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Aortic pseudoaneurysm secondary to Mycobacterium tuberculosis infection is exceedingly rare. Extrinsic compression of the left main coronary artery by an aortic pseudoaneurysm is also uncommon, and cases attributable to tuberculosis are particularly rare. This report describes a mid-ascending aortic pseudoaneurysm causing left main coronary artery compression resulting in cardiac arrest in a patient with a history of tuberculosis, which was successfully managed with emergent surgical intervention. A 76-year-old man with a history of tuberculosis and radiologic findings suggestive of previous tuberculous disease experienced cardiac arrest prior to transfer and was referred to the authors' institution. Coronary angiography, performed because of chest pain and elevated cardiac biomarkers, demonstrated extrinsic compression of the left main coronary artery by an ascending aortic pseudoaneurysm. Return of spontaneous circulation was achieved after approximately 48 min of cardiopulmonary resuscitation. Upon arrival at our emergency department, computed tomography revealed a 6-cm pseudoaneurysm of the proximal-to-mid ascending aorta. Emergent surgical resection of necrotic ascending aortic tissue and graft replacement of the ascending aorta were performed, and the postoperative course was favorable. Ascending aortic pseudoaneurysm may cause sudden cardiac arrest through extrinsic compression of the left main coronary artery. In patients with a history or radiologic evidence of tuberculosis, tuberculosis-related involvement may be considered, but definitive surgical treatment should not be delayed in life-threatening presentations.
Whereas correlates of cyberbullying have been studied extensively, there has been comparatively less work examining predictors of the different ways in which bystanders to cyberbullying might respond. Adopting a person-situation interaction approach, this study investigated the extent to which the Big Five personality traits and severity of cyberbullying interactively predict the likelihood of different cyberbystander behaviors. Adults in the U.S. (N = 303) took part in an online survey in which they were presented with a series of nine simulated social media interactions in the form of screenshots that involved exchanges between two social media users. Each screenshot depicted one of three distinct levels of cyberbullying severity: none, low severity, and high severity. For each screenshot, participants were asked to report the likelihood that they would respond in a range of ways as a bystander, including remaining a passive observer, confronting a bully, reinforcing a bully, supporting a victim, and flagging or reporting a post. Participants then completed a measure of the Big Five personality traits. Regardless of cyberbullying severity, participants were significantly more likely to indicate that they would remain a passive observer in response to the depicted social media interactions than any other cyberbystander behavior. Informative two-way interactions did, however, emerge between cyberbullying severity and cyberbystander behavior and between these variables and Big Five traits across a series of mixed effects models. A significant three-way interaction emerged for agreeableness, such that participants higher in agreeableness reported a greater likelihood of bystander action in response to high severity cyberbullying than those with moderate or lower levels of agreeableness. This research offers support for the predictive value of both individual differences in the Big Five personality traits and cyberbullying severity for understanding diverse forms of cyberbystander behavior.
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the emergence of autoantibodies and deposition of immune complexes. SLE presents with heterogeneous multi-organ involvement that varies among patients and its mechanisms have been investigated to facilitate appropriate stratification and treatment selection. Bulk RNA-seq and bulk ATAC-seq have provided important insights into the pathogenesis of SLE; however, these approaches are inherently limited by their reliance on predefined cell subsets and known markers, which can introduce bias and restrict their ability to fully resolve cellular heterogeneity. Recent advances in multi-omics analyses have enabled the investigation of multi-layered information beyond single-cell RNA sequencing (scRNA-seq) alone and have contributed substantially to elucidating the pathogenesis of SLE. Although the emergence of autoreactive B cells and the production of autoantibodies in SLE are well established, the mechanisms of evasion from negative selection remain unclear. Multi-omics analyses have revealed key aspects of SLE pathogenesis, particularly the expansion of atypical B cells (ABCs), an autoreactive population driven by extrafollicular pathways. Furthermore, beyond transcriptional profiling, multi-omics analysis has emerged as an additional investigative method, which combines scRNA-seq with other modalities. Spatial analyses, for instance, have provided critical insights into the tissue localization and persistence of autoreactive B cells within inflammatory niches in lupus nephritis, suggesting that local microenvironments contribute to treatment resistance. Additionally, B cell receptor (BCR) sequencing has revealed distinctive BCR features in SLE, such as reduced somatic hypermutation, increased repertoire naiveness, and increased immunoglobulin variable region heavy chain gene (IGHV4-34) usage in B cells in bone marrow and affected organs (not only in peripheral blood). Furthermore, emerging multimodal approaches integrating spatial, transcriptomic, and epigenomic information further highlight pathogenic cell-cell interactions and inflammatory circuits that cannot be captured by scRNA-seq alone. In this review, we summarize recent multi-omics studies that elucidate the origin, differentiation, and tissue localization of pathogenic B cells in SLE. We provide an overview of the multi-omics analyses focusing on B cells so far, especially at single-cell resolution, and discuss their possible applications in precision medicine.
