Mitral annular disjunction (MAD) is associated with ventricular arrhythmias and sudden cardiac arrest (SCA). Echocardiographic characterization of pediatric MAD-associated SCA remains limited. Among 35 patients aged <21 years with MAD (1/2023-12/2024), 4 had SCA (3 with idiopathic ventricular fibrillation and 1 with an implantable cardioverter-defibrillator shock following an episode of polymorphic ventricular tachycardia). All echocardiograms and clinical data were reviewed. Three patients had moderate-to-severe ventricular dysfunction following cardiac arrest. MAD was not identified on the postarrest echocardiogram in the setting of dysfunction but became apparent after functional recovery. One of the 4 patients had an echocardiogram before their arrest, which demonstrated MAD. All 4 patients continued to have MAD at follow-up. This suggests that in pediatric SCA, moderate-to-severe left ventricular dysfunction may mask MAD in the postarrest period. Serial imaging after functional recovery is important to identify MAD in these patients.

ObjectiveTriple-negative breast cancer (TNBC) represents the most aggressive subtype of breast cancer. HSPA8 is a chaperone protein involved in the proper folding or degradation of many proteins that are implicated in various types of cancers, while its role in TNBC remains unclear.MethodsIn this study, we extensively explored the cellular function and molecular targets of HSPA8 in TNBC cells by performing small interfering RNA (siRNA)-mediated knockdown, followed by cytological assays and transcriptome sequencing (RNA-seq).ResultsThe results of HSPA8 expression levels across distinct breast cancer subtypes indicated that TNBC exhibits higher HSPA8 expression. Then, cytological experiments demonstrated that knockdown of HSPA8 significantly inhibited TNBC cell proliferation, invasion and migration, and induced apoptosis. Mechanistically, RNA-seq showed that HSPA8 globally regulates gene expression and alternative splicing (AS), particularly modulating expression of genes in PI3K/AKT signaling pathway, and AS of genes in protein phosphorylation. Finally, we experimentally confirmed that knockdown of HSPA8 significantly suppressed the activation of the PI3K/AKT axis and AKT phosphorylation in TNBC cells.ConclusionsOur findings highlight an important pro-oncogenic role of HSPA8 in TNBC progression, mediated in part through transcriptomic remodeling and activation of the PI3K/AKT signaling pathway. These results may inform the development of novel targets and strategies for future targeted therapy in TNBC.

The rapid miniaturization of electronic devices has exponentially increased power densities, making heat accumulation and transient thermal shocks primary bottlenecks. Phase-change thermal interface materials (PC-TIMs) offer a promising solution, but their application is hindered by low intrinsic thermal conductivity and liquid leakage. Furthermore, traditional outside-in impregnation strategies suffer from a severe trade-off between thermal conductivity enhancement and latent heat preservation. In this work, a hierarchical inside-out structural engineering strategy is proposed to fabricate a core-sheath phase-change graphene fiber framework (GFF@PEG). Coaxial wet-spinning densely encapsulates a polyethylene glycol (PEG) core within a graphene oxide shell. Subsequent vacuum impregnation and chemical reduction create a "thermal soldering" effect, bridging discrete fibers to convert resistive point-to-point contacts into surface-to-surface interconnections, establishing an unbroken 3D phonon transport highway. Thus, the GFF@PEG composite achieves an exceptional thermal conductivity of 77.67 W m-1 K-1 while preserving a latent heat capacity of ∼90 J g-1. Meanwhile, the robust graphene shell ensures near-zero leakage over 600 thermal cycles. In a simulated chip cooling system (20 W cm-2), it delivered a dramatic 60.7 °C temperature reduction. Ultimately, this fully enveloped paradigm circumvents traditional interfacial thermal barriers, providing a highly robust dual-mode thermal management solution for high-power electronics.

