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The hypercoagulable state in Kawasaki disease (KD) may lead to complex cardiovascular sequelae. We present the case of a 2-month-old infant with complete KD complicated by giant coronary artery aneurysms, coronary sinus thrombosis, and post-myocardial infarction syndrome (Dressler syndrome), resulting in 2 distinct episodes of pericardial effusion. (Level of Difficulty: Intermediate.).

BACKGROUND: Although Kawasaki disease is commonly regarded as a single disease entity, variability in clinical manifestations and disease outcome has been recognised. We aimed to use a data-driven approach to identify clinical subgroups. METHODS: We analysed clinical data from patients with Kawasaki disease diagnosed at Rady Childrens Hospital (San Diego, CA, USA) between Jan 1, 2002, and June 30, 2022. Patients were grouped by hierarchical clustering on principal components with k-means parcellation based on 14 variables, including age at onset, ten laboratory test results, day of illness at the first intravenous immunoglobulin infusion, and normalised echocardiographic measures of coronary artery diameters at diagnosis. We also analysed the seasonality and Kawasaki disease incidence from 2002 to 2019 by subgroup. To explore the biological underpinnings of identified subgroups, we did differential abundance analysis on proteomic data of 6481 proteins from 32 patients with Kawasaki disease and 24 healthy children, using linear regression models that controlled for age and sex. FINDINGS: Among 1016 patients with complete data in the final analysis, four subgroups were identified with distinct clinical features: (1) hepatobiliary involvement with elevated alanine transaminase, gamma-glutamyl transferase, and total bilirubin levels, lowest coronary artery aneurysm but highest intravenous immunoglobulin resistance rates (n=157); (2) highest band neutrophil count and Kawasaki disease shock rate (n=231); (3) cervical lymphadenopathy with high markers of inflammation (erythrocyte sedimentation rate, C-reactive protein, white blood cell, and platelet counts) and lowest age-adjusted haemoglobin Z scores (n=315); and (4) young age at onset with highest coronary artery aneurysm but lowest intravenous immunoglobulin resistance rates (n=313). The subgroups had distinct seasonal and incidence trajectories. In addition, the subgroups shared 211 differential abundance proteins while many proteins were unique to a subgroup. INTERPRETATION: Our data-driven analysis provides insight into the heterogeneity of Kawasaki disease, and supports the existence of distinct subgroups with important implications for clinical management and research design and interpretation. FUNDING: US National Institutes of Health and the Irving and Francine Suknow Foundation.

Earthquake and other disasters nowadays still threat people’s lives and property due to their destructiveness and unpredictability. The past decades have seen the booming development of search and rescue robots due to their potential for increasing rescue capacity as well as reducing personnel safety risk at disaster sites. In this work, we propose a spider-inspired wheeled compliant leg to further improve the environmental adaptability of search mobile robots. Different from the traditional fully-actuated method with independent motor joint control, this leg employs an under-actuated compliant mechanism design with overall semi-tendon-driven control, which enables the passive and active terrain adaptation, system simplification and lightweight of the realized search robot. We have generalized the theoretical model and design methodology for this type of compliant leg, and implement it in a parametric program to improve the design efficiency. In addition, preliminary load capacity and leg-lifting experiments are carried out on a one-leg prototype to evaluate its mechanical performance. A four-legged robot platform is also fabricated for the locomotion tests. The preliminary experimental results have verified the feasibility of the proposed design methodology, and also show possibilities for improvements. In future work, structural optimization and stronger actuation elements should be introduced to further improve the mechanical performance of the fabricated wheeled leg mechanism and robot platform.

BACKGROUND: Palliative care requires a collaborative approach from a multidisciplinary team, incorporating nurses with ethical, clinical, communicative-relational, psychosocial, and teamwork skills. However, many professionals feel unprepared to face end-of-life challenges, highlighting a lack of skills, especially regarding psychosocial and spiritual aspects. AIM: The purpose of this study is to explore nurses' self-perception of competencies in palliative care. METHODS: A single-center descriptive observational study was conducted among palliative and non-palliative care nurses at the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT), using the short Italian version of the Professional Competence Scale (PCSQ). The Kruskal-Wallis test was used along with multivariate ANOVA for statistical analysis. RESULTS: 122 nurses participated (response rate: 52%), predominantly women (78%), aged 25-34 (50%), with a degree (46%) and over 10 years of experience (41%). The majority had no experience (71%) in palliative care, while 16% were currently working in this field. Statistical analysis revealed no significant correlations between educational level and responses. The Kruskal-Wallis test showed that experience in palliative care significantly influenced self-assessment scores, such as in activating non-pharmacological management strategies (p=0.004). CONCLUSIONS: Nurses perceive high competence in ethical and clinical decision-making in palliative care, influenced more by experience than by training. Addressing patients' subjective needs and using non-pharmacological interventions remain a challenge for nurses not working in palliative care settings.

