Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C), associated with SARS-CoV-2 infection share overlapping clinical and laboratory features, making differential diagnosis particularly challenging during the COVID-19 pandemic. Accurate distinction is essential due to differences in pathophysiology, management strategies, and cardiovascular outcomes. We report the case of a 7-year-old boy presenting with prolonged fever, mucocutaneous manifestations, arthritis, and elevated inflammatory markers following SARS-CoV-2 exposure. The clinical course demonstrated features compatible with both incomplete Kawasaki disease and MIS-C. Laboratory findings and cardiac biomarkers showed a mixed profile, while echocardiography and coronary imaging revealed the development of coronary artery aneurysms. Notably, a complex congenital coronary artery anomaly was incidentally identified during coronary evaluation. Although such anomalies are not considered independent risk factors for coronary aneurysm formation, their presence may complicate the interpretation of coronary findings in the setting of systemic inflammation. The patient showed a rapid and sustained clinical response to systemic glucocorticoid therapy without intravenous immunoglobulin administration; however, coronary artery aneurysms subsequently developed. This case highlights the diagnostic and therapeutic challenges at the interface of KD and MIS-C and underscores the importance of an integrated, individualized approach that incorporates clinical evolution, laboratory data, and detailed coronary assessment.

Myocarditis is a non-ischaemic myocardial injury caused by infectious agents, immune-mediated diseases, cardiotoxic drugs, and vaccines. Treatment options are largely supportive, with emphasis on close monitoring, exclusion of other diseases explaining symptoms, adherence to heart failure treatment recommendations, and consideration of etiology-directed interventions, if applicable, such as antiviral or immunosuppressive agents, steroids, discontinuation of antineoplastic therapy, and strategies to increase left ventricular (LV) ejection fraction (LVEF). In this context, cell-based therapies (CBTs) have emerged as a new therapeutic strategy and were believed to fill this gap. However, results were inconsistent across studies, which necessitates the need for rigorous systematic reviews to analyze available evidence comprehensively.

The review protocol was registered on the PROSPERO website, and the study was conducted in accordance with PRISMA regulations. Searches were conducted in Embase, CINAHL Plus via EBSCO host, Web of Science, Scopus, and PubMed. A total of 60 original papers published between 2004 and 2022 in 48 peer-reviewed journals were included in the meta-analysis to determine the efficacy of CBTs on the LV fractional shortening (LVFS), LVEF, capillary density (CD), inflammatory cell infiltration rate (ICIR), and fibrotic area (FA). The risk of bias (RoB) and study quality were assessed using the SYRCLE RoB tool and CAMARADES checklist, respectively. As the preliminary assessment indicated substantial heterogeneity among the included studies, a random-effects model was applied to pool effect sizes. Subgroup analyses were performed to explore potential sources of heterogeneity across studies. Publication bias was assessed by visual inspection of funnel plots for asymmetry and statistically evaluated using Egger's regression test.

In total, the adapted and optimized search strategy retrieved 14,503 records from five databases. The majority of studies exhibited an unclear or high risk of bias in several domains, particularly selection bias and performance bias. Quality assessment revealed that only four studies (6.7%) were classified as high quality and four (6.7%) as low quality, while the remaining 52 studies (86.7%) were rated as moderate quality, with scores ranging from 4 to 6. CBTs improved LVFS (%) by 7.17 [95 % CI: 5.67, 8.66], LVEF (%) by 9.00 [95 % CI: 7.03, 10.97], CD (capillaries/mm²) by 300.50 [95 % CI: 45.01, 555.99] and decreased ICIR (cells/mm²) and FA (%) by -178.99 [95 % CI: -225.91, -132.08] and -6.04 [95 % CI: -6.83, -5.25], respectively. However, significant heterogeneity between studies was maintained at I² = 84-99%.

Despite significant heterogeneity and moderate publication bias, the results were very encouraging, as reflected in the consistent effect directions across all studies in terms of cardiac function and histology. Overall, our results demonstrated the need for well-designed studies with adequate animal sample sizes, a standardized approach to reporting, and mechanistic investigations that directly link structural remodeling to functional recovery. Addressing these issues will be critical steps for conducting large-scale clinical trials.

This study aimed to assess the potential mediating role of metabolic syndrome (MetS) between depression and cardiovascular disease (CVD).