Severe quetiapine overdose may lead to central nervous system depression and cardiovascular instability; however, refractory distributive shock is an uncommon and life-threatening presentation. Intravenous lipid emulsion has emerged as a potential adjunctive therapy in intoxications caused by highly lipophilic drugs, although evidence remains limited. We report the case of a 25-year-old woman with intentional ingestion of approximately 4.5 g of quetiapine, who developed progressive neurological deterioration and refractory distributive shock despite mechanical ventilation and dual vasopressor support. Laboratory findings showed severe metabolic acidosis with hyperlactataemia, and echocardiography revealed a hyperdynamic profile with reduced systemic vascular resistance. Given the persistence of haemodynamic instability and neurological impairment, a 20% intravenous lipid emulsion was administered as rescue therapy. Within three hours, the patient exhibited marked neurological improvement, with recovery of consciousness (Glasgow Coma Scale score 14/15), along with progressive haemodynamic stabilization allowing discontinuation of vasopressors. Lactate levels normalized within 9 h, and the patient was successfully extubated at 24 h, with no treatment-related adverse events. This case highlights the potential role of intravenous lipid emulsion as an adjunctive rescue therapy in severe quetiapine intoxication with refractory haemodynamic and neurological compromise. Although causality cannot be definitively established, the temporal association and rapid clinical response support its consideration when conventional supportive measures are insufficient.

This mini-review synthesizes recent interdisciplinary evidence showing that financial market volatility carries psychological as well as economic costs. Across 36 studies, two domains emerge: (1) traditional market turbulence, where shocks are linked to economic anxiety, household stress transmission, and panic-selling associated with traits such as neuroticism and hyperbolic discounting; and (2) cryptocurrency and speculative asset markets, where Fear of Missing Out (FoMO), impulsivity, and herding promote short-term, gambling-like risk taking, particularly among younger or inexperienced investors. FoMO frequently mediates loss aversion and speculative engagement, while institutional participation and policy measures exhibit stabilizing, protective effects. Overall, volatility functions as a psychosocial exposure characterized by emotional contagion and behavioral reinforcement, with implications for mental health. The review calls for prevention-oriented policy integrating behavioral finance, public health, and social regulation, and for treating compulsive speculative trading as a candidate for future clinical classification, a hypothesis the current evidence base can motivate but not yet confirm.

When stress strikes, cells initiate adaptive responses, including perturbation of RNA splicing, modulation of nuclear RNA export, and formation of stress granules (SGs). Despite their central role, the composition and regulation of fungal SGs remain poorly understood. Here, we report the formation of heat shock-induced SG-like structures in Fusarium graminearum. Through purification of SG-like structures followed by RNA-sequencing, we performed a transcriptome-wide characterization of their associated transcripts and found that heat shock induces a distinct enrichment of intron-containing transcripts within SG-like structures compared to physiological conditions. Moreover, these SG-like structures co-localize with the nuclear RNA export factor FgYra1 in the nucleus, linking SG-like structures to the RNA export system. Furthermore, transcripts associated with SG-like structures exhibit distinct nuclear retention behaviors during heat shock, and the loss of FgYRA1 alters nuclear retention in an atypical manner. Together, this study defines the molecular architecture of F. graminearum SG-like structures and highlights their functional relevance in coordinating nuclear RNA export during heat shock.

