Kawasaki disease (KD) and viral infection (VD) share similar clinical features but require distinct treatments. A practical biomarker to distinguish them is therefore clinically important. Previous blood transcriptome studies identified many differentially expressed genes, but large gene panels are impractical for routine laboratories. A ratio-based Direct Leukocyte Single-cell-type Transcript Abundance (DIRECT LS-TA) assay was recently developed to quantify monocyte gene expression directly in whole blood using a monocyte-specific target gene relative to monocyte reference genes (PSAP or CTSS). Interferon-stimulated genes IFI27, IFI44L, and SIGLEC1 can be measured by this approach. In this study, three ratio biomarkers (IFI27/PSAP, IFI44L/PSAP, SIGLEC1/PSAP) and a conventional interferon (IFN) score derived from eight genes were calculated from public blood transcriptome datasets (GSE73461 and GSE68004) and compared between KD and VD. VD patients showed markedly elevated IFN-related biomarkers, with all three ratios significantly higher in VD and IFI27/PSAP giving the largest increase. IFI27/PSAP achieved the highest diagnostic performance (AUC 0.90), slightly exceeding the conventional IFN score (AUC 0.89). These findings suggest that absent or minimal IFN activation argues against VD and supports KD, and that this simple ratio assay could serve as a clinically useful exclusion test.

A large body of evidence has helped reframe atherosclerotic cardiovascular disease from a mere lipid storage disorder to a chronic inflammatory disease. Both innate and adaptive immune pathways contribute to atherogenesis, plaque progression, and plaque destabilization. Macrophages, T cells, and cytokines-among them IL-1β, IL-6, and IL-18-have emerged as key immune cells and mediators implicated in atherosclerosis progression. Residual inflammatory risk-as measured by highly sensitive C-reactive protein (hsCRP) - has gained broad clinical acceptance as an important biomarker of cardiovascular risk prediction independent of cholesterol burden. Finding strategies that target residual inflammatory risk has proven an elusive goal in preventative cardiology. Specific approaches-such as IL-1β inhibition or low-dose colchicine-have shown benefit in reducing cardiovascular events, while other strategies have failed, underscoring the importance of targeting disease-relevant immune pathways and selecting patients that will benefit. Newer approaches-including IL-6 inhibitors, NLRP3 inflammasome inhibitors, and low-dose IL-2-offer promise for further risk reduction. Efforts to use inflammatory biomarkers to more precisely identify patients who may benefit may further improve the benefit-to-risk profile of emerging therapies.

Adverse pregnancy outcomes (APOs) confer long-term cardiovascular risk, yet population-level temporal trends in heart failure (HF) burden among APO-exposed women in the United States remain uncharacterized.

We used the TriNetX U.S. Collaborative Network (64 U.S. health care organizations; n = 979,178 women aged 15-60 years with ≥1 documented APO at delivery) to calculate annual HF incidence proportion and period prevalence from 2013 through 2023, stratified by 5-year age band and self-reported race/ethnicity. HF was identified by International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code I50; a prewindow lookback distinguished the incident from prevalent cases.

HF incidence proportion rose 2.70-fold (0.782-2.110 per 1,000), and prevalence increased 3.20-fold (0.39-1.26%) from 2013 to 2023. By 2023, women aged 15-19 years had an HF incidence of 1.529 per 1,000, exceeding the 2013 incidence of women a decade older (30-34 years: 0.916 per 1,000) (7.7-fold increase). Incidence declined 10.7% in 2020, whereas prevalence continued to rise (0.74-0.81%), before incidence rebounded 31.1% in 2021. AI/AN women maintained the highest absolute incidence throughout (5.845 per 1,000 in 2013; 5.467 per 1,000 in 2023). Black/AA women showed a 2.1-fold increase (1.673-3.534 per 1,000), maintaining a 2.0- to 3.2-fold excess over White women at all time points. Native Hawaiian/Other Pacific Islander women had the largest incidence-prevalence divergence: a 5.8-fold prevalence increase (0.40-2.33%) against a near-stable incidence proportion.

HF burden increased substantially across all age groups and racial categories among APO-exposed U.S. women from 2013 to 2023.

Stroke is a major cause of morbidity and mortality, characterized by neuronal damage and complex cell death pathways. This study aimed to investigate the protective role of spermine oxidase (Smox) in ischemic stroke and its effect on neuronal autophagy.

We employed transient middle cerebral artery occlusion (tMCAO) models and oxygen-glucose deprivation/reoxygenation (OGD/R) experiments in HT22 cells to explore the protective effects of Smox knockdown against ischemic injury and to evaluate changes in autophagy.

