Background Cardiovascular disease (CVD) remains the leading cause of premature morbidity and mortality among individuals living with type 1 diabetes mellitus (T1DM). Although overt cardiovascular events are uncommon during childhood, endothelial dysfunction and subclinical atherosclerosis develop early, making timely cardiovascular risk assessment essential. Plasma homocysteine has emerged as a potential biomarker of vascular injury; however, its clinical value in pediatric T1DM remains controversial, and evidence from African populations is scarce. This study aimed to evaluate plasma homocysteine concentrations in children and adolescents with T1DM and to investigate their relationship with cardiovascular risk profiles and diabetes-related complications. Methods A cross-sectional observational study was conducted at the Department of Pediatrics B, in the university hospital center of Oran, Algeria. A total of 50 children and adolescents aged 5-19 years with confirmed T1DM were included. Demographic, anthropometric, clinical, and laboratory data were retrospectively collected from medical records. Plasma total homocysteine (tHcy) concentrations, glycemic control, lipid profile, diabetes duration, insulin therapy, nephropathy, and cardiovascular risk factors were analyzed. Hyperhomocysteinemia prevalence was determined, and its association with cardiovascular risk stratification was assessed using descriptive and inferential statistical analyses. Results The study included 27 male (54%) and 23 female patients (46%), and hyperhomocysteinemia was identified in 17 of 50 participants (34%). Plasma tHcy concentrations were significantly higher in participants with HbA1c >7.5% than in those with HbA1c ≤7.5% (18.9 ± 5.8 vs. 11.8 ± 3.9 μmol/L; Student's t-test, t = 4.44, p < 0.001). Plasma tHcy concentrations were positively correlated with HbA1c (r = 0.61, p < 0.001), diabetes duration (r = 0.49, p = 0.001), LDL cholesterol (r = 0.42, p = 0.004), and triglycerides (r = 0.35, p = 0.015). Participants with diabetic nephropathy had significantly higher plasma tHcy concentrations than those without nephropathy (21.1 ± 5.9 vs. 15.2 ± 5.3 μmol/L; Student's t-test, t = 2.53, p = 0.015). In exploratory multivariable analysis, poor glycemic control (HbA1c >7.5%; aOR = 3.26, 95% CI: 1.18-9.02; p = 0.021) and diabetes duration ≥5 years (aOR = 2.54, 95% CI: 1.01-6.42; p = 0.047) were independently associated with hyperhomocysteinemia. Plasma tHcy showed good discriminative ability for the study-specific moderate-to-high cardiovascular risk classification (AUC = 0.82, 95% CI: 0.69-0.94; p < 0.001). Conclusion Hyperhomocysteinemia was prevalent among children and adolescents with T1DM in our cohort and was associated with an unfavorable cardiovascular risk-factor profile. These findings suggest that plasma homocysteine may represent a potential investigational adjunctive marker of cardiovascular risk-factor burden in pediatric T1DM. Prospective multicenter studies are warranted to validate these associations and determine their incremental clinical value beyond established cardiovascular risk factors.

We present the case of a 55-year-old male with a past medical history of cerebral palsy, obstructive sleep apnea (OSA), seizures, and generalized anxiety disorder who presented with recurrent episodes of respiratory distress and was incidentally found to have a right aortic arch (RAA) on radiologic imaging. Although this anatomical variation is rare, this case serves as a teaching point to raise awareness of the existence of a RAA and how it can be mistaken for a lung lesion, mass, or malignancy. Studies have shown that this anatomical abnormality can also give rise to subtle esophageal and respiratory symptoms. In addition, some patients diagnosed with RAA, especially older adults, have been found to have concurrent vascular anomalies, such as right coronary artery stenosis, left and/or right subclavian artery stenosis, and aortic dissection.

Capillary malformation (CM) is a congenital vascular anomaly yet the regulatory mechanisms driving endothelial remodeling remain incompletely defined. Our previous data have shown that CM lesion-derived induced pluripotent stem cells (iPSCs), their induced ECs (iECs) and vascular organoids preserve vascular phenotypes. These models do not harbor detectable GNAQ p.R183Q and other common low varaint allele frequency mutations after reprogramming. To further explore the pathological signaling underlying endothelial phenotypes in these models, we profiled bulk chromatin accessibility from ATAC-seq and gene expression from RNA-seq in CM and control iECs. A panel of integrated genes was revealed by intersecting differentially accessible regions, differentially expressed genes, and peak-to-gene candidate links. The signatures of this panel highlighted the enriched pathways involving stem cell development and differentiation, inflammatory signaling, extracellular matrix reorganization, and endothelial function. Locus-level of KLF6 and TGF-beta-induced loci illustrated concordant accessibility and expression changes in CM iECs. These results are consistent with a model of inflammation-associated endothelial remodeling in CM. Furthermore, several transcription factors and transcriptional co-regulators associated with endothelial differentiation displayed increased distal chromatin accessibility accompanied by reduced transcript abundance. This data suggests that distal regulatory elements may participate in active transcriptional repression and contribute to impaired endothelial differentiation in CM iECs.

