Interstitial lung disease (ILD) is a major cause of morbidity and mortality in systemic sclerosis (SSc); yet, data from Middle Eastern populations remain limited. This study aimed to describe clinical characteristics, pulmonary involvement, and predictors of ILD in a Jordanian SSc cohort. A retrospective analysis was conducted on 129 adult patients with confirmed SSc based on the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria or rheumatologist-confirmed diagnosis, all of whom had available high-resolution computed tomography (HRCT) scans. ILD was defined by fibrotic bands, ground-glass opacities, and honeycombing on HRCT, interpreted by an experienced radiologist. Patients were categorized into an old cohort (pre-2019, n = 71) and a new cohort (2019 or later, n = 58). Demographic, clinical, serologic, pulmonary function, and radiologic data were analyzed. Multivariable logistic regression was used to identify predictors of ILD. The cohort was predominantly female (90%) with a mean disease duration of 13.4 years. Mean age at symptom onset was 40.7 ± 13 years, with a diagnostic delay of 3.4 ± 5.1 years. ILD was present in 58.9% of patients and was more frequent in diffuse cutaneous SSc (dcSSc) compared with limited cutaneous SSc (77.2% vs 44.4%), with dcSSc associated with 2.82-fold higher odds of ILD (P < .001). HRCT was performed a mean of 6.9 years after diagnosis, indicating delayed ILD assessment. ILD prevalence was higher in the new cohort (69% vs 50.7%). Pulmonary arterial hypertension (PAH) occurred in 27.1% and was associated with ILD (P = .015). Patients with ILD had significantly lower diffusing capacity of the lung for carbon monoxide (DLCO), forced expiratory volume in 1 second, and forced vital capacity. Independent predictors of ILD included dcSSc, anti-Scl70 antibody positivity, PAH, and reduced DLCO. Treatment patterns differed between cohorts, with increased use of mycophenolate and nintedanib in the new cohort. Overall mortality was 11.6%, with ILD present in 80% of deaths. ILD is highly prevalent in Jordanian patients with SSc and is strongly associated with the diffuse disease subtype, anti-Scl70 positivity, PAH, and reduced DLCO. Delayed HRCT assessment may underestimate the true incidence. Early screening and adherence to international guidelines are essential to improve detection and outcomes.

Myocardial fibrosis secondary to pulmonary hypertension-induced right heart failure remains a challenging clinical condition with few effective therapeutic options. Gut microbiota-derived metabolites have emerged as critical regulators of cardiovascular homeostasis; however, the role and underlying mechanisms by which butyrate ameliorates right ventricular myocardial fibrosis remain undefined. Here, we established a monocrotaline (MCT)-induced rat model of right heart failure and performed in vitro macrophage-cardiac fibroblast co-culture assays. We demonstrated that butyrate-producing bacteria were significantly depleted in model rats. Sodium butyrate suppressed macrophage M1 polarization, reduced pro-inflammatory cytokine secretion, and inhibited cardiac fibroblast activation. Mechanistically, butyrate downregulated the expression of the chemokine CXCL3 and blocked the JAK2/STAT3 signaling pathway, thereby alleviating myocardial fibrosis. In vivo, butyrate supplementation ameliorated myocardial structural damage and collagen deposition. Collectively, our findings reveal that butyrate attenuates right heart failure-associated myocardial fibrosis by inhibiting CXCL3-mediated macrophage M1 polarization via the JAK2/STAT3 pathway, highlighting a novel therapeutic target for pathological cardiac remodeling.

Pulmonary arterial hypertension (PAH) is a rare, progressive, and ultimately deadly cardiovascular disease. A large disparity in the prevalence and progression of PAH between the sexes exists, which may be underpinned by differences in estrogen signaling. Downstream metabolites of estrogen can possess both protective and harmful effects in health and disease, affecting cellular proliferation and angiogenesis. Understanding estrogenic profiles within the lung requires new analytical approaches. A novel approach to the analysis of estrogens by liquid chromatography-triple quadrupole mass spectrometry in lung tissue was developed and applied to a rodent PAH model induced by SUGEN-Hypoxia, versus vehicle-treated normoxic controls. Both male and female rats were studied (n = 6/group). The protocol was developed, optimized, and validated for a panel of 12 estrogens and their metabolites using solid phase extraction followed by derivatization with 1-(5-fluoro-2,4-dinitrophenyl)-4,4-dimethylpiperazine (MPPZ). Acceptable ranges for recovery (90-104%) and ion suppression (91-109%) of estrogens extracted from lung tissue were achieved. Method validation showed limits of detection of 50 pg/g of tissue (10 pg/mL) and quantitation of 165 pg/g of tissue (33 pg/mL) for most analytes. When the finalized method was applied to rodent tissue samples, four of the analytes were detected, namely estradiol, estrone, 16α-hydroxyestradiol and 16α-hydroxyestrone. Higher amounts of estradiol and estrone were present in lung tissue of female controls compared with males. However, the amounts of estrogen metabolites in lung did not differ in either sex after the induction of PAH. Thus, a novel method to assess estrogenic compounds in fibrous lung tissue was developed, which can be implemented in further studies of sex-specific lung diseases.

