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A 34-year-old man presented with recurrent palpitations and dyspnea on exertion. Palpitations started at the age of 13 years; he received direct-current cardioversion for unstable tachycardia at 22 years and recently developed an acute ischemic stroke. The admission 12-lead electrocardiogram showed atrial fibrillation (AF), and echocardiography demonstrated a hypertrophic cardiomyopathy (HCM) phenotype with moderate left ventricular (LV) systolic dysfunction. His father was diagnosed with HCM and high-grade conduction disease requiring a permanent pacemaker at the age of 46 years. After cardioversion, the sinus rhythm electrocardiogram revealed a short PR interval with ventricular pre-excitation (mid-septal pattern). Electrophysiological study showed a short, fixed HV interval of 24 ms that remained unchanged during atrial pacing and after adenosine, with persistence of the pre-excited QRS morphology during junctional beats and no inducible tachycardia. These findings were diagnostic of a fasciculoventricular pathway. Cardiac magnetic resonance imaging (CMR) revealed asymmetric septal hypertrophy with multifocal late gadolinium enhancement, and targeted genetic testing confirmed a pathogenic PRKAG2 variant (c.905G>A, p.Arg302Gln). Because no ablatable arrhythmic substrate was present, management was directed at heart failure, anticoagulation, rhythm control of AF, and surveillance for progressive conduction disease with cascade family screening. In conclusion, this case illustrates the clinical manifestations of PRKAG2 mutation-associated glycogen-storage cardiomyopathy, a phenocopy of hypertrophic cardiomyopathy characterized by ventricular pre-excitation and progressive conduction disease, highlighting the convergence of structural, electrophysiological, and genetic mechanisms.
Blastocystis hominis is a ubiquitous intestinal parasite commonly detected in human stools. Queries about the pathogenic nature of B. hominis in immunocompetent individuals have been raised with conflicting reports about the clinical significance of detecting the parasites in various specimens. Reports have documented invasive intestinal infections and the detection of Blastocystis species in both a splenic cyst and a hepatic abscess. We present the case of a 65-year-old man with a history of recent travel to a tropical country who was found to have multiple hepatic abscesses. Analysis of the hepatic abscess fluid confirmed the presence of Entamoeba histolytica and Blastocystis species, and, to our knowledge, this is the second reported case of the same findings. Overall, the clinical and microbiological picture was most consistent with amoebic liver abscess secondary to E. histolytica; however, the presence of Blastocystis species introduces uncertainty around its clinical significance. Further studies are required to investigate the pathogenicity of Blastocystis species, including molecular investigations into the various genetic subtypes.
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Solution-phase nanomaterials synthesis is sensitive to the interplay between the many species in solution. Additives that do not directly participate in the net chemical reaction often moderate nanoparticle formation and growth, affecting the polymorphic phase distribution, particle size, and morphology. While ionic salts are common reaction-modifying additives, they necessarily introduce two distinct species in tandem, a cation and an anion, each of which can influence reaction evolution in different ways. Here, we separate the influence of cationic and anionic additives during TiO2 nanoparticle synthesis by comparing reactions with systematically varied additive compositions. We evaluate 4 cations (Li+, Na+, K+, and NH4+) and 5 anion compositions across a NO3--Cl- gradient, comprising 20 total salt compositions. We combine in situ time-lapse photography and image analysis, which reveal the kinetics of product formation and sedimentation, with post facto depth-resolved X-ray pair distribution function (PDF) analysis to map the polymorph distribution accumulated at different stages of the reaction. The results show that ion additives most strongly perturb the reaction during the first of two distinct TiO2 formation events, where they bias hydrolysis, nucleation, colloidal destabilization, and sedimentation in a coupled way. These findings show that the outcome of TiO2 nanoparticle synthesis is controlled by the evolving solution environment and that spectator ions exert systematic control over how the system first departs from the initial state.
Attempts to synthesize a phenanthroline palladium(0) complex with an η2-coordinated nitrosoarene starting from a palladium(II) precursor and the corresponding aryl hydroxylamine afforded instead apparent palladium(I) metallacyclic complexes that, on a closer inspection, were proven to be Pd(II) complexes with a new kind of radical-anionic nitrosoarene ligand.
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In 2021, Netflix released Clickbait and The Guilty, which both feature white men who are wrongfully accused of gender-based violence. The character trope of the wrongfully accused man is a staple in popular film and television but takes on a new meaning in the #MeToo era. This article argues that Clickbait's and The Guilty's use of this trope is created by perpetuating rape myths. Thus, they contribute to rape and domestic violence myth acceptance. Furthermore, it will demonstrate that their overall narratives show striking parallels with what Jennifer J. Freyd coined as DARVO (Deny, Attack, Reverse Victim and Offender).
