Citations

Abstract Background Adults with congenital heart disease (ACHD) represent a rapidly expanding population with complex lifelong clinical and psychosocial needs. Nurses play a pivotal role within multidisciplinary ACHD care, yet internationally their education, scope of practice and professional preparation remain highly variable, with no globally agreed curriculum. This gap has limited role clarity, workforce development and international harmonisation of standards. The aim of this project was to develop the first dedicated, competency-based curriculum for ACHD nursing to support consistent, high-quality, patient-centred care worldwide. Methods An international, multidisciplinary working group led by the Association of Cardiovascular Nurses and Allied Professions of the European Society of Cardiology, in collaboration with the Working Group on Adult Congenital Heart Disease and the International Society for Adult Congenital Heart Disease, developed the curriculum through expert consensus. The development group included nurses, physicians, educators and individuals with lived experience of ACHD, ensuring patient perspectives were embedded throughout the process. Existing international guidance, professional frameworks and evidence on ACHD nursing practice were synthesised. The curriculum was structured around Entrustable Professional Activities (EPAs), mapped to the CanMEDS professional roles and designed to accommodate international variation in regulation, resources and scope of practice. Results The resulting curriculum defines core and specialist competencies across the ACHD lifespan, encompassing clinical care, transition, reproductive health, psychosocial support, prevention, advanced therapies, care coordination and research. EPAs specify required knowledge, skills, attitudes, assessment strategies and levels of entrustment, with a minimum standard for practice. The framework supports career progression from specialist to advanced practice roles and is adaptable for academic, workplace-based and continuing professional development contexts. Conclusions This curriculum represents the first internationally applicable, competency-based framework for ACHD nursing. By standardising expectations while allowing contextual flexibility, it strengthens role clarity, supports workforce development and promotes harmonised, high-quality ACHD care globally.

Complex bidirectional interactions between the nervous and cardiovascular systems are integrated through the heart–brain axis, a physiological pathway that governs both neural regulation of cardiovascular function and cardiovascular influences on brain health. Emerging evidence indicates that even in the absence of overt disease, subclinical changes in the heart, aortic arch, and extracranial arteries contribute to brain injury and cognitive vulnerability. This review synthesizes current knowledge on how subclinical heart–brain axis dysfunction affects brain structure and function, highlighting the roles of central and autonomic neural pathways as well as hormonal signaling in driving neurological decline. Key biomarkers linked to silent brain injury, cognitive decline, and dementia are discussed, emphasizing their potential for early risk stratification and as targets for preventive interventions. We also outline mechanistic pathways connecting subclinical heart–brain axis dysfunction to adverse brain outcomes, identify major gaps in current evidence, and propose priorities for future research and clinical trials aimed at early detection and risk reduction to preserve brain health.

Radiology is undergoing a paradigm shift from traditional single-function AI systems to sophisticated multi-agent networks capable of autonomous reasoning, coordinated decision-making, and adaptive workflow management. These agentic AI systems move beyond simple pattern recognition to encompass complex radiological workflows including image analysis, report generation, clinical communication, and care coordination. While multi-agent radiological AI promises enhanced diagnostic accuracy, improved workflow efficiency, and reduced physician burden, it simultaneously amplifies the long-standing “black box” problem. Traditional explainable AI methods, which are adequate for understanding isolated diagnostic predictions, fail when applied to multi-step reasoning processes involving multiple specialized agents coordinating across imaging interpretation, clinical correlation, and treatment planning. This paper examines how agentic AI systems in radiology create “compound opacity” layers of inscrutability from agent interactions and distributed decision-making processes. We analyze the autonomy–transparency paradox specific to radiological practice, where increasing AI capability directly conflicts with interpretability requirements essential for clinical trust and regulatory oversight. Through examination of emerging multi-agent radiological workflows, we propose frameworks for responsible implementation that preserve both diagnostic innovation and the fundamental principles of medical transparency and accountability.

