Background: Semaglutide, a glucagon-like peptide-1 receptor agonist, is increasingly used for obesity and type 2 diabetes treatment. As its use rises among women of reproductive age, understanding its impact on neonatal health is essential. Objectives: To assess neonatal outcomes associated with semaglutide exposure during pregnancy or within two months before conception. Search Strategy: PubMed, Embase, and ClinicalTrials.gov were searched for relevant studies. Selection Criteria: Studies reporting neonatal outcomes following semaglutide exposure before or during pregnancy were included, with no language restrictions. Data Collection and Analysis: Two reviewers independently screened and extracted data. Due to study heterogeneity, a narrative synthesis was used, and bias risk and study quality were assessed. Main Results: Five studies involving a total of 1,128 semaglutide exposed pregnancies, showed mixed results. One study reported adverse outcomes including spontaneous abortion and preeclampsia. Another study found spontaneous abortion rate of 23%, comparable to diabetes- and obesity-groups. A third study observed a prevalence of congenital malformations of 8.3%, with no significant risk increase compared to insulin. One study linked semaglutide discontinuation to foetal macrosomia and neonatal hypoglycaemia. Another noted preterm birth and large-for-gestational-age infants, with no increased congenital malformation risk. No clear association with birth defects was identified, however the evidence is limited by study variability and bias risk. Conclusions: The limited number of available studies precludes firm conclusions nevertheless current evidence does not indicate a consistent increased risk of major congenital malformations associated with semaglutide exposure.

This study evaluated the tissue reaction and inflammatory response after implantation of endodontic sealers in the subcutaneous connective tissue of isogenic mice. 120 mice were divided into 4 groups: BioRoot RCS, AH-Plus jet, ZOE and Sham group (negative control), which were evaluated in the experimental periods of 7, 21 and 63 days (n= 10). A macroscopic analysis was performed through digitized photograph to measure the thickness of the reaction tissue. Microscopic analysis were performed to count the number of blood vessels present in the reaction tissue and to evaluate collagen fiber networks. Data were analyzed using the non-parametric Kruskal-Wallis test and Dunn’s post-test (α=5%). The reaction tissue showed greater thickness and amount of vessels and blood cells in the initial period of 7 days and was reduced over time, except the group AH Plus Jet which presented similar values of blood cells and vessels in all experimental periods. The BioRoot RCS at 7 days, presented the values of thickness and blood cells in the reaction tissue significantly higher (p˂ 0.001). Regarding collagen fiber formation, there was a greater amount of collagen fibers in the Sham group (7, 21 and 63 days), BioRoot at 63 days and AH Plus Jet at 21 and 63 days. In conclusion, endodontic cements presented greater thickness and amount of blood cells in the initial period, being reduced with time. On the other, collagen fiber formation were more pronounced at final periods.

We examine bilateral bargaining, where participants first select a preferred allocation norm among equal division, equal gain, and proportional division. When matched with another sharing the same norm, participants decide whether to adhere to the projected division or negotiate a different outcome. Experimental results reveal that norm abandonment occurs more frequently when allocations are perceived as unfair: high contributors in equal division and low contributors in proportional division. Attachment is sturdiest for strict equality and weakest for proportionality. Equal gain, a middle ground, is the most favored at both preselection and negotiation outcomes. Several applications in international conflicts are discussed.

Environmental DNA (eDNA) is emerging as a promising hydrological tracer, complementing its established role in ecological monitoring. Here, we develop a feasible and easily realisable method for including eDNA sampling in automated hydrological time-series sampling. The 3D printable and reusable frames, appropriate for common filter membranes, passively sample eDNA in triplicate replication. The influence of the frames on other hydrological parameters, such as the composition of ions and organic matter, was assessed, as well as the impact of standing time. No significant influence on water chemistry measurements could be detected through the presence of eDNA passive samplers. As expected, an impact of standing time could be observed for both biodegradable parameters, organic matter and eDNA. Simultaneously, an increase in total DNA content was observed over time, probably related to biofilm growth. Surprisingly, the concentration of a spike fragment stabilised after 24 h of exposure to sampling water and remained at that level even until 7 days of exposure to sampling water. Biofilm formation could play a role in this stabilisation of free eDNA over longer periods. Due to the reusability and adaptability of the 3D printable frames, there is no need for additional devices to integrate eDNA sampling. Our results show that passive eDNA sampling can be seamlessly integrated into automated hydrological time series monitoring by simultaneously sampling the composition of ions and organic matter, and, under certain limitations, e.g. the use of microbial communities, even if several days of standing times are necessary. Adaptability of the frame to various membrane formats and reusability of the model make it broadly applicable in research and applied cases.

