Vascular Ehlers-Danlos syndrome (vEDS), caused by likely pathogenic COL3A1 variants, carries a high risk of arterial dissection or rupture, intestinal perforation and uterine rupture, and a median survival near 51 years. It is often recognized only at a catastrophe, and its acute management is deliberately counter-intuitive. The therapeutic landscape changed in 2025 with the first randomized evidence for an angiotensin-receptor blocker. We provide a clinical, practice-oriented review for internists and the multidisciplinary team. As is appropriate for a rare disease, case-level evidence was considered alongside cohorts and trials. Suspicion is the rate-limiting step, and we set out speciality-specific red flags. Diagnosis requires molecular confirmation, with differentiation from other heritable arteriopathies. Genotype is a probabilistic predisposition, not a deterministic predictor: there is ascertainment bias, reduced penetrance and intrafamilial variability temper inference. Emergency care is harm-avoidant-catheter angiography, elective endoscopy and unnecessary surgery should be avoided, and endovascular and tissue-sparing techniques preferred. Pharmacological prevention rests on celiprolol, with randomized evidence now supporting irbesartan added to background celiprolol, and expert-centred consideration of angiotensin-receptor blockade when celiprolol is not tolerated. Surveillance should be individualized along the European Reference Network on Rare Multisystemic Vascular Diseases logic. Pregnancy, psychosocial care and cascade testing complete lifelong management. In vEDS, earlier recognition and the avoidance of iatrogenic harm-not new molecules-offer the largest near-term gains in survival and quality of life.

Translating adsorption performance from batch experiments to continuous-flow operation is a key step toward practical water-treatment applications. In this study, a laboratory-scale continuous adsorption system based on a water-insoluble β-cyclodextrin-epichlorohydrin (β-CD-EPI) polymer was validated from hydrodynamic, adsorptive, and operational perspectives. Downflow operation caused progressive bed compaction and excessive pressure development, whereas a 90 mm column operated in upflow mobile-bed mode, with visually observed bed expansion, showed comparatively stable pressure-drop behavior at superficial linear velocities below approximately 12 m h[-1]. Under these controlled high-loading conditions, removal was strongly contaminant-dependent: cyproconazole exceeded 90%, acetaminophen reached 72-77%, hydrochlorothiazide reached 40-65%, ciprofloxacin reached 24-50%, and furosemide remained below 30%. The relative performance for furosemide and hydrochlorothiazide differed from that predicted by previous batch-derived adsorption parameters, demonstrating that batch results cannot be directly extrapolated to dynamic operation. Competitive adsorption in binary and ternary mixtures reduced contaminant removal, while cyproconazole removal decreased from >90% in tap water to 48-55% in secondary-treated wastewater, demonstrating the relevance of the aqueous matrix under the tested continuous-flow conditions. Operational screening tests showed that desorption with 220 mM acetate buffer at pH 4.0 recovered >80% of the retained cyproconazole within 10 min in the tested sequence, followed by a two-stage rinse that restored the operational pH. These preliminary conditions require confirmation through replicated adsorption-desorption cycles under continuous-flow operation. These results identify laboratory-scale hydrodynamic, adsorption, matrix, and regeneration considerations that require confirmation through fixed-condition, long-term testing during subsequent process development.

Mitochondria play a crucial role in cellular energy metabolism. The heart and brain require a continuous and stable energy supply. Energy production strongly depends on proper mitochondrial function. Mitochondrial fusion and fission, known as "plasticity", are vital for maintaining the normal physiological function of cells. Recent studies have shown that impaired mitochondrial dynamics are present in many aging-related diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), and atherosclerotic cardio-cerebrovascular disease. The role of impaired mitochondrial dynamics in the pathophysiological process of aging-related diseases is being actively researched. We discovered that targeting proteins related to mitochondrial dynamics, especially those involved in fission and fusion, may offer new treatment strategies for these diseases. Various approaches, including aerobic interval and treadmill training and the use of drugs such as the antidiabetic agents metformin and dapagliflozin, the antihypertensive agent irbesartan, and certain traditional Chinese medicine components, have shown potential in alleviating imbalances in mitochondrial dynamics in aging-related cardio-cerebrovascular diseases. In this review, we systematically summarize recent research on alterations in mitochondrial dynamics in age-related cardio-cerebral diseases and explore therapeutic strategies targeting these alterations, which may offer new directions for improving cardiac and brain health and guiding clinical practice.

Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) widely used in human heart failure and has demonstrated potential cardiorenal and neurohormonal effects in experimental canine studies. Hydrochlorothiazide is a thiazide diuretic that acts at a more distal segment of the nephron than furosemide. Its addition to loop diuretic therapy may enhance sodium and fluid excretion through sequential nephron blockade and thereby improve the diuretic response in cases of refractory congestion. However, information regarding the combination of these two drugs in cats with congestive heart failure is lacking. This report describes the long-term clinical outcome of a cat with recurrent cardiogenic pleural effusion treated with sacubitril/valsartan and hydrochlorothiazide. A 14-year-old spayed female Persian-cross cat was referred for severe respiratory distress caused by recurrent pleural effusion. Echocardiography identified advanced cardiomyopathy with a nonspecific phenotype and overlapping hypertrophic and restrictive features, including focal basal septal hypertrophy, biatrial enlargement, atrial fibrillation and spontaneous echocardiographic contrast. Despite conventional treatment, which included pimobendan, torasemide, and antithrombotic medications, the cat experienced multiple episodes of pleural effusion over the following months, requiring repeated thoracocentesis. Consequently, the treatment regimen was expanded to include sacubitril/valsartan and hydrochlorothiazide. According to the owner, all other cardiac medications were discontinued approximately one week later without veterinary consultation. At long-term follow-up approximately two years after sacubitril/valsartan and hydrochlorothiazide therapy initiation, the cat remained clinically stable, with no further episodes of respiratory distress. Echocardiography revealed persistent severe structural heart disease, although improved left ventricular systolic indices were observed. This case report describes prolonged clinical stabilization in a cat with advanced cardiomyopathy and recurrent congestive heart failure following the administration of sacubitril/valsartan and hydrochlorothiazide over a two-year period. Whether this outcome reflects a specific effect of sacubitril/valsartan, the addition of hydrochlorothiazide, or a combination of both cannot be determined from a single observation. Nonetheless, the duration and completeness of the response observed here warrant prospective evaluation of combination of ARNI therapy and hydrochlorothiazide in cats with refractory congestive heart failure. Further studies are needed to assess the safety and effectiveness of this approach in feline cardiomyopathy.

We investigated seasonal variation in the office and ambulatory blood pressure control in hypertensive patients treated with two single-pill dual-combination antihypertensive therapies. The study participants (n = 560) were hypertensive patients enrolled in a 24-week therapeutic study. Antihypertensive treatment was initiated with amlodipine/benazepril 5/10 mg/day or benazepril/hydrochlorothiazide 10/12.5 mg/day, with the possible up-titration to 10/20 mg/day or 20/25 mg/day during follow-up, respectively. Office blood pressure was measured at each clinic visit, and ambulatory blood pressure monitoring was performed at baseline and 24-week follow-up. At 24 weeks of follow-up, in patients who continued antihypertensive treatment (n = 511), the proportion of up-titration to higher dosages was significantly different across seasons of treatment commencement in the benazepril/hydrochlorothiazide group (P = 0.002), but not in the amlodipine/benazepril group (P = 0.84). The between-group difference was significantly different in 134 patients who commenced treatment in winter (18.9% vs. 5.0%, P = 0.02), but not in 377 patients who commenced treatment in the other seasons (P ≥ 0.33). The control rate of office blood pressure (<140/90 mmHg) was significantly different across seasons of treatment commencement in the amlodipine/benazepril group (P = 0.01), but not in the benazepril/hydrochlorothiazide group (P = 0.16). The mean changes from baseline to 24-week follow-up tended to be smaller in the benazepril/hydrochlorothiazide than amlodipine/benazepril group in 24-h (mean between-group difference, -2.8 mmHg) and daytime diastolic blood pressure (mean between-group difference, -3.2 mmHg) in patients who commenced treatment in winter, though statistical significance was not achieved (P ≥ 0.07). In conclusion, there was seasonality in the clinic and ambulatory blood pressure-lowering effect of antihypertensive drug combinations, with a marginally significant difference in treatment intensity and blood pressure control between treatment with amlodipine or hydrochlorothiazide in combination with benazepril.

