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  • Cardiovascular health declines in older adults with heart conditions

    Cardiovascular health declines in older adults with heart conditions

    U.S. adults, ages 65 and older, with high blood pressure, heart failure or stroke had significant declines in cardiovascular health, according to new research published today in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the American Heart Association.

    The cardiovascular scores calculated in the analysis were based on participants’ health data in relation to the American Heart Association’s Life’s Essential 8 health metrics for optimal cardiovascular health. Life’s Essential 8 measures eight components for ideal heart and brain health – four health behaviors and four health factors, including: diet, physical activity, smoking status, sleep, body mass index, cholesterol, blood sugar and blood pressure.

    During the COVID-19 pandemic, it became evident that older adults were disproportionately impacted by cardiovascular disease. We aimed to examine the state of cardiovascular health among older adults before the pandemic, establishing a baseline that would allow us to assess the changes that occurred during and after the pandemic.”


    James M. Walker, B.A., study co-author, fourth-year M.D./M.B.A. student at Northwestern University’s Feinberg School of Medicine and Kellogg School of Management, Chicago

    “This study provides new information about the cardiovascular health of older adults before the pandemic. It shows that overall heart health scores were getting worse, particularly for those with heart failure, stroke or high blood pressure,” Walker said.

    In this analysis of health information from the U.S. National Health and Nutrition Examination Survey from 2013 to 2018, researchers reviewed the changes in cardiovascular health, as measured by Life’s Essential 8, among adults ages 65 and older. The analysis was based on a sample of 3,050 older adults, with survey weights applied to generate U.S. population-level estimates representing 37,908,305 adults ages 65 or older (54.7% women; average age of 72.6 years).

    The analysis included adults with and without self-reported cardiovascular conditions, including coronary heart disease, stroke, heart failure, high blood pressure, heart-related chest pain, heart attack or no cardiovascular disease. Each Life’s Essential 8 metric was scored for each person on a scale of 0 to 100 points (higher is better). Cardiovascular health was calculated for each person by summing the eight metric scores and dividing by eight. Scores below 50 indicate low cardiovascular health; 50 to 79 is considered moderate; and scores of 80 and above signal high cardiovascular health. The change in these scores from 2013 to 2018 was calculated for each group.

    When the Life’s Essential 8 scores among the groups were compared, the analysis found:

    • People with no cardiovascular disease had an average cardiovascular health score of 68 out of 100.

    • People who reported having one or more cardiovascular conditions had an average cardiovascular health score below 60, and scores tended to decline with each additional cardiovascular disease.

    • From 2013-2018, cardiovascular health scores among people with high blood pressure decreased about 4.1% (from 59.6 to 57.1), 11.5% (from 60.6 to 53.6) among people with a history of stroke, and 15.2% (from 60.9 to 51.6) among people with heart failure.

    “Physical activity and blood pressure scores tended to be very low for people with cardiovascular disease,” Walker said. “On average, participants with one cardiovascular disease had a Life’s Essential 8 score 9 points lower than those without cardiovascular disease. That gap seemed to be explained by low scores for blood pressure and physical activity.”

    “Health care professionals and physicians should seek to provide support earlier in life to help our elderly population stay healthier for longer,” he said.

    According to the researchers, these findings are intended to lay the groundwork for future research on how cardiovascular health trends may have changed in older U.S. adults with cardiovascular conditions.

    “It’s natural that as you age your health may start to decline, particularly as you develop conditions such as high blood pressure or have major cardiovascular events like a stroke. That’s why the American Heart Association urges everyone to get their best start at good health by following the elements of Life’s Essential 8 early in life, even as young as childhood,” said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association and senior vice president of women’s health and executive director of the Katz Institute for Women’s Health of Northwell Health in New York City. “It’s also critical that we recognize that our aging population is quickly growing. The last of the Baby Boomers will reach 65 in the next 5 years, and more people are living longer, even after a heart attack or stroke, thanks, in part, to medical advances and improved diagnosis and treatment. We must identify ways to support these older individuals with information and resources to maintain a healthy lifestyle in every way they can, because good health is important at every age.” Rosen was not a part of this study.

    A main limitation of the study is that it is cross-sectional (analyzed different groups based on specific criteria), so it cannot prove cause and effect. Researchers also only examined six types of cardiovascular disease, so if participants had other cardiovascular disease (less common cardiovascular disease diagnoses), they may have been missed or not included in this analysis.

    Study details, background and design:

    • Researchers reviewed health data from the National Health and Nutrition Examination Survey (NHANES), 2013-2018, to examine the cardiovascular health of U.S. adults ages 65 and older. NHANES collects data about the health and nutrition of adults and children in communities across the U.S.

    • The analysis included 3,050 adults (weighted to represent 37,908,305 adults; 54.7% women; average age of 72.6 years) with coronary heart disease, stroke, heart failure, high blood pressure, heart-related chest pain or heart attack, or no cardiovascular disease.

    • Participants self-identified as 79.9% white, 7.2% Black, 3.4% Asian, 3.9% Mexican, 3.3% other Hispanic, and 2.4% selected other race, which included multiracial.

    Source:

    American Heart Association

    Journal reference:

    Walker, J. M., et al. (2025) Comparing the “Life’s Essential 8” Scores of Older Adults Living With Cardiovascular Diseases: NHANES, 2013 to 2018. Journal of the American Heart Association. doi.org/10.1161/JAHA.124.039659.

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  • AI has passed the aesthetic Turing Test − and it’s changing our relationship with art

    AI has passed the aesthetic Turing Test − and it’s changing our relationship with art

    Pick up an August 2025 issue of Vogue and you’ll come across an advertisement for the brand Guess featuring a stunning model. Yet tucked away in small print is a startling admission: She isn’t real. She was generated entirely by AI.

    For decades, fashion images have been retouched. But this isn’t airbrushing a real person; it’s a “person” created from scratch, a digital composite of data points, engineered to appear as a beautiful woman.

    The backlash to the Guess ad was swift. Veteran model Felicity Hayward called the move “lazy and cheap,” warning that it undermines years of work to promote diversity. After all, why hire models of different sizes, ages and ethnicities when a machine can generate a narrow, market-tested ideal of beauty on demand?