Background and purpose: SARS-CoV-2 causes a severe respiratory disease known as COVID-19 and is responsible for a global viral pandemic. The SARS-CoV-2 receptor binding domain (RBD) is located on the spike protein, which identifies and binds to the angiotensin-converting enzyme 2 (ACE2) receptor. The RBD is an important target for developing virus-neutralizing antibodies, vaccines, and inhibitors. Experimental approach: In this study, recombinant SARS-CoV-2 RBD was expressed in E. coli BL21 (DE3) and purified and its binding activity was determined. Purification was conducted using the Ni-NTA column. ELISA. flow cytometry assays were set to evaluate the binding ability of recombinant RBD to different anti-RBD antibodies and native ACE2 receptors on HEK293A cells, respectively. Findings/Results: The SDS-PAGE analysis revealed the corresponding band at 27 kDa in the culture after induction with 0.7 mM IPTG, while the corresponding band was not observed in the culture without IPTG induction. ELISA results showed that antibodies produced in the human sera could bind to the recombinant RBD protein and the commercial anti-RBD antibody. Also, flow cytometry analysis revealed that the recombinant RBD could bind to human ACE2 on the surface of HEK293A cells. Conclusion and implication: Our outcomes displayed that the recombinant RBD expressed in the E. coli strain has biological activity and can be used as an antigen for the development of diagnosis kits and vaccines as well as a tool for screening drugs against SASR-CoV-2.

ObjectiveThis multilanguage study used simple speech recording and high‐end pattern analysis to provide sensitive and reliable noninvasive biomarkers of prodromal versus manifest α‐synucleinopathy in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and early‐stage Parkinson disease (PD).MethodsWe performed a multicenter study across the Czech, English, German, French, and Italian languages at 7 centers in Europe and North America. A total of 448 participants (337 males), including 150 with iRBD (mean duration of iRBD across language groups 0.5–3.4 years), 149 with PD (mean duration of disease across language groups 1.7–2.5 years), and 149 healthy controls were recorded; 350 of the participants completed the 12‐month follow‐up. We developed a fully automated acoustic quantitative assessment approach for the 7 distinctive patterns of hypokinetic dysarthria.ResultsNo differences in language that impacted clinical parkinsonian phenotypes were found. Compared with the controls, we found significant abnormalities of an overall acoustic speech severity measure via composite dysarthria index for both iRBD (p = 0.002) and PD (p < 0.001). However, only PD (p < 0.001) was perceptually distinct in a blinded subjective analysis. We found significant group differences between PD and controls for monopitch (p < 0.001), prolonged pauses (p < 0.001), and imprecise consonants (p = 0.03); only monopitch was able to differentiate iRBD patients from controls (p = 0.004). At the 12‐month follow‐up, a slight progression of overall acoustic speech impairment was noted for the iRBD (p = 0.04) and PD (p = 0.03) groups.InterpretationAutomated speech analysis might provide a useful additional biomarker of parkinsonism for the assessment of disease progression and therapeutic interventions. ANN NEUROL 2021;90:62–75

TPS3155 Background: Genomic signatures are revolutionizing the definition, identification, and treatment of breast cancer. To precisely stratify breast cancers into actionable subgroups, full genome expression data and matching clinical data must be aggregated into a large data set. Such a data set will accelerate research and discovery, especially for smaller patient subsets who are not as widely represented within the current body of literature. Methods: FLEX is a multicenter, prospective, population-based, observational trial for patients with Stage I, II, and III breast cancer. All patients with stage I to III breast cancer who receive MammaPrint, with or without BluePrint on a primary breast tumor are eligible for enrollment. The study’s primary aim is to create a large scale, population-based registry of full genome expression data matched with clinical data to investigate new gene associations with prognostic and/or predictive value. Secondary objectives include utilizing the shared study infrastructure to examine and generate hypotheses for targeted subset analyses and/or trials based on full genome expression data. The design of FLEX allows targeted sub-studies and sub-analyses to be added as appendices after the initial baseline study is opened. Patients enrolled in the initial study are also eligible for inclusion in sub-studies where they meet all criteria and additional consent is not required. Additional clinical data will be collected as specified in the appendix protocols. The FLEX collaborative platform allows participating investigators the opportunity to author their own sub-study protocols, as approved by the FLEX Steering Committee of their peers. 13 sub-studies have already been identified and are under development. Eligibility: The study will enroll a minimum of 10000 patients aged ≥18 years with histologically proven invasive stage I-III breast cancer who signed informed consent. Enrollment began April 2017 and 1506 patients have been enrolled. Clinical trial information: NCT03053193.