In the past, patients with pulmonary hypertension (PH) were advised to avoid exercise due to concerns that it might strain cardiac function and exacerbate symptoms. However, recent evidence indicates that structured exercise programs can enhance outcomes and improve health-related quality of life for these patients. Consequently, exercise rehabilitation is now recommended in international guidelines as a key component of PH management. This consensus statement, developed by experts from the Taiwan Society of Cardiology Pulmonary Hypertension and Circulation Committee, the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation, and the Taiwan Association of Caring for pulmonary arterial hypertension, emphasizes the significance of rehabilitation and tailored exercise programs for PH patients. This article aims to raise awareness and promote the adoption of these practices among healthcare professionals treating patients with PH.

Background: To evaluate the correlation between atrial fibrillation (AF) burden and two-dimensional LA (left atrium) longitudinal reservoir strain (LARS) to explore the potential clinical utility of this novel parameter in patients with AF. Methods: This cross-sectional study was conducted at the cardiac electrophysiology clinic of a tertiary centre by consecutively enrolling patients with non-valvular AF. The AF burden was evaluated using 14-day patch-based electrocardiography and defined as the percentage of time spent in AF during a 14-day monitoring period. High and low AF burdens were defined based on the median 14-day AF burden. Echocardiographic measurements, including the longitudinal strain of the LA, were performed in all patients. Results: Among 267 patients, LARS was successfully performed in 221 (age 63 ± 11 years, male 71%, paroxysmal AF 71%). After adjusting for age, diabetes mellitus, congestive heart failure, estimated glomerular filtration rate, low-density lipoprotein level, left ventricular ejection fraction, LA dimension, and LA volume in multivariable linear regression analysis, low LARS remained a significant predictor of AF burden in addition to N-terminal pro-B-type natriuretic peptide and sex. Receiver operating curve analysis demonstrated that the best cut-off value for LARS to predict high AF burden (above median 10.49%) was 21.5%, with 75% sensitivity and 83% specificity. Conclusions: LARS is associated with the AF burden in patients with AF. Further studies are needed to determine the role of routine LARS measurements in such patients.

Background: Chest compressions are life-saving in cardiac arrest but concern by layperson of causing unintentional injury to patients who are not in cardiac arrest may limit provision and therefore delay initiation when required. Aim: To perform a systematic review of the evidence to identify if; among patients not in cardiac arrest outside of a hospital, does provision of chest compressions from a layperson, compared to no use of chest compressions, worsen outcomes. Method: We searched Medline (Ovid), Web of Science Core Collection (clarivate) and Cinahl (Ebsco). Outcomes included survival with favourable neurological/functional outcome at discharge or 30 days; unintentional injury (e.g. rib fracture, bleeding); risk of injury (e.g. aspiration). ROBINS-I was used to assess for risk of bias. Grading of Recommendations, Assessment, Development and Evaluation methodology was used to determine the certainty of evidence. (PROSPERO registration number: CRD42023476764). Results: From 7832 screened references, five observational studies were included, totaling 1031 patients. No deaths directly attributable to chest compressions were reported, but 61 (6 %) died before discharge due to underlying conditions. In total, 9 (<1%) experienced injuries, including rib fractures and different internal bleedings, and 24 (2 %) reported symptoms such as chest pain. Evidence was of very low certainty due to risk of bias and imprecision. Conclusion: Patients initially receiving chest compressions by a layperson and who later were determined by health care professionals to not be in cardiac arrest rarely had injuries from chest compressions.

Cerebral vascular disorders often accompany hypoxia-induced brain injury. In this study, we develop a zebrafish model of hypoxia-induced cerebral vascular injury to replicate the associated phenotypic changes, including cerebrovascular damage, neuronal apoptosis, and neurological dysfunction. We then explored the therapeutic potential of extracellular vesicles derived from Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) cultured on soy protein-coated surfaces. These vesicles demonstrated superior recovery efficacy, especially in restoring the blood-brain barrier integrity and improving neurological function. Our findings suggest that these potent therapeutic extracellular vesicles, easily produced from WJ-MSCs cultured in the presence of soy proteins, may mitigate hypoxia-induced brain injury by decreasing the severity of vascular disorder caused by oxidative stress. Protein-protein interactome analysis further suggests that multiple signaling pathways are likely involved in restoring normal neurovascular unit function.

Pei-Lin Lee serves as Clinical Associate Professor, School of Medicine, National Taiwan University; Consultant, Center of Sleep Disorder, National Taiwan University Hospital. Her current academic positions at international sleep societies include American Academy of Sleep Medicine Fellow and Co-Chair International Assembly; Asian Society of Sleep Medicine, Sleep Medicine Education Task Force committee member. Her current research focuses on the era of new technology and big data in sleep medicine; and intervention on sleep and metabolism in sleep disordered breathing.