 [0.45, 0.61], respectively). Very elderly (≥ 75 years) patients showed similar results. Favorable effects were also observed across all age groups, including ≥ 75 years, in patients with coronary artery disease or atrial fibrillation and with concomitant β-blocker, diuretics, or insulin. Conclusion The use of SGLT2 inhibitors at discharge was associated with a lower risk of one-year mortality and HF readmission in patients across a broad spectrum of HF with DM in the superaged society. The findings further support the benefits of using SGLT2 inhibitors in very elderly HF care and complement the current evidence.

Background Continuous anticoagulation based on the CHA2DS2‐VASc score is recommended to prevent embolism caused by atrial fibrillation (AF), but it does not consider AF episodes. The Apple Watch's continuous heart rhythm monitoring and fast‐acting direct oral anticoagulants (DOACs) could enable precise, episode‐tailored anticoagulation, reducing bleeding risks while preventing stroke. This study evaluates Apple Watch‐guided personalized anticoagulation therapy, adjusting DOAC usage based on real‐time AF detection. Methods This multicenter prospective single‐arm study will enroll patients who have maintained sinus rhythm post‐ablation and are on DOACs. The target enrollment is 50 patients free of AF for at least 30 days following the initiation of Apple Watch monitoring. If no AF occurs for the first 30 days of monitoring, anticoagulants will be discontinued on day 31. If AF is confirmed after day 31, DOAC administration will be resumed and continued until the end of the observation period. The primary endpoint is the reduction in the total number of days with DOACs from day 31 to day 360 compared to the conventional method of continuing anticoagulation. Secondary endpoints include all‐cause mortality, stroke, systemic thromboembolism, bleeding events, and Apple Watch malfunctions. Results Enrollment of a total of 50 patients was completed in April 2024. Follow‐up of the last enrolled patient will be completed in April 2025 and primary results are expected to be available in late 2025. Conclusions The Up to AF trial is the first trial to evaluate Apple Watch‐guided personalized anticoagulation therapy. This trial represents a potential advancement in personalized medicine for AF management. The Up to AF trial evaluates Apple Watch‐guided personalized anticoagulation therapy for atrial fibrillation (AF), adjusting DOAC use based on real‐time AF detection. In this single‐arm study, 50 post‐ablation patients are monitored, aiming to reduce DOAC days while assessing mortality, stroke, and bleeding events. Results are expected in 2025.

It is unclear whether adaptive servo-ventilation (ASV) therapy for heart failure with preserved ejection fraction (HFpEF) is effective. The aim of this study was to investigate the details of ASV use, and to evaluate the effectiveness and safety of ASV in real-world HFpEF patients. We retrospectively enrolled 36 HFpEF patients at nine cardiovascular centers who initiated ASV therapy during hospitalization or on outpatient basis and were able to continue using it at home from 2012 to 2017 and survived for at least one year thereafter. The number of hospitalizations for heart failure (HF) during the 12 months before and 12 months after introduction of ASV at home was compared. The median number of HF hospitalizations for each patient was significantly reduced from 1 [interquartile range: 1–2] in the 12 months before introduction of ASV to 0 [0–0] in the 12 months after introduction of ASV (p < 0.001). In subgroup analysis, reduction in heart failure hospitalization was significantly greater in female patients, patients with a body mass index < 25, and those with moderate or severe tricuspid valve regurgitation. In patients with HFpEF, the number of HF hospitalizations was significantly decreased after the introduction of ASV. HFpEF patients with female sex, BMI < 25, or moderate to severe tricuspid valve regurgitation are potential candidates who might benefit from ASV therapy.