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A 46-year-old woman with intravenous heroin use presented with fever, respiratory symptoms, and methicillin-susceptible Staphylococcus aureus bacteremia. Thoracic computed tomography demonstrated multiple septic emboli. Transthoracic echocardiography revealed severe tricuspid regurgitation without vegetations. Transesophageal echocardiography (TEE) discovered a vegetation on the Chiari network and tricuspid leaflet perforation. She was successfully treated with antibiotics. Follow-up TEE showed resolution of the vegetation. This case highlights the Chiari network as an uncommon but clinically relevant substrate for right-sided infective endocarditis in high-risk patients. In patients with risk factors for right-sided infective endocarditis with apparently no valvular vegetation on transthoracic echocardiography, the Chiari network and Eustachian valve should be evaluated with TEE.
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Congenital pericardial agenesis (CPA) is a rare anomaly that is often considered a benign incidental finding but may present with nonspecific symptoms and mimic structural heart disease. Its clinical relevance remains incompletely defined, particularly regarding the distinction between a harmless anatomical variant and a clinically significant condition. We present a retrospective two-center case series of four patients with imaging-confirmed CPA, combined with a narrative review of the literature aiming to evaluate the clinical spectrum, diagnostic challenges, and management implications of CPA. The clinical presentation of our patients was heterogeneous, ranging from incidental findings to chest discomfort and dyspnea. In all cases, initial echocardiography suggested alternative diagnoses, including right ventricular cardiomyopathy, atrial septal defect, or pericardial disease, leading to diagnostic uncertainty. Definitive diagnosis was established using multimodality imaging, particularly cardiac magnetic resonance and computed tomography, which demonstrated characteristic features such as cardiac levoposition and interposition of lung parenchyma. Three patients had complete left pericardial agenesis and one had a partial defect. All patients were managed conservatively, without complications during follow-up.
Systolic murmurs are common in adults without significant valvular heart disease (VHD) and are more prevalent in women than in men, but the determinants of murmur audibility remain unclear. We aimed to identify the physiological determinants of innocent murmurs and examine the basis for sex differences in murmur prevalence. In this cross-sectional population-based study, we analysed data from 1680 participants in Tromsø7 without significant VHD who underwent echocardiography and heart sound recording. We used multivariable logistic regression with complete-case data from 1643 participants to identify determinants of innocent murmurs. Among 1680 participants, 339 (20.2%) had an innocent murmur. In multivariable analysis, mean aortic valve gradient was the strongest determinant (OR 23.79 per 5 mm Hg, 95% CI 15.01 to 38.71), followed by female sex (OR 3.42, 95% CI 2.38 to 4.99), age (OR 1.41 per 10 years, 95% CI 1.22 to 1.64), systolic blood pressure (OR 1.12 per 10 mm Hg, 95% CI 1.04 to 1.20) and haemoglobin (OR 0.86 per 10 g/L, 95% CI 0.75 to 0.98). Murmur probability increased steeply with increasing gradient and exceeded 50% at 6-8 mm Hg, depending on sex. Women had a higher murmur probability than men across the observed gradient range. In adults without significant VHD, systolic murmurs were strongly associated with mean aortic valve gradient and occurred at lower gradients in women than in men. These findings support interpreting systolic murmurs as a probabilistic and context-dependent clinical finding rather than a binary marker of VHD.
Artificial intelligence (AI) is rapidly transforming cardiovascular medicine, with growing applications in pediatric cardiology. AI techniques, particularly machine learning and deep learning, enable the analysis of complex and heterogeneous data, supporting diagnosis, risk stratification, and clinical decision-making. This paper provides an overview of current AI applications in this field, discusses existing challenges, and explores future perspectives. In pediatric cardiology, AI has shown promising results across multiple domains. In electrocardiography, AI algorithms improve diagnostic accuracy and enable early detection of cardiac conditions, even in asymptomatic patients, while facilitating telecardiology-based care pathways. In cardiac auscultation, AI-assisted digital stethoscopes enhance the distinction between innocent and pathological murmurs, supporting primary care physicians and optimizing referral to pediatric cardiologic centers. Multimodality imaging represents one of the most advanced areas of AI applications. In echocardiography, magnetic resonance and computed tomography, AI improves image acquisition, view classification, and automated quantification, contributing to more standardized and reproducible assessments. Additionally, emerging technologies such as virtual reality, integrated with AI, offer innovative tools for education, surgical planning, and patient-specific modelling. Despite these advances, several limitations remain, including limited availability of large pediatric datasets, challenges in model generalizability and issues related to interpretability and integration into clinical workflows. In conclusion, AI represents a powerful complementary tool in pediatric cardiology, with the potential to improve diagnostic accuracy, optimize healthcare resources and support the transition toward precision medicine.
