Chronic viral infections are ubiquitous in humans, with individuals carrying multiple viruses that can reactivate during physiological stress, including severe illness¹. Notably, SARS-CoV-2 infection has been shown to reactivate chronic viruses such as Epstein-Barr virus and cytomegalovirus, yet the full extent, temporal dynamics and immunological impact of viral reactivation in COVID-19 remain incompletely understood^2-7. Here, leveraging multi-omic longitudinal data from 1,154 hospitalized patients with COVID-19 from the Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) study, we reveal significant reactivation of Herpesviridae and Anelloviridae during acute COVID-19, with distinct temporal dynamics for different viruses, and demonstrate that reactivation correlates with disease severity, host immune effects and clinical outcomes. Although our results do not establish causation between virus reactivation and clinical outcomes, we highlight the prevalence of chronic viral reactivation during acute COVID-19 and long COVID. Our findings challenge the prevailing view that chronic viral reactivation is primarily a consequence of immunosuppression, demonstrating that reactivations occur frequently in immunocompetent individuals during severe illness and in association with increased systemic inflammation. Additionally, we demonstrate persistence of viral reactivation in convalescence, and report an association of Anelloviridae with long COVID. This study provides immune, transcriptomic and metabolomic signatures of viral reactivation that could inform future strategies to prognosticate and treat acute COVID-19 and long COVID.

Previous meta-analyses have suggested that intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduces the risk of adverse outcomes compared with angiography-guided PCI in patients with coronary artery disease. However, several large-scale randomized controlled trials published recently have provided new evidence, necessitating an updated evaluation.

This updated meta-analysis aimed to compare the clinical effects of IVUS-guided PCI versus angiography-guided PCI in patients with complex coronary artery lesions.

Randomized controlled trials (RCTs) comparing IVUS-guided PCI with angiography-guided PCI in patients with complex coronary anatomy were systematically searched in PubMed/MEDLINE, EMBASE, and the Cochrane Library. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Sensitivity analyses and publication bias assessments were performed. The primary outcome was cardiac death. Secondary outcomes included all-cause death, myocardial infarction, stent thrombosis, any repeat revascularization, target lesion revascularization, and target vessel revascularization.

A total of 12 RCTs comprising 7089 patients were included, with a weighted mean follow-up of 18.0 months (range 12-24 months). Compared with angiography-guided PCI, IVUS-guided PCI was not associated with significant reductions in cardiac death (RR 1.02, 95% CI 0.76-1.38, P = 0.870), all-cause death (RR 0.97, 95% CI 0.77-1.22, P = 0.800), or myocardial infarction (RR 0.90, 95% CI 0.71-1.15, P = 0.370). However, IVUS guidance significantly reduced definite stent thrombosis (RR 0.31, 95% CI 0.12-0.77, P = 0.010), any repeat revascularization (RR 0.67, 95% CI 0.51-0.88, P = 0.007), target lesion revascularization (RR 0.73, 95% CI 0.55-0.97, P = 0.031), and target vessel revascularization (RR 0.70, 95% CI 0.52-0.95, P = 0.039). These revascularization benefits were attenuated and no longer statistically significant after trim-and-fill adjustment for potential publication bias.

In patients undergoing PCI for complex coronary artery lesions, IVUS-guided PCI did not reduce the incidence of cardiac death, all-cause death, or myocardial infarction compared with angiography-guided PCI. It was, however, associated with lower rates of definite stent thrombosis and repeat revascularization, although these benefits were sensitive to potential publication bias and largely driven by contemporary trials. These results support the selective use of IVUS-guidance for treatment of complex coronary lesions and call for further studies to optimize its use.

Occlusion of the culprit artery (OCA) is observed in a substantial proportion of non-ST-segment elevation myocardial infarction (NSTEMI) patients, showing a poor clinical prognosis. NSTEMI management remains challenging, potentially due to pathophysiological mechanisms across different clinical phenotypes. This study investigated the morphological features of culprit plaque in NSTEMI with vs. without OCA.

