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Sudden cardiac arrest (CA) is a leading cause of death in the United States, with coexisting chronic obstructive pulmonary disease (COPD) recognized as an independent risk factor. National trends in mortality among individuals with both conditions remain unclear. Using Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (multiple cause-of-death data, we conducted a retrospective cross-sectional analysis of deaths with International Classification of Diseases, Tenth Revision codes for COPD (J41–J44) and CA (I46). Age-adjusted mortality rates (AAMRs) were calculated and stratified by race, sex, age group, census region, urbanization level, and place of death. Temporal trends were assessed using Joinpoint regression, reporting annual percent change (APC), and average annual percent change. From 1999 to 2023, a total of 853,773 deaths were recorded, with AAMRs declining from 35.48 to 22.77. The decline was steepest from 1999 to 2006 (APC: –2.77), followed by a more gradual reduction through 2021 (APC: –0.84), and a marked acceleration between 2021 and 2023 (APC: –5.52). Males consistently had higher AAMRs than females (35.41 vs 23.32). Racial disparities persisted, with non-Hispanic (NH) White (29.5) and NH Black individuals (28.16) experiencing the highest rates, followed by NH American Indians (26.17), Hispanics (22.2), and NH Asian/Pacific Islanders (17.82). Mortality was also highest in nonmetropolitan areas (31.37) and the Western region (39.68). Notably, home deaths increased following the coronavirus disease 2019 pandemic. Overall, CA-related mortality in individuals with COPD has declined over the past 25 years, with sharper reductions observed in the post-coronavirus disease period. Despite these improvements, persistent and widening disparities underscore the need for targeted interventions in high-risk populations.

Background Mechanical thrombectomy for ischemic stroke has traditionally been performed via transfemoral access (TFA). However, newer literature on the subject suggests that transradial access (TRA) may be equally efficacious. Methods Online databases (including PubMed, Google Scholar, Embase, and Cochrane) were queried from inception until May 2024. Abstracts and full texts were screened according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Risk of bias assessment was performed using standardized screening tools. All dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI). RevMan was used to perform the statistical analysis. Results Thirteen observational studies and one randomized clinical trial (RCT) were included in this meta-analysis. The total sample size was 4973, 4074 patients (81.2%) were in the TFA group, and 899 (18.8%) were in the TRA group. No significant differences were observed between the two groups in terms of successful recanalization (OR = 0.92; 95% CI 0.66–1.27; p = 0.60), first-pass recanalization (OR = 0.84; 95% CI 0.69–1.01, p = 0.06), access to reperfusion time (mean difference −2.99 min; 95% CI −8.33 to 2.44, p = 0.27), and favorable functional outcome. Mortality and rates of intracranial hemorrhage were comparable between the two groups, but access site complications were significantly lower in the TRA group (OR = 0.57; 95% CI 0.37–0.88; p = 0.01). Conclusion TRA for thrombectomy in large vessel ischemic strokes is comparable to TFA in terms of efficacy and has a lower incidence of access site complications. RCT data comparison of the two techniques is limited, underscoring the importance of conducting trials.

Heart failure with reduced ejection fraction is a major cause of morbidity and mortality. Cardiac resynchronization therapy (CRT) improves outcomes but faces challenges such as unsuccessful lead placement and suboptimal responses. The Wireless Stimulation Endocardially for CRT (WiSE-CRT) system, a novel leadless left ventricular (LV) pacing technology, uses ultrasonic energy to deliver electrical stimulation directly to the LV endocardium, potentially improving the response rates. A comprehensive literature search was performed across multiple databases from inception until August 2024. The outcomes of interest included the New York Heart Association (NYHA) functional score, LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and QRS duration. Statistical analysis involved pooling the mean differences (MDs) and their corresponding 95% confidence intervals (CIs) from each study using the inverse-variance random-effects model in RevMan version 5.4.1 software. Seven studies, including 468 patients with heart failure treated with the WiSE-CRT system, were included. The pooled analysis showed significant improvements in NYHA functional score (MD: −0.44; 95% CI: −0.67 to −0.21; P = 0.0002; I 2 = 77%), LVEF (MD: 5.71; 95% CI: 4.54 to 6.87; P < 0.001), LVEDV (MD: −24.49; 95% CI: −33.24 to −15.73; P < 0.001), and LVESV (MD: −24.47; 95% CI: −32.80 to −16.14; P < 0.001). The QRS duration also decreased significantly (MD: −38.62; 95% CI: −46.76 to −30.49; P < 0.001; I 2 = 60%). The WiSE-CRT system significantly improved NYHA functional score, LVEF, QRS duration, LVEDV, and LVESV in patients with heart failure. This leadless pacing technology offers a promising alternative for ineligible candidates or for those who do not respond to conventional CRT.

