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- ItemOpen AccessContemporary achievement of guideline recommendations for blood pressure management after stroke in the CONVINCE trial(European Stroke Organisation, 2026) Synnott, Pádraig; Walsh, Cathal; Weimar, Christian; Purroy Garcia, Francisco; Price, Chris; Fonseca, Ana Catarina; Hill, Michael; Jatuzis, Dalius; Kõrv, Janika; Kruuse, Christina; Mikulik, Robert; Nederkoorn, Paul; Czlonkowska, Anna; Fischer, Urs; Nabavi, Darius G; Harbison, Joseph; Cassidy, Tim; O'Connor, Margaret; Iversen, Helle Klingenberg; Adie, Katja; Lemmens, Robin; Kelly, Peter JIntroduction: Hypertension is a major modifiable risk factor for stroke. Studies between 1996 and 2013 reported high rates of non-achievement of guideline recommended blood pressure (BP) targets following stroke/TIA. Few recent large studies of long-term post-stroke BP management exist, and no studies have reported findings since the introduction of new guideline recommendations (systolic blood pressure [SBP] < 130 mmHg) in 2022. Patients and methods: We analysed BP control in the CONVINCE trial, which randomised 3154 recent ischaemic stroke/high-risk TIA patients to colchicine 0.5 mg daily or usual care. Clinic BP was measured at 6-monthly trial visits from 2017 to 2024. We calculated mean follow-up BP using all available follow-up BP measurements, and examined factors associated with non-achievement of pre-2022 guideline BP targets by multivariable logistic regression. Results: Of 3144 randomised consenting patients, at least 1 follow-up BP reading was available for 2920. There were high rates of antiplatelet medication (97.6%) and statin (94.1%) usage. Mean SBP during follow-up was 136.6 mmHg (SD 12.8), mean diastolic BP was 79.3 mmHg (SD 7.8). A total of 36% of participants had mean SBP ≥ 140 mmHg and failed to meet pre-2022 guideline targets, while 70% had mean SBP ≥ 130 mmHg, not achieving current guideline targets. On multivariable logistic regression, increased age (OR: 1.026 per year increase; 95% CI, 1.018-1.034), history of hypertension (OR: 1.47; 95% CI, 1.24-1.74) and lacunar stroke subtype (OR: 1.26; 95% CI, 1.06-1.49) were independently associated with guideline non-achievement. Discussion and conclusion: In a large contemporary secondary stroke prevention trial, over one-third of participants did not achieve less-stringent pre-2022 BP guideline targets, and 70% did not achieve current ESO guideline targets. New approaches are needed to improve guideline implementation in practice.Trial Registration: ClinicalTrials.gov (NCT02898610).
- ItemOpen AccessOSA and Acute Coronary Syndrome Severity: The Potential Role of Coronary Collateral Circulation(Elsevier, 2026) Dodani, Krish; Aldomà, Albina; Targa, Adriano; Sánchez-de-la-Torre, Manuel; Sánchez-de-la-Torre, Alicia; Pinilla, Lucía; Abad, Jorge; Mínguez, Olga; Pascual, Lydia; Martínez, Dolores; Vaca, Rafaela; Juez-Garcia, Ivan; Barbé Illa, Ferran; Benítez, IvánBackground: Some evidence suggests that OSA may attenuate myocardial injury and reduce infarct severity during acute coronary syndromes (ACSs), potentially through stimulation of coronary collateral circulation (CCC). However, the relationship between OSA and collateral development, and their combined impact on ACS event severity, remains unclear. Research question: What is the relationship between OSA and coronary collateral development and what is their combined impact on ACS severity? Study design and methods: Post hoc analysis of the Impact of Sleep Apnea in the Evolution of Acute Coronary Syndrome: Effect on Intervention With CPAP (ISAACC) trial, including patients with first-time ACS with CCC assessment using the Cohen-Rentrop scale (CRS), where a score of ≥ 2 (CRS grade 2 or 3) indicated well-developed collaterals. OSA was diagnosed via respiratory polygraphy performed within 24 to 72 hours of hospitalization. Associations between OSA and CRS grade 2 or 3 were evaluated using adjusted logistic regression. Peak creatine kinase (CK), peak cardiac troponin I (cTnI), and left ventricular ejection fraction (LVEF) were analyzed as ACS severity markers. Results: Of 185 participants included, 79.5% had OSA. Participants were mainly middle-aged male individuals and demonstrated a high comorbidity burden. OSA was associated with greater odds of well-developed collaterals with an adjusted OR of 2.84 (95% CI, 1.24-7.19; P = .019), with a dose-response increase across OSA severity categories. Among patients with OSA, the presence of robust collaterals was associated with significantly lower peak CK and cTnI levels during the ACS episode, but not with improved LVEF. Interpretation: Our research shows that in patients with first-time ACS, OSA was associated with a higher prevalence of well-developed coronary collaterals. Among patients with OSA, robust collateralization was associated with less myocardial injury during ACS, supporting the hypothesis that OSA may promote adaptive vascular remodeling, which warrants further mechanistic investigation.