Cardiovascular disease is a significant cause of morbidity and mortality in kidney transplant candidates and recipients. Whilst pre-transplant cardiac assessment often focuses on ischaemic coronary artery disease, the identification and management of heart failure, valvular heart disease and pulmonary hypertension are also imperative when assessing patients for transplant. The Joint British Transplantation Society and British Cardiovascular Society guideline on 'Cardiovascular assessment of potential adult kidney transplant recipients' has recently been developed. This manuscript summarises the relevant recommendations from chapters related to non-ischaemic cardiac disease.

ObjectiveVentilator-associated pneumonia is a common complication among critically ill patients, particularly those with acute cerebrovascular diseases, including acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. This study aimed to identify the factors associated with ventilator-associated pneumonia in patients with acute cerebrovascular diseases.MethodsA systematic review and meta-analysis were conducted using MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and Google Scholar. Studies involving patients aged ≥18 years who were hospitalized in an intensive care unit for >48 h, required mechanical ventilation, and had a primary diagnosis of ischemic stroke or aneurysmal subarachnoid hemorrhage were included. Risk of bias was assessed using a domain-based Risk of Bias in Non-randomized Studies of Interventions framework across all included studies, with complementary Newcastle-Ottawa Scale assessments for cohort and case-control studies. Data were analyzed using Review Manager. No publication-year restrictions were applied, and all eligible studies indexed up to the date of the final search were considered for inclusion.ResultsIn total, 16 studies involving 16,702 patients were included. The pooled incidence of ventilator-associated pneumonia was 31.62% (95% confidence interval: 24.82%-38.42%). Older age (≥65 years) (odds ratio: 2.74, 95% confidence interval: 1.68-4.48; p < 0.001) and chronic obstructive pulmonary disease (odds ratio: 2.03, 95% confidence interval: 1.05-3.93; p = 0.04) were significantly associated with ventilator-associated pneumonia, whereas diabetes mellitus demonstrated a borderline association (odds ratio: 1.52; 95% confidence interval: 1.00-2.29; p = 0.05). In contrast, arterial hypertension (odds ratio: 0.99; 95% confidence interval: 0.63-1.57; p = 0.98), tobacco use (odds ratio: 1.98, 95% confidence interval: 0.25-15.49, p = 0.51), and tracheostomy (odds ratio: 2.19, 95% confidence interval: 0.73-6.58; p = 0.16) were not consistently associated with ventilator-associated pneumonia. Risk of bias across the included studies was generally low to moderate.ConclusionVentilator-associated pneumonia remains a frequent complication among patients with acute cerebrovascular diseases. Older age and chronic obstructive pulmonary disease were consistently associated with an increased risk of ventilator-associated pneumonia in our study. These findings may improve the understanding of ventilator-associated pneumonia risk in this understudied neurocritical population and provide a foundation for future prospective studies evaluating targeted preventive interventions.

Renal artery stenting has been less frequently performed following the results of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions trial. In this trial, stenting demonstrated no benefit over medical therapy in a composite outcome including mortality as well as cardiovascular and renal events. However, these findings must be interpreted in the context of the study population, which included many patients less likely to benefit from intervention due to relatively mild renal artery stenosis, as well as less severe hypertension and renal dysfunction. More recent investigations have focused on identifying subgroups of patients who may benefit from revascularization. Identified subgroups include patients with high systolic blood pressure, diastolic hypertension, worsening kidney function, greater antihypertensive burden, flash pulmonary edema, and mild-range proteinuria. Many of these variables illustrate a clinical picture of a patient with severe ischemic kidney disease leading to problems with hypertension and volume regulation that has not yet irreparably damaged the renal parenchyma. Deciding which patients fit into this picture, and therefore should be stented, presents a challenge. This review synthesizes the current evidence surrounding these predictive variables and explores how they may be integrated into clinical decision-making.