not-yet-known not-yet-known not-yet-known unknown Evaluating open-ended questions is a common and time-consuming task in the education environment. With the continuous and rapid advances in Natural Language Processing (NLP), we have large language models (LLMs) which have been trained with large datasets. The objective of this study is to evaluate the use of these LLMs using retrieval augmented generation (RAG) techniques for the numerical evaluation of open-ended questions with answers of approximately 250 words, evaluating the improvement that the use of the RAG technique brings to this task. For this purpose, a dataset composed of 351 questions evaluated by the teachers of 2 courses, and also the course materials, has been used. We found that, in general, using the RAG technique improves the numerical grades awarded by a LLM, achieving improvements in the MAE of up to 24%. It was also observed that generally the LLM tends to give high grades. Our study concludes with practical guidelines for integrating RAG models into educational settings.

Apple is an important economic species, and it always suffered by biotic stress during its growth and development. Fungi and pests are two types of biotic stress that have significant destructive effects on apples. Besides, the LRR-RLKs family play a key role in regulating plant responses to biotic stress. In this study, overexpressing MdLRR-RLK1 enhanced apple resistance to Colletotrichum fructicola and aphids by promoting the expression of resistance genes such as WRKYs, PRs and JA-pathway genes, as well as increasing the content of antioxidant enzymes s and econdary metabolites. Additionally, MdLRR-RLK1 could interact with MdGRP1-LIKE in vivo and in vitro, and MdLRR-RLK1 could phosphorylate MdGRP1-LIKE in vitro. Overexpressing MdGRP1-LIKE enhanced apple resistance to C. fructicola by increasing the expression of resistance genes such as WRKYs and PRs and the content of antioxidant enzymes. However, overexpressing MdGRP1-LIKE did not enhance the apple resistance to aphids. These findings reveal the mechanism of the MdLRR-RLK1-MdGRP1-LIKE module regulated apple resistance to biotic stress.

During photosynthesis, CO 2 uptake is counterbalanced by concurrent CO 2-releasing processes, complicating the interpretation of gas exchange measurements. While photorespiration accounts for a significant portion of this CO 2 release, emerging evidence indicates that there are additional metabolic pathways that release CO 2 during photosynthesis. This metabolism– termed day respiration (often Rd) or respiration in the light ( RL)–is now recognized as an independent and significant source of CO 2 emission during photosynthesis. Here we revisit classical models of photosynthesis and incorporate new insights from isotopic labeling and metabolic flux analysis (MFA) to investigate the biochemical basis of RL. We identified the cytosolic glucose-6-phosphate (G6P) shunt through the oxidative pentose phosphate pathway (OPPP) as the predominant contributor to RL. This shunt explains some long-standing anomalies in Calvin-Benson-Bassham (CBB) cycle labeling. Under non-stressed conditions, RL remains stable across varying CO 2 concentrations and light intensities. Under heat stress, RL shifts toward a plastidial source. Together, these findings resolve longstanding questions about carbon flux during photosynthesis and improve our understanding of RL by explaining its metabolic origin, physiological significance in carbon balance during photosynthesis, and regulation under varying environmental conditions.