    I study human-AI collaboration, and my work focuses on how AI influences decision-making, trust and human agency, all of which came into play during the Vogue controversy.

    This new reality is not a cause for doom. However, now that it’s becoming much harder – if not impossible – to tell whether something is created by a human or a machine, it’s worth asking what’s gained and what’s lost from this technology. Most importantly, what does it say about what we truly value in art?

    The forensic viewer and listener

    In 1950, computer scientist Alan Turing wondered whether a machine could exhibit intelligent behavior indistinguishable from that of a human.

    He proposed his famous imitation game. In it, a human judges whether they’re conversing with a person or a computer. If the human can’t tell the difference, the computer passes the test.

    In 1950, British scientist Alan Turing wondered how and when the outputs of a computer would be indistinguishable from those of humans.
    Pictures From History/Universal Images Group via Getty Images

    For decades, this remained a theoretical benchmark. But with the recent explosion of powerful chatbots, the original Turing Test for conversation has arguably been passed. This breakthrough raises a new question: If AI can master conversation, can it master art?

    The evidence suggests it has already passed what might be called an “aesthetic Turing Test.”

    AI can generate music, images and movies so convincingly that people struggle to distinguish them from human creations.

    In music, platforms like Suno and Udio can produce original songs, complete with vocals and lyrics, in any imaginable genre in seconds. Some are so good they’ve gone viral. Meanwhile, photo-realistic images are equally deceptive. In 2023, millions believed that the fabricated photo of Pope Francis in a puffer jacket was real, a stunning example of AI’s power to create convincing fiction.

    Why our brains are being fooled

    So why are we falling for it?

    First, AI has become an expert forger of human patterns. These models are trained on gigantic libraries of human-made art. They have analyzed more paintings, songs and photographs than any person ever could. These models may not have a soul, but they have learned the mathematical recipe for what we find beautiful or catchy.

    Second, AI has bridged the uncanny valley. This is the term for the creepy feeling we get when something looks almost human but not quite – like a humanoid robot or a doll with vacant eyes.

    That subtle sense of wrongness has been our built-in detector for fakes. But the latest AI is so sophisticated that it has climbed out of the valley. It no longer makes the small mistakes that trigger our alarm bells.

    Finally, AI does not just copy reality; it creates a perfected version of it. The French philosopher Jean Baudrillard called this a simulacrum – a copy with no original.

    The AI model in Vogue is the perfect example. She is not a picture of a real woman. She is a hyperreal ideal that no living person can compete with. Viewers don’t flag her as fake because she is, in a sense, more “perfect” than real.

    The future of art in a synthetic world

    When art is this easy to generate – and its origin this hard to verify – something precious risks being lost.

    The German thinker Walter Benjamin once wrote about the “aura” of an original artwork – the sense of history and human touch that makes it special. A painting has an aura because you can see the brushstrokes; an old photograph has an aura because it captured a real moment in time.

    AI-generated art has no such aura. It is infinitely reproducible, has no history, and lacks a human story. This is why, even when it is technically perfect, it can feel hollow.

    When you become suspicious of a work’s origins, the act of listening to a song or viewing a photograph is no longer simply about feeling the rhythm or wondering what may have existed outside the frame. It also requires running a mental checklist, searching for the statistical ghost in the machine. And that moment of analytical doubt pulls viewers and listeners out of the work’s emotional world.

    To me, the aesthetic Turing Test is not just about whether a machine can fool us; it’s a challenge that asks us to decide what we really want from art.

    If a machine creates a song that brings a person to tears, does it matter that the machine felt nothing? Where does the meaning of art truly reside – in the mind of the creator or in the heart of the observer?

    We have built a mirror that reflects our own creativity back at us, and now we must decide: Do we prefer perfection without humanity, or imperfection with meaning? Do we choose the flawless, disposable reflection, or the messy, fun house mirror of the human mind?


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  • Big breaking: Saudi cabinet denounces ‘Greater Israel' plan – Samaa TV

    1. Big breaking: Saudi cabinet denounces ‘Greater Israel’ plan  Samaa TV
    2. Arab, Islamic countries condemn Netanyahu’s ‘Greater Israel’ remark  Al Jazeera
    3. Palestinian foreign ministry condemns Netanyahu’s ‘provocative’ West Bank visit  Dawn
    4. Netanyahu says he’s on a ‘historic and spiritual mission,’ also feels a connection to vision of Greater Israel  The Times of Israel
    5. Are Arab states waiting to be occupied by Israel one by one? | Daily Sabah  Daily Sabah

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  • What counts as plagiarism? AI-generated papers pose new risks

    What counts as plagiarism? AI-generated papers pose new risks

    This January, Byeongjun Park, a researcher in artificial intelligence (AI), received a surprising e-mail. Two researchers from India told him that an AI-generated manuscript had used methods from one of his papers, without credit.

    Park looked up the manuscript. It wasn’t formally published, but had been posted online (see go.nature.com/45pdgqb) as one of a number of papers generated by a tool called The AI Scientist — announced in 2024 by researchers at Sakana AI, a company in Tokyo1.

    The AI Scientist is an example of fully automated research in computer science. The tool uses a large language model (LLM) to generate ideas, writes and runs the code by itself, and then writes up the results as a research paper — clearly marked as AI-generated. It’s the start of an effort to have AI systems make their own research discoveries, says the team behind it.

    The AI-generated work wasn’t copying his paper directly, Park saw. It proposed a new architecture for diffusion models, the sorts of model behind image-generating tools. Park’s paper dealt with improving how those models are trained2. But to his eyes, the two did share similar methods. “I was surprised by how closely the core methodology resembled that of my paper,” says Park, who works at the Korea Advanced Institute of Science and Technology (KAIST) in Daejeon, South Korea.

    Researchers built an ‘AI Scientist’ — what can it do?

    The researchers who e-mailed Park, Tarun Gupta and Danish Pruthi, are computer scientists at the Indian Institute of Science in Bengaluru. They say that the issue is bigger than just his paper.

    In February, Gupta and Pruthi reported3 that they’d found multiple examples of AI-generated manuscripts that, according to external experts they consulted, used others’ ideas without attribution, although without directly copying words and sentences.