Summary: Background: Major depressive disorder (MDD) is prevalent and disabling among older adults. Standing on its tolerability profile, vortioxetine might be a promising alternative to selective serotonin reuptake inhibitors (SSRIs) in such a vulnerable population. Methods: We conducted a randomised, assessor- and statistician-blinded, superiority trial including older adults with MDD. The study was conducted between 02/02/2019 and 02/22/2023 in 11 Italian Psychiatric Services. Participants were randomised to vortioxetine or one of the SSRIs, selected according to common practice. Treatment discontinuation due to adverse events after six months was the primary outcome, for which we aimed to detect a 12% difference in favour of vortioxetine. The study was registered in the online repository clinicaltrials.gov (NCT03779789). Findings: The intention-to-treat population included 179 individuals randomised to vortioxetine and 178 to SSRIs. Mean age was 73.7 years (standard deviation 6.1), and 264 participants (69%) were female. Of those on vortioxetine, 78 (44%) discontinued the treatment due to adverse events at six months, compared to 59 (33%) of those on SSRIs (odds ratio 1.56; 95% confidence interval 1.01–2.39). Adjusted and per-protocol analyses confirmed point estimates in favour of SSRIs, but without a significant difference. With the exception of the unadjusted survival analysis showing SSRIs to outperform vortioxetine, secondary outcomes provided results consistent with a lack of substantial safety and tolerability differences between the two arms. Overall, no significant differences emerged in terms of response rates, depressive symptoms and quality of life, while SSRIs outperformed vortioxetine in terms of cognitive performance. Interpretation: As opposed to what was previously hypothesised, vortioxetine did not show a better tolerability profile compared to SSRIs in older adults with MDD in this study. Additionally, hypothetical advantages of vortioxetine on depression-related cognitive symptoms might be questioned. The study's statistical power and highly pragmatic design allow for generalisability to real-world practice. Funding: The study was funded by the Italian Medicines Agency within the “2016 Call for Independent Drug Research”.

The identification and quantification of biomarkers with innovative technologies is an urgent need for the precise diagnosis and follow up of human diseases. Body fluids offer a variety of informative biomarkers, which are traditionally measured with time-consuming and expensive methods. In this context, lateral flow tests (LFTs) represent a rapid and low-cost technology with a sensitivity that is potentially improvable by chemiluminescence biosensing. Here, an LFT based on gold nanoparticles functionalized with antibodies labeled with the enzyme horseradish peroxidase is combined with a lensless biosensor. This biosensor comprises four Silicon Photomultipliers (SiPM) coupled in close proximity to the LFT strip. Microfluidics for liquid handling complete the system. The development and the setup of the biosensor is carefully described and characterized. C-reactive protein was selected as a proof-of-concept biomarker to define the limit of detection, which resulted in about 0.8 pM when gold nanoparticles were used. The rapid readout (less than 5 min) and the absence of sample preparation make this biosensor promising for the direct and fast detection of human biomarkers.

The hypercoagulable state in Kawasaki disease (KD) may lead to complex cardiovascular sequelae. We present the case of a 2-month-old infant with complete KD complicated by giant coronary artery aneurysms, coronary sinus thrombosis, and post-myocardial infarction syndrome (Dressler syndrome), resulting in 2 distinct episodes of pericardial effusion. (Level of Difficulty: Intermediate.)

Abstract Robotic legs are an important component of the quadruped robot for achieving different motion gaits. Although the conventional rigid-link-based legs can generally perform robust motions, they still have the issues with poor sealing when operating in complex and liquid terrains. To cope with this problem, fully compliant legs with monolithic structure have been introduced in recent years to improve the system compactness and structural compliance of quadruped robots. In this article, we present a topology-optimization-based method to achieve efficient design of compliant robotic legs. In order to balance the structural stiffness and bending flexibility of the realized leg, a multi-objective optimization algorithm is utilized. A series of design cases are presented to illustrate the design principle and analytical procedure of the proposed method. In addition, experimental evaluation is also performed, and the results have demonstrated that, a quadruped robot with the optimized legs can successfully achieve stable and continuous straight-line walking motions.