Soil contamination by bisphenol A (BPA) has raised considerable ecological and environmental concerns, particularly due to its potential impact on plant growth. However, the interactive effects of BPA and different soil types on soil–plant systems remain poorly understood. Capsicum annuum L., a widely cultivated vegetable crop, was used as a model to systematically investigate the mechanisms of BPA uptake, translocation, and metabolic disruption in roots under varying soil types and BPA concentrations. Greenhouse experiments showed that BPA accumulation in pepper roots was highest in clay soil, significantly greater than in sandy or loamy soils. When BPA concentrations exceeded 10 mg/kg, root elongation and vitality were markedly suppressed, accompanied by enhanced antioxidant enzyme activity and elevated malondialdehyde content, indicating increased oxidative stress. Integrated transcriptomic and metabolomic analyses identified 995 differentially expressed genes and revealed significant disruptions in root metabolic processes. BPA stress altered the expression of genes related to the biosynthesis of hormone precursors and branched metabolites. Key pathways, including indole-3-acetic acid biosynthesis and hormone signal transduction, were significantly affected. These findings clarify the soil-dependent uptake and translocation patterns of BPA in pepper roots and provide important molecular insights into the plant’s adaptive and defense responses under BPA-induced stress.

Dirichlet series, or, series of the form D(A, s) = ∞ i=1 a i i s are central objects in complex analysis and analytic number theory. This paper seeks to generalize them by introducing & studying new types of Dirichlet series-quaternionic Dirichlet series, and lattice Dirichlet series. That is, Dirichlet series over quaternions, and, various types of Dirichlet series over lattices.

Using outputs from eight CMIP6/PMIP4 models, we analyze the hydrographic and surface ocean circulation differences across three climate states: the pre-industrial (PI; 1850 CE), the Last Interglacial (LIG; 127 ka BP), characterized by strong summer insolation, and a future warming scenario driven by gradually increasing atmospheric CO2 and with similar annual Arctic sea-ice volume to the LIG. In the LIG experiments, an anomalous cyclonic circulation over Greenland and surrounding seas enhances the Baffin and Labrador currents, while slightly weakening the East Greenland Current relative to PI. These changes affect sea-ice and water export on both sides of Greenland. Most models also show a strengthened North Atlantic Subpolar Gyre (SPG) and increased volume transports through the Fram Strait and Barents Sea Opening. However, this does not always correlate with a larger heat transport into the Arctic. In contrast, the CO2-forced simulations show a weakened SPG, but more amount of water and heat are carried towards the Arctic compared with the PI period. Consequently, temperatures of the surface and subsurface waters are higher in the Eurasian Basin and sea-ice decline in the Barents Sea is more pronounced compared with the PI and LIG periods. These changes in the CO2-forced experiments closely resemble the ongoing Arctic Atlantification, whereas evidence for a similar process during the LIG is less clear.

Climate change is shifting upward the elevational limit of many species. When plants migrate along elevational gradients to follow their thermal niche, they experience a decrease in atmospheric pressure the higher they migrate. The direct effect of low air pressure on plant morphology, physiology, and metabolism remains unclear. Using Ecotron chambers that independently control atmospheric pressure and other climatic drivers, we studied a broad spectrum of physiological and metabolic parameters of the model plant Arabidopsis thaliana at two different air pressures (101 and 62 kPa). We found a decrease in stomatal conductance, CO2 assimilation rate, and internal-to-atmospheric CO2 ratio at lower atmospheric pressure. Interestingly, despite reduced gas exchange, we observed an increase in leaf 13C abundance, suggesting enhanced carboxylation capacity. Moreover, at 62 kPa, we observed a higher leaf accumulation of secondary metabolites, a defense mechanism that plants usually adopt under stress conditions. Our results confirm that air pressure is a key abiotic factor influencing plant performance and fitness across a broad spectrum by modifying both physiological and metabolic processes. Therefore, understanding the mechanisms behind a model plant’s response to low air pressure is essential for incorporating this factor into future studies on plant migration along elevational gradients.

Heat stress poses a significant threat to crop productivity; however, the thermotolerance mechanisms in underutilised oilseed crops, such as chia ( Salvia hispanica L.), remain poorly understood. Despite the growing interest in chia as a rich source of ω-3 fatty acids, its molecular response to heat stress, particularly in vegetative tissues, has not been explored. We conducted transcriptomic and lipidomic profiling to examine how chia leaves respond to short-term (3 h) and prolonged (27 h) heat stress (38 °C/20 °C day/night) followed by recovery. Over 20% of transcripts showed differential expression, revealing pathways involving Ca 2+ signalling, heat shock factors, and other stress-related regulators. Almost all heat-responsive genes (>99%) returned to normal levels within 24 hr of recovery, showing a robust restoration of homeostasis. Among 287 annotated lipid species, triacylglycerols exhibited the most significant and reversible changes (>2-fold), suggesting a role in membrane remodelling. These findings highlight the significance of Ca 2+-mediated signalling pathways and molecular chaperones, such as heat shock proteins and heat shock factors, in heat stress adaptation, providing foundational molecular data on chia leaf thermotolerance. This resource enhances our understanding of stress tolerance mechanisms in chia and contributes to broader efforts in developing heat-resilient oilseed crops.