Integrating artificial intelligence (AI) into green analytical chemistry offers new opportunities for rapid, objective, and reproducible sustainability assessment. In this work, we developed an AI-assisted, Python-based platform for automated, multi-metric evaluation of analytical methods. The developed platform integrates the Green Analytical Procedure Index (GAPI), Analytical GREEnness metric (AGREE), White Analytical Chemistry (WAC), Red analytical performance index (RAPI), and solvent sustainability assessment within a unified computational framework, enabling automated scoring, visualization, and comparative sustainability profiling. The platform was applied to eco-friendly spectrophotometric methods for the simultaneous determination of metoprolol (MET) and hydrochlorothiazide (HYD) in binary mixtures and pharmaceutical dosage forms. Four signal-processing techniques, namely ratio difference (RD), first ratio derivative (RD[1]), mean centering (MC), and Fourier self-deconvolution (FSD), were successfully employed to resolve the severe spectral overlap without prior separation. The proposed methods exhibited linear responses over concentration ranges of 5-50 μg/mL for MET and 5-30 μg/mL for HYD, while FSD demonstrated the highest sensitivity, with detection limits of 0.756 and 0.707 μg/mL for MET and HYD, respectively. The methods showed satisfactory accuracy, precision, and reliability in accordance with international validation requirements. The AI-assisted sustainability assessment demonstrated favorable green, white, and solvent sustainability profiles, with minimal solvent consumption and avoidance of hazardous reagents. Importantly, the developed Python code is provided as Supplementary Material, allowing transparent and reproducible implementation and facilitating adaptation to other analytical methodologies. Overall, this work combines automated intelligence-driven sustainability assessment with advanced spectrophotometric analysis, providing a practical and transferable framework for sustainable pharmaceutical analytical chemistry.

Pairwise drug-drug interaction databases flag co-prescribed pairs, but they under-weight multi-drug combinations that drive adverse drug events in older adults. We studied that gap in Virginia All-Payer Claims Database records (2016-2019) for adults aged 65-114 years with non-opioid emergency department visits (n = 1182 cases; 16,105 matched controls across three geriatric age bands). Features came from pharmacy and medical claims in a short pre-index window optimized for acute ADE timing (21-30 days by age band; 21 days for ages 65-84). We trained gradient-boosting models separately among patients with similar pre-index healthcare contact volume (2016-2018 training; 2019 holdout), then used Formal Feature Attribution to score drug pairs and triplets and Intervention Rate ranks to order deprescribing review. On the 2019 holdout, geriatric AUPRC was 0.101-0.335 (PR lift 1.6×-4.2×). FFA flagged 115 synergistic pairs and 312 high-confidence triplets (e.g., furosemide + hydrochlorothiazide + lisinopril; digoxin + furosemide + amiodarone, IE = 8.7). Top Intervention Rate drugs included simvastatin, furosemide, and alprazolam. Moderate preventive Z-code monitoring (Q2) was protective (OR = 0.25; 95% CI 0.18-0.34) versus no monitoring, while fragmented high-intensity monitoring (Q4) was not. The framework prioritizes medication combinations for pharmacist review in claims data; it does not replace pharmacokinetic confirmation or prove that changing a drug caused fewer ED visits.

Primary aldosteronism is the most common cause of secondary hypertension but remains frequently underdiagnosed in primary care. We report a 71-year-old man with resistant hypertension and low-normal serum potassium in whom a minimal increase in hydrochlorothiazide dosage (12.5 to 25 mg) precipitated severe hypokalaemia (1.6 mmol/L), metabolic alkalosis, and rhabdomyolysis. An office electrocardiogram showed hypokalaemia-related changes, prompting urgent referral to the emergency department. Further evaluation revealed an elevated aldosterone-to-renin ratio and a left adrenal nodule, supporting the diagnosis of primary aldosteronism. This case highlights the importance of recognizing a disproportionate hypokalaemic response to thiazide treatment as a potential indicator of underlying primary aldosteronism. It also underscores the role of family physicians in early detection through appropriate screening.