Two-dimensional transition metal dichalcogenides (TMDCs) are demonstrated to be appealing semiconductors for optoelectronic applications, thanks to their remarkable properties in the ultraviolet-visible spectral range. Interestingly, TMDCs have not yet been characterized when exposed to x rays, although they would be ideal candidates for optoelectronic applications in this spectral range. They benefit from the high cross section of the constituent heavy atoms, while keeping the absorption very low, due to the ultrathin structure of the film. This encourages the development of photodetectors based on TMDCs for several applications dealing with x rays, such as radioprotection, medical treatments, and diagnosis. Given the atomic thickness of TMDCs, they can be expected to perform well at low dose measurements with minimal perturbation of the radiation beam, which is required for in vivo applications. In this paper, the use of TMDCs as active materials for direct x-ray detection is demonstrated, using a photodetector based on a MoS2 monolayer (1L-MoS2). The detector shows a response to x rays in the range of 101–102 keV, at dose rates as low as fractions of mGy/s. The sensitivity of 1L-MoS2 reaches values in the range of 108–109 µC Gy−1 cm−3, overcoming the values reported for most of the organic and inorganic materials. To improve the x-ray photoresponse even further, the 1L-MoS2 was coupled with a polymeric film integrating a scintillator based on terbium-doped gadolinium oxysulfide (Gd2O2S:Tb). The resulting signal was three times larger, enabled by the indirect x ray to visible photoconversion mechanism. This paper might pave the way toward the production of ultrathin real-time dosimeters for in vivo applications.

We assessed the accuracy of a prototype radiation detector with a built in CMOS amplifier for use in dosimetry for high dose rate brachytherapy. The detectors were fabricated on two substrates of epitaxial high resistivity silicon. The radiation detection performance of prototypes has been tested by ion beam induced charge (IBIC) microscopy using a 5.5 MeV alpha particle microbeam. We also carried out the HDR Ir-192 radiation source tracking at different depths and angular dose dependence in a water equivalent phantom. The detectors show sensitivities spanning from (5.8 ± 0.021) × 10−8 to (3.6 ± 0.14) × 10−8 nC Gy−1 mCi−1 mm−2. The depth variation of the dose is within 5% with that calculated by TG-43. Higher discrepancies are recorded for 2 mm and 7 mm depths due to the scattering of secondary particles and the perturbation of the radiation field induced in the ceramic/golden package. Dwell positions and dwell time are reconstructed within ±1 mm and 20 ms, respectively. The prototype detectors provide an unprecedented sensitivity thanks to its monolithic amplification stage. Future investigation of this technology will include the optimisation of the packaging technique.

Tendons are collagen-rich musculoskeletal tissues that possess the mechanical strength needed to transfer forces between muscles and bones. The mechanical development and function of tendons are impacted by collagen crosslinks. However, there is a limited understanding of how collagen crosslinking is regulated in tendon during development and aging. Therefore, the objective of the present review was to highlight potential regulators of enzymatic and non-enzymatic collagen crosslinking and how they impact tendon function. The main collagen crosslinking enzymes include lysyl oxidase (LOX) and the lysyl oxidase-like isoforms (LOXL), whereas non-enzymatic crosslinking is mainly mediated by the formation of advanced glycation end products (AGEs). Regulators of the LOX and LOXL enzymes may include mechanical stimuli, mechanotransducive cell signaling pathways, sex hormones, transforming growth factor (TGF)β family, hypoxia, and interactions with intracellular or extracellular proteins. AGE accumulation in tendon is due to diabetic conditions and aging, and can be mediated by diet and mechanical stimuli. The formation of these enzymatic and non-enzymatic collagen crosslinks plays a major role in tendon biomechanics and in the mechanisms of force transfer. A more complete understanding of how enzymatic and non-enzymatic collagen crosslinking is regulated in tendon will better inform tissue engineering and regenerative therapies aimed at restoring the mechanical function of damaged tendons.