    Gupta and Pruthi say that this amounts to the software tools plagiarizing other ideas — albeit with no ill intention on the part of their creators. “A significant portion of LLM-generated research ideas appear novel on the surface but are actually skillfully plagiarized in ways that make their originality difficult to verify,” they write.

    In July, their work won an ‘outstanding paper’ award at the Association for Computational Linguistics conference in Vienna.

    But some of their findings are disputed. The team behind The AI Scientist told Nature that it strongly disagrees with Gupta and Pruthi’s findings, and doesn’t accept that any plagiarism occurred in The AI Scientist case studies that the paper examines. In Park’s specific case, one independent specialist told Nature that he thought the AI manuscript’s methods didn’t overlap enough with Park’s paper to be termed plagiarism. Park himself also demurred at using ‘plagiarism’ to describe what he saw as a strong methodological overlap.

    Beyond the specific debate about The AI Scientist lies a broader concern. So many papers are published each year — especially in computer science — that researchers already struggle to keep track of whether their ideas are really innovative, says Joeran Beel, a specialist in machine-learning and information science at the University of Siegen, Germany.

    And if more LLM-based tools are used to generate ideas, this could deepen the erosion of intellectual credit in science. Because LLMs work in part by remixing and interpolating the text they’re trained on, it would be natural for them to borrow from earlier work, says Parshin Shojaee, a computer scientist at the Virginia Tech Research Center — Arlington.

    The issue of ‘idea plagiarism’, although little discussed, is already a problem with human-authored papers, says Debora Weber-Wulff, a plagiarism researcher at the University of Applied Sciences, Berlin, and she expects that it will get worse with work created by AI. But, unlike the more familiar forms of plagiarism — involving copied or subtly rewritten sentences — it’s hard to prove the reuse of ideas, she says.

    That makes it difficult to see how to automate the task of checking for true novelty or originality, to match the pace at which AIs are going to be able to synthesize manuscripts.

    “There’s no one way to prove idea plagiarism,” Weber-Wulff says.

    Overlapping methods

    Bad actors can, of course, already use AI to deliberately plagiarize others or rewrite others’ work to pass it off as their own (see Nature https://doi.org/gt5rjz; 2025). But Gupta and Pruthi wondered if well-intentioned AI approaches might be using others’ methods or ideas too.

    Gupta and Pruthi were first alerted to the issue when they read a 2024 study led by Chenglei Si, a computer scientist at Stanford University in California4. Si’s team asked both people and LLMs to generate “novel research ideas” on topics in computer science. Although Si’s protocol included a novelty check and asked human reviewers to assess the ideas, Gupta and Pruthi argue that some of the AI-generated ideas produced by the protocol nevertheless lifted from existing works — and so weren’t ‘novel’ at all.

    They picked out one of the AI-generated ideas in Si’s paper, which they say borrowed from a paper first posted as a preprint5 in 2023. Si tells Nature that he agrees that the ‘high-level’ idea was similar to material in the preprint, but that “whether the low-level implementation differences count as novelty is probably a subjective judgement”. Shubhendu Trivedi, a machine-learning researcher who co-authored that 2023 preprint, and was until recently at the Massachusetts Institute of Technology in Cambridge, says that “the LLM-generated paper was basically very similar to our paper, despite some superficial-level differences”.

    AI is complicating plagiarism. How should scientists respond?

    Gupta and Pruthi further tested their concern by taking the four AI-generated research proposals publicly released by Si’s team and the ten AI manuscripts released by Sakana AI, and generated 36 fresh proposals themselves, using Si’s methodology. They then asked 13 specialists to try to find overlaps in methods between the AI-made works and existing papers, using a 5-point scale, on which 5 corresponded to a ‘one-to-one mapping in methods’ and 4 to ‘mix-and-match from two-to-three prior works’; 3 and 2 represented more-modest overlaps and 1 indicated no overlap. “It’s essentially about copying of the idea or crux of the paper,” says Gupta.

    The researchers also asked the authors of original papers identified by the specialists to give their own views on the overlaps.

    Including this step, Gupta and Pruthi report that 12 papers in their sample of AI-generated works reached levels 4 and 5, implying, they said, a plagiarism proportion of 24%; the figure rises to 18 (36%) if cases in which the original authors didn’t reply are included. Some were from Sakana’s and Si’s work, although Gupta and Pruthi discuss in detail only the examples reported in this story.

    They also said they’d found a similar kind of overlap in an AI-generated manuscript (see go.nature.com/4oym4ru) that, Sakana announced this March, had passed through a stage of peer review for a workshop at a prestigious machine-learning conference, the International Conference on Learning Representations.

    At the time, the firm said that this was the first fully-AI-generated paper to pass human peer review. It also explained that it had agreed with workshop organizers to trial putting AI-generated papers into peer review and to withdraw them if they were accepted, because the community hadn’t yet decided whether AI-generated papers should be published in conference proceedings. (The workshop organizers declined Nature’s request for comment.)

    Gupta and Pruthi say that this paper borrowed its core contribution from a 2015 work6, without citing it. Their report quotes the authors of that paper, computer scientists David Krueger and Roland Memisevic, as saying that the Sakana work is “definitively not novel”, and identifying a second uncited manuscript7 that the paper borrowed from.

    Another computer scientist, Radu Ionescu at the University of Bucharest, told Nature he rated the similarity between the AI-generated work and Krueger and Memisevic’s paper as a 5.

    Krueger, who is at the University of Montreal in Canada, told Nature that the related works should have been cited, but that he “wouldn’t be surprised to see human researchers reinvent this and miss previous work” too. “I think this AI system and others are not capable of achieving academic standards for referencing related work,” he said, adding that the AI paper was “extremely low quality overall”. But he wasn’t sure whether the word plagiarism should be applied, because he feels that term implies that the person (or AI tool) reusing methods was aware of earlier work, but chose not to cite it.

    Pushback

    The team behind The AI Scientist, which includes researchers at the University of Oxford, UK, and the University of British Columbia in Vancouver, Canada, pushed back strongly against Gupta and Pruthi’s work when asked by Nature. “The plagiarism claims are false,” the team wrote in an e-mailed point-by-point critique, adding that they were “unfounded, inaccurate, extreme, and should be ignored”.

