Background: Maternal Hypertensive Disorders (MHD), encompassing gestational hypertension, chronic hypertension, preeclampsia, and eclampsia, which was a significant contributor to maternal morbidity and mortality, particularly in regions with lower socioeconomic status. Methods: Using data from the 2021 Global Burden of Disease (GBD) study, we analyzed the burden of MHD globally. We used the slope index and concentration index to measure cross-country inequality in MHD burden, and employed a Bayesian age-period-cohort (BAPC) model to project the burden from 2022 to 2045. Additionally, we conducted a two-sample Mendelian randomization (MR) analysis based on genome-wide association study (GWAS) to investigate potential causal relationships between occupational exposures and MHD. Results: Overall, the global incidence, prevalence, mortality, and DALYs for MHD have declined. However, incidence and prevalence rose in Central Asia, Eastern Europe, and Western Europe, while the Caribbean increasing in mortality and DALYs. Iron deficiency emerged as the leading risk factor. Significant SDI-related inequalities in MHD burden were observed, especially in lower SDI countries. Projections suggest ongoing reductions in MHD burden through 2045. MR results revealed a significant causal link between frequent exposure to chemical or other fumes in the workplace and MHD, while no clear causal relationships were identified for particulate matter or other assessed exposures. Conclusions: Although the global MHD burden is decreasing, marked regional disparities persist. Efforts focusing on addressing iron deficiency, improving nutritional support, and mitigating occupational exposures may further reduce the burden. Strengthening maternal healthcare services—especially in low-SDI will be crucial for achieving sustainable declines in MHD worldwide.

Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the electrogram recorded from NT, making it possible to obtain epicardial access (EA) independent of fluoroscopy. This study was designed to establish and validate a technique by which EA is obtained under guidance of three-dimensional (3D) EAM combined with NT electrogram. 3D shell of the heart was generated, and the NT was made trackable in the EAM system. Unipolar NT electrogram was continuously monitored. Penetration into pericardial sac was determined by an increase in NT potential amplitude and an injury current. A long guidewire of which the tip was also visible in the EAM system was advanced to confirm EA. Epicardial access was successfully obtained without complication in 13 pigs and 22 patients. In the animals, NT potential amplitude was 3.2 ± 1.0 mV when it was located in mediastinum, 5.2 ± 1.6 mV when in contact with fibrous pericardium, and 9.8 ± 2.8 mV after penetrating into pericardial sac (all P ≤ 0.001). In human subjects, it measured 1.54 ± 0.40 mV, 3.61 ± 1.08 mV, and 7.15 ± 2.88 mV, respectively (all P < 0.001). Fluoroscopy time decreased in every 4–5 cases (64 ± 15, 23 ± 17, and 0 s for animals 1–4, 5–8, 9–13, respectively, P = 0.01; 44 ± 23, 31 ± 18, 4±7 s for patients 1–7, 8–14, 15–22, respectively, P < 0.001). In five pigs and seven patients, EA was obtained without X-ray exposure. By tracking NT in the 3D EAM system and continuously monitoring the NT electrogram, it is feasible and safe to obtain EA with minimum or no fluoroscopic guidance. Demonstration of connection of pericardiocentesis needle to the EAM system and recording of needle tip electrogram. (A–C) The proximal end of a modified Tuohy needle was connected to the EAM system via a jumper wire (J), the body of needle was covered by outer sheath (N + S) except for the tip that remained electrically conductive. The needle was inserted underneath the subxiphoid at an angle of 45–60° to the body surface and was kept at a direction towards to the front one-half of the inferior wall of the right ventricle. (D) A closer view at LAO 45° of the needle tip (NT) and its relative location to the heart. The red circles represented the needle tip location when it was in the mediastinum over the diaphragm (MD), in contact with fibrotic epicardium (FP), and penetrated into pericardial sac (PS). The typical needle tip unipolar electrogram (N1) at these three locations were shown in panel F. (E) In the EAM system, the needle was detected as a bipolar catheter (yellow arrow). It was real-timely tracked and displayed with pre-acquired 3D shells of LV and RV in different projections (left: AP view; right: LAO 45° view). (F) The dominant component of the needle electrogram was the electrical activity from ventricles, namely Ned potential, corresponding to the QRS complex on surface ECG. Lower row—small Ned potential when NT in the mediastinal; middle row—larger Ned potential with small injury current (white arrow) when NT in contact with fibrotic pericardium. A PVC (blue arrow) indicated that the needle tip has been in contact with the heart; upper row—giant Ned potential with significant injury current (red arrow) when NT penetrated into pericardial sac. FP, fibrous pericardium; MD, mediastinum; PS, pericardial space; Myo, myocardium; Ned, the dominant potential on needle electrogram; J, jumper wire; N + S, needle with outer sheath; other abbreviations as Figures 1–6.

Atrial fibrillation/flutter (AF/AFL) poses significant risks of heart failure and stroke. From 1990 to 2021, China's AF/AFL cases surged from 3.20 to 10.78 million. Using Global Burden Disease (GBD) 2021 data and Bayesian age‐period‐cohort (BAPC) modeling, we analyzed trends and projected disease burden through 2045. Age‐standardized incidence and prevalence rose by 5.4% and 14.5%, respectively, while mortality and disability‐adjusted life year (DALY) rates declined by 12.2% and 3.8%. By 2045, prevalent cases may reach 23.04 million, with 1.93 million new cases, 220 000 deaths, and 4.21 million DALYs. Key risk factors include hypertension, smoking, high‐sodium diet, and obesity. Sex disparities emerged, with females showing better mortality/DALY improvements than males. Population aging and metabolic risks will drive future burden. Targeted interventions (blood pressure control, smoking cessation, sodium reduction) and sex‐/age‐specific strategies are critical. Innovations in digital health (AI monitoring) and tiered healthcare networks could mitigate risks. Prioritizing China‐specific prevention frameworks is essential to address this escalating public health challenge. Geriatr Gerontol Int 2025; 25: 1047–1057 .

Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy compared with onsite fibrinolytic therapy (O‐FT) for ST‐segment–elevation myocardial infarction when delivered promptly. However, the contemporaneous data to inform the comparative benefits of primary PCI versus O‐FT, especially in developing countries, have been largely understudied. Methods: We used data from the National Chest Pain Center Program (NCPCP), the largest nationwide registry in China, including patients with ST‐segment–elevation myocardial infarction treated with primary PCI or O‐FT from January 2016 to December 2022. Patients were matched using propensity scores, and the PCI‐related delay was defined as the difference between the observed door‐to‐wiring time and the door‐to‐needle time. Mortality outcomes were assessed at different delay intervals (90 minutes). Subgroup analyses were conducted based on age, infarction location, and Killip classification. Results: In 19 334 matched patients, primary PCI demonstrated a significant mortality benefit over O‐FT when PCI‐related delays were <60 minutes (2.34% versus 6.01%). However, this advantage diminished when delays exceeded 90 minutes. The critical threshold at which PCI lost its mortality benefit was identified as 119.51 minutes (door‐to‐wiring time – door‐to‐needle time). Subgroup analyses showed that older patients, patients with anterior infarction, and those with a higher Killip class appeared to have lower equipoise thresholds. Conclusions: Primary PCI offers a mortality benefit compared with O‐FT in patients with timely treated ST‐segment–elevation myocardial infarction, but treatment delays can mitigate this benefit. In settings with prolonged treatment delays, immediate fibrinolysis may be a more effective strategy. Treatment decisions should incorporate both patient characteristics and health care system constraints to optimize ST‐segment–elevation myocardial infarction outcomes.