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. Low-dose colchicine is a novel and nonstandard management approach for patients with CVDs who are at an increased risk of adverse events. However, few studies have reported the risk of stroke with colchicine, with controversial results. This meta-analysis aimed to compare the efficacy of colchicine and placebo for stroke prevention in patients with CVD. Major electronic databases were screened for randomized controlled trials (RCTs) comparing colchicine and placebo in patients with CVDs from inception to June 2024. Pooled estimates were calculated as risk ratios (RRs) with 95% confidence intervals (CIs) using an inverse-variance random-effects model. Statistical significance was set at P < 0.05. A total of 15 RCTs encompassing 25,116 patients with CVDs were included (12,568: colchicine and 12,548: placebo). The pooled analysis demonstrated a significant reduction in stroke [RR, 0.80 (95% CI, 0.64–0.99); P = 0.04] with colchicine compared with placebo. The risk of all-cause mortality [RR, 1.00 (95% CI, 0.77–1.28)] was comparable between the 2 groups. On subgroup analysis, low-dose colchicine (0.5 mg/day) demonstrated a significantly lower risk of stroke compared with high-dose (>0.5 mg/day) colchicine, which failed to achieve statistical significance. Based on this meta-analysis, colchicine significantly reduced stroke in patients with CVDs compared with placebo. This effect was most significant with low-dose colchicine at 0.5 mg/day. However, no differences were observed in all-cause mortality. Further long-term RCTs are warranted to investigate stroke prevention using colchicine in this population.

Introduction Mechanical thrombectomy for ischemic stroke has traditionally been performed via transfemoral access (TFA). However, newer literature on the subject suggests that trans‐radial access (TRA) may be equally efficacious. Materials and Methods Using relevant keywords, online databases (including Pubmed, Google Scholar, Embase, and Cochrane) were queried from inception until May 2024. Abstracts and full texts were screened according to Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines to shortlist studies that met the inclusion criteria. Risk of bias assessment was performed according to the New Castle Ottawa Scale and Cochrane risk of bias tool 2.0. All dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI). RevMan software was used to perform the statistical analysis. Results Thirteen observational studies and one randomized clinical trial were included in this meta‐analysis. The total sample size was 4973, of which 4074 patients (81.2%) were included in the TFA group and 899 (18.8%) were included in the TRA group. No significant differences were observed between the two groups in terms of successful recanalization (OR=0.92; 95% CI 0.66‐1.27; p =0.60), first‐pass recanalization (OR=0.84; 95% CI 0.69‐1.01, p =0.06), access to reperfusion time (mean difference ‐2.99 minutes; 95% CI ‐8.33 to 2.44, p =0.27) and favorable functional outcome. Mortality and rates of intracranial hemorrhage were comparable between the two groups as well, but access site complications were significantly lower in the TRA group (OR=0.57; 95% CI 0.37‐0.88; p =0.01). Conclusion Trans‐radial access for thrombectomy in large vessel acute ischemic strokes is comparable to trans‐femoral access in terms of efficacy and has a lower incidence of access site complications. Randomized clinical trial data on head‐to‐head comparison of two techniques is limited, underscoring the importance of conducting pragmatic clinical trials.

