Superior vena cava (SVC) syndrome is a potentially life-threatening condition caused by impaired venous return from the head, neck, and upper extremities that can present with prominent facial cyanosis. This finding may be misleading, as it does not necessarily reflect impaired arterial oxygenation. We report a 68-year-old woman with metastatic colorectal cancer receiving chemotherapy through a right internal jugular implantable venous access port who presented with acute dyspnea, weakness, and progressive facial and perioral cyanosis 2 days after completing FOLFOX (A chemotherapy regimen consisting of folinic acid (leucovorin), fluorouracil (5-FU), and oxaliplatin. It is commonly used to treat colorectal cancer) chemotherapy. Given recent chemotherapy exposure, her presentation initially raised concern for hypersensitivity or anaphylactoid reaction. Despite the patient's striking cyanotic appearance, arterial blood gas analysis demonstrated normal oxygenation, whereas venous blood gas revealed marked desaturation with elevated deoxyhemoglobin. Imaging subsequently identified extensive catheter-associated thrombosis involving the bilateral internal jugular, subclavian, and brachiocephalic veins with complete occlusion of the SVC and extension into the right atrium. The patient was treated with systemic anticoagulation and urgent endovascular thrombectomy with the removal of the indwelling port, resulting in rapid clinical improvement. This case emphasizes that in SVC obstruction, visible cyanosis may reflect localized venous congestion rather than systemic hypoxemia. Recognition of discordant arterial and venous oxygenation can help avoid misdiagnosis and facilitate timely intervention, particularly in oncology patients with central venous devices.

Drawing upon firsthand accounts of GLP-1RA weight-loss drugs, this paper challenges the bioconservative view that effort is essential to self-control and the narrower view that obesity is simply a matter of weakness of will. Many dieters have persistent intrusive food thoughts that are neither transparent nor voluntarily controllable. By quieting food noise, these drugs offer users epistemic access to the true target of effective self-control and provide a pathway to long-term success that effort alone rarely secures. We argue that the value of self-control lies not in the subjective experience of struggle but in the skillful alignment of behavior with one's goals. "Effortless" self-control, far from being a cheat, can exemplify precisely what is valuable about agency.

Background Chest CT is a primary method for identifying pulmonary nodules, yet interpreting scans remains time-intensive and demanding. Currently, artificial intelligence (AI) is expected to reduce reading times, but the effect of AI on reporting times in this setting is unknown. Purpose To evaluate the impact of a commercial AI software on radiologists' reading time for pulmonary nodule assessment on chest CT scans within a real-world clinical setting. Materials and Methods This retrospective study included patients who underwent chest CT examinations at a tertiary medical center between September 2021 and May 2024. The study period was divided into pre- and post-AI phases. The primary outcome was radiology reporting time. The association between AI implementation and reporting time was evaluated using a multivariable parametric Weibull shared frailty survival model adjusted for reader function, examination type, patient location, and requesting specialty, with clustering at the radiologist level. Interaction analyses assessed heterogeneity across prespecified subgroups. An exploratory extrapolation estimated projected workforce and financial impact. Results This study included 19 433 patients (mean age, 62 years ± 14.2 [SD]; 21 814 men; 39 323 chest CT examinations, 19 190 pre-AI, and 20 133 post-AI). AI implementation was associated with faster report completion (adjusted hazard ratio, 1.17; 95% CI: 1.14, 1.21; P < .001). The adjusted median reporting time decreased from 21.3 minutes pre-AI to 18.2 minutes post-AI (14.6% reduction; P < .001). Heterogeneity was observed across reader function (P < .001), examination type (P = .048), and requesting specialty (P = .03). The largest relative reductions were observed for CT thorax electrocardiogram-gated examinations (-41.1%; P < .001) and thoracic radiologists (-25.0%; P < .001), whereas emergency department examinations showed increased median reporting time (7.1%; P < .001). At institutional scan volumes (approximately 20 000-22 000 chest CT examinations annually), exploratory modeling suggested an approximate reduction of 0.5 full-time equivalent radiologist workload. Conclusion Implementation of commercial AI-assisted pulmonary nodule assessment on chest CT scans reduced radiologist reporting time in a real-world clinical setting. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Iwasawa in this issue.

Respiratory syncytial virus (RSV) has long been underrecognized as a significant pathogen in older adults, despite accumulating evidence of its substantial morbidity and mortality burden in this population. While RSV vaccination is now well established as an effective intervention for preventing lower respiratory tract disease, this narrative review examines whether its public health value may extend beyond these primary clinical endpoints. A targeted search of Scopus and Web of Science from database inception to May 2026 was conducted to identify biological, epidemiological, observational, interventional, and modelling evidence relevant to potential downstream vaccine effects. The available evidence potentially supports hypotheses concerning possible reductions in cardiovascular complications and secondary bacterial infections, possible decreases in transmission to younger household contacts, and potential preservation of functional status and independence. However, the strength of evidence varies substantially across these outcomes. Cardiovascular protection has not been independently demonstrated in randomized trials, bacterial and antimicrobial-use outcomes have rarely been prespecified, real-world household transmission studies are unavailable, and functional trajectories may be strongly modified by baseline frailty and pre-existing disability. RSV vaccination in older adults therefore remains a well-validated strategy for preventing acute respiratory disease, whereas its proposed broader effects should be regarded as biologically plausible but incompletely demonstrated benefits. Future studies should incorporate prespecified cardiovascular, bacterial, transmission, geriatric, and functional outcomes, with particular attention to frailty, antimicrobial use, and longer-term follow-up.