The glymphatic system plays a critical role in central nervous system waste clearance, and its impairment is increasingly linked to neuroinflammation and accelerated disease progression. The latest 2025 evidence reveals that inflammatory microglial activation, perivascular aquaporin-4 disorganization, and impaired cerebrospinal fluid-interstitial fluid exchange contribute to dysfunctional neuro-clearance, fostering protein aggregation and neuronal injury. Emerging data also highlight the potential for drug-mediated modulation of glial metabolism, vascular inflammation, and aquaporin-4 stability to support early neuro-barrier protection and glymphatic flow recovery.

Neurological injury remains a major contributor to morbidity, mortality, and long-term cognitive decline in patients undergoing cardiac surgery, despite significant advancements in surgical techniques and cardiopulmonary bypass (CPB) technology. These injuries arise from a complex interplay of embolic load, hypoperfusion, impaired cerebral autoregulation, inflammatory responses, and patient-specific vulnerabilities, underscoring the need for a precision-based approach rather than generalized neuroprotective strategies. This narrative review synthesizes current evidence across the perioperative continuum to propose an integrated, data-driven framework for precision neuroprotection. This structured narrative review was conducted according to the SANRA framework. Literature was retrieved from PubMed and Scopus databases covering publications from January 2005 to October 2025.Preoperative risk assessment is enhanced by multimodal imaging, frailty evaluation, neurocognitive screening, metabolic and inflammatory biomarkers, and emerging machine learning models capable of predicting postoperative delirium and cognitive dysfunction. Intraoperatively, precision neuroprotection centers on autoregulation-guided blood pressure management, individualized perfusion targets during CPB, optimized temperature and glucose control, and multimodal neuromonitoring, including transcranial Doppler (TCD), near-infrared spectroscopy (NIRS), processed EEG/BIS, and embolic load characterization, to identify and mitigate cerebral insults in real time. Postoperative precision strategies incorporate biomarker-based surveillance, delirium screening, early mobilization, cognitive rehabilitation, and digital monitoring through wearable devices and remote platforms to detect delayed neurological decline. Although these modalities demonstrate clear potential, major research gaps persist, including variability in device accuracy, limited ability to differentiate embolic subtypes, inconsistent biomarker performance and insufficient integration of AI-driven analytics with clinical workflows. Collectively, available evidence supports the transition from fragmented, organ-focused neuroprotection to a unified, multimodal continuum that leverages data integration, personalized thresholds, and predictive analytics. Future large-scale, human-centered clinical trials are essential to validate this approach and operationalize precision neuroprotection across cardiac surgical practice.

Helicobacter pylori is considered a modifiable and exacerbating risk factor in influencing post-myocardial infarction (MI) upper gastrointestinal (GI) bleeding, either due to antithrombotic therapies or other mechanisms. Numerous studies suggest high prevalence of H. pylori in post-MI patients, emphasizing the role of screening of H. pylori and timely introduction of eradication therapy in infected individual as a cost-effective strategy. H. pylori is not only involved in post-MI bleeding but also play a role in triggering myocardial events and its recurrences through plaque destabilization, inflammatory response while its role in dyslipidemia remains inconsistent. This issue is under investigation since 2000 and had shown a significant relationship between involvement of H. pylori (especially CagA strains) and MI, role of genetics and environmental factors in triggering H. pylori in MI patients; however, most evidence up to date are either observational or cohort studies. Current randomized controlled trials (RCTs) suggest the role of targeted screening in high-risk population and area proved to be beneficial than blanket screening. However, lack of subgroup analysis with RCTs and long-term follow-up is necessary to establish the role H. pylori screening in preventing recurrent MI, reducing upper GI bleeding and cardiovascular outcomes. Furthermore, integrating inflammatory biomarkers and genetic factors in screening might help in risk stratification.

The expanding volume and heterogeneity of post-marketing drug-safety data have exposed the limitations of conventional pharmacovigilance systems. Artificial intelligence (AI) offers scalable solutions for detecting adverse drug reactions by integrating electronic health records, spontaneous reporting systems, and patient-generated data. Recent advances in natural language processing and deep learning enable earlier identification of rare and complex safety signals while reducing reporting delays. Nevertheless, issues related to algorithmic transparency, bias, and regulatory oversight remain critical. This letter highlights emerging applications, current challenges, and future directions for responsible AI integration in pharmacovigilance.