Olfactory dysfunction (OD) and Alzheimer disease (AD) represent significant global public health challenges. Growing evidence underscores the need to clarify the neuropathological mechanisms underlying their association. Our study intends to analyze global research trends and overlapping molecular mechanisms underlying OD and AD. Reviews and articles on OD and AD published between 2008 and 2024 were extracted from the Web of Science Core Collection. CiteSpace and VOSviewer were applied to for the analysis and visualization of the publication outputs, as well as the distribution of countries/regions, institutions and authors, the journals output, keywords co-occurrence, and reference citations. Molecular targets and associated pathways were investigated by GeneCards, STRING, and Metascape databases. One thousand nine hundred sixteen publications were identified, demonstrating steady growth in research output across 7006 institutions from 398 countries. The USA emerged as the top contributor, excelling in both publication output and citation impact. The University of Pennsylvania, University of California San Francisco, and Chinese Academy of Sciences stood out as the top influential institutions. Among 10,476 authors, Thomas Hummel from Technische Universität Dresden, Germany, emerged as the most prominent scholar. In terms of journals, Journal of Alzheimer's Disease leaded in publications in this field. Keywords including "Alzheimer's disease," "olfactory bulb," and "cognitive impairment" represent the current research focuses. A total of 1779 overlapping genes were identified between OD and AD. ACTB, AKT1, TP53, CTNNB1, and INS were identified as the most central regulatory genes. Enrichment analyses revealed involvement in PI3K-Akt, mitogen-activated protein kinases, and cyclic adenosine monophosphate signaling pathways, as well as biological functions related to signaling receptor activator activity, growth factor activity, and cytokine activity. Our study uncovers the dynamic research trends on OD and AD, while we further identified shared molecular mechanisms underlying these 2 disorders. Early olfactory risk assessment, diagnosis, and intervention may serve as critical components in the prevention and management in AD.
To secure the stable operation of seawater reverse osmosis during harmful algal blooms (HABs), this pilot-scale study evaluated an emergency pretreatment strategy combining sodium hypochlorite (NaClO) pre-oxidation, dissolved air flotation (DAF) and postsand filtration (SF) to optimize algae and turbidity removal. Results demonstrated that moderate NaClO pre-oxidation effectively avoided the risk of flocculant oxidation while enhancing algal and turbidity removal by approximately 6% and 18% after DAF, respectively. About 12 mg/L polyaluminum chloride (PAC) and 15 mg/L FeCl3 showed optimal algae removal performance, but PAC had a better coagulation effect on DAF than FeCl3, which was 26.8% higher than FeCl3. Low-dose cationic polyacrylamide (PAM) could further enhance flocculation. The SF unit after DAF served as a key physical barrier, elevating overall algae removal to > 95% and achieving 100% turbidity removal under the optimal dosing process (0.5 mg/L NaClO + 12 mg/L PAC + 0.2 mg/L PAM). This study provided a technically feasible emergency strategy for seawater desalination pretreatment against HABs shocks, ensuring water supply security.
