Erythrocytes play a crucial role in human life and are a good model for single-cell ageing research. Therefore, the mechanism of erythrocyte ageing has been a serious concern for researchers. Here, we investigate the ageing mechanism of human erythrocytes in circulation with a new approach. We first try to discover all the factors that affect erythrocyte ageing from the existing findings about the interactions of erythrocytes with the environment during circulation and the resulting alterations in the cells during their ageing process. Then, we define the main events in erythrocyte ageing according to the incidence and strength of the interactions and the magnitude of the biophysical and biochemical alterations induced by these interactions. With the main events as a guide for tracking the ageing process and analysing the causes and consequences of the events taking place during erythrocyte ageing, we depict the pathways and framework of the ageing mechanism. We hope that understanding the ageing mechanism of erythrocytes will help people to have a deep insight into the biophysical and biochemical processes of cell ageing and their molecular basis. Additionally, it may offer solutions to different fundamental and practical problems related to erythrocyte ageing, storage lesions, transfusion and diseases.

We described a 14-year-old boy who underwent catheter ablation for atrial tachycardia that had difficulty in creating the whole circuit of 3D map due to widely spread scar after repeated surgery for multivalvular heart disease. The classical atrial entrainment method was very effective in planning the catheter ablation for the invisible circuit of the atrial tachycardia.

Pulmonary valve or main pulmonary artery infective endocarditis is rare in children and is associated with high morbidity and mortality. Fungal infective endocarditis, most commonly caused by Candida species, is particularly aggressive and often requires a combination of antifungal therapy and surgical intervention. We report two infants who developed Candida endocarditis following pulmonary artery banding.

In the first case, a female infant developed persistent candidemia after pulmonary artery banding, with echocardiography revealing a mobile mass at the pulmonary bifurcation and computed tomography angiography demonstrating a mycotic pseudoaneurysm. Blood cultures confirmed Candida albicans. She underwent debanding and main pulmonary artery reconstruction, later requiring pacemaker implantation, and recovered without relapse. In the second case, a female infant presented with fever and candidaemia after pulmonary artery banding. Echocardiography identified a distal main pulmonary artery vegetation, and cultures grew Candida parapsilosis. She received amphotericin B–based induction therapy followed by fluconazole step-down after surgical source control, achieving clinical cure at follow-up.

These cases highlight the diagnostic and therapeutic challenges of Candida endocarditis after right-sided palliation. Early multimodality imaging, species-directed antifungal therapy, and timely surgery are critical to optimise outcomes in this rare but life-threatening complication.

This single center retrospective observational study of serial plasma metagenomic next-generation sequencing testing shows that >95% of serial testing was without meaningful clinical impact. Only 5/173 cases were adjudicated as having significant clinical impact.

We report two adult patients who had rare systemic artery lesions with a history of Kawasaki disease, with a review of the literature. A 39-year-old male with Kawasaki disease at the age of 2 months underwent coronary artery bypass grafting to the right coronary artery and left anterior descending artery because of coronary artery stenoses. In the screening by thoracic-abdominal CT before the operation, calcification of the distal abdominal aorta was detected, and an abdominal aortic aneurysm with stenosis was diagnosed. He had been asymptomatic, and there were no differences in his extremities’ blood pressure. Although a slight dilatation of the distal abdominal aorta had existed in his aortogram at 2 years 9 months old, the abnormal finding had been unnoticed. A 26-year-old female with coronary artery bypass grafting at the age of 23 months had hypertension. A stenosis of the orifice at the right renal artery was detected by two-dimensional echocardiography and a magnetic resonance angiogram. Her hypertension in adulthood was suspected to result from her renal artery stenosis, which acute Kawasaki vasculitis underlies. Although coronary artery lesions in both patients were diagnosed in their childhood, systemic artery lesions were not realised until adulthood. Because abdominal aortic aneurysms and renal artery stenosis are extremely rare, they were not recognised as systemic artery lesions caused by Kawasaki disease. Their lesions can occur in patients with severe acute vasculitis at a significantly younger age, less than 6 months. Systemic artery lesions in such adult patients must be carefully evaluated.