A case of acute disseminated encephalomyelitis in an infant with mild paralysisHideki Tanouea, MD, Sayaka Ishiharaa, MD, Mari Asakuraa, MD,Masahiro Nodaa, MD, PhD, Kunihiro Obaa, MD, PhD, Masashi Ogasawaraa, MD, PhD

A document by Luqman muhammadi. Click on the document to view its contents.

A document by Mahmoud Shalalfeh. Click on the document to view its contents.

A document by Michael McNally. Click on the document to view its contents.

Title: Cerebellar Tonsillar Herniation Following Acute Ischemic Stroke in Meningovascular Neurosyphilis: A Case ReportAbstract:   Introduction: Meningovascular neurosyphilis (MVNS) represents an uncommon manifestation of Treponema pallidum infection, potentially leading to stroke, cerebral edema, and elevated intracranial pressure. Cerebellar tonsillar herniation represents a rare yet critical complication with potentially life-threatening consequences. Timely diagnosis and intervention are critical to avert lethal consequences.Case Presentation: A 20-year-old female presented with headache, dizziness, and altered sensorium, which were preceded by a self-limiting genital lesion eight weeks prior. She exhibited disorientation without any focal neurological deficits. The MRI indicated a left thalamic infarct, while cerebrospinal fluid analysis validated the presence of meningovascular neurosyphilis. Intravenous ceftriaxone and corticosteroids were administered for her treatment. On the 14th day of hospitalization, the patient experienced a generalized seizure accompanied by a rapid deterioration in consciousness. Subsequent imaging revealed widespread cerebral edema and herniation of the cerebellar tonsils. Despite receiving supportive care, she ultimately died due to complications arising from brainstem compression and increased intracranial pressure.Conclusion: This case illustrates the significant consequences of MVNS resulting in infarction, cerebral edema, and tonsillar herniation in a young woman without a previous STD diagnosis. Early neuroimaging, cerebrospinal fluid analysis, and timely antimicrobial therapy are essential. The provision of IV penicillin and prompt surgical decompression are essential, particularly in resource-limited settings.Key Clinical Message: This case shows how a thalamic stroke caused by meningovascular neurosyphilis can quickly lead to cerebral edema and a tonsillar herniation. Neurological problems need to be diagnosed, treated, and decompressed surgically as soon as possible to avoid permanent damage.Keywords: Meningovascular neurosyphilis, ischemic stroke, cerebellar tonsillar herniationIntroduction:Syphilis, caused by Treponema pallidum, can progress to neurosyphilis at any stage. It is more prevalent in high-risk groups, including men who have sex with men and individuals with human immunodeficiency virus (HIV) 1. Early neurosyphilis may involve the meninges, cerebrospinal fluid (CSF), and vasculature 2; syphilitic meningitis and meningovascular forms are more common, and timely treatment along with earlier diagnosis can help prevent late progression to conditions such as tabes dorsalis 3.While most cases resolve spontaneously and remain asymptomatic, approximately 5% progress to meningitis, which may present with seizures, aphasia, hemiplegia, or confusion. Meningovascular neurosyphilis (MVNS), a sub-type, typically occurs as early as six months to seven years after primary infection 4. It causes vascular inflammation, ischemic infarction, cerebral edema, and increased intracranial pressure (ICP) 5.Cerebellar tonsillar herniation, an exceptionally rare but life-threatening consequence of elevated ICP, can result in brainstem compression, hydrocephalus, and fetal cardio-respiratory failure6. Timely recognition and neurosurgical decompression are essential to prevent irreversible injuries 7.We present a rare case of a 20-year-old female with neuro-psychiatric symptoms and altered sensorium, ultimately diagnosed with MVNS complicated by thalamic infarction, which progressed to diffuse cerebral edema and ultimately cerebellar tonsillar herniation. This case underscores the critical importance of early neuroimaging, CSF analysis, and prompt decompression to prevent life-threatening complications.Case History and Examination:A 20-year-old female presented to our hospital with a sudden onset of a dull headache localized to the parietal region. The patient reported dizziness, nausea, vomiting, and orbital pain. The patient presented with a history of multiple episodes of watery vomiting, devoid of bile or blood. The patient reported no fever, visual disturbances, or prior history of trauma, diabetes, or hypertension. The patient’s mother reported that eight months ago, the patient developed a painless, itchy lesion on her genitalia, which resolved spontaneously after two months without treatment. Two weeks ago, she had visited the emergency room with similar symptoms, which painkillers alleviated. The patient exhibited altered sensorium characterized by confusion, disorientation, amnesia, nervousness, personality changes, hostility, aggressive behaviors, hallucinations, and illusions. The patient’s temperature measured 98.9°F, with a pulse rate of 100 beats per minute, a respiratory rate of 20 breaths per minute, blood pressure recorded at 110/90 mm Hg, and oxygen saturation at 94% in room air. On physical examination, pupils were equal, measuring 4 mm in diameter, and exhibited reactivity to light. She experienced disorientation regarding time, place, and person. Motor examinations reveal that muscle bulk, tone, and power in both upper and lower limbs are within normal limits. The plantar reflex, along with other reflexes, was intact. We did not conduct the sensory examination. Aside from the neurological examination, the examination of other systems revealed no significant findings.Differential Diagnosis:At this point, given the patient’s presentation with altered mental status, headache, visual hallucinations, and a prior painless genital lesion, the most probable differential diagnoses included viral encephalitis, bacterial or tubercular meningoencephalitis, autoimmune encephalitis and cerebral vasculitis.

