Summary: Type 2 diabetes is a global health priority, given that it is driven, in part, by an ageing population, the role of immune senescence has been overlooked. This is surprising, as the functional impairments of senescent T cells show strong similarities to patients with hyperglycaemia. Immune senescence is typified by alterations in T cell memory, such as the accumulation of highly differentiated end-stage memory T cells, as well as a constitutive low-grade inflammation, which drives further immune differentiation. We show here in a preliminary study that people living with type 2 diabetes have a higher circulating volume of senescent T cells accompanied with a higher level of systemic inflammation. This inflammatory environment drives the expression of a unique array of chemokine receptors on senescent T cells, most notably C-X-C motif chemokine receptor type 2. However, this increased expression of migratory markers does not translate to improved extravasation owing to a lack of glucose uptake by the T cells. Our results therefore demonstrate that the presence of senescent T cells has a detrimental impact on immune function during type 2 diabetes.

Cardiac arrhythmias are a growing global health concern, and the need for accessible, continuous monitoring has driven rapid advancements in wearable technologies. This review explores the evolution, capabilities, and clinical impact of modern wearables for arrhythmia detection, including smartwatches, smart rings, ECG patches, and smart textiles. In light of the recent surge in commercially available wearables across all categories, this review offers a detailed comparative analysis of leading devices, evaluating cost, regulatory approval, model specifications, and system compatibility. Smartwatches and patches, in particular, show a strong performance in atrial fibrillation detection, with patches outperforming Holter monitors in long-term monitoring and diagnostic yield. This review highlights a paradigm shift toward patient-initiated diagnostics but also discusses challenges such as false positives, regulatory gaps, and healthcare integration. Overall, wearable devices hold significant promise for reshaping arrhythmia management through early detection and remote monitoring.

Background and objectives: Atrial fibrillation (AF), the most prevalent sustained arrhythmia, poses a significant public health challenge due to its links with stroke, heart failure, and mortality. Hypertension, a primary modifiable cardiovascular risk factor, is a well-established risk factor for AF that facilitates structural and electrical changes in the atria, including dilation, fibrosis, and pressure overload. Material and Methods: we conducted a literature search regarding the shared mechanisms, risks and treatments of hypertension and atrial fibrillation. Results: The renin–angiotensin–aldosterone system plays a pivotal role in this remodelling and inflammation, increasing AF susceptibility. Uncontrolled hypertension complicates AF management, diminishing the effectiveness of mainstay treatments, including antiarrhythmic drugs, catheter ablation, and cardioversion. Effective blood pressure management, particularly with therapies targeting the renin–angiotensin–aldosterone system (RAAS), can lower the risk of new-onset AF and reduce the incidence of recurrent AF, enhancing the success of rhythm control strategies. These antihypertensive therapies mitigate myocardial hypertrophy and fibrosis and attenuate both atrial pressure strain and the inflammatory response, mitigating the substrates for AF. Conclusion: This review highlights the urgent need for integrated strategies that combine BP control, AF screening, and lifestyle modifications to minimise the burden of AF and its complications. Future research should investigate the specific mechanisms of cellular-level interactions associated with a hypertensive predisposition to AF, including systematic inflammation and the role of genetics, the impact of blood pressure variations on AF risk, and individualised treatment strategies specifically targeting the shared mechanisms, simultaneously propagating hypertension and AF.

Background: pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) improves health-related quality of life (QoL). This study compares QoL improvement after radiofrequency ablation (RF) and cryoballoon ablation (cryo) and assesses additional ablations’ role in QoL improvement. Methods: we evaluated the QoL of consecutive patients with first-time RF and cryo for PAF between January 2017 and June 2019. A combined EQ-VAS, AFEQT, and EQ-5D-3L paper questionnaire was sent to patients at baseline, 12, and 30 months after the procedure. Procedure and patient details were collected from medical notes. Results: the analysis included 207 patients, of which 127 (61%) had RF and 144 (70%) were males. RF patients had more additional ablations (52 [41%] versus 22 [28%], p = 0.01). There was a significant improvement from baseline to 12 months post-RF in AFEQT (43 ± 9 to 83 ± 7.8, p < 0.001), EQ-5D-3L (−0.01 ± 0.01 to 1.1 ± 0.02, p < 0.001), and EQ-VAS (51 ± 8 to 77 ± 13, p = 0.01). Similarly, an improvement at 12 months was observed after cryo in AFEQT (55 ± 11 to 77 ± 9, p < 0.001), EQ-5D-3L (−0.04 ± 0.03 to 1.3 ± 0.03, p < 0.001), and EQ-VAS (56 ± 7 to 85 ± 9, p = 0.01). QoL improvement was similar between RF and cryo. Additional ablations provided no additional QoL improvement compared to patients with PVI alone. Conclusions: Patients undergoing first-time PVI for PAF, RF, and cryo showed similar QoL improvement at 12 months, which was sustained at 30 months. Additional ablations did not provide further QoL benefits.