    On two AI Scientist manuscripts discussed in Gupta and Pruthi’s paper, for instance, the team says that these works have different hypotheses from those in the earlier papers and apply them to different domains, even if some elements of the methods are related.

    Is it OK for AI to write science papers? Nature survey shows researchers are split

    The references found by the specialists for Gupta and Pruthi’s analysis are work that the AI-generated papers could have cited, but nothing more, the AI Scientist team says, adding: “What they should have reported is some related work that went uncited (a daily occurrence by human authors).” The team says it would be “appropriate” to have cited Park’s paper. In the case of Krueger’s paper and the second uncited manuscript, the AI Scientist team says, “these two papers are related, so, while it is an everyday occurrence by humans not to include works like this, it would have been good for The AI Scientist to cite them”.

    Ben Hoover, a machine-learning researcher at the Georgia Institute of Technology in Atlanta who specializes in diffusion models, told Nature that he’d score the overlap with Park’s paper as a ‘3’ on Gupta’s scale. He said the AI-generated paper is of much lower quality and less thorough than Park’s work, and should have cited it, but “I would not go so far as to say plagiarism.” Gupta and Pruthi’s analysis relies on ‘superficial similarities’ between generic statements in the AI-generated work that, when read in detail, don’t meaningfully map to Park’s paper, he adds. Ionescu told Nature he would give the AI-generated paper a rating of 2 or 3.

    Park judges the overlap with his paper to be much stronger than Hoover’s and Ionescu’s ratings. He says he would give it a score of 5 on Gupta’s scale, and adds that it “reflects a strong methodological resemblance that I consider noteworthy.” Even so, this does not necessarily align with what he sees as the legal or ethical definition of plagiarism, he told Nature.

    What counts as plagiarism

    Part of the disagreement could stem from different operational understandings of what ‘plagiarism’ means, especially when it comes to overlap in ideas or methods. Researchers who study plagiarism hold different views on the term from those of some of the computer scientists in the current debate, says Weber-Wulff.

    “Plagiarism is a word we should and do reserve for extreme cases of intentional fraudulent cheating,” the AI Scientist team wrote, adding that Gupta and Pruthi “are wildly out of line with established conventions regarding what counts as plagiarism in academia”. But Weber-Wulff disagrees: she says that intent shouldn’t be a factor. “The machine has no intent,” she says. “We don’t have a good mechanism for explaining why the system is saying something and where it got it from, because these systems are not built to give references.”

    Weber-Wulff’s own favoured definition of plagiarism is that it occurs when a manuscript “uses words, ideas, or work products attributable to another identifiable person or source without properly attributing the work to the source from which it was obtained in a situation in which there is a legitimate expectation of original authorship”. That definition was produced by Teddi Fishman, the former director of a US non-profit consortium of universities called the International Center for Academic Integrity.

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  • ECB announces schedule for England's white-ball series against Sri Lanka ahead of T20 World Cup 2026 – MSN

    1. ECB announces schedule for England’s white-ball series against Sri Lanka ahead of T20 World Cup 2026  MSN
    2. England set for Sri Lanka tour ahead of T20 World Cup  ICC
    3. England Men to tour Sri Lanka ahead of ICC Men’s T20 World Cup  ECB
    4. England to tour Sri Lanka ahead of T20 World Cup 2026  Cricbuzz.com
    5. England to tour Sri Lanka in T20 World Cup lead-up two weeks after Ashes ends  Wisden

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  • Laser-free vision correction uses electrical current to reshape eye

    Laser-free vision correction uses electrical current to reshape eye

    The technique was presented during a meeting of the American Chemical Society by a team led by Michael Hill, professor of chemistry at Occidental College. EMR relies on generating pH changes in collagen-containing tissues such as the cornea, making them temporarily malleable.

    In experiments involving rabbits, the team used a platinum “contact lens” in the shape of a corrected cornea as a way to generate precise pH changes in the animal’s tissues.

    Roughly a minute later, around the time it takes to perform LASIK, the rabbit’s cornea conformed to the contact lens — but with fewer steps and no incisions, according to the researchers.

    The team successfully improved the shape of eyeballs, which were treated as if they had myopia, or nearsightedness, in ten out of 12 rabbit eyeballs.

    According to the team, EMR could address conditions such as myopia and may also treat chemical-induced cloudiness, which usually requires a corneal transplant.

    Brian Wong, professor at the University of California, Irvine, said the effect was discovered by accident while studying tissue modification. Hill noted that further detailed animal studies will be required before any clinical use, but added that the approach could prove more affordable and potentially reversible compared with current methods.

    “There’s a long road between what we’ve done and the clinic,” said Hill in the statement. “But, if we get there, this technique is widely applicable, vastly cheaper and potentially even reversible.”

    Noteworthy, a team of scientists has identified potential keys to human eye regeneration by studying the apple snail Pomacea canaliculata, which inhabits rice paddies and can regrow damaged or lost eyes within a month.

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  • Clinical Implications of Extreme Blood Pressure Fluctuations in Head a

    Clinical Implications of Extreme Blood Pressure Fluctuations in Head a

    Introduction

    Blood pressure fluctuations (BPF) are a physiological phenomenon that occur on a beat-by-beat basis and over a 24-hour period, governed by autonomic nervous system regulation via baroreflexes.1 While transient postoperative hypertension is common and often attributed to factors such as anesthesia, inflammation, or pain,2,3 it typically resolves within 24 hours. However, in a subset of patients undergoing major head and neck cancer (HNC) surgeries—particularly those involving skull base tumors or requiring extensive neck dissection—BP instability may persist beyond the immediate postoperative period, manifesting as extreme and unpredictable BPF.

    Barboi and Pocica4 recently described 23 patients with afferent baroreflex failure (ABF) after treatment for skull base tumors, highlighting the role of impaired baroreceptive signaling in autonomic dysfunction. The glossopharyngeal (IX) and vagus (X) nerves—key conduits of baroreceptor input—are frequently damaged during radiation therapy or salvage surgical interventions involving the carotid sheath or skull base, disrupting brainstem-mediated cardiovascular control.5–7 In such cases, the loss of afferent baroreflex signaling leads to erratic blood pressure control, characterized by sustained severe hypertension (SBP ≥180 mmHg)8 followed by abrupt drops of ≥20 mmHg or even hypotensive episodes (SBP <90 mmHg), which can significantly complicate postoperative management in the intensive care unit (ICU).