Objectives: This study investigates brain responses to natural speech in patients with disorders of consciousness (DoC), focusing on the speech envelope. Two measures were used: neural tracking, which evaluates how well brain activity follows the speech envelope, and spectral entropy, which assesses the complexity of brain responses. These measures were compared to clinical diagnosis and behavioral responsiveness, assessed via the Coma Recovery Scale-Revised (CRS-R). Design: Four DoC patients underwent electroencephalography (EEG) recording while listening to a narrated story in Dutch and Swedish, alongside baseline EEG. We employed both spectral entropy and a backward modeling approach to evaluate the speech envelope’s neural tracking. This technique involves training a model to map the relationship between EEG signals and the corresponding speech envelope. Once the model is trained, it can use unseen EEG data to reconstruct the speech envelope, which is then compared to the original speech envelope to assess how effectively the patient processed the auditory stimulus. For the behavioral assessment, CRS-R scores were converted into the CRS-R index. Results: Spectral entropy positively correlated with the CRS-R index during listening. Neural tracking correlated with CRS-R diagnoses but not the index. An interaction showed that higher neural tracking strengthened the link between spectral entropy and behavioral responsiveness. Conclusion: This study demonstrated the potential of neural tracking and spectral entropy as complementary tools to investigate patients with DoC. Spectral entropy proved valuable for assessing behavioral responsiveness, while neural tracking shows promise in assessing the DoC diagnosis.

Early career researchers (ECRs) are often faced with uncertainty about their professional futures, a challenge exacerbated by the increasing pressures within the academic research landscape. As ECRs navigate their next steps in science, mentorship is crucial, particularly as they face points of decision-making and possible career diversions from the traditional postdoctoral-to-professor pathway. In response to these challenges, the second iteration of the Australian and New Zealand Society of Immunology (ASI) Mentor-Mentee Program aimed to provide mentorship and training to ECRs about academic career pathways in research and education to bridge the professional communities, values, and advice of these two often independent career choices. As a component of the Program, three eminent Australian immunologists in research-intensive, teaching and research (TnR) and education-focused careers, shared their professional journeys and experiences which led to their chosen career pathways in national workshops. Here, we share their insights, lessons learned and professional development tips to establish an academic career. By outlining the three primary scientific academic career pathways available post-PhD, we aim to inform and inspire the next generation of immunologists as they consider the diversity of possible academic careers ahead.