To evaluate whether centralized appointment scheduling and same-day virtual clinician evaluation improved appointment timeliness and follow-up after nurse triage. We also assessed whether these changes were associated with differences in downstream utilization, costs, reach, and Veteran experience. Retrospective quasi-experimental evaluation of Veteran Administration Health Connect (VAHC) modernization across 18 regions between October 1, 2018, and September 30, 2024. Staggered rollout enabled difference-in-differences and event-study analyses comparing outcomes before and after modernization. Data were drawn from the Veterans Administration Corporate Data Warehouse, Telecare Record Manager, and Customer Relationship Management platforms, and VSignals Veteran experience surveys. The analytic sample comprised 11,118,916 encounters (4,560,677 pre-modernization; 6,558,239 post-modernization). Centralized scheduling was associated with modest and mixed improvements in appointment access. Same-day scheduling increased by 14.3 percentage points (95% CI, 10.1 to 18.5). Time from call to scheduled appointment decreased by 0.37 days (95% CI, -0.49 to -0.26), while time to completed appointment increased by 2.9 days (95% CI, 0.2 to 5.7). Following modernization, time from nurse triage to any subsequent care decreased by 0.28 days (95% CI, -0.45 to -0.11), and the proportion of callers receiving no follow-up care within 7 days declined by 2.3 points (95% CI, -4.0 to -0.5). Modernization was not associated with changes in the proportion of all emergency department (ED) visits preceded by a nurse triage call or in total ED visit volume. Seven-day ED visits, admissions, and total costs did not change meaningfully. Veteran satisfaction was high for post-modernization virtual encounters. VAHC modernization improved appointment access and follow-up after nurse triage but was not associated with short-term changes in ED use or costs, highlighting gains in navigation and experience without immediate shifts in downstream utilization.
Research on intimate partner violence has traditionally focused on discrete aggressive acts and their frequency, with less attention to how appraisal, emotion, and response readiness are organized within specific conflict episodes. This study advances an event-based structural model of conflict escalation in intimate relationships by examining how appraisal processes, negative emotional activation, escalation tendency, and behavioral responding cohere within standardized conflict events. Using a vignette-based survey of 2,702 adults in long-term intimate relationships, participants responded to scenarios involving potentially offensive partner demands. Path analyses tested associations among appraisal components, anger and fear activation, escalation tendency, behavioral responses, and expectations of partner escalation. To explicitly evaluate the robustness of the proposed structural configuration, behavioral responding was modeled in two alternative ways: as differentiated decision and response style components and as a unified ordinal severity index, with the full structural model estimated under both specifications. Appraisal components were positively associated with negative emotional activation, particularly anger, which in turn was linked to escalation tendency and to more confrontational behavioral indicators, whereas fear was not associated with escalation tendency. This differentiation between anger and fear indicates that not all negative emotional activation within conflict events carries the same escalation potential. The overall pattern of associations remained substantively consistent across both behavioral representations. Gender differences emerged in levels of several components, with women reporting higher perceived hurt, anger, and escalation tendency, and men reporting higher compliance. By conceptualizing escalation as a structurally embedded response orientation within conflict events, the study clarifies how event-specific appraisal and emotion relate to both readiness and behavioral expression in intimate partner conflict and highlights anger-focused, rather than globally emotion-focused, targets for de-escalation efforts.
Acute gastroenteritis (AGE) is a common cause of pediatric emergency department (ED) visits and is frequently associated with dehydration and metabolic disturbances. Rapid assessment of electrolytes and glucose is essential in clinical management. Although venous blood gas analysis provides faster results, its agreement with standard serum biochemistry in pediatric AGE remains unclear. This retrospective observational study included children aged 1 month to 18 years who presented to the pediatric ED with AGE between January 1, 2024, and December 31, 2025, and underwent paired venous BGA and serum biochemical testing during the same visit. A total of 1853 paired measurements were obtained from 1191 patients, as some children contributed multiple paired measurements during repeated testing. Method comparison was performed according to Clinical and Laboratory Standards Institute (CLSI) EP09-A3 guidelines using intraclass correlation coefficients (ICC), paired comparisons, Pearson correlation, and Bland-Altman analysis. Both analyzers demonstrated acceptable intra-device reliability (ICC > 0.70). However, agreement between venous blood gas and serum biochemistry was poor for sodium, potassium, chloride, and glucose, with all inter-method ICC values below 0.70. Mean values differed significantly between methods for all parameters (P < .01). Bland-Altman analysis demonstrated wide limits of agreement (LOA) between the 2 methods; for example, glucose measurements showed a mean difference of 2.1 mg/dL with LOA ranging from -64.3 to 68.5 mg/dL. Venous blood gas electrolyte and glucose measurements are not interchangeable with serum biochemistry in children with acute gastroenteritis. While blood gas analysis may be useful for rapid screening or trend monitoring in urgent settings, confirmatory serum biochemical testing remains necessary for clinical decision-making in pediatric AGE.