    Despite these clinical observations, there is a lack of research evaluating the prevalence, characteristics, and prognostic implications of extreme BPF in patients undergoing major HNC surgery. Existing studies on BPF have primarily focused on populations with neurological disorders such as spinal cord injury or Guillain-Barré syndrome,9,10 with limited relevance to the surgical oncology setting.

    Therefore, the primary objective of this study is to define and characterize extreme postoperative BPF in patients with head and neck cancer, to evaluate its clinical implications, and to identify predictors of poor outcomes. Addressing this gap may inform the development of targeted perioperative monitoring strategies and improve patient outcomes in this high-risk surgical population.

    Patients and Methods

    Study Design and Participants

    This retrospective study included 98 patients who underwent long (duration ≥ 6 hours), major surgery for head and neck cancers from January 2019 to December 2022. Patients with simple thyroid cancer without metastasis who underwent thyroidectomy, or those with benign masses, infections, or other lymphadenopathy were excluded. In all patients, BP was measured at one-hour intervals for 24 hours post-surgery, and the standard deviation (SD) of BP variation was calculated. It is based on the definition of orthostatic hypotension,11 and since the mean SD of systolic BP (SBP) in this study was 18.7, patients with an SD of 20 or higher were defined as having BPF.

    Figure 1A depicts the BP measured at hourly intervals over 24 hours post-surgery for the top 10 patients with severe postoperative BPF and the bottom 10 patients without BPF. The highest and lowest BP during the 24 hours after surgery were investigated, focusing on cases where systolic BP exceeded 200 mmHg and where it fell below 90 mmHg. Figure 1B illustrates the difference between the highest and lowest BP recorded in groups with and without BPF.

    Figure 1 (A) Blood pressure variations at one-hour intervals over the 24 hours following surgery. The upper panel shows the top decile with pronounced extreme blood pressure fluctuations (BPF), while the lower panel depicts the bottom decile without BPF. The graph clearly illustrates heightened BP fluctuations over the 24-hour period in the group with BPF. Y-axis: Systolic blood pressure (SBP) (B) The difference in postoperative peak and lowest BP between the groups with and without extreme BPF. The figure highlights that the magnitude of this difference is more pronounced in the group with BPF, indicating increased variability in BP observed in this subgroup. Y-axis: SBP.

    We analyzed clinical factors including baseline characteristics, echocardiographic and laboratory parameters, and clinical outcomes, such as the occurrence of complications (infection, re-operation, heart failure, arrhythmia, thrombosis, etc)., mortality within 30 days after surgery, hopeless discharge, or death within 6 months to 1 year after surgery. Mortality, hopeless discharge, and death were defined as poor outcomes. The surgical approach was categorized based on the location of neck dissection into unilateral and bilateral, and further classified according to the extent as selective neck dissection (SND), modified radical neck dissection (MRND), radical neck dissection (RD), and extended radical neck dissection (ERND) in accordance with medical literature.12

    Ethical Considerations

    All procedures conducted in this study involving human participants adhered to the ethical standards set by the institutional and/or national research committee, as well as the principles outlined in the 1964 Declaration of Helsinki and its subsequent amendments or equivalent ethical guidelines. As this study was retrospective and observational, data were obtained through a review of medical records, and informed consent from individual participants was not required. The authors did not have access to any personally identifiable patient information. The ethics committee granted a waiver for informed consent. This study received approval from the Institutional Review Board (IRB no. 2024–02-001).

    Transthoracic Echocardiography

    Transthoracic echocardiography was performed using standard techniques with a 2.5-MHz transducer, following established guidelines.13 The left ventricular end-diastolic dimension (LVEDD) and end-systolic dimension (LVESD) were measured, and left ventricular ejection fraction (LV EF) was assessed using the biplane Simpson method. The maximal left atrial volume was determined using the Simpson method and indexed to body surface area. Left ventricular (LV) mass was calculated according to the Devereux formula, and LV wall thickness (both septal and posterior) was measured in both systole and diastole.

    Mitral inflow velocities were recorded from the apical four-chamber view, with measurements including peak early (E) and peak late (A) flow velocities, as well as the E/A ratio. Tissue Doppler imaging was used to assess early diastolic (E’) and late diastolic (A’) velocities, along with the E/E’ ratio, based on mitral annular motion obtained from the apical four-chamber view. Adequate mitral inflow and tissue Doppler signals were successfully recorded for all patients. Right ventricular systolic pressure (RVSP) was estimated using tricuspid regurgitation (TR) velocity, which was acquired from the apical four-chamber or right ventricular (RV) inflow view using continuous wave (CW) Doppler imaging.

    Statistical Analysis

    Continuous variables are reported as mean ± SD, while categorical variables are presented as percentages or absolute counts. Comparisons of continuous variables among three independent groups were conducted using one-way analysis of variance (ANOVA), whereas comparisons between two independent groups were performed using the Student’s t-test. The chi-square test was used for categorical variables. Additionally, multivariable analysis was conducted using logistic regression (SPSS for Macintosh, version 27.0, IBM Corp., Armonk, NY, USA). Non-normally distributed variables were analyzed using the Kruskal–Wallis test or the Mann–Whitney U-test. A p-value < 0.05 was considered statistically significant.

    Results

    Clinical Characteristics of the Study Population (Table 1)

    In a cohort of 98 patients undergoing neck dissection for various HNC, the mean SD of SBP was 18.7 ± 7.2. Postoperatively, 35% exhibited an SD of BP ≥ 20, 30% had the highest systolic BP (SBP) ≥ 200 mmHg, and 17% had the lowest SBP ≤ 90 mmHg. The majority of patients were male (86%), with a mean age of 63.8 ± 9.4 years. The most prevalent diagnoses included laryngeal cancer (29%) and hypopharyngeal/esophageal cancer (24%).

