Rheumatic and musculoskeletal diseases (RMDs) usually lead to morphological and functional deficits of various extend, increased morbidity and a considerable loss of quality of life. Modern pharmacological treatment has become effective and can stop disease progression. Nonetheless, disease progression is often only slowed down. Moreover, pharmacological treatment does not improve functionality per se. Therefore, multimodal treatment of rheumatic disorders with physical therapy being a key element is of central importance for best outcomes. In recent years, research into physical medicine shifted from a sole investigation of its clinical effects to a combined investigation of clinical effects and potential changes in the molecular level (e.g., inflammatory cytokines and the cellular autoimmune system), thus offering new explanations of clinical effects of physical therapy. In this review we provide an overview of studies investigating different heat applications in RMDs, their effect on disease activity, pain and their influence on the molecular level.

Introduction: The 2024 ESC atrial fibrillation guidelines introduced the CHA₂DS₂-VA score by removing female sex as an independent risk criterion. Although intended to simplify risk stratification and avoid sex-based overtreatment, the real-world implications for women who present with AF-related ischemic stroke/TIA remain unclear. In this prospective observational study, we examined the clinical implications of CHA₂DS₂-VA recalibration in a post-stroke setting, focusing on sex-specific differences in stroke severity and early functional outcome, and on the proportion of women who newly fall below the anticoagulation threshold (score ≤ 1). Methods: In a prospective cohort of 714 consecutive stroke patients, 161 (22.5%) had documented AF. Risk stratification was performed using both CHA₂DS₂-VASc and the revised CHA₂DS₂-VA score. Stroke severity (NIHSS) and functional outcome (mRS) were analyzed by sex. Propensity score matching and multivariable logistic regression were used to examine the independent association between sex and stroke severity. Results: Female patients with AF were older and had a higher vascular risk burden than men. They presented with significantly more severe strokes (median NIHSS 12 vs. 8; P < 0.01) and tended toward worse outcomes. After score recalibration, 11 of 81 women (13.6%) had a CHA₂DS₂-VA score ≤ 1, falling below the ESC anticoagulation threshold—despite having experienced an ischemic stroke. Most of these patients had cardioembolic strokes and moderate-to-severe neurological deficits. In matched analyses, female sex remained independently associated with severe stroke (aOR 1.54, 95% CI 1.03–2.29). Conclusion: In this prospective cohort of AF-related ischemic stroke, women had greater comorbidity burden and higher stroke severity than men. A subgroup with CHA₂DS₂-VA ≤ 1 nonetheless sustained ischemic stroke, and exploratory 5-year follow-up suggested excess recurrence without anticoagulation. These findings require validation in larger cohorts.

Background and Objectives: Embolic stroke of undetermined source (ESUS) was introduced to standardize the classification of cryptogenic strokes with presumed embolic origin. However, ESUS comprises a heterogeneous group with diverse clinical and diagnostic features. This study aimed to characterize ESUS within a prospective stroke cohort and compare it with other defined ischemic stroke subtypes. Methods: In this prospective, single-center study, patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled over 6 months. Stroke etiology was classified according to established criteria, including ESUS definitions based on the exclusion of major cardioembolic sources, ≥50% large-artery stenosis, and small-vessel disease. All patients underwent neuroimaging, vascular diagnostics, and cardiological workup, including echocardiography and rhythm monitoring. Results: Of 714 patients, 98 (13.7%) met ESUS criteria. ESUS patients were younger (median 67 vs. 74 years), predominantly male (61.2%), and had fewer prior strokes or TIAs (11.2% vs. 27.6%, P < 0.001) than nonESUS patients. Hypertension (72.2%) and obesity (54.2%) were common. Stroke severity at discharge was lower in ESUS (National Institutes of Health Stroke (NIHSS) 1.9 ± 2.3) compared to cardioembolic (4.8 ± 3.7) and atherosclerotic strokes (3.5 ± 3.1) ( P < 0.05), and no in-hospital deaths occurred in the ESUS group ( P = 0.02). While overall diagnostic imaging rates were similar across groups, transesophageal echocardiography was performed more frequently in ESUS (38.8%). Conclusions: ESUS accounted for 18% of ischemic strokes and represents a distinct, clinically relevant subgroup with unique demographic and outcome profiles. These findings support the refinement of ESUS classification and the need for individualized diagnostic and secondary prevention strategies.