Post-traumatic stress disorder (PTSD) is maintained by dysfunctional trauma-related appraisals. Cognitive Bias Modification for Appraisals (CBM-APP) aims to train more functional trauma-related appraisals and has been shown to reduce PTSD symptoms. However, little is known about how this training affects the interrelations among symptoms and cognitive appraisals. In this secondary analysis of a randomized controlled trial involving 77 adult patients diagnosed with PTSD (CBM-APP: n = 37; control training: n = 40), we applied repeated cross-sectional network analysis to examine changes in the structure and centrality of associations among PTSD symptom clusters (re-experiencing, avoidance, negative cognition and mood, hyperarousal, assessed with the PTSD Checklist for DSM-5) and trauma-related cognitive measures, all assessed at both pre- and post-training. To capture multiple levels of cognitive processing, we included responses during a scenario task (reflective, idiosyncratic, spontaneous appraisals) and the Implicit Association Test (automatic self-associations). Four cross-sectional Gaussian Graphical Models were estimated for the training and control group and both timepoints (pre-/post-training × CBM-APP vs. control group). While overall network connectivity did not differ significantly across networks, descriptive patterns indicated that Alterations in Cognition and Mood emerged as the most central node in both groups at post-training assessment. Further, in the CBM-APP group, the centrality of implicit trauma-related associations decreased pre- to post-training, suggesting potential weaker associations of automatic negative self-associations with symptom activation. Given the small sample and moderate network stability, findings are preliminary but suggest that CBM-APP may influence the relational structure of PTSD symptoms and cognitions.
The global emergence of monkeypox virus (MPXV) highlights the urgent need for a deeper understanding of host-pathogen interactions. Although transcriptional responses to MPXV infection have been characterized, the role of epitranscriptomic regulation particularly N6‑methyladenosine (m6A) modification remains largely unexplored. We performed an integrated analysis of time‑series transcriptomic and m6A methylome profiles using whole blood samples collected from MPXV‑infected rhesus macaques at 7, 14, and 21 days post‑infection, with distinct animals used at each time point. Host gene expression and m6A modification dynamics were examined over the course of infection. Differential expression and differential m6A modification analyses were conducted, followed by integrative pathway and immune cell signature profiling. MPXV infection induced sustained host reprogramming, characterized by suppression of immune pathways and activation of metabolic processes. A global increase in m6A modifications was observed, accompanied by upregulation of the methyltransferase METTL3 and downregulation of demethylases (FTO, ALKBH5) and readers (YTHDF1-3). Knockdown of METTL3 or YTHDF2 reduced viral replication, suggesting a proviral role for this regulatory circuit. Integrative analysis identified 38 genes with coordinated changes in both transcription and m6A modification across all three time points. Focusing on literature-curated pathogenic pathways, we further identified 11 dual-regulated host factors. Notably, DNAJB1 was the only gene shared between these two independent selection strategies. m6A peaks near transcription start sites and within 5'UTR positively correlated with gene expression, whereas coding region modifications showed weak negative correlations. Immune lineage signatures showed gradual declines in T cell, NK, and monocyte/macrophage signatures with a progressive increase in B cell signatures. Cross‑dataset comparison confirmed core m6A regulatory trends despite heterogeneity across tissues and viral strains. This study reveals m6A epitranscriptomic remodeling as a key correlate of the host response to MPXV infection and nominates DNAJB1 alongside the other 10 dual‑regulated genes as candidate host factors for further mechanistic investigation.