Currently, optical sensors based on molecularly imprinted polymers (MIPs) have been attracting significant interest. MIP sensing relies on the combination of the MIP’s selective capability, which is conveyed to the polymeric material by a template-assisted synthesis, with optical techniques that offer exquisite sensitivity. In this work, we devised an MIP nanoparticle optical sensor for the ultralow detection of serum albumin through time-resolved fluorescence spectroscopy. The Fluo-nanoMIPs (∅~120 nm) were synthetized using fluorescein-O-methacrylate (0.1×, 1×, 10× mol:mol versus template) as an organic fluorescent reporter. The ability of 0.1× and 1×Fluo-nanoMIPs to bind albumin (15 fM–150 nM) was confirmed by fluorescence intensity analyses and isothermal titration calorimetry. The apparent dissociation constant (Kapp) was 30 pM. Conversely, the 10× fluorophore content did not enable monitoring binding. Then, the time-resolved fluorescence spectroscopy of the nanosensors was studied. The 1×Fluo-nanoMIPs showed a decrease in fluorescence lifetime upon binding to albumin (100 fM–150 nM), Kapp = 28 pM, linear dynamic range 3.0–83.5 pM, limit of detection (LOD) 1.26 pM. Selectivity was confirmed testing 1×Fluo-nanoMIPs against competitor proteins. Finally, as a proof of concept, the nanosensors demonstrated detection of the albumin (1.5 nM) spiked in wine samples, suggesting a possible scaling up of the method in monitoring allergens in wines.

The literature on social cognition abilities in bipolar disorder (BD) is controversial about the occurrence of theory of mind (ToM) alterations. In addition to other cerebral structures, such as the frontal and limbic areas, the processing of socially relevant stimuli has also been attributed to the cerebellum, which has been demonstrated to be involved in the above-mentioned disorder. Nevertheless, the cerebellar contribution to ToM deficits in bipolar patients needs to be elucidated further. To this aim, two tests assessing different components of ToM were used to evaluate the ability to appreciate affective and mental states of others in 17 individuals with a diagnosis of BD type 1 (BD1) and 13 with BD type 2 (BD2), both in the euthymic phase, compared to healthy matched controls. Cerebellar gray matter (GM) volumes were extracted and compared between BD1 and controls and BD2 and controls by using voxel-based morphometry. The results showed that BD1 patients were compromised in the cognitive and advanced components of ToM, while the BD2 ToM profile resulted in a more widespread compromise, also involving affective and automatic components. Both overlapping and differing areas of cerebellar GM reduction were found. The two groups of patients presented a pattern of GM reduction in cerebellar portions that are known to be involved in the affective and social domains, such as the vermis and Crus I and Crus II. Interestingly, in both BD1 and BD2, positive correlations were detected between lower ToM scores and decreased volumes in the cerebellum. Overall, BD2 patients showed a more compromised ToM profile and greater cerebellar impairment than BD1 patients. The different patterns of structural abnormalities may account for the different ToM performances evidenced, thus leading to divergent profiles between BD1 and BD2.

Monolithic Active Pixel Sensors (MAPS) represent one of the most promising technologies for the next generation of radiation detectors. The ARCADIA project aims at the development of Fully Depleted (FD) MAPS employing a production process compatible with a 110 nm commercial CMOS technology. The first engineering run of the project included matrices of active pixels with embedded analog and digital frontend electronics and passive test structures such as passive pixel arrays, MOS capacitors and backside diodes. Although the produced samples were already characterized from the electrical point of view, a thorough study of the charge collection dynamics of the passive pixel arrays was still missing. In this paper we show the results of the dynamic characterization of a group of passive pixel arrays with different pixel pitches (50, 25 and 10 μm) and different pixel layouts. The tested samples have been illuminated from the backside with an infrared and a red laser with wavelengths equal to 1,060 nm and 660 nm, respectively. The pixel arrays have been mounted on a custom readout PCB connected to an external amplifier with 1 GHz bandwidth and the signals have been acquired through a fast digital oscilloscope. We employed both focused and unfocused laser spots to evaluate the change in the measured signal as a function of the laser spot position and the average response of the pixel arrays. An excellent agreement has been demonstrated by comparing the measured signals with the results of transient TCAD simulations and a time for 50% charge collection of 7.8, 4.2 and 2.6 ns has been predicted and experimentally validated in pixels with 50, 25 and 10 μm pitch, respectively.