    Table 1 Clinical Parameters of the Study Population

    Operative procedures involved both unilateral (53%) and bilateral (47%) approaches, with selective neck dissection (41%) and modified radical neck dissection (40%) being common. Tracheostomy was performed in 79% of cases. The mean hospital and ICU stays were 31.6 ± 23.4 days and 7.3 ± 16.0 days, respectively. Complications occurred in 47% of cases, with a 3% 30-day mortality rate, 6% experiencing a hopeless discharge, and a 17% 1-year mortality rate, contributing to a 24% overall poor outcome rate.

    Analysis of Complications (Table 2)

    In a cohort of 98 patients, postoperative complications were observed, underscoring the significance of vigilant postoperative care. Thirty cases experienced infections, prompting reoperation for issues such as wound defects, fistula, leakage, and bleeding. Other complications included thromboembolism (2 cases), interventions related to feeding tubes due to the inability to take orally (2 cases), syncope due to carotid artery compression (1 case), pneumothorax (1 case), foot drop (1 case), and encephalopathy (1 case). Notably, 12 cases presented with postoperative cardiac problems, comprising tachycardia (8 cases – atrial fibrillation, supraventricular, ventricular, or sinus tachycardia) and heart failure (11 cases – congestive heart failure [CHF], Takotsubo syndrome [TTS], or myocardial ischemia), with specific cardiac parameters documented.

    Table 2 Postoperative Complications

    Comparison of Patients’ Clinical Characteristics Between the Groups (Table 3)

    This study compared two patient groups, those with BPF (n=34) and those without (n=64), revealing significant differences. Patients with BPF exhibited a higher prevalence of recurrent cancer (38% vs 9%, p=0.001), lower BMI (21.2 ± 3.8 vs 22.9 ± 3.3, p=0.020), and increased complications, notably cardiac problems (29% vs 3%, p<0.001). Moreover, the BPF group displayed elevated postoperative peak SBP and a higher frequency of peak SBP ≥ 200 mmHg (p<0.001).

    Table 3 Comparison of Baseline Characteristics and Clinical Parameters of the Study Population

    The study further revealed that patients with BPF experienced a longer duration of ICU stay (13.6 ± 25.0 vs 4.0 ± 6.0 days, p=0.033) and overall hospital stay (39.3 ± 29.4 vs 27.5 ± 18.5 days, p=0.038), along with higher rates of complications, including infection and wound revision. Notably, 30-day mortality was higher in the BPF group (9% vs 0%, p=0.039), as was 1-year mortality (29% vs 11%, p=0.028), contributing to a higher overall rate of poor outcomes (38% vs 16%, p=0.023).

    Echocardiographic Parameters and Laboratory Findings (Table 4)

    When comparing patients with BPF to those without, there were no significant differences in echocardiographic parameters, including cardiac chamber size and both systolic and diastolic functions, suggesting that BP variations were not indicative of preexisting heart failure or fluid deficit. Notably, there was no substantial difference in preoperative blood test results between the two groups. However, a noteworthy observation was an increase in postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in the BPF group, suggesting a potential association with the development of heart failure and BPF.

    Table 4 Echocardiographic Parameters and Laboratory Results of the Study Population

    Uni and Multivariable Analyses (Table 5)

    In the univariable analysis, key factors associated with adverse outcomes in patients with BPF were identified. These factors included lower BMI (p=0.023), higher postoperative peak SBP (p<0.001), lower postoperative lowest SBP (p<0.001), presence of recurrent cancer (p=0.001), prolonged ICU stay (p=0.027), extended hospital stay (p=0.033), overall complications (p=0.003), need for reoperation (p=0.002), cardiac problems (p=0.002), and poor overall outcome (p=0.014).

    Table 5 Uni-and Multivariable Analysis on the Associating Factors of Elevated RVSP

    In the multivariable analysis, after adjusting for other variables, recurrent cancer (p=0.003) and cardiac problems (p=0.040) remained significantly associated with BPF. Other factors, including BMI, ICU stay, hospital stay, complications, reoperation, and poor outcome, did not show significant associations after multivariate adjustment. These findings underscore the importance of considering recurrent cancer and cardiac problems as critical factors impacting patient outcomes in the presence of postoperative BPF.

    Discussion

    In this retrospective study of 98 patients undergoing prolonged major surgery for head and neck cancers, significant post-operative BPF were observed in 35% of patients. The group with BPF, characterized by recurrent cancer, lower BMI, and increased complications, showed elevated postoperative SBP, heightened SBP variability, and longer stays in both the intensive care unit and hospital. Preoperative echocardiographic parameters did not differ significantly between groups, but an increase in postoperative NT-proBNP levels in the BPF group suggested a potential link with heart failure. Multivariate analysis highlighted recurrent cancer as a significant predictor of severe BPF, while increased cardiac problems were associated with patients experiencing BPF, underscoring its clinical implications in this patient population.

    Clinical Implications of Postoperative BPF in Hear and Neck Cancer Surgeries

    Physiologically, BPF are intricately regulated by neural responses, including central sympathetic drive and reflex modulation by arterial and cardio-pulmonary reflexes.1 In specific medical conditions such as SCI and GBS, characterized by autonomic nervous system dysfunction, BPF encompass both hypertensive autonomic dysreflexia and hypotensive events.9,10,14 Following surgery, transient hypertension is common, yet prolonged extreme BPF pose challenges, especially in extended head and neck cancer surgeries.2

    This study explores the clinical implications of postoperative BPF in head and neck cancer surgeries. Recent research by Barboi and Pocica in Clinical Autonomic Research identified 23 patients with pronounced BPF attributed to afferent baroreflex failure and prior treatment for skull base tumors.4 Damage to glossopharyngeal (IX) and vagus (X) cranial nerves, crucial for baroreceptor signaling in the brainstem, disrupts BP control following neck radiation or dissection surgeries.5–7 Figure 2 illustrates preoperative PET-CT (A) and postoperative spine MRI (B) images of a patient who underwent surgery for recurrent hypopharyngeal cancer, highlighting severe BP fluctuations and postoperative hypotension. The PET scan shows evidence of hypopharyngeal cancer and metastatic lymph nodes in various neck regions, while the MRI reveals a significant soft tissue lesion along the prevertebral space, suggestive of nerve damage.

