Introduction: Reintubation is an adverse postoperative complication in patients with Type A aortic dissection (AAD) that correlates to poor outcomes. This study aims to employ machine learning algorithms to establish a practical platform for the prediction of reintubation.Methods: A total of 861 patients diagnosed with AAD and undergoing surgical procedures, 688 patients as training and testing cohort from a single center, and 173 patients as validation cohort from four centers were enrolled. The least absolute shrinkage and selection operator (LASSO) was used for screening risk variables associated with reintubation for subsequent model construction. Subsequently, seven machine-learning models were built. The model with the best discrimination and calibration performance was used to predict reintubation. Finally, the SHapley Additive exPlanation (SHAP) was employed to explain the prediction model.Results: Reintubation was performed in 107 patients (12.43%). The LASSO analysis identified re-admission to the intensive care unit (ICU), continuous renal replacement therapy, length of stay in the ICU, and duration of invasive mechanical ventilation as significant risk factors for reintubation. The XGBoost model was selected as the final prediction model due to its better performance than other models, with the AUC, sensitivity, and specificity of 0.969, 0.8889, and 0.8611 in the testing cohort. SHAP values demonstrated the effects of individual features on the overall model. Finally, a web calculator was developed based on XGBoost model for the clinical use.Conclusion: We have developed and validated a high-performing risk prediction model for postoperative reintubation in patients with AAD. It can provide valuable guidance to clinicians in predicting reintubation and in developing timely preventative measures.

Cardiovascular, metabolic, and immune disorders intersect through inflammasome signaling, motivating the development of a unified framework for cardiovascular risk across obesity, diabetes, infection, and autoimmunity. We first outline inflammasome architecture and activation, highlighting cryo-EM evidence that NEK7 licenses NLRP3 assembly, the coupling of priming to ion-flux and oligomerization, and cross-talk with the non-canonical caspase-4/5/11 pathway that feeds forward into IL-1β/IL-18 maturation and pyroptosis. In metabolic disease, lipotoxicity, mitochondrial ROS, oxidized lipids, and crystalline cholesterol converge on NLRP3 across adipose, myeloid, and vascular compartments, driving endothelial dysfunction, plaque growth, and adverse cardiac remodeling. Immune system diseases further amplify cardiovascular injury: population-level data link autoimmunity to heightened CVD risk, while AIM2- and NLRP3-dependent axes accelerate atherogenesis and destabilize plaques, particularly in clonal hematopoiesis and after acute infectious or ischemic insults. Translationally, anti-inflammatory trials validate this biology—IL-1β blockade lowered recurrent events in CANTOS, and low-dose colchicine reduced events in chronic coronary disease—yet heterogeneity of benefit and safety signals underscores the need for precise patient selection and timing. We propose a path forward that mirrors disease chronology: dampen priming, selectively inhibit assembly, and modulate effectors (IL-1 pathway or pyroptosis). Collectively, this review integrates mechanism and medicine to position inflammasomes as actionable hubs linking metabolic dysfunction, immune dysregulation, and cardiovascular disease, and charts priorities for precise, durable prevention and therapy.

Background: Transcatheter aortic valve replacement (TAVR) has gained increasing acceptance for patients with aortic disease. Both transfemoral (TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while their performances are limited to a few studies with controversial results. This meta-analysis aimed to compare the mortality and morbidity of complications between TF- versus TA-TAVR based on the latest data. Methods: Electronic databases were searched until April 2021. RCTs and observational studies comparing the outcomes between TF-TAVR versus TA-TAVR patients were included. Heterogeneity assumption was assessed by an I² test. The pooled odds ratios(OR) or mean differences with corresponding 95% confidence intervals (CI) were used to evaluate the difference for each end point using a fixed-effect model or random-effect model based on I² test. Results: The meta-analysis included 1 RCT and 20 observational studies, enrolling 19,520 patients (TF-TAVR, n = 11,986 and TA-TAVR, n = 7,534). Compared with TA-TAVR, TF-TAVR patients showed significantly lower rate of postoperative in-hospital death (OR = 0.67, 95% CI 0.59–0.77, P < 0.001) and 1-year death (OR = 0.53, 95% CI 0.41–0.69, P < 0.001). Incidence of major bleeding and acute kidney injury were lower and length of hospital stay was shorter, whereas those of permanent pacemaker and major vascular complication were higher in TF-TAVR patients. There were no significant differences between TF-TAVR versus TA-TAVR for stroke and mid-term mortality. Conclusions: There were fewer early deaths in patients with transfemoral approach, whereas the number of mid-term deaths and stroke was not significantly different between two approaches. TF-TAVR was associated with lower risk of bleeding, acute kidney injury as well as shorter in-hospital stay, but higher incidence of vascular complication and permanent pacemaker implantation.