- ItemOpen AccessMuertes por cáncer de próstata atribuibles al trabajo nocturno, Cataluña (España) 2012-2022(Acadèmia de Ciències Mèdiques i de la Salut de Catalunya i de Balears, 2026) Soler-Saña, Meritxell; Godoy i García, PereIntroducción: El cáncer de próstata es una de las neoplasias más frecuentes. Entre los factores de riesgo destaca el trabajo nocturno, clasificado por la IARC como probable carcinógeno humano (grupo 2A). Aunque la evidencia disponible sugiere una asociación débil, diversas revisiones sistemáticas indican un aumento del riesgo en exposiciones prolongadas. El objetivo fue estimar las muertes en hombres por cáncer de próstata en Cataluña atribuibles al trabajo nocturno y los años potenciales de vida perdidos por este factor de riesgo. Método: Se estimó la mortalidad por cáncer de próstata atribuible al trabajo nocturno en Cataluña entre 2012-2022. La fracción atribuible poblacional (FAP) se calculó utilizando estimaciones de riesgo de la literatura y la ecuación de Levin. Se calcularon las tasas brutas de mortalidad (TBM) y años potenciales de vida perdidos. Los datos procedieron de registros oficiales de mortalidad. Resultados: Entre 2012–2022 se registraron 9259 muertes por cáncer de próstata en Cataluña, la TBM fue de 22,6 por 100.000 habitantes. Se estimó un total de 432,96 muertes atribuibles al trabajo nocturno, lo que representa una FAP del 4,7%. La mayoría de las muertes atribuibles se concentraron en mayores de 70 años, mientras que el 27,2% de los años potenciales de vida perdidos se observaron en el grupo de 50–59 años. Conclusiones: La identificación del trabajo nocturno como factor de riesgo y la estimación de su FAP aportan información útil para el diseño de políticas preventivas en salud laboral. La promoción de la salud y la vigilancia específica podrían reducir la morbilidad y mortalidad por cáncer de próstata y mejorar la calidad de vida de los trabajadores expuestos al trabajo nocturno.