The physiological oxygen levels for several mammalian cell types in vivo are considered to be hypoxic (low oxygen tension), but the vast majority of in vitro mammalian cell culture is conducted at atmospheric oxygen levels of around 21%. In order to understand the impact of low oxygen environments on cells, oxygen levels need to be regulated during in vitro culture. Two common methods for simulating a hypoxic environment are through the regulation of gas composition or chemical induction. Chemically mimicking hypoxia can have adverse effects such as reducing cell viability, making oxygen regulation in cell culture chambers crucial for long-term culture. However, oxygen-regulating cell culture incubators and commercial hypoxia chambers may not always be a viable option due to cost and limited customization. Other low-cost chambers have been developed, but they tend to lack control systems or are fairly small scale. Thus, the objective of this project was to design and develop a low-cost, open-source, controllable, and reproducible hypoxia chamber that can fit inside a standard cell culture incubator. This design allows for the control of O2 between 1 and 21%, while maintaining CO2 levels at 5%, as well as monitoring of temperature, pressure, and relative humidity. Testing showed our hypoxia chamber was able to maintain CO2 levels at 5% and hypoxic O2 levels at 1% and 5% for long-term cell culture. This simple and easy-to-manufacture design uses off the shelf components, and the total material cost was $832.47 (USD).

The market for SiPMs has grown rapidly in recent years, driven by their increasing use in applications such as medical imaging, nuclear and particle physics. Due to the growing demand, many manufacturers are now offering SiPMs, each of them with unique features and performance characteristics. As a result, it is essential to conduct comparative studies to evaluate and compare the performance of different SiPM arrays. Therefore, this work aims to compare the performance of assembled detectors based on two different SiPM arrays (AdvanSiD-NUV hybrid array ASD-NUV4S-P-4x4TD 17 mm x17 mm and the MPPC Hamamatsu S14161-6050HS-04 25 mm x 25 mm) coupled to two organic scintillators, a liquid scintillator EJ-309 (50 mm diameter x 50 mm thickness) and a plastic scintillator EJ-276G (25 mm diameter x 25 mm thickness). The assessment of the performance was made in terms of their energy resolution, time resolution, and capability to discriminate between γ-rays and fast neutrons. The outcomes show that the Hamamatsu SiPM array performs better for all of the characteristics studied, with the best configuration being when it was coupled to the EJ-309 liquid scintillator, obtaining the lowest energy and time resolutions, (0.108±0.004) and (0.599 ± 0.004) ns respectively, and the highest Figure of Merit (2.04 ± 0.01). A good Figure of Merit value that ensures an effective discrimination between fast neutrons and γ-rays.

Chimney endovascular aneurysm repair (ChEVAR) is an accepted alternative for abdominal aortic aneurysm (AAA) treatment in patients with complex anatomy or urgent cases. In selected high-risk patients, the association with Endoanchors seems attractive and could potentially reduce type IA endoleak rate. Moreover, the transfemoral approach for ChEVAR is a validated option when the transbrachial access is not feasible or contraindicated and recent works have highlighted the use of steerable sheaths as a method to achieve total transfemoral ChEVAR. The study reports two successful secondary procedures for a type IA endoleak treated with a single renal chimney endografting plus Endoanchors. These procedures were performed from the femoral access using Heli-Fx Guide 22 mm steerable sheath (Medtronic, Santa Rosa, CA) associated with a coaxial Flexor Introducer (Cook Medical Inc., Bloomington, IN). Technical steps are accurately underlined to make the procedure reproducible. ChEVAR from femoral arteries with Heli-Fx Guide 22 mm steerable sheath associated with a telescopic 90 cm Flexor seems feasible and safe following some specific technical hints.

Electroadhesion is a suitable technology for developing grippers for applications where fragile, compliant or variable shape objects need to be grabbed and where a retention action is typically preferred to a compression force. This article presents a self-sensing technique for electroadhesive devices (EAD) based on the capacitance measure. Specifically, we demonstrate that measuring the variation of the capacitance between electrodes of an EAD during the adhesion can provide useful information to automatically detect the successful grip of an object and the possible loss of adhesion during manipulation. To this aim, a dedicated electronic circuit is developed that is able to measure capacitance variations while the high voltage required for the adhesion is activated. A test bench characterization is presented to evaluate the self-sensing of capacitance during different states: (1) the EAD is far away from the object to be grasped; (2) the EAD is in contact with the object, but the voltage is not active (i.e., no adhesion); and (3) the EAD is activated and attached to the object. Correlation between the applied voltage, object material and shape and capacitance is made. The self-sensing EAD is then demonstrated in a closed-loop robotic application that employs a robot manipulator arm to pick and place objects of different kinds.