The purpose of this study was to identify older siblings' responses to their younger siblings' peer conflict situations and reasons for their responses. Findings will contribute to a gap in the field of violence prevention, which rarely considers siblings' roles as socialization agents. Qualitative interviews were completed with 20 Black sibling pairs (M = 11.08, SD = 2.81) from high-violence, under-resourced communities in the southeastern U.S. Younger siblings recalled an experience of peer conflict of which their older sibling was aware, and siblings discussed their responses to that situation. Themes that emerged during the interviews suggested that older siblings were likely to be present for and consulted about their younger siblings' conflict situations, which primarily involved physical aggression. Younger siblings valued their older siblings' input, as evidenced by older siblings' responses being highly influential in younger siblings' behavioral decisions. A conceptual model was proposed whereby older siblings' responses to younger siblings' conflict mediate the relation between older siblings' roles and responsibilities, older siblings' goals for their younger siblings, and older siblings' beliefs about fighting and younger siblings' responses to conflict. Moderators, such as younger siblings' preferred support, sibling dyad characteristics, and sibling relationship processes, are proposed for the relation between older and younger siblings' responses to peer conflict. Sibling relationships are a promising and underexplored avenue for effective youth violence prevention. These findings have the potential to inform prevention and intervention strategies by identifying older siblings as additional targets for programming.
Male infertility is an increasing global health concern with multifactorial origins. Recent evidence highlights air pollution as a key environmental risk factor affecting male reproductive health. This review synthesises studies from 2020 to 2026 on how airborne pollutants including particulate matter, gaseous compounds, polycyclic aromatic hydrocarbons and microplastics induce oxidative stress and impair testicular function. Oxidative damage emerges as a central mechanism driving mitochondrial dysfunction, inflammation, antioxidant depletion and DNA damage. Epidemiological findings consistently link higher pollutant exposure to reduced sperm quality including count, motility, morphology and genetic integrity. Experimental studies further demonstrate disruption of the blood-testis barrier, apoptosis of germ cells, hormonal imbalance and impairment of the hypothalamic-pituitary-testicular axis. Despite strong mechanistic insights, gaps remain in dose-response relationships, pollutant interactions and long-term reproductive outcomes. This review emphasises the need for integrated strategies combining pollution control, clinical monitoring and antioxidant interventions to mitigate reproductive risks.
Allosteric effects are widespread in proteins, but predicting the impact of sequence substitutions at positions distant from ligand-binding or enzyme active sites remains challenging, as their effects are mediated through complex dynamical networks. Pinpointing such positions experimentally is labour-intensive and low throughput. Equilibrium molecular dynamics (MD) simulations are useful: analysis methods can identify functional distal sites and networks, while free energy simulations can predict effects on stability or binding, given sufficient sampling; such simulations are typically time-consuming, requiring extensive simulation of each individual mutant. Here, we introduce a dynamical-nonequilibrium MD (D-NEMD) protocol using alanine substitutions as targeted perturbations to identify distal positions that influence enzyme function. Using the well characterised class A β-lactamase KPC-2 as a test system, we show that D-NEMD distinguishes functional from non-functional sites based on whether substitutions generate structured, long-range responses that reach the active site. KPC-2 is clinically important due to its broad substrate spectrum and the emergence of resistance-associated point mutations, many of which act through non-local effects on catalytic residues. Alanine substitutions at positions 179 and 164, which disrupt the Ω-loop salt bridge, trigger persistent structural responses propagating through the protein and reach both catalytic residues and the oxyanion hole backbone. Likewise, alanine substitution at position 220 elicits pronounced responses extending to the active-site β-sheet and key loops, consistent with its known role in substrate specificity. In contrast, substitution at position 276-mutations of which have negligible kinetic impact-produces only local displacements with minimal propagation and no effect on catalytically relevant regions. These differential response patterns align with experimentally observed resistance phenotypes. D-NEMD therefore provides a fast, generalisable, and predictive approach for identifying allosterically connected distal positions. The protocol complements equilibrium MD, is straightforward to implement, and offers a tractable route for prioritising candidate sites for mechanistic study or future mutational scanning efforts.