The global burden of hypertension and its severe form, resistant hypertension, affecting up to 20% of 1.4 billion adults worldwide, drives mass consumption of multiple drugs. Consequently, antihypertensive agents from different classes enter aquatic environments, yet simultaneous extraction of such chemically diverse drugs remains challenging. This work developed a green analytical method for the simultaneous determination of three model antihypertensive agents from distinct classes, namely, furosemide, atenolol, and lisinopril, in water samples. The method employed dispersive liquid-liquid microextraction using a thymol-based natural deep eutectic solvent selected for its superior hydrophobicity and tunability across varying analyte polarities and acid-base characteristics. Extraction was optimized via Box-Behnken design, followed by HPLC-UV analysis on a phenyl column with gradient elution (detection at 220 nm). The validated method showed good linearity (furosemide: 2-100 µg L[-1], lisinopril: 5-100 µg L[-1], and atenolol: 0.1-50 µg L[-1]) with LODs of 0.18, 0.66, and 0.031 µg L[-1], respectively. The practical applicability of the developed method was evaluated by analyzing real water samples collected from multiple sites across Egypt. The results revealed detectable concentrations of the target pharmaceuticals in several samples, confirming the presence of these contaminants in Egyptian water systems. Specifically, furosemide was detected at 4.72 µg L[-1], atenolol at 0.43 µg L[-1], and lisinopril at 7.21 µg L[-1] in samples collected from Giza. A comprehensive greenness assessment using the GAPI, AGREE, BAGI, and EVG tools confirmed strong alignment with sustainable chemistry principles. By enabling multi-class extraction of antihypertensive drugs with a low-ecological-footprint NADES-based protocol, this method addresses a critical gap as no prior NADES-based method exists for these three therapeutic classes together, supporting environmental monitoring and clean water objectives.

Prosthetic valve endocarditis (PVE) is a diagnostically challenging and frequently fatal infection in which echocardiography, the diagnostic cornerstone, is substantially less sensitive than in native valve disease. We describe a 67-year-old man with a bioprosthetic aortic valve who was hospitalized twice within three months, each admission characterized by polymicrobial bacteremia with Pseudomonas aeruginosa and Enterococcus faecalis, magnetic resonance imaging-confirmed bilateral thromboembolic cerebral infarcts, and septic shock. Transthoracic and transesophageal echocardiography (TTE/TEE) were performed during both hospitalizations and repeatedly failed to demonstrate valvular vegetations. Despite the absence of echocardiographic evidence of endocardial involvement, the clinical constellation of a prosthetic valve, persistent and recurrent bacteremia with biofilm-forming organisms, recurrent septic cerebral emboli, and failure of prolonged targeted antimicrobial therapy to achieve durable bacteremic clearance satisfied the modified Duke criteria for definite infective endocarditis (IE) on both admissions. This case underscores that a negative echocardiogram does not exclude PVE, that the modified Duke criteria enable a definite diagnosis when one major and three minor criteria are met, even when imaging is unrevealing, and that recurrent bacteremia with septic embolization in a patient with prosthetic material constitutes a compelling indication for surgical source control irrespective of echocardiographic findings. After multidisciplinary evaluation, the patient was transferred to a tertiary center for consideration of valve explantation. Clinicians must resist anchoring on false-negative imaging and allow the totality of clinical, microbiological, and radiographic data to guide definitive management.

Acute esophageal necrosis (AEN), also called "black esophagus," is a rare, life-threatening condition characterized by circumferential black discoloration of the esophageal mucosa, usually secondary to ischemia, impaired mucosal defenses, and gastric acid injury. It is often associated with severe debilitating illnesses, diabetes mellitus, malignancy, and hemodynamic shock, among other comorbidities. We report a female patient in her 80s with a history of breast cancer who presented with gross hematuria and was diagnosed with advanced clear cell renal cell carcinoma with inferior vena cava thrombosis. She underwent radical nephrectomy with vascular reconstruction, and the postoperative course was complicated by bleeding and sudden cardiopulmonary collapse on the second postoperative day, leading to death. Autopsy revealed acute tubular necrosis, cardiomegaly, diffuse alveolar damage, and circumferential black discoloration and necrosis of the distal esophagus, consistent with AEN. To our knowledge, this is the first case of AEN in the setting of renal cell carcinoma reported in the English language literature. The condition was not clinically suspected during hospitalization, underscoring its diagnostic challenge and potential under-recognition.

In early 2025, the United States (U.S.) federal government issued several executive orders restricting healthcare access and non-discrimination protections for transgender and nonbinary (trans) populations. The current study investigated correlates of HIV prevention service disruptions among trans adults across five U.S. states.