Vaneet ChatheyAbstract - Operational resilience is critical for investment banking firms, where even minor system outages can lead to regulatory penalties, reputational damage, and financial loss. This article presents a practical framework for achieving 99.5%+ system uptime through proactive monitoring and automation. Drawing from real-world implementations at leading global banks, the paper highlights how embedding resilience into the technology operations strategy through automated validation checks, intelligent alerting, and cross-regional incident management can significantly enhance system stability and reduce operational risk. The results showcase tangible benefits, including a 75% reduction in incidents, enhanced regulatory compliance, and improved user productivity. Financial institutions must shift from reactive incident management to proactive operational resilience strategies to sustain performance in an increasingly digital and regulated environment.Index Terms - Operational resilience, investment banking, proactive monitoring, automation, system uptime, compliance.

This paper examines the rise of the social media platform Bluesky following Elon Musk’s acquisition of X and the 2024 U.S. presidential election, which triggered the largest exodus in the platform” history. To understand this transformation in the social media landscape, I first analyze Gab’s emergence in 2017 as a case study in how alternative technology platforms develop in response to perceived political censorship and content moderation. Drawing parallels between these platforms’ trajectories, I argue that Bluesky’s growth requires us to fundamentally redefine our understanding of “alt-tech” beyond its traditional association with right-wing platforms. Through analysis of platform architecture, user demographics, and key events, I demonstrate how Bluesky’s development, like Gab’s before it, reflects broader tensions in the digital space. By expanding our conception of alt-tech to include progressive platforms emerging in response to perceived right-wing capture of digital spaces, this research suggests that Bluesky’s emergence marks a fundamental shift in our understanding of Big Tech, alternative platforms, and the possibility of maintaining ideologically diverse digital spaces.

Author responseDear Prof Papageorghiou,We are grateful to Vinogradov and Robson for their letter on the importance of adherence to Aspirin1 in response to our Editorial2. We could not agree more; and so does the RCOG guideline on prevention of stillbirth3. Whatever the reasons for it, suboptimal adherence explains the massive dilution of the effect of aspirin2 in systematic reviews and its reduced impact in clinical practice. Lack of adherence may be the result of conflicting information. For example, with regards to breastfeeding the British National Formulary states: ‘Avoid’ in breastfeeding.4 Conversely, LactMed affirms the compatibility of low-dose aspirin and breastfeeding, stating for doses of 75-325mg “no aspirin is excreted into breastmilk and salicylate levels are low”.5We are also grateful to Vinogradov and Robson for identifying1 that whereas 150 mg dose achieves near-complete Thromboxane B2 suppression, 75 mg dose was still sufficient to reach the same level of inhibition in 86% of participants. This may be particularly relevant to women who are underweight or have conditions such as chronic renal disease, where 75mg may be sufficient and preferable.Finally, a word of caution. Whereas the role of aspirin in preventing, or at the very least delaying, placental dysfunction may be useful for preventing many stillbirths3, the time may have come to pay more attention to the elephant in the room: the role of under-diagnosed and under-treated diabetes, and the potential role of weight-loss medications pre-conception.