Lane-changing is one of the most common driving maneuvers. Nevertheless, dangerous lane-changing can pose a serious threat to surrounding innocent vehicles. Modeling lane-changing risks is crucial for understanding dangerous driving behaviors and preventing hazardous accidents. When assessing lane-changing risk based on the physical processes of lane-changing behavior, there are certain limitations in considering the uncertainty of driving behavior. This study proposes a lane-changing risk assessment model that explicitly incorporates the uncertainty of driving behavior. By integrating a risk attenuation function and computing the definite integral of risk values across varying acceleration scenarios, the model comprehensively accounts for diverse driving behaviors to evaluate lane-changing risk. A subset of lane-changing samples is extracted from the NGSIM and highD datasets for model analysis and evaluation. The results show that, when compared with four commonly used lane-changing risk assessment indicators or models, the model proposed in this study performs better in identifying instantaneous lane-changing risks and predicting the deceleration behavior of the adjacent following vehicles. The risk model proposed in this study provides new ideas for lane-changing risk estimation and can effectively support the construction of human-like autonomous driving systems.
This study aimed to determine the prevalence and associated factors of anemia among HIV-positive children receiving antiretroviral therapy (ART) at two urban clinics in Mbarara City, Southwestern Uganda. We conducted a cross-sectional study among 293 HIV-positive children (<18 years) attending ART clinics at Mbarara Municipal Health Center IV and Holy Innocent Children's Hospital between July and September 2025. A structured questionnaire captured sociodemographic and clinical data. Venous blood were collected for complete blood count (CBC) analysis, and stool samples were examined for intestinal parasites. Data on CD4 count and viral load were abstracted from medical records. Anemia was defined using age-specific WHO criteria. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with anemia, with statistical significance set at p ≤ 0.05. The overall prevalence of anemia was 6.14% (95% CI: 3.4% - 8.9%). Normocytic normochromic anemia was the predominant morphological type (72.2%). In the multivariate analysis, a recent episode of malaria (AOR = 9.61; 95% CI: 3.26-28.34), the presence of an opportunistic infection (AOR = 6.78; 95% CI: 1.28-35.83), and poor adherence to ART (AOR = 14.75; 95% CI: 1.31-165.65) were independently and significantly correlated with anaemia. While the prevalence of anemia in this cohort of HIV-infected children on ART was lower than global averages, it remains a significant clinical concern. The strong associations with malaria, opportunistic infections, and suboptimal ART adherence highlight critical areas for intervention. Targeted strategies, including integrated malaria control, enhanced prevention and management of OIs, and reinforced adherence support, are required to decrease the anaemia burden and optimize health outcomes in this at-risk population.
Tricuspid valve regurgitation is a frequent valve lesion and, if severe, an independent predictor of mortality. In most patients, the valve itself has historically been considered intact. Yet, we have previously shown that the valve may not be an innocent bystander. In multiple sheep models, we have shown that the tricuspid valve thickens and stiffens. This remodeling may contribute to valve disease. Our goal is to extend our investigation of tricuspid valve remodeling to a rodent model, potentially opening scientific opportunity and enabling scaling our studies. To this end, we used pulmonary artery banding (PAB) in male rats to induce pressure overload and right ventricular remodeling. After excising the tricuspid valve, we quantified anterior leaflet morphology, mapped anterior leaflet thickness using optical coherence tomography, and evaluated anterior leaflet belly mechanics using a custom bulge testing system. Compared with SHAM controls, PAB increased anterior leaflet area. Moreover, anterior leaflets in PAB animals exhibited region-specific thickening, with the largest increases near the annulus. Finally, anterior leaflets in PAB animals were significantly less compliant. However, leaflet stiffening stemmed from aforementioned thickening, i.e., structural stiffening, not constitutive stiffening. Our findings demonstrate that we can reliably quantify leaflet area, thickness, and stiffness in the minuscule tricuspid valves of rats. We also show that tricuspid valve remodeling is not ovine-specific, but also affects the tricuspid valves of rats. Together, our findings support our hypothesis that tricuspid valves are not innocent bystanders in regurgitation, and that rats may serve as a scalable model system for future investigations.
Witnesses may experience inattentional blindness (IB), failing to notice crimes occurring when focusing elsewhere. Witnesses who experience IB may be perceived negatively by jurors. The current studies aimed to determine whether expert testimony and demonstrations of IB can improve perceptions of witness IB. In two experiments, some participants completed a demonstration prior to reading a trial transcript containing the testimony of two witnesses (one of whom experienced IB). In both studies, some participants then read the testimony of an expert witness on the topic of IB within the trial. The findings revealed that the witness who experienced IB was perceived as less credible than the witness who saw the crime. Neither expert testimony nor demonstrating IB influenced this. These findings suggest that safeguards may not protect innocent witnesses who have experienced IB from legal charges.