This population-based prospective cohort study analyzed data collected between March 2006 and December 2010 from 353,610 participants aged 37 to 73 years from the UK Biobank. Depression was assessed using self-reported questionnaires and linked hospital-based clinical depression diagnosis. MetS was defined as the presence of 3 or more of unhealthy waist circumference, dyslipidemia, hypertension, hyperglycemia and hypertriglyceridemia. Incident CVD was identified through linked hospital and death records. Counterfactual-based mediation analysis was conducted to estimate the mediating effect.

After an average follow-up of 15 years, 38424 CVD events occurred in 353,610 participants (55% women; mean age at baseline, 56 years). Study findings indicated a significant direct association between depression and CVD (HR = 1.310; 95% CI, 1.277-1.342). A significant indirect association was also observed between depression and CVD (HR = 1.035; 95% CI, 1.031-1.037), indicating that 12.9% of the association of depression with CVD was mediated by MetS. Among the components of MetS, unhealthy waist circumference showed the largest estimated mediated proportion (PM = 10.2%; NIE HR = 1.027). MetS accounted for a higher proportion of the association between depression and CVD in males (PM = 14.2%; NIE HR = 1.026), than females (PM = 11.2%; NIE HR = 1.034). Blood pressure mediated the association only in participants aged ≥55 years (PM = -2.2%).

MetS partially mediates the association between depression and CVD during midlife. Unhealthy waist circumference may be the most important potential target for preventive interventions.

The KCNK17 gene encodes k_2p17.1 channels (TASK-4 or TALK-2) with dominant expressions in the atria and the Purkinje fibers. Emerging studies have suggested possible associations between KCNK17 variants and cardiovascular as well as cerebrovascular diseases. This review aimed to systematically evaluate the evidence on KCNK17 mutations and/or polymorphisms in cardiovascular diseases (primary outcome) and cerebrovascular diseases (secondary outcome). Given the fragmented and limited evidence, a systematic review is warranted to summarize current knowledge and clarify potential clinical implications.

PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched for studies evaluating any cardiovascular or cerebrovascular diseases associated with KCNK17 published up to August 1, 2023. Inclusion criteria were original studies reporting KCNK17 mutations and/or polymorphisms in relation to cardiovascular diseases (primary outcome) or cerebrovascular diseases (secondary outcome). Exclusion criteria were studies evaluating pharmacological interventions on the K2P17.1 (TALK-2) channel, as well as reviews, editorials, and non-original articles.

Nine studies concerning KCNK17 were finally included in the systematic review. Six studies evaluated cardiovascular diseases, including atrial fibrillation, cancer-induced cardiac dysfunction, long QT syndrome, and progressive cardiac conduction defects, and 3 studies evaluated cerebrovascular diseases, including ischemic stroke and cerebral hemorrhage.

Recent genetic discoveries in the aforementioned diseases warrant further research to develop innovative cardiovascular treatments based on KCNK17.

Transcatheter aortic valve replacement (TAVR) has evolved significantly, expanding its indication to lower surgical risk patients. However, challenges remain, including conduction disorders or paravalvular leak (PVL). The ALLEGRA TAVI system (Biosensors International) is a supra-annular self-expanding prosthesis designed to optimize implantation and hemodynamic performance.

The objective of this study was to analyze short-term outcomes following the implantation of the Allegra valve in real-world practice.

This multicenter retrospective study included 500 patients who underwent TAVR with the Allegra valve across 11 Spanish centers between 2017 and 2024. Success rates, complications, and 30-day clinical outcomes were analyzed.

The median age was 82.1 ± 5.5 years. The overall success rate was 96.8% (95% CI 94.8%-98.0%), with complications in 11.6% (95% CI 8.0%-13.0%) of cases. The need for permanent pacemaker implantation (PPI) was 19.2% (95% CI 16.0%-22.9%), while moderate-to-severe PVL occurred in 4.1% (95% CI 2.7%-6.3%). The in-hospital mortality rate was 1.0% (95% CI 0.5%-2.6%). Hemodynamic performance was favorable, with post-implant mean gradients of 4.0 mmHg (IQR 2.0-5.0 mmHg) in native aortic stenosis and 7.0 mmHg (IQR 5.0-10.0 mmHg) in valve-in-valve procedures. A reduction in complications was observed, but not significantly, with increased experience (15.2% vs. 10.4%, p 0.147), though without impact on success rates.