Hematopoietic stem cells (HSCs) constitute the pivotal cellular subset sustaining long-term hematopoietic homeostasis, characterized by robust self‑renewal and multilineage differentiation potential. Under physiological conditions, HSCs undergo stepwise differentiation through rigorously controlled regulatory networks to produce a full repertoire of mature blood cells, fulfilling basal physiological demands. Upon exposure to stress or pathological insults (e.g., bone marrow niche dysregulation), HSCs rapidly activate emergency regenerative programs to reconstitute hematopoietic function and restore systemic homeostasis. As intracellular "powerhouses" and central hubs of metabolic regulation, mitochondria exert profound regulatory effects on HSCs fate determination. The dynamic balance of mitochondrial metabolism not only furnishes HSCs with sufficient bioenergy but also generates critical metabolic intermediates; meanwhile, the fine-tuning of oxidative stress and autophagic machinery ensures mitochondrial network integrity. These biological processes are intricately intertwined, forming a complex regulatory network that profoundly modulates HSCs self-renewal, lineage commitment, and long-term hematopoietic reconstitution potential. This review systematically dissects the multi-dimensional regulatory mechanisms by which mitochondria govern HSCs, elaborates on the synergistic interactions and antagonistic effects among distinct components of the regulatory circuitry, and defines the pivotal role of mitochondria in sustaining HSCs homeostasis and orchestrating their repair responses to cellular damage. This work establishes a novel theoretical framework for devising mitochondrial-targeted interventions to sustain metabolic homeostasis in HSCs. Furthermore, it lays a solid scientific foundation for the treatment of hematological diseases and the development of precision therapeutic strategies, offering new insights into the clinical management of hematopoietic disorders.
In popular discourse, personal success is often attributed to mindset. In psychological science, such claims correspond to self-related core beliefs-generalized self-representations. However, the lack of a comprehensive framework has prevented systematic investigation of their links to socioeconomic inequality. The present study aimed to provide the first systematic mapping of how socioeconomic status (SES) is reflected in individuals' core beliefs. Building on the CorBel model-an integrative taxonomy of 97 belief nuances derived via natural language processing-we analyzed two preregistered, SES-representative national samples (Germany: N = 435, UK: N = 266). Positive beliefs (e.g., competence, autonomy, trust) were associated with higher SES, whereas negative beliefs (e.g., insecurity, unworthiness, pessimism) were associated with lower SES. These associations replicated across SES indicators (education, income, wealth) and across countries, explaining up to 20% of the variance in SES outcomes. The findings offer the first systematic mapping of how socioeconomic inequalities are mirrored in individuals' innermost psychological constitution. Core beliefs emerge as potential targets for interventions with both societal and policy relevance.
Autism spectrum disorder manifests through dysbiosis across the microbiota-gut-brain-immune axis, characterized by depletion of short-chain fatty acid (SCFA)-producing taxa like Bifidobacterium, Faecalibacterium, and Roseburia, along with an increase in endotoxin-producing taxa like Desulfovibrio and Bacteroides. SCFA emerge as one of the regulators of neuroimmune homeostasis by governing microglial maturation through GPR43/GPR109A-dependent histone deacetylase inhibition, modulating astrocytic tryptophan-aryl hydrocarbon receptor signaling, and preserving tight junction integrity at blood-brain and blood-CSF barriers. SCFA insufficiency constitutes the upstream metabolic defect linking gut dysbiosis to ASD neuropathology, such as impaired microglial priming and brain-resident CD4+ T cell differentiation, reactive astrocytosis with kynurenine neurotoxicity superseding protective signaling, barrier breakdown enabling LPS-driven TLR4-NF-κB neuroinflammation, and excitatory/inhibitory imbalance from reduced glutamate decarboxylase and astrocyte glutamate dysregulation. This review advances an integrative SCFA-centric framework repositioning ASD as metabolite-dependent neuroimmune dysregulation during brain development. Preclinical and early clinical data demonstrate that SCFA restoration through prebiotic fiber/resistant starch, probiotics, or direct SCFA supplementation normalizes gastrointestinal symptoms, behavioral deficits, microglial morphology, and neurotransmitter ratios. This guides mechanistically targeted microbiota interventions with fecal/plasma SCFA profiling as stratification biomarkers, establishing precision therapeutic regimens for ASD.
Disaster response in neonatal intensive care units is particularly complex because care continuity depends on coordinated teamwork, stable infrastructure, and technology-dependent support for highly vulnerable infants. However, qualitative evidence on how nurses experience disaster response in these settings remains limited, especially in the context of the 2023 Türkiye-Syria earthquakes. This study explored how nurses working in neonatal intensive care units experienced disaster response during the earthquakes. Data were collected through semistructured in-depth interviews with 21 nurses and analyzed using descriptive phenomenological analysis. Participants described disaster response not only as a clinical emergency but also as a disruption of the systems supporting coordination, safe neonatal care, and practical preparedness. They reported breakdowns in communication and role clarity, fragility in care when electricity, oxygen delivery, monitoring systems, evacuation planning, and essential supplies became unstable, and a clear gap between general disaster education and unit-specific readiness. Overall, the findings highlight the need for neonatal intensive care-specific disaster preparedness.