Predicting Neonatal Coarctation: In Search of a New ParadigmRajesh U. Shenoy, M.D., MS Wolfson Children’s Hospital 841 Prudential Drive, Jacksonville, FL 32207 Tel: (904) 202-8550 Fax: (904) 393-7808 E-mail: Rajesh.Shenoy@bmcjax.comCoarctation of the aorta (CoA) is a common congenital heart defect accounting for 5 – 8% of all forms of CHD1. It is a difficult diagnosis to make prenatally, since only 10% of the left ventricular output crosses the aortic isthmus, and flow into the descending aorta comes primarily from the patent ductus arteriosus. However, prenatal diagnosis of coarctation is of vital importance, since it would enable counseling of prospective parents, delivery at a tertiary institution, and institution of prostaglandin infusion if appropriate after the baby is born.CoA is usually suspected prenatally when there is discrepancy between the right and left heart structures. Multiple fetal echocardiographic parameters have been studied by various groups, in an effort to define those that can predict the likelihood of neonatal CoA. With advances in technology, novel parameters keep getting added to the mix. A systematic review2 of many of these studies concluded that z scores of diameters of mitral valve annulus, tricuspid valve annulus, aortic annulus, pulmonary valve annulus, and aortic isthmus, as well as ratios of right/left ventricles and pulmonary artery/ascending aorta were significantly different in fetuses that developed CoA in the neonatal period. The authors concluded that using a multiple-criterion prediction model may improve the detection of CoA in fetal life, and called for large multicenter studies to develop objective models to risk stratify these fetuses. A recent retrospective single-center study3 found discrepancies in z scores based on the multiple datasets available currently. The authors called for larger multi-center data in order to generate more reliable z scores. The same study identified the carotid-subclavian artery index and a product of isthmus/duct ratio and mitral valve/tricuspid valve ratio as highly sensitive and specific in identifying the fetus at risk for developing neonatal CoA. This was validated in a prospective group of fetuses.Fetal echocardiography likely overestimates the likelihood of neonatal coarctation, leading to parental anxiety and over-utilization of resources. However, only 20-35% of neonatal CoA is identified prenatally4. There exists a need for larger studies, preferably prospective and multi-center, to identify parameters which can more accurately identify the fetus at risk for neonatal CoA.In this issue of Echocardiography, Chen et al5 report on their prospective case-control matched study in which they assessed an exhaustive list of parameters which have been identified in other studies as predictive of neonatal CoA. On multi-variate analysis, they identified the diameter of the ductus arteriosus, aortic isthmus in the 3-vessel view, aortic arch between the 2nd and 3rd vessels, ascending aorta, and main pulmonary artery, in addition to the distance between the left common carotid and left subclavian arteries as significantly abnormal in fetuses who developed neonatal CoA. The AUC was robust for these parameters, and the authors also established a cut-off for dimensions at 28 weeks of gestation for these parameters (obviating the need for z-scores).This again is a single-center study in a defined ethnic group. Nearly half of the pregnancies where the fetus was identified as being at risk for developing neonatal CoA were not carried to term. We would do well to heed the call by the authors for a multi-center prospective study with diverse populations to examine the applicability of the findings from this comprehensive look at fetal parameters.1 Rosenthal E. Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart . 2005;91 :1495–1502.2 Familiari A, Morlando M, Khalil A, Sven-Kirk S, Scala C, Rizzo G, Del Sordo G, Vassallo C, Flacco M, Manzoli L, Lanzone A, Scambia G, Acharya G, D’Antonio F. Risk Factors for Coarctation of the Aorta on Prenatal Ultrasound. Circulation 2017;135 :772-785.3 Fricke K, Liuba P, Weismann CG. Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation. Pediatric Cardiology 2021;42 :517-25.4 Lytzen R, Vejlstrup N, Bjerre J, Petersen OB, Leenskjold S, Dodd JK, Jorgensen FS, Sondergaard L. Live-born major congenital heart disease in Denmark: incidence, detection rate, and termination of pregnancy rate from 1996 to 2013. JAMA Cardiol 2018;3 :829–837.5 Chen G, Mi J, Han Y, Qin K, Peng Y, Geng X, Zhou P, Yu T, Sun C, Gao B-L, Ge S. Changes of prenatal sonographic vascular parameters in Coarctation of the Aorta and the Risk Factors.Echocardiogr 2025;XX:XXX-XXX.

Background: SARS-CoV-2 infection has been linked to both acute and long-term cardiovascular (CV) complications. Objective: Provide a narrative synthesis of evidence on cardiac remodeling, myocarditis, arrhythmia, microthrombosis, and heart failure following COVID-19. Methods: We reviewed PubMed-indexed clinical and epidemiologic studies (2020-2025) addressing post-acute CV complications. Results: COVID-19 survivors face elevated risks of myocarditis (~6×), arrhythmias (~1.6×), and heart failure (1.7-2×) even after mild disease [1-3]. Endothelial dysfunction, microthrombi, direct myocardial injury, and inflammation underpin these sequelae [3-5]. CMR studies in athletes show low prevalence of clinically relevant myocarditis (~1-3%), with subclinical fibrosis in a minority [6-8]. Conclusions: Persistent CV sequelae after COVID-19 are prevalent and clinically relevant; surveillance with imaging, biomarkers, and guideline-based therapy is imperative.