Smox levels were significantly elevated following stroke, and correlated with increased autophagic activity and neuronal apoptosis. In contrast, knockdown of Smox reduced neuronal death and improved neurological function while decreasing autophagy activation. Mechanistically, Smox may regulate autophagy via the phosphorylation of protein kinase B (AKT), AMP-activated protein kinase (AMPK), and mechanistic target of rapamycin (mTOR); Smox knockdown increased AKT and mTOR phosphorylation, while reducing AMPK phosphorylation, suggesting a potential shift in the regulation of neuronal autophagy.

Our findings suggest a dual role for Smox in stroke pathology, indicating that it may influence autophagy via the AKT/AMPK/mTOR signaling, which could be critical for neuronal survival after ischemic injury. Targeting Smox may offer a therapeutic strategy for neuronal protection and recovery in stroke management, suggesting the potential importance of autophagy modulation in ischemic brain injury.

Short-term exposure to ambient air pollution has been associated with cardiovascular disease (CVD) mortality, but localized evidence from subtropical cities in southwestern China remains limited. This 11-year time-series study aimed to evaluate the short-term associations between six criteria air pollutants and daily CVD mortality in Nanning, China.

We conducted a time-series analysis using daily data on CVD mortality, air pollutant concentrations, and meteorological variables from 2014 to 2024 in Nanning. Generalized additive quasi-Poisson models were used to estimate associations across single-day lags (lag0-lag7) and cumulative lag windows (lag0-1 to lag0-7), adjusting for long-term trends, temperature, relative humidity, and day of the week. Exposure-response relationships were assessed using natural cubic splines. Stratified analyses were conducted by season and age group, and two-pollutant models and sensitivity analyses were performed to evaluate robustness.

A total of 87,913 CVD deaths were recorded during the study period, of which 57.5% occurred in males and 77.9% occurred among individuals aged ≥65 years. In single-day lag models, PM_2.5, PM₁₀, SO₂, NO₂, and O₃-8h showed significant positive associations with CVD mortality at early lag days. At lag0, the RRs were 1.014 (95% CI: 1.008-1.020) for PM_2.5, 1.009 (95% CI: 1.006-1.013) for PM₁₀, and 1.018 (95% CI: 1.011-1.026) for NO₂, while SO₂ showed its largest estimate at lag1 [RR = 1.044 (95% CI: 1.018-1.069)]. In cumulative lag models, PM_2.5, PM₁₀, SO₂, NO₂, and O₃-8h showed significant cumulative associations, whereas CO was significant mainly in shorter lag windows. Season-stratified analyses suggested pollutant-specific variation between cold and warm seasons, although formal pollutant-by-season interaction tests were not statistically significant. Age-stratified analyses indicated broader susceptibility among older adults. The main associations were generally robust in sensitivity analyses, distributed lag models, and two-pollutant models, particularly for PM_2.5, PM₁₀, and NO₂.

Short-term exposure to ambient air pollution was associated with increased CVD mortality, particularly for PM_2.5, PM₁₀, and NO₂, with consistent effects across single-day and cumulative lag structures. The results highlight the cardiovascular risks of particulate and traffic-related pollution and support pollutant-specific air quality management and targeted protection for older adults during high-pollution periods.

Objective: Evaluate an outpatient neuropsychology stepped-care model to improve healthcare quality and efficiency. Compare utilization patterns and quality outcomes between brief neuropsychology evaluations (referred to as screening visit; [SV]) and comprehensive neuropsychological evaluations (CNEs) in a retrospective sample of Veterans. Methods: Consults (n = 139) were triaged based on chart review and evaluation of who may benefit from SV over CNE (e.g. active/undertreated mental health symptoms, substance use, recent CNE). All patients offered SV were also offered CNE. Referral questions were answered for both SV and CNE. Results: When offered the choice between SV and CNE, all patients selected SV. Active/under-treated mental health concerns were the most common reason for SV. Most SV visits did not require further neuropsychological testing (n = 25/36 or 69.44%). SVs facilitated faster access to care, with shorter time to feedback (SV mean days = 1.56, CNE mean days = 12.04) and an almost 20% faster time to see patients overall. Similar recommendations were provided for both SV and CNE, with mental health referrals as the most frequently cited. Utilizing SVs resulted in time and money savings and with 20% faster time to scheduling. Conclusions: The application of a neuropsychology stepped-care approach using SVs at our local facility demonstrated several positive outcomes, including improved efficiency and increased access to care.