This study investigates the associations between social determinants of health (SDOH) and hypertension prevalence across Wisconsin communities, with particular attention to food environments, economic factors, and transportation patterns. Using data from the 2019–2020 Wisconsin State Inpatient Database (387,047 patients) and the 2020 AHRQ SDOH database, we employed spatial analysis and logistic regression models to examine relationships between hypertension prevalence and neighbourhood characteristics across 597 ZIP codes. Lower-income areas exhibited significantly higher hypertension prevalence (EE = 1.233, 95% CI: 1.128–1.347 for incomes under $14,999), neighbourhoods with greater food resource density showed protective associations (EE = 0.549, 95% CI: 0.474–0.636 for supermarket access). Active transportation patterns were associated with lower hypertension rates (EE = 0.879, 95% CI: 0.829–0.933 for walking). We observed a ‘Hispanic paradox’ in Milwaukee County, where Hispanic populations demonstrated lower hypertension prevalence despite socioeconomic disadvantages, whereas African American populations with similar disadvantages exhibited higher prevalence. Our proposed ‘Food Environment Synergy Model’ helps frame these findings by conceptualising food environments through three interacting dimensions: physical access, economic accessibility, and cultural dietary patterns. This integrated approach highlights how these dimensions collectively relate to unique risk and resilience profiles within communities, challenging conventional binary classifications of ‘food deserts’ versus ‘food secure’ areas. These findings indicate that addressing food access disparities, promoting walkable neighbourhoods, and preserving beneficial cultural dietary traditions may be related to lower hypertension prevalence and advance health equity in diverse communities. However, the analysis is cross-sectional, causality cannot be inferred; further longitudinal studies are needed to establish causal relationships.

Primary pulmonary malignancies in single-ventricle patients are rare. Improved survival following surgical palliation has resulted in a growing Fontan population whose malignancy risk remains undefined. Standard oncologic approaches, especially for adenocarcinoma of the lung, need to be considered within the context of Fontan physiology. We present our management of primary lung adenocarcinoma in an adult with tricuspid atresia status postlateral tunnel Fontan palliation, highlighting considerations for this unique scenario.

In this article, I explore how the mental health and mental capacity laws in England and Wales can be used for suicide prevention. I criticise the use of compulsion for persons diagnosed with a mental disorder who nonetheless retain decision-making capacity and argue for a greater reliance upon capacity as a distinguisher between autonomous decision-making about the end of life and the risk to life posed by symptoms of mental illness. The label of ‘suicide’ is also criticised as an outdated legal notion carrying pejorative meaning. Although focused on the law in England and Wales, the arguments apply much more broadly to all jurisdictions seeking to reconcile the demands of respect for life and respect for autonomy.

Malnutrition is highly prevalent among oncology patients, with large-scale studies reporting involuntary weight loss in 31–87%, depending on tumour site and disease stage. A combination of nutrition-impact symptoms, reduced oral intake and systemic inflammation lead to poor tolerance to treatment, diminished quality of life and reduced survival. Systemic inflammation is a hallmark of cancer-associated malnutrition and contributes to loss of lean mass and abnormal body composition phenotypes (sarcopenia, cachexia and low muscle density) which may coexist with overweight and obesity. Malnutrition screening tools are widely used to identify patients at risk; however, traditional weight and BMI-based instruments such as the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) frequently misclassify patients with cancer as well-nourished. These tools fail to account for nutrition-impact symptoms, inflammation and muscle wasting. Although obesity is an established cancer risk factor, 40–60% of patients with metastatic disease remain overweight or obese during treatment. When screening tools are BMI-based, high fat stores mask muscle wasting, leading to misclassification of nutritional risk and delayed dietetic referrals. To improve detection, screening tools should incorporate patient-reported symptoms, inflammatory markers and body composition assessment, enabling earlier, proactive nutritional care. Alternatively, it may be time to acknowledge that all cancer patients are inherently ‘at-risk’ of malnutrition and to prioritise universal access to dietetic support from diagnosis through treatment. This review summarises current malnutrition screening and assessment practices in oncology and outlines key considerations for future research and clinical practice.

Circular shunt is a very rare, albeit critical, condition. We present a case of a post-surgical circular shunt that resulted after correction of an anomalous total pulmonary venous connection to the coronary sinus with a persistent left superior vena cava. A left cavo-pulmonary anastomosis was performed; however, she developed heart failure during follow-up. The anastomosis was closed by interventional cardiac catheterisation without complications that led to resolution of heart failure symptoms.