In all, 324 NSTEMI patients who underwent optical coherence tomography (OCT) imaging were enrolled in this study. Patients were divided into an OCA group (n=105; 32.4%) and a non-OCA group (n=219; 67.6%). Compared with the non-OCA group, the OCA group had significantly higher rates of plaque rupture (67.6% vs. 42.5%; P<0.001), lipid-rich plaque (81.0% vs. 67.1%; P=0.01), thin-cap fibroatheroma (48.6% vs. 25.1%; P<0.001), thrombus (88.6% vs. 66.7%; P<0.001), macrophage accumulation (92.4% vs. 76.7%; P<0.001), and cholesterol crystals (48.6% vs. 27.4%; P<0.001) on OCT. Symptom-to-catheter time was found to be an independent predictor of 2-year major adverse cardiovascular events for OCA patients.

The underlying plaque morphologies were different between OCA and non-OCA patients. The OCA had a higher rate of plaque rupture, with more features (e.g., lipid-rich plaque, thin-cap fibroatheroma, thrombus, macrophage accumulation, cholesterol crystals) resembling ST-elevation myocardial infarction-like plaques. Symptom-to-catheter time was an independent predictor of major adverse cardiovascular events in the OCA group.

The international burden of neonatal brain injury (NBI) remains significant with enormous potential for therapeutic intervention. Recent large trials have demonstrated no neuroprotection with either erythropoietin or darbepoetin for term or pre-term brain injury. Neuroprotective strategies with strong evidence are currently limited to antenatal steroids, antenatal magnesium, and supportive care for pre-term NBI and therapeutic hypothermia for term hypoxic-ischemic encephalopathy. Of the pharmacologic strategies currently being investigated clinically, the agents with the highest likelihood of success and closest to clinical implementation include melatonin, topiramate, and stem cell-based therapies. More therapies to prevent or treat NBI are urgently needed.

This overview provides a summary of the commonly used vasoactive agents and the various clinical scenarios in which they are used in the neonatal intensive care unit (NICU). The lack of well-designed clinical trials in this vulnerable population means that these agents continue to be administered without sufficient evidence-based knowledge on their dosing, safety, efficacy and long-term effects. The lack of age appropriate cardiotonic formulations remains an ongoing challenge. Future trials of cardiotonic drugs need to incorporate echocardiography and other objective monitoring tools in their design with robust assessments of short and longer-term outcomes.

Hypertensive disorders affect 15% of US pregnancies, significantly contributing to maternal and neonatal morbidity. This paper explores the profound hemodynamic adaptations of pregnancy and how their failure leads to conditions like preeclampsia and gestational hypertension. Diagnosis relies on blood pressure thresholds (≥140/90 mm Hg), with management focusing on preventing severe sequelae. Labetalol and nifedipine are established as first-line treatments due to their safety and efficacy, while angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are strictly contraindicated due to fetotoxicity. Low-dose aspirin is recommended for high-risk patients. Ultimately, early recognition and evidence-based pharmacologic intervention are critical for improving obstetric outcomes.

The risk of venous thromboembolism following major trauma is high without pharmacologic prophylaxis. The timing of initiation is controversial. It can be delayed, interrupted for procedures, or never initiated due to concern for bleeding from injury sites. Current evidence supports initiation of pharmacologic prophylaxis within 24 hours of admission to reduce the risk of venous thromboembolism. Initiation within 24 hours of admission appears to be safe with low risk of bleeding from injuries, including progression of intracranial hemorrhage.