This study confirms that the Allegra valve is a safe and effective TAVR option, with outcomes comparable to other self-expanding prostheses. Further design optimization could reduce PVL and PPI rates. Long-term studies are needed to assess durability.

Chronic respiratory diseases (CRDs) affect over 545 million individuals globally, with COPD alone causing approximately 3.2 million deaths annually. Flavonoids have shown promise in reducing lung inflammation and disease risk; however, their clinical application is hindered by poor solubility and low bioavailability. Nanocarrier-based pulmonary delivery systems offer a solution by enabling targeted, controlled release and improved solubility.

This review explores the preclinical and clinical potential of flavonoid-loaded nanocarriers in mitigating CRDs by regulating inflammation and cellular senescence, while offering sustained release and enhanced biocompatibility.

A comprehensive analysis of flavonoid mechanisms in modulating inflammatory pathways (e.g. NF-κB, Nrf2/Keap1) and enzymes (COX, 5-LOX, iNOS) was conducted using data from electronic databases (PubMed, ScienceDirect, Web of Science, TRIP, Springer). MeSH terms included 'Flavonoids,' 'Preclinical Studies,' 'Clinical Trials,' and 'Lung Health.' Taxonomy, epidemiology, and chemical data were verified using World Flora Online, WHO factsheets, and ChemSpider.

Flavonoid-loaded nanocarriers demonstrated significant anti-inflammatory and antioxidant effects. PLGA-based systems reduced TNF-α and IL-6 levels by up to 80%. Lipid-based carriers (SLNs, NLCs) enhanced bioavailability 2-5 fold, while liposomes improved cell viability (40-50%) and reduced oxidative stress (>60%). Inhalable nanoformulations, such as quercetin achieved 3-fold higher lung concentration and 50% longer retention compared with oral formulations.

Flavonoid-loaded nanocarriers, especially liposomes, show enhanced pulmonary targeting, bioavailability, and therapeutic efficacy in CRDs. Their ability to suppress inflammation and cellular aging highlights their potential as a promising nanomedicine strategy for improving lung health.

Pertussis-related hyperleukocytosis is a major driver of pediatric mortality. While exchange transfusion (ET) improves survival, predictors of death in ET-treated children remain poorly defined. We sought to identify independent predictors of death to refine treatment strategies.

A single-center retrospective cohort study analysis of 44 children with pertussis-related hyperleukocytosis treated with ET was conducted. Patients were stratified into survival (n = 27) and mortality (n = 17) groups. Univariate comparisons of clinical, laboratory, and ET-related parameters were performed. Multivariate logistic regression identified independent mortality risk factors.

The mortality group exhibited a younger median age at onset (55 vs. 103 days, p = 0.006), higher peak white blood cell (WBC) count (82.19 ± 21.95 vs. 68.10 ± 18.78 × 10⁹/L, p = 0.023), and greater incidence of pre-ET cardiovascular failure (94.1% vs. 22.2%, p < 0.001). In multivariable analysis using Firth's penalized logistic regression, pre-ET cardiovascular failure (OR 53.69, 95% CI 3.63-795.10), higher peak WBC count (OR 1.09 per 1 × 10⁹/L increase, 95% CI 1.02-1.17), and younger age at onset (OR 0.97 per day increase, 95% CI 0.95-0.99) showed significant associations with mortality.

Younger age at onset, marked leukocytosis, and pre-ET cardiovascular failure were associated with increased mortality in children with pertussis complicated by hyperleukocytosis. These factors may help identify patients at higher risk and highlight the importance of early recognition, close monitoring, and timely supportive management. Further prospective studies with larger sample sizes are warranted to validate these findings and to inform optimized management strategies in this vulnerable population.

Wide geographic disparities in mental health care use exist, particularly between rural and urban areas. Telemedicine could enable mental health specialists to reach patients who live farther away in rural communities and communities with low access to care.

To examine the association of the proportion of mental health specialists' visits delivered via telemedicine and the share of their visits to patients living in rural, low-access-to-care, or distant communities.

This cohort study examined Medicare fee-for-service claims for mental health specialist services from January 1, 2018, to December 31, 2023. Specialists were categorized into quartiles based on their 2021 telemedicine uptake (lowest, 0%-40% of visits; low-middle, 41%-79%; middle-high, 80%-98%; highest, 99%-100% of visits). Data were analyzed between November 2024 and December 2025.