Background: Acute Kidney Injury (AKI) is a multifactorial complication following repair of Stanford Type A aortic dissection (TAAD) with an alarmingly high incidence, varying from 20 to 77%. Postoperative AKI following life-threatening disease tends to be much more complex. However, the exact role of postprocedural AKI in the prognosis of patients undergoing TAAD repair has not been elucidated. Aims: This meta-analysis aimed to evaluate the prognostic significance of postprocedural AKI in patients undergoing TAAD repair. Methods: A literature search was conducted using PubMed, EMBASE, and SCOPUS databases. The primary endpoint was 30-day mortality with several secondary endpoints. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using Review Manager software. Statistical significance was set at p <0.05. Random-effects meta-analyses were performed for all outcomes. Results: Our analysis included 21 studies comprising 10396 patients. Patients with AKI exhibited a significantly higher risk of 30-day mortality (RR=3.98; 95% CI: 3.04-5.22; p<0.00001; I 2 =57%), stroke (RR= 2.05; 95% CI: 1.68-2.50; p<0.00001; I 2 =32%), dialysis requirement (RR= 32.9; 95% CI: 10.39-104.24; p<0.00001; I 2 =90%) (Figure 1), cardiovascular complications (RR= 2.85; 95% CI: 1.65-4.92; p<0.0002; I 2 =85%), sepsis (RR= 4.92; 95% CI: 2.62-9.24; p<0.00001; I 2 =64%), and re-exploration for bleeding (RR=2.46; 95%CI: 1.79-3.39; p<0.00001; I 2 =58%) compared to those without AKI (Figure 2). Conclusion: Patients with AKI demonstrated a significantly increased risk of mortality, stroke, need for dialysis, sepsis, postoperative cardiovascular complications, and re-exploration for bleeding. Further prospective studies are required to better understand the prevention strategies and long-term effects on prognosis of AKI post-repair for TAAD.

AbstractBackgroundMutation of the m. 8993 T > G ATP6 subunit of ATP synthase causes a maternally inherited Leigh Syndrome (LS), a rapidly fatal encephalomyelopathy in childhood called and related Neuropathy, Ataxia and Retinitis Pigmentosa (NARP) in adults. There is no cure, and relevant animal models are few. Here we describe a novel ATP6 mouse model of LS and preclinical efficacy of a gene therapy approach to neutralize the ATP6 mutation by competition with a mitochondrial targeted adeno‐associated virus serotype 9 (AAV9) vector containing wild‐type ATP6.MethodsLS transgenic mice with an ATP6 mutation were developed by microinjecting AAV2 modified by a COX8 mitochondrial targeting sequence (MTS) into mouse blastocysts to deliver the human ATP6 gene with a T > G mutation at position 8993 of the mitochondrial genome, responsible for clinical LS DNA, protein, and metabolic assays confirmed functional gene delivery and in depth physiological/clinical assessments supported germline transmission of an LS phenotype. Rescue of LS in this model was evaluated after intravenous injection of mito‐targeted AAV9 containing wild‐type ATP6 followed by reevaluation of phenotypes.ResultsLS transgenic mice expressed mutant ATP6 protein in multiple relevant tissues including brain, eye, liver. Mutant ATP6 incorporated into Complex V and conferred decreased ATP synthase efficiency. Mice exhibited hallmarks of the human disease with one or multiple systemic symptoms including early death, paralysis, hunching, vision loss and seizures over six generations. Necropsy revealed spongiform encephalopathy, retinal degeneration, and cardiomegaly. Rescue by mitochondrially directed AAV9 containing wild type ATP6 after disease onset conferred prolonged survival and reduced paralysis. When administered prior to disease onset all treated ATP6 mice survived with evidence of globally improved function.ConclusionsThe results are consistent with efficient delivery and expression of foreign genes in mitochondria by AAV vectors directed by MTS and support further development of such strategies via intravenous injection of mitochondrial targeted AAV9 to deliver corrective genes.

Calcification and ossification are uncommon in schwannomas; however, when present these findings may cause diagnostic confusion with other mesenchymal tumors which more frequently harbor these features. We sought to better characterize the type and rate of calcification and ossification in schwannomas. Cases of schwannoma diagnosed at our institution from 2005 to 2019 were reviewed to determine the type and amount of calcification and ossification present. Of 2116 total cases of schwannoma reported during the study period, 38 cases harbored calcification or ossification per the pathology report. Thirty‐two of the 38 cases had slides available for review, of which 27 (84.3%) showed calcification, nine showed ossification (28.1%), and four (12.5%) cases demonstrated both. Foci of ossification typically occurred adjacent to large vessels. Of the 27 cases showing calcification, coarse dystrophic calcification was seen in 22 cases, psammomatous calcification in nine cases, and combined dystrophic and psammomatous calcification was seen in four cases. Cases with psammomatous calcification predominantly occurred in spinal roots and cerebellopontine angle of a younger age group with almost equal gender distribution. All four cases tested for protein kinase cyclic adenosine monophosphate‐dependent type I regulatory subunit alpha immunohistochemical stain demonstrated retained expression. We confirm that calcification and ossification are rare findings in schwannoma. Awareness that these features may be present in these tumors will prevent misdiagnosis and ensure appropriate clinical management.