Volatile organic compounds (VOCs) in exhaled breath reflect biological processes in the lungs. Exploring VOC profiles in severe asthma patients starting biologics may reveal treatment-related biological changes over time. This study aimed to assess the performance and feasibility of applying a sparse partial least squares-discriminant analysis (sPLS-DA) analytical approach in detecting longitudinal changes in exhaled VOCs of patients with severe asthma initiating biologic treatment. Exhaled breath was collected in the 3TR-ABC study, a multicenter observational prospective cohort study, at baseline and 4 months after starting biologics (benralizumab or dupilumab). VOCs were trapped on thermal desorption tubes and analyzed by gas chromatography-mass spectrometry. Paired sPLS-DA was used to distinguish baseline from post-treatment VOC profiles, and Kendall rank correlation assessed associations with clinical parameters at baseline. Data from two sites (Amsterdam and Copenhagen) were available of 25 severe asthma patients. The sPLS-DA resulted in a model containing five VOCs (methyl isobutyl ketone, 2-ethyl-1-hexanol, 5-methyl octadecane, 2-methylundecane and 1,1'-oxybis(decane)) with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval: 0.79-0.99) for distinguishing baseline and 4 months post treatment. At baseline, a positive correlation was observed between 2-ethyl-1-hexanol and asthma control (Asthma Control Questionnaire); τ = 0.40, p < 0.01. A negative correlation was found between 1,1'- oxybis(decane) and blood eosinophil counts (τ = -0.30, p=0.04). Based on our results, the proposed analytical approach appears feasible for analyzing longitudinal data in patients with severe asthma initiating biologics. Further validation in larger cohorts is warranted to confirm robustness and generalizability.

Obesity is a modifiable risk factor for atrial fibrillation (AF), but its relationship with acute procedural response and long-term rhythm durability after ablation for persistent AF (PeAF) remains incompletely defined.

To evaluate the association of body mass index (BMI) with acute AF termination and long-term atrial arrhythmia recurrence after first-time radiofrequency catheter ablation for PeAF.

We analyzed prospective data from 7,559 consecutive patients with clinically documented PeAF undergoing first-time radiofrequency catheter ablation between January 2018 and March 2025. Patients were classified according to World Health Organization BMI categories. The primary outcome was atrial arrhythmia recurrence after a 3-month blanking period.

During a median follow-up of 41 months, atrial arrhythmia recurrence occurred in 3,494 patients (46.2%). In the fully adjusted model, higher BMI was associated with recurrence as a continuous variable (HR 1.03, 95% CI 1.02-1.04). Compared with normal-weight patients, overweight and obese patients had higher recurrence risks (HR 1.15, 95% CI 1.06-1.24; and HR 1.31, 95% CI 1.18-1.45, respectively). Acute AF termination occurred in 832 patients (11.0%) and decreased with increasing BMI. Higher BMI was associated with lower odds of acute AF termination (OR 0.95, 95% CI 0.93-0.97). Findings were consistent across sensitivity analyses.

In patients with PeAF undergoing first-time radiofrequency ablation, higher BMI was associated with lower acute AF termination and increased long-term recurrence. BMI may serve as a practical marker for preprocedural risk stratification.

Cardiovascular diseases are the leading cause of mortality in Spain, yet there is no systematic population-based cardiovascular screening program. This study evaluated the feasibility of a nurse-led, single-visit cardiovascular screening program in primary care (PreveCardio), and identified the prevalence of modifiable cardiovascular risk factors, their associated socioeconomic factors, and the translation of pilot findings into regional health policy.

We conducted a cross-sectional study across 42 primary care centers in a Spanish region (January-March 2023). A random sample of 8491 individuals aged 50 to 75 years was invited to participate. Trained nurses performed a single 30-minute visit with point-of-care measurements (blood pressure, lipid profile, HbA1c) and validated questionnaires. Multivariable logistic regression models were fitted with Benjamini-Hochberg correction.

A total of 3545 individuals participated (41.8%; mean age 61.2 ± 7.3 years; 56.7% women). The completeness of clinical data exceeded 99%. Elevated blood pressure was identified in 40.4%, obesity in 29.5%, nonoptimal low-density lipoprotein cholesterol in 48.7%, prediabetes in 30.7%, and active smoking in 19.5%. Smoking showed the steepest socioeconomic gradient (aOR, 3.25; 95%CI, 2.09-5.03). The direct cost per participant was euro11.75.

A nurse-led, single-visit cardiovascular screening program is operationally feasible in Spanish primary care, revealing a high burden of modifiable cardiovascular risk factors and significant socioeconomic disparities. Smoking showed the steepest income-associated gradient. This pilot study led to the approval of the first systematic cardiovascular screening program in a Spanish autonomous community.