Telemedicine use among mental health specialists in 2021.

The main outcome was the proportion of mental health specialists' patients who lived in (1) a rural area, (2) an area with a mental health specialist shortage, (3) a different state from their specialist, and (4) a community 20 miles or more from their specialist. Differential changes in outcomes between specialists in the highest and lowest telemedicine uptake quartiles were estimated using a difference-in-differences framework. A secondary analysis examined the fraction of the changes observed due to established patients moving their residence vs new patients.

The cohort included 17 742 mental health specialists categorized into quartiles based on their telemedicine uptake in 2021. Compared with 2018 and specialists in the lowest telemedicine quartile, specialists with the highest telemedicine use had 0.88 percentage points (95% CI, 0.35-1.39 percentage points) more visits with rural patients in 2023. Similar small changes were observed in the fraction of visits with patients living in mental health specialist shortage areas, in a different state from their specialist, and living 20 miles or more away from their specialist. Specialists with higher telemedicine use visited differentially fewer new patients by 2023 than those with lower use (-3.55 percentage points [95% CI, -5.73 to -1.38 percentage points]).

This cohort study found that greater telemedicine uptake was associated with only small increases in the share of visits to patients in rural, low-access-to-care, or distant communities. Tailored policy interventions may be needed for telemedicine to reach its potential of improving mental health care of individuals with the greatest difficulty accessing it in their local community.

Exposure and response prevention (EX/RP) is a first-line, evidence-based treatment for obsessive-compulsive disorder (OCD), yet its widespread implementation remains limited. Major barriers to EX/RP access are the intervention's intensity and lack of qualified providers. There is a growing need for scalable, technology-supported interventions that reduce treatment burden while preserving core therapeutic components. Therefore, we developed Beating OCD and Learning Digitally (BOLD), a self-guided EX/RP web application delivered with minimal therapist support. This small open trial (N = 16) evaluated the acceptability, feasibility, and preliminary outcomes of BOLD in adults with OCD. We found that BOLD significantly reduced OCD symptoms with large effect sizes among treatment completers (d = -1.27). Half of participants completed the full intervention and reported high satisfaction and gains in self-efficacy. Two-thirds (62.5%) of treatment completers were classified as treatment responders. When compared to a matched sample receiving traditional EX/RP, BOLD showed comparable treatment outcomes. Time-effectiveness analysis indicated that BOLD required 73.39% less therapist contact time to achieve equivalent symptom reduction than traditional EX/RP. These findings highlight BOLD's potential as a scalable, cost-effective intervention for OCD. Researchers should refine BOLD by optimizing engagement and reducing barriers to participation and investigate its effectiveness in a full-power randomized controlled trial.

The guidelines recommend kidney-sparing surgery as the primary treatment for selected patients with low-risk upper urinary tract urothelial carcinoma (UTUC). An important issue with ureteroscopic laser ablation (ULA) is the high rate of surgical-site recurrence, largely attributable to residual lesions at the initial ULA. This trial aimed to investigate the efficacy and safety of oral 5-aminolevulinic acid hydrochloride-mediated photodynamic diagnosis (ALA-PDD)-assisted ULA for UTUC.

The study evaluated 20 patients with cTa-1N0M0 UTUC who underwent ALA-PDD-assisted ULA using thulium-holmium:YAG dual lasers. The primary endpoint was the 2-year progression-free survival rate. Treatment-related adverse events (AEs), usefulness of the UroVysion test combined with conventional urinary cytology for detecting recurrent tumors, and longitudinal changes in patient-reported health-related quality of life (HRQoL) after ULA were evaluated.

Of the 20 patients, 3 (15 %) experienced disease progression, and the 2-year progression-free survival rate was 82 % (95 % confidence interval [CI], 54-93 %). The lower limit of the 95 % CI for the 2-year PFS rate was less than the prespecified threshold survival rate of 58 %. The most common AEs were transient urinary-related symptoms. No grade ≥3 AEs were observed throughout the trial. Due to the low positivity rate of pretreatment UroVysion testing, the study could not evaluate its usefulness for monitoring post-ULA recurrence. Most domains and scales of HRQoL showed acceptable changes during treatment and follow-up evaluation. In particular, the intervention positively affected mental and emotional conditions.

This study provided evidence for the potential benefits and efficacy of this treatment option for selected patients with UTUC.