Efficient, wide-scale testing for SARS-CoV-2 is crucial for monitoring the incidence of the infection in the community. The gold standard for COVID-19 diagnosis is the molecular analysis of epithelial secretions from the upper respiratory system captured by nasopharyngeal (NP) or oropharyngeal swabs. Given the ease of collection, saliva has been proposed as a possible substitute to support testing at the population level. Here, we used a novel saliva collection device designed to favour the safe and correct acquisition of the sample, as well as the processivity of the downstream molecular analysis. We tested 1003 nasopharyngeal swabs and paired saliva samples self-collected by individuals recruited at a public drive-through testing facility. An overall moderate concordance (68%) between the two tests was found, with evidence that neither system can diagnose the infection in 100% of the cases. While the two methods performed equally well in symptomatic individuals, their discordance was mainly restricted to samples from convalescent subjects. The saliva test was at least as effective as NP swabs in asymptomatic individuals recruited for contact tracing. Our study describes a testing strategy of self-collected saliva samples, which is reliable for wide-scale COVID-19 screening in the community and is particularly effective for contact tracing.

The impact of a faecal immunochemical test-based colorectal cancer (CRC) screening program in terms of patient prognosis could be affected by lead-time bias, which artificially increases the survival of screen-detected patients due to the early diagnosis. To provide a description of the impact of the CRC screening program in the Trentino Region (Italy), including the Cure Fraction (CF), a prognostic indicator not affected by lead-time bias. The program started in 2008, inviting the resident population aged 50–69 years. In this retrospective cohort study, 1,697 CRC diagnosed between 2003 and 2014 in patients aged 50–69 years were classified as pre-screening (PS), screen-detected (SD), interval cancers (IC) and not-screen-detected (NSD). We compared groups by stage at diagnosis and CF. Trends in CRC mortality were reported. The proportion of stage I among SD cases was 51%, higher than PS (19%; OR 4.66, 95%CI 3.50–6.20), NSD (20.6%; OR 3.96, 95%CI 2.95–5.32) and IC (33.3%; OR 2.11, 95%CI 1.10–4.04). The CF of PS, NSD and SD cases was respectively 57% (95%CI 54–60%), 60% (95%CI 58–63%) and 93% (95%CI 89–96%). CRC mortality dropped from 40.7 to 25.6\100,000. The program significantly improved the prognosis of patients, decreasing CRC mortality and incidence of advanced CRCs. [ABSTRACT FROM AUTHOR]

Objectives: To determine the safety, pharmacokinetics, and immunomodulatory effects of 2-6 weeks of anakinra therapy in patients with acute Kawasaki disease with a coronary artery aneurysm (CAA).Study Design: We performed a Phase I/IIa dose-escalation study of anakinra (2-11 mg/kg/day) in 22 patients with acute Kawasaki disease with CAA. We measured interleukin (IL)-1RA concentrations after the first dose and trough levels up to study week 6. Markers of inflammation and coronary artery z-scores were assessed pretreatment and at 48 hours, 2 weeks, and 6 weeks after initiation of therapy.Results: Up to 6 weeks of anakinra (up to 11 mg/kg/day) was safe and well tolerated by the 22 participants (median age, 1.1 years), with no serious adverse events attributable to the study drug. All participants were treated with intravenous immunoglobulin (IVIG), and 20 also received infliximab (10 mg/kg) before initiation of anakinra. Serum levels of IL-6, IL-8, and tumor necrosis factor α decreased similarly in patients with Kawasaki disease treated with IVIG, infliximab, and anakinra compared with age- and sex-matched patients with Kawasaki disease treated only with IVIG and infliximab. Anakinra clearance increased with illness day at diagnosis. Simulations demonstrated that more frequent intravenous (IV) dosing may result in more sustained concentrations without significantly increasing the peak concentration compared with subcutaneous (SC) dosing.Conclusions: Both IV and SC anakinra are safe in infants and children with acute Kawasaki disease and CAA. IV dosing every 8-12 hours during the acute hospitalization of patients with Kawasaki disease may result in a sustained concentration while avoiding frequent SC injections. The efficacy of a short course of IV therapy during hospitalization should be studied. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT02179853. [ABSTRACT FROM AUTHOR]