Objective: Internet gaming disorder (IGD) has gained increasing global recognition, yet little is known about how health care providers perceive and manage this condition in clinical practice. The objective of this study was to assess health care providers' IGD-related beliefs, familiarity with diagnostic criteria, confidence in diagnosis and management, and perceived training needs. Methods:A cross-sectional online survey of internal medicine and psychiatry health care providers was conducted between September and October 2025 at a large academic medical center, assessing IGD-related beliefs, familiarity with diagnostic criteria, confidence in diagnosis and management, and perceived training needs. Results: Among 67 respondents, most participants endorsed IGD as a clinically significant condition (84%) that contributes to psychiatric comorbidities (87%). However, fewer than half of providers reported confidence diagnosing (44%) or managing IGD (29%), and only 37% were familiar with currently proposed Diagnostic and Statistical Manual of Mental Disorders criteria. Psychiatric health care providers reported greater confidence and familiarity with IGD than their internal medicine counterparts, particularly in diagnosis, management, and identification of diagnostic criteria during clinical encounters. Overall, 81% of participants indicated that they would benefit from additional IGD-related education. Conclusion: Despite broad recognition of IGD's clinical significance, substantial gaps remain in provider confidence and familiarity with diagnostic and management approaches, particularly outside of psychiatry. These findings identify actionable gaps in provider preparedness and highlight the need for targeted educational efforts to support effective clinical management of IGD across medical specialties. Prim Care Companion CNS Disord 2026;28(4):26m04192. Author affiliations are listed at the end of this article.

Objective: To adapt the Borderline Symptom List 23 (BSL-23) to Brazilian Portuguese and evaluate its psychometric properties in a large nonclinical sample. Methods: A total of 2,682 participants completed an online questionnaire between December 2021 and January 2022. Participants had a mean age of 26.64 years; most were female (78.2%) and had completed higher education. The adaptation process followed established guidelines, including translation, back-translation, expert evaluation, and target-population review. In addition to the BSL-23, participants completed the Depression, Anxiety and Stress Scale-21 Items (DASS-21), Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale, and Childhood Trauma Questionnaire. Statistical analyses included exploratory and confirmatory factor analyses, internal consistency assessment, and tests of concurrent validity and measurement invariance. Results: The BSL-23 maintained a unidimensional structure and demonstrated excellent internal consistency (Cronbach α=0.95). Exploratory factor analysis indicated high factor loadings for most items, while confirmatory factor analysis required minor adjustments due to collinearity between certain item pairs. Measurement invariance analyses showed small but statistically significant gender differences with minimal practical impact. Concurrent validity was supported by strong correlations with DASS-21 stress and depression subscales and moderate correlations with DERS dimensions. Conclusion: The Brazilian Portuguese version of the BSL-23 demonstrated robust psychometric properties, confirming its validity for use in Brazilian samples. Future studies should include clinical populations and assess test-retest reliability to strengthen evidence of temporal stability. Prim Care Companion CNS Disord 2026;28(4):26m04184. Author affiliations are listed at the end of this article.

Many with psychosis spectrum disorders are not in education, employment, or training. The present study aimed to describe the facilitators and barriers surrounding competitive employment or advanced education.

Qualitative data were collected through first three interviews with service providers working in SEE (N = 3), followed by two focus groups with experts by experience with schizophrenia spectrum disorders (N = 13). The interviews and focus group discussions were audio taped and transcribed, enabling reflexive thematic analysis.

Three themes, each compromising two subthemes, were identified. The participants described the (1) Price and prize of work and study, including (1.1) Breaking points and (1.2) Motivations. In (2) Facilitators: The importance of individualized support, interventions were viewed as either (2.1) Fruitful or (2.2) Futile. The participants described (3) Barriers: Managing the invisible in conjunction with (3.1.) Symptoms and (3.2) Handling stigma.

Experts by experience with psychosis spectrum disorders are highly motivated to pursue education or employment. Both benefits and challenges of this were identified. While work or study was seen as meaningful and confidence-building, it could also worsen symptoms or trigger first episode psychosis. Professionals taking a special interest in job-seeking were valued, though factors like lacking social skills and stigma formed barriers. Overall, the findings highlight strong motivation alongside a need for flexible, individualized approaches that balance opportunities with mental health risks.

Justice-involved youth report increased mental health concerns, substance misuse, and risky sexual behavior compared to non-justice-involved youth. Supporting Youth Navigating Choices (SYNC) is a manualized evidence-based practice for justice-involved youth that has demonstrated success in reducing sexual risk behaviors, aggression, and recidivism. Dissemination and scale-up are necessary for SYNC to reach more justice-involved youth. This study examined barriers and facilitators of implementing SYNC using the Consolidated Framework for Implementation Research to strengthen SYNC's future implementation. Participants (n = 18) were individuals who work with justice-involved youth and received training to deliver SYNC. Structured interviews were deductively coded using Consolidated Framework for Implementation Research domains and subdomains, and data were examined to identify patterns. As facilitators, participants expressed that SYNC provides necessary skills to youth, and they highlighted the strong training, curriculum, and manual. As barriers, participants noted program length, instructor discomfort, lack of leadership support, and staffing concerns. Applying recommendations may facilitate improved dissemination, implementation, and scalability.