A 77-year-old male presented with a progressively enlarging midline neck mass. On further investigation he was found to have synchronous thyroglossal duct cyst and extranodal mantle cell lymphoma (MCL) localized to the base of tongue. Both pathologies were managed simultaneously with a surgical approach and the patient remained in clinical remission at the time of publication without indication for systemic oncological treatment. Histology revealed primary extranodal nonblastoid MCL forming a base of tongue mass, with colonization of the thyroglossal duct cyst. Lymphoma was also found in the epithelium of a crypt-like tract traversing one of the tongue base tumor sections. This tract was anatomically and histologically consistent with documented descriptions of the foramen cecum. This case report illustrates a previously undescribed temporal, clinical, and histological association between a base of tongue MCL and symptomatic thyroglossal duct cyst. We provide evidence for a potential causal relationship for the presentation of the thyroglossal duct cyst as a result of oropharyngeal MCL, in the absence of clinical and histological evidence of disseminated disease, directly infiltrating from its tongue base origin to the infrahyoid neck region, potentially via an embryologic foramen cecum remnant. We also highlight the crucial role of the histopathologist in multidisciplinary clinicopathological discussion in demonstrating how fundamental embryological and microanatomical relationships can unite apparently separate diseases.

Background/Objectives: Accurate localisation of manifest accessory pathways from the 12-lead electrocardiogram remains clinically relevant in Wolff–Parkinson–White syndrome, particularly for pre-procedural planning. Although purpose-built artificial intelligence models have shown promise in ECG interpretation, the reliability of general-purpose multimodal large language models for accessory pathway localisation is unknown. We evaluated two contemporary general-purpose AI systems against an electrophysiology-confirmed reference standard and assessed reproducibility across repeated analyses. Methods: In this retrospective, single-centre proof-of-concept diagnostic accuracy study, 49 consecutive patients with manifest accessory pathways confirmed during electrophysiology study/ablation were included. Anonymised pre-procedural 12-lead ECGs were compiled into a single PDF and analysed by ChatGPT 5 Thinking and Gemini 2.5 Pro using predefined EASY-WPW anatomical categories. Each model was tested in three independent context-reset runs. The primary outcome was repeated-run diagnostic accuracy against the electrophysiology-confirmed pathway location, with confidence intervals calculated using an ECG-clustered approach. Secondary outcomes included majority-vote accuracy, pathway-specific descriptive accuracy, exact output consistency, no-consensus outputs, and “unable to identify” responses. Results: Each model generated 147 repeated outputs from the same 49 ECGs. ChatGPT 5 Thinking correctly localised 28/147 outputs, corresponding to a repeated-run accuracy of 19.0% (ECG-clustered 95% CI 11.5–26.6), while Gemini 2.5 Pro correctly localised 18/147 outputs, corresponding to 12.2% accuracy (95% CI 6.8–17.7). Both models performed below the no-information majority-class baseline of 36.7%. Majority-vote accuracy was 7/49 for ChatGPT 5 Thinking and 2/49 for Gemini 2.5 Pro. Exact output consistency across all three runs was observed in 2/49 ECGs for ChatGPT 5 Thinking and 0/49 ECGs for Gemini 2.5 Pro. Complete no-consensus outputs occurred in 30/49 and 26/49 ECGs, respectively. “Unable to identify” responses were infrequent: 8/147 outputs for ChatGPT 5 Thinking and 2/147 outputs for Gemini 2.5 Pro. Pathway-specific estimates were descriptive only because of class imbalance and small subgroup denominators. Conclusions: General-purpose multimodal large language models demonstrated poor repeated-run accuracy, very low reproducibility, frequent no-consensus outputs, and limited abstention when localising manifest accessory pathways from 12-lead ECGs. These findings do not support their current clinical use for accessory pathway localisation. Future progress is more likely to come from purpose-built, signal-native, or rigorously validated multimodal cardiac AI systems.