    Figure 2 Illustration of preoperative PET-CT (A) and postoperative spine MRI (B) images of a patient who underwent surgery for recurrent hypopharyngeal cancer, depicting severe blood pressure fluctuations and hypotension post-procedure. PET findings reveal evidence of hypopharyngeal cancer and metastatic lymph nodes in the retropharyngeal, neck level II bilaterally, left neck level V, and left upper paratracheal areas. The postoperative MRI image demonstrates a 3.7×1.6x4cm lobulated soft tissue lesion with marginal contrast enhancement along the C6-T1 prevertebral space (white arrows).

    Mechanisms and Implications of BPF in HNC Surgeries

    Understanding mechanisms underlying BPF in HNC surgeries is crucial for targeted interventions. The study underscores the impact of glossopharyngeal and vagus nerve damage on BP control, emphasizing the need for neuroprotective measures during skull base surgeries. Future research should explore strategies to mitigate nerve injuries during radiation or dissection surgeries and assess their impact on preventing extreme BPF. These insights align with broader understanding of neural pathways involved in BP regulation, providing clinical context on maintaining autonomic control in extended head and neck cancer surgeries. Further research in this area may refine preventive measures and targeted interventions to optimize BP control postoperatively.15 Recent findings indicate that patients hospitalized for ischemic stroke face increased complications and mortality with significant BPF.16 Compared to our study results, severe BP variability in various clinical scenarios associates with unfavorable outcomes and heightened complication rates, emphasizing the need for thorough investigation and subsequent research into appropriate treatments addressing detrimental effects of extreme BPF across diverse clinical situations.

    Challenges and Cardiac Implications of BPF in HNC Surgeries

    This study on prolonged extreme BPF in head and neck cancer surgeries identifies significant challenges. Factors such as recurrent cancer, lower BMI, and increased complications are linked to higher prevalence of extreme BPF, suggesting potential predictive factors. The BPF group exhibits adverse outcomes, including elevated postoperative SBP, widened variability, and extended hospital stays. The observed correlation between BPF and postoperative NT-proBNP elevation indicates a potential link to heart failure, underscoring the need for vigilant postoperative cardiac monitoring. Patients with BPF experience higher rates of postoperative cardiac complications like tachy-arrhythmias and heart failure (TTS, CHF, or ischemia). NT-proBNP serves as a strong prognostic marker in both acute and chronic HF, with higher levels associated with worse outcomes.17 Studies have shown that a reduction of NT-proBNP by more than 30% during treatment is associated with improved prognosis.17 Therefore, in cases where acute HF is suspected after surgery, an elevated NT-proBNP level should prompt more proactive monitoring, diagnostic evaluation, and therapeutic intervention for heart failure. Such an approach may help prevent acute complications and improve long-term outcomes. However, NT-proBNP levels may also be elevated in a variety of cardiac and non-cardiac conditions. These include chronic kidney disease, pulmonary diseases, sepsis, anemia, arrhythmias, advanced age, and neurological disorders.18 To avoid misdiagnosis of HF, clinicians should interpret NT-proBNP levels in the context of the patient’s overall clinical status.

    Recent studies by De Angelis et al report on management and outcomes in patients with pheochromocytoma-induced cardiogenic shock (PICS), stressing the importance of suspecting PICS in severe cyclic BPF cases, rapid hemodynamic deterioration, and elevated inflammatory markers.19 While distinct from our study, both underscore the clinical importance of BPF and adverse cardiac outcomes. Patients with PICS typically exhibit rapid recovery post-surgical removal, yet differences in underlying conditions necessitate distinct treatment approaches for our study population. While direct comparison with TTS prognosis in the general population is challenging, existing literature suggests generally favorable prognosis and lower recurrence rates compared to myocardial infarction.20 However, heightened cardiovascular death risk in TTS mandates consideration of appropriate drug therapy, such as ACE inhibitors. Further research in our cohort is needed to explore additional therapeutic strategies aimed at enhancing recovery and mitigating adverse cardiovascular outcomes.

    Study Limitations

    The study acknowledges several limitations, including its retrospective design, reliance on single-center data, small sample size, and focus on immediate postoperative outcomes. Additionally, intraoperative variables such as anesthetic agents, fluid balance, and blood loss were not analyzed in this study, which may have influenced the results. However, it is important to note that patients included in the study received ICU care for more than 24 hours postoperatively without significant intraoperative events such as major bleeding or shock, and no substantial differences in anesthetic agents were observed in this cohort. This strict inclusion criterion may have contributed to the relatively small sample size. Therefore, larger, multicenter studies involving more diverse patient populations, detailed intraoperative data, and long-term follow-up are warranted to validate and expand upon these findings.

    Conclusion

    This retrospective study suggests that extreme postoperative BPF are associated with adverse cardiac outcomes in patients undergoing head and neck cancer surgery, particularly in recurrent cases. While NT-proBNP may serve as a marker of postoperative cardiac stress, further prospective studies are needed to validate its role. Given the study’s limitations, including its single-center design and small sample size, cautious interpretation is warranted. Nonetheless, individualized postoperative monitoring strategies may help improve outcomes in this high-risk population.

    Data Sharing Statement

    The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

    Ethical Approval

    This study was approved by the Institutional Review Board (IRB no. 2024-02-001). This study was a retrospective observational study for which patient consent was waived, and it received approval from the Institutional Review Board of Hallym University Kangnam Sacred Heart Hospital.

    Consent to Participate

    This was not available in this study because this study was a retrospective, observational study.

    Funding

    No funds, grants or other support was received.

    Disclosure

    The authors report no conflicts of interest in this work.

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    15. Stocker SD, Ferreira CB, Souza GMPR, Jackson K, Shen L, Zimmerman MC. Brain pathways in blood pressure regulation. Hypertension. 2024;81(3):383–386. doi:10.1161/HYPERTENSIONAHA.123.21723

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  • Researchers discover earliest evidence of interbreeding between Neanderthal, modern humans

    JERUSALEM, Aug. 20 (Xinhua) — Israeli and French researchers have discovered the earliest physical evidence that Neanderthal ancient humans and modern humans not only co-existed but also had social interactions and interbred, Tel Aviv University said in a statement on Wednesday.

    Published in the journal L’Anthropologie, the study focused on a fossil of a five-year-old child found in Skhul Cave on Mount Carmel in northern Israel.