- ItemOpen AccessFrom Lungs to Vascular Health: Airflow Obstruction, Not Lung Function Decline, Predicts Atherosclerosis Progression Independent of Smoking Status(Elsevier, 2026) Henríquez-Beltrán, Mario; Gracia-Lavedan, Esther; Sánchez-Cucó, Anna; Torres, Gerard; Targa, Adriano D. S.; Bermúdez López, Marcelino; Valdivielso, José Manuel; Pamplona Gras, Reinald; Mauricio, Dídac; Castro-Boqué, Eva; Fernández, Elvira; Lecube, Albert; de Batlle, Jordi; Barbé Illa, Ferran; González, JessicaObjectives: To prospectively evaluate the relationship between 4-year changes in lung function and the progression of subclinical atherosclerosis among 1623 middle-aged adults with at least one cardiovascular risk factor participating in ILERVAS, and to determine whether individuals who develop airflow obstruction (AO) are especially susceptible to accelerated atherosclerosis progression. Methods: This prospective cohort study included 1623 middle-aged adults from the ILERVAS cohort, recruited in primary care centers in the province of Lleida (Catalonia, Spain), with baseline assessments conducted between 2015 and 2018 and follow-up visits between 2019 and 2021 (mean follow-up, 3.99 [SD, 0.22] years). Pulmonary function was assessed by spirometry at baseline and at 4-year follow-up. Subclinical atherosclerosis was evaluated using vascular ultrasound of 12 carotid and femoral territories at baseline and at follow-up, with total plaque area quantified. Associations were analyzed using multivariable linear regression models, adjusting for clinical variables and baseline plaque burden. Analyses were stratified by smoking status. Results: Median annual declines were -95mL (-2.04%) for FVC and -78mL (-2.00%) for FEV1. Categorization of annual pulmonary function decline by tertiles showed no significant association with plaque progression. In contrast, incident AO was associated with greater annual FEV1 decline (-146.73 vs -74.90mL; P<.001) and with greater plaque burden, reflected by an increase in affected vascular territories (0.26 [IQR, 0.00-0.75]; P<.001). Multivariable models confirmed larger annual increases in total (4.40mm2; P<.001), carotid (2.33mm2; P<.001), and femoral (1.99mm2; P=.031) plaque areas among participants with incident AO, with consistent results across smoking strata. Sensitivity analyses using a lower limit of normal-based definition of AO showed similar findings, with effect estimates consistent with the primary fixed-ratio analyses. Conclusions: In this two-time-point analysis, lung function decline was not independently associated with subclinical atherosclerosis progression. In contrast, incident AO was consistently associated with greater plaque progression across smoking strata. These findings support incident AO as a spirometric marker associated with vascular risk.
- ItemOpen AccessDiagnostic yield and safety of needle-based COnfocaL LAser endomicroscopy and ultrasound-guided pleural BiOpsy in diagnosing patients with unknown pleuRAl effusion: a protocol for a mulTIcenter, randomized cONtrolled trial (COLLABORATION-II)(BioMed Central, 2026) Zheng, Ziwen; Ye, Shenglan; Liu, Xiaoping; Xiao, Kui; Deng, Mingming; Tong, Run; Porcel Pérez, José; Wang, Tao; Hou, GangBACKGROUND: The diagnosis of exudative pleural effusion is challenging. Although ultrasound-guided pleural biopsy (UGBx) is common, its effectiveness varies, especially in the absence of pleural abnormalities. New imaging techniques have been explored to improve UGBx outcomes, but the results remain inadequate. Recently, needle-based confocal laser endomicroscopy (nCLE) has been used to improve biopsy targeting and diagnostic yield through real-time cellular-level imaging; however, robust evidence is lacking. This trial aims to assess the diagnostic yield and safety of nCLE-assisted UGBx for unknown exudative pleural effusions. METHODS: COLLABORATION-II is a multicenter randomized controlled study in China involving 324 participants across ten centers. Participants will be divided into two groups based on the ultrasound findings: Group 1 with pleural thickening (> 5 mm) and/or pleural nodularity, and Group 2 with thickness ≤ 5 mm and no nodularity. Each group will be randomly assigned to either the nCLE-assisted UGBx or UGBx arm at a 1:1 ratio, with a 12-month follow-up. The primary outcome is the overall diagnostic yield, while secondary outcomes include the biopsy success rate, diagnostic sensitivity for specific diseases, complication in incidence, and specimen characteristics, such as size, quality, interpretability, and adequacy for achieving molecular diagnosis. DISCUSSION: We hypothesize that the nCLE-assisted UGBx will achieve higher diagnostic yield than conventional UGBx by providing real-time, cellular-level visualization and targeted sampling of pathological areas. If this hypothesis is validated, nCLE-assisted UGBx could emerge as a novel and effective option for diagnosing patients with unknown exudative pleural effusion. TRIAL REGISTRATION: This study has been registered at www.clinicaltrials.gov (Registration number: NCT07040241; Registration Date: 2025-06-26).