Background and purpose: Atrial fibrillation (AF) episodes ≥ 30 s are currently considered clinically relevant in stroke diagnostics. However, shorter AF episodes may signal a significant embolic risk, especially in patients with embolic stroke of undetermined source (ESUS). This study investigates the prevalence, risk profile, and stroke severity associated with short-duration AF (SDAF < 30 s) across ischemic stroke subtypes. Methods: We prospectively enrolled 714 consecutive patients with ischemic stroke or Transient ischemic attacks who underwent ≥ 48-hour ECG monitoring. AF episodes were classified as 0–14 s, 15–29 s, or ≥ 30 s. Stroke subtypes were defined using TOAST and ESUS criteria. Risk profiles, NIH Stroke Scale scores, and CHA₂DS₂-VASc scores were analyzed by AF duration. Results: AF of any duration was detected in 53.8% of patients; 22.8% had episodes ≥ 30 s and 29.9% had SDAF. Among ESUS patients, 35.7% exhibited SDAF, and 80.2% of these had CHA₂DS₂-VASc scores ≥ 2. Stroke severity and risk scores were significantly higher in patients with SDAF than those without AF. SDAF was more prevalent in women (37.0%) and in individuals aged > 65 years (89.4%). Conclusions: SDAF is common across stroke subtypes—particularly ESUS—and is associated with elevated thromboembolic risk despite falling below current diagnostic thresholds. These findings highlight a diagnostic blind spot in stroke workup and support reevaluation of duration-based criteria for post-stroke AF detection and risk profiling.

Background: Cardiogenic shock (CS) after myocardial infarction remains associated with high mortality. Acute kidney injury (AKI), a common complication, substantially impacts outcomes. We investigated the prognostic relevance of AKI and renal replacement therapy (RRT) in CS. Methods: In this retrospective study, 369 patients with infarct-related CS admitted to a tertiary center were analyzed. AKI was defined by KDIGO criteria. Clinical, laboratory, and hemodynamic data, including RRT use and in-hospital outcomes, were evaluated. Multivariable logistic regression identified independent predictors of AKI and RRT. Discriminatory power was assessed using AUC. Results: AKI occurred in 42.8% of patients (n = 143), with 60.1% developing AKI within 48 h and 35.0% classified as stage 3. AKI patients were older (70.5 vs. 67.2 years; p = 0.010), had more pre-existing CKD (100 vs. 83.3%; p = 0.002), and required longer ventilation (168 vs. 65.5 h; p < 0.001). Inflammatory, renal, and perfusion markers were significantly elevated from day 2 onward. RRT was initiated in 8.9% overall and 23.1% of AKI patients, with 60.6% mortality. Predictors of AKI included age (OR 2.40; 95% CI 1.10–5.12) and norepinephrine dose (OR 1.001 per µg/kg; p = 0.042; AUC = 0.71). Predictors of RRT were admission creatinine (OR 2.05 per mg/dL; p = 0.003) and absence of CPR (OR 0.22; p = 0.008; AUC = 0.75). Overall mortality was 57.7%, higher in women (66.4% vs. 53.4%; p = 0.021). Conclusions: AKI is common in infarct-related CS and linked to poor outcomes. Early identification of high-risk patients may enable timely renoprotective strategies.

Background: Acute kidney injury (AKI) is common in cardiogenic shock (CS) and increases mortality, but the prognostic impact of onset timing in infarct-related CS is unclear. We examined whether early versus late AKI onset is associated with differences in patient characteristics and outcomes. Methods: In this retrospective observational study, 369 patients with infarct-related CS were classified by AKI timing within the first 96 h of admission: early (≤ 48 h) or late (> 48 h), according to KDIGO criteria. Clinical, hemodynamic, and inflammatory parameters and outcomes were compared. Multivariable logistic regression identified independent predictors of early AKI and in-hospital mortality. Results: AKI occurred in 143 patients (38.8%), with 56.6% early-onset. In-hospital mortality was higher with early AKI than late AKI (71.6% vs. 54.8%; absolute difference 16.8%, 95% CI 3.1–30.5; p = 0.018). Early AKI patients had higher lactate at admission (median 4.3 vs. 3.1 mmol/L; p = 0.028), greater norepinephrine requirements (0.34 vs. 0.21 µg/kg/min; p = 0.044), and more frequent mechanical ventilation (81.5% vs. 61.3%; p = 0.011). In multivariable analysis, early AKI independently predicted in-hospital mortality (adjusted OR 2.12, 95% CI 1.16–3.87; p = 0.015), and was associated with baseline creatinine (OR 5.68 per 1 mg/dL, p = 0.008) and 24-h lactate (OR 2.67 per mmol/L, p < 0.001). Conclusions: In infarct-related CS, AKI within 48 h marks a high-risk hemodynamic phenotype with markedly increased mortality, driven by renal vulnerability and early hypoperfusion. Incorporating AKI timing into risk stratification may help target early renoprotective interventions. Keywords: Acute kidney injury; cardiogenic shock; myocardial infarction; AKI timing; early-onset AKI; hemodynamic instability; lactate; renal dysfunction; in-hospital mortality