    The fossil, around 140,000 years old, shows traits of both Neanderthals and Homo sapiens, which for many years were seen as two separate species.

    Previous genetic studies have shown that these two groups exchanged genes, and even today, 40,000 years after the last Neanderthals disappeared, between two and six percent of the modern human genome is of Neanderthal origin.

    These genetic exchanges, however, were thought to have occurred much later, between 60,000 and 40,000 years ago.

    The discovery pushes back this timeline by showing a child with a skull shaped like modern humans but with a blood vessel system, lower jaw, and inner ear typical of Neanderthals.

    Research shows that early Neanderthals lived in ancient Israel as early as 400,000 years ago. They encountered Homo sapiens, who began migrating out of Africa around 200,000 years ago, and these groups interbred.

    The child from Skhul Cave is the oldest known fossil showing biological and social connections between these populations. The local Neanderthals eventually disappeared after being absorbed into the modern human population.

    Advanced scanning and 3D modeling of the fossil’s skull and jaw helped researchers analyze the complex structures, including the brain’s blood vessels and inner ear, confirming the fossil’s hybrid traits. Enditem

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  • The Commercial Race to Mars Heats Up

    The Commercial Race to Mars Heats Up

    Space companies are not-so-quietly preparing to build crucial infrastructure for Mars exploration.

    On Aug. 7, Rocket Lab CEO Peter Beck told investors on an earnings call about his company’s interest in building a Mars telecommunications orbiter (MTO)—a spacecraft called for in President Donald Trump’s policy bill, which became law in July.

    Five days later, Jeff Bezos’ Blue Origin threw its hat in the ring with a short blog post saying it would adapt its Blue Ring spacecraft to serve as an MTO for NASA, which has yet to formally request proposals.

    Yo, MTO: The bill sets aside $700M for NASA to hire a company on a fixed-price contract to build an MTO. The orbiter will need to provide communications for efforts to return samples waiting in limbo on Mars, as well as future crewed and robotic missions. The law specifies that a contractor must be selected in FY26 and deliver the MTO by the end of 2028. 

    Talk priority: Notably, that contractor needs to have “proposed a separate, independently launched Mars telecommunication orbiter supporting an end-to-end Mars sample return mission” at the time when NASA solicited private sector help fixing NASA’s now-abandoned MSR program in 2024.

    At least eight companies received funding for MSR studies last year: Rocket Lab, Lockheed Martin, Blue Origin, Quantum Space, L3Harris, Northrop Grumman, SpaceX and Whittinghill Aerospace. It’s not clear which ones proposed their own MTO solutions besides Blue Origin, Rocket Lab and Lockheed Martin.

    Back to the lab: Beck has aggressively pushed Rocket Lab into planetary science, including the CAPSTONE lunar mission, the two ESCAPADE satellites heading to Mars next month after a year’s wait for Blue Origin’s New Glenn rocket, and a mission to Venus slated for 2026. 

    Rocket Lab pushed its way into the 2024 MSR study project a month after the other competitors, and Beck has repeatedly called on NASA to take up his company’s plan. He says it would cost $4B, much less than the $11B price tag that led the original mission to be cancelled. 

    “Our whole technology stack has been built with addressing planetary requirements in mind, and executing on it,” Richard French, a Rocket Lab vice president tasked with space systems business development, told Payload. 

    Rocket Lab stands out, French added, because it isn’t working on major components of NASA’s Artemis lunar return like its competitors. “We’ve got capacity—we’re not burdened by having all of these Artemis obligations; this can be a priority for us, and we can be trusted by NASA to deliver.”

    Ring around the rosie: Blue Origin’s MTO plan centers on Blue Ring, its all-things-to-all-people space platform that is expected to make its first trip to orbit in 2026 on an SDA demonstration mission. 

    The company declined to talk about its idea, but the blog post sketches out a deep-space version of Blue Ring. The vehicle aims to carry 1 metric ton of payload to Mars orbit to act as a telecom relay, while also deploying smaller satellites to provide network coverage of the Red Planet.  

    Experience counts: When asked about MTO, Whitley Poyser, Lockheed Martin’s director of deep space exploration, noted that her company built and operates NASA’s current science and communications orbiters at Mars. 

    “With our extensive experience supporting Mars missions, we are well-positioned for this opportunity and are currently developing options to support the agency’s needs for the next generation of Mars communications capabilities,” Poyser said. 

    In the red? Private companies are eager to see the LEO and lunar business models behind NASA’s public-private partnerships come to Mars, but the companies are figuring out exactly how much risk they can take on in deep space. 

    “There’s a lot of commercial opportunity here, and we want to see all the lessons of CLPS applied: Fixed price…some cost and schedule risk allocation on the industry side,” French said. “But we also think [Mars] needs to be a public-private partnership—the US government in particular really is the primary user of this, and so the program has to be capitalized appropriately.”

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  • Unilever Pakistan H1 Sales Up 15 Percent Profit Falls Update

    Unilever Pakistan H1 Sales Up 15 Percent Profit Falls Update

    Unilever Pakistan Foods reported a strong rise in sales during the first half of 2025. Net revenue reached Rs 19.59 billion, which is an increase of about 15.2 percent year on year. The company said higher volume and selective pricing supported top-line growth. Profit after tax for the six months ended June 30 stood at Rs 3.09 billion, down from Rs 3.80 billion in the prior year.

    The gap between revenue and profit reflected cost and tax pressures. Cost of sales rose faster than revenue and reached Rs 12.06 billion. Other income fell sharply, which reduced non non-operating cushioning. Finance cost increased due to certain financing flows, and taxation rose sharply, which together pressed net earnings.

    What this means for consumers and investors

    The firm retained gross margin gains but showed tighter net margins. Management paid a cash dividend, which will interest many shareholders. Investors will watch pricing actions and cost control measures in the months ahead. Traders will also monitor because of their impact on output changes in the prices of factors of production, and the taxes until the end of the year.

    Unilever Pakistan should maintain equilibrium regarding the brand investment and margin security. The first half picture will indicate a strong demand, but increased overhead and tax expenses. The company will have to stabilize execution in order to revive profits and maintain the price at bearable levels.

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