A 0/2-h algorithm for the i-STAT point-of-care (POC) high sensitivity troponin I (hs-cTnI) assay was recently derived in Australia. The objective of this study was to validate and optimize the performance of the 0/2-h algorithm in a multisite U.S. Emergency Department (ED) cohort. A prospective cohort study was conducted at three U.S. EDs (February-September 2025). Adults without STEMI and at least one hs-cTnI ordered were accrued. Blood samples were collected simultaneously for POC hs-cTnI measurement on an i-STAT 1 analyzer (Abbott Laboratories) and central laboratory hs-cTnI measurement (Beckman Coulter). The primary outcome was index myocardial infarction (MI), adjudicated by experts using clinical hs-cTnI measures. Diagnostic performance of the Australian 0/2-h algorithm was assessed by calculating negative and positive predictive values (NPV, PPV) with associated 95% confidence intervals. Efficacy, defined as the proportion of patients classified into the rule-out zone, was calculated. Algorithm optimization tested modified cut points to increase efficacy while maintaining NPV ≥ 99% and achieving PPV ≥ 65%. During the study period, 578 patients with complete 0/2-h algorithm assessments were accrued. These patients were 48% (279/578) female, 40% (233/578) non-White, with a median age of 60 years (IQR: 50-70). Index MI occurred in 7.4% (43/578). Algorithm efficacy was 54.8% (317/578) and 8.8% (51/578) were classified to the rule-in zone. Among patients ruled-out, the NPV was 99.4% (95% CI: 97.7%-99.9%). The rule-in zone was associated with a PPV of 62.7% (95% CI: 48.1%-75.9%). Among 36.3% (210/578) patients classified to the observation zone, 4.3% (9/210) had an adjudicated index MI. An optimized 0/2-h algorithm increased efficacy to 60.0% (347/578) while achieving an NPV of 99.4% (95% CI: 97.9%-99.9%) and PPV of 74.4% (95% CI: 58.8, 86.5%) for index MI. The original Australian and optimized 0/2-h algorithms for i-STAT POC hs-cTnI measurement had high NPV and efficacy in a multisite U.S. Trial Registration: NCT06899776.
Coronary artery lesions (CAL) complicating Kawasaki disease (KD) are a central concern affecting the long-term cardiovascular health of affected children. This study aimed to systematically depict the macro landscape, knowledge structure, and evolutionary dynamics of this field through bibliometric and knowledge graph methods, providing strategic guidance for future research. Literature related to KD-CAL was retrieved from the Web of Science Core Collection. Quantitative and visual analyses of publication trends, countries/regions, institutions, authors, journals, references, and keywords were conducted using CiteSpace 6.3.R1, VOSviewer 1.6.20, and the Bibliometrix R package. A total of 2655 publications were included. The annual publication volume showed an increasing trend, with acceleration after 2015. The United States emerged as the country with the highest productivity and influence (citation frequency, centrality), while China ranked first in publication output (909 articles) but had a lower rate of international collaboration (MCP_Ratio = 0.08). The core journal cluster comprised Circulation, Journal of Pediatrics, and Pediatric Cardiology, among others. A close international collaboration network was formed around key figures like Jane Carleton Burns and Adriana H. Tremoulet. Keyword and document co-citation analyses revealed 5 major research clusters: acute-phase management, immunopathological mechanisms, coronary complications, treatment of intravenous immunoglobulin resistance, and long-term follow-up. The research frontier has evolved from "epidemiology" and "diagnosis" to "biomarkers" and "IVIG resistance," and is now predominantly focused on "biologics" (e.g., infliximab, anakinra) and "artificial intelligence/machine learning." The new phase of KD-CAL research may focus on precision medicine. Future efforts may focus on deepening immunological mechanism studies to develop targeted therapies, utilizing artificial intelligence to optimize risk stratification and imaging assessment, and establishing globally collaborative long-term cohorts to clarify cardiovascular outcomes in adulthood. Strengthening basic and clinical translation is essential to advance KD-CAL diagnosis and treatment into a new era of precision and efficiency.