A carotid web is an under-recognized vascular abnormality increasingly identified as a cause of embolic ischemic stroke in younger patients without conventional vascular risk factors. Delayed diagnosis may lead to recurrent cerebrovascular events despite otherwise unrevealing investigations.  We report the case of a 35-year-old woman who experienced three ischemic strokes over a three-year period. Initial investigations, including carotid Doppler ultrasonography, cardiac evaluation, CT angiography, and a young stroke laboratory screen, did not identify a clear etiology. Ongoing clinical suspicion in the setting of recurrent embolic events prompted further vascular reassessment. A subsequent MRI of the neck with magnetic resonance angiography demonstrated an abnormality of the proximal left internal carotid artery suggestive of a carotid web, and hence, repeated CT angiography confirmed the diagnosis. The patient underwent carotid endarterectomy, with operative confirmation of the diagnosis.  This case highlights carotid webs as an important and potentially treatable cause of recurrent embolic strokes. Increased awareness and careful review of vascular imaging may facilitate earlier diagnosis and prevention of further cerebrovascular events.

Middle lobe syndrome (MLS) is characterized by recurrent or chronic collapse of the right middle lobe of the lung. While non-vascular inflammatory causes dominate, endobronchial rupture of mediastinal tuberculous lymphadenitis causing obstructive MLS is an under-recognized entity that presents significant diagnostic challenges. In this context, we report the case of a 24-year-old male immigrant with no past medical history who presented with cough and right-sided chest pain. Chest radiography revealed right middle lobe alveolar opacity. He received empirical levofloxacin without radiological follow-up. Four months later, he experienced symptom recurrence associated with weight loss, asthenia, and night sweats. Repeat chest radiography revealed persistent middle lobe consolidation with ipsilateral pleural effusion. Sputum smear for acid-fast bacilli and PCR for Mycobacterium tuberculosis were negative. Chest CT confirmed necrotic mediastinal lymph nodes with endobronchial rupture into the middle lobe bronchus and cavitated middle lobe consolidation. Flexible bronchoscopy demonstrated mucosal infiltration and pearly-white stenosis of the middle lobar bronchus. Endobronchial biopsies revealed necrotizing epithelioid and giant-cell granulomatous inflammation. The diagnosis of obstructive MLS secondary to endobronchial tuberculosis following lymph node rupture was established, and antituberculosis therapy was initiated. In conclusion, tuberculous lymphadenitis with broncho-nodular fistulization should be considered in the etiology of obstructive MLS. Initial empirical fluoroquinolone treatment can mask bacteriological detection, highlighting the essential diagnostic role of endobronchial biopsies.

Computed tomography angiography (CTA) is crucial for preprocedural TAVI planning, providing the anatomical information required for prosthesis sizing and vascular access assessment. As the volume of TAVI procedure increases, improving efficiency and standardizing annotations is becoming essential in clinical practice. This study presents TAVI-TEC, a fully automated artificial intelligence-based framework integrated into a web-based DICOM viewer for routine preoperative TAVI planning. Pre-procedural CTA scans from patients undergoing TAVI with SAPIEN 3 Ultra (S3U) prostheses were processed using a fully automated pipeline. Deep learning-based segmentation of cardiovascular structures, calcification detection, centerline extraction, landmark identification, and annular plane definition was implemented to quantify key annular and aortic root measurements and color-coded maps of lumen reduction and vessel diameter for vascular access. A multilayer perceptron classifier was trained to predict prosthesis size prior to the TAVI procedure. Results revealed that TAVI-TEC enabled pre-procedural measurements in approximately 2-6 min. Strong agreement with clinician-derived measurements was observed for annular area (coefficient of concordance, CCC = 0.934; interclass correlation coefficient, ICC = 0.935; R² = 0.881) and perimeter (CCC = 0.909; ICC = 0.909; R² = 0.854). The valve-size prediction model achieved a classification accuracy of 77.1% (95% CI: 70.1-83.9%) with the clinically selected and implanted valve size, with most discordances occurring between adjacent prosthesis sizes. These findings support the technical feasibility and promising initial performance of TAVI-TEC. Prospective multicenter and external validation, including additional valve platforms, will be required before routine clinical implementation and before its effects on operator variability and clinical workflow can be established.

Strategies to prevent infection are key in safe neonatal vascular access. This recommendation outlines infection prevention strategies throughout the vascular access lifecycle, from insertion through maintenance to discontinuation. It incorporates international guidance and NICU-specific adaptations to reduce microbial burden. This recommendation incorporates international expert guidance and NICU-specific adaptations to reduce microbial burden. The importance of standardized protocols for assessment, insertion and evaluation is highlighted. As part of a Special Article Series these recommendations encompass the full process involved in neonatal vascular access.