To compare the clinical outcomes and complication profiles of open reduction and internal fixation with plate (ORIF-P) versus reduction and internal fixation with threaded Kirschner wire (ORIF-TKW) for midshaft clavicular fractures (MCFs). A retrospective analysis was conducted on patients with MCFs who underwent either ORIF-P or ORIF-TKW between January 2012 and October 2023. Based on the surgical technique, patients were divided into ORIF-P and ORIF-TKW groups. The two groups were compared in terms of intraoperative blood loss, operative duration, radiographic union duration, shoulder function (Constant-Murley score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), complication rates, and implant removal characteristics. Of 128 eligible patients, 85 received ORIF-P and 43 received ORIF-TKW. The ORIF-TKW group demonstrated more favorable peri‑operative metrics: shorter operative time (51.5 ± 6.4 vs. 63.6 ± 5.7min, p < 0.001), less blood loss (38.7 ± 5.6 vs. 56.2 ± 10.1ml, p < 0.001), and smaller incision length (3.9 ± 0.7 vs. 8.8 ± 0.9cm, p < 0.001). Radiographic union occurred earlier in ORIF-TKW (median 5.0 vs. 6.0months, p < 0.001). All 43 patients in the ORIF‑TKW group underwent planned implant removal, with minimal operative time and blood loss, whereas in the ORIF‑P group, only 50 patients (58.8%) underwent removal, exclusively for symptomatic reasons or patient request, with significantly more invasive removal procedures (p < 0.001). Functional outcomes at 6months were equivalent. Complication rates did not differ significantly between groups. Two refractures in the ORIF P cohort were successfully revised using ORIF TKW. In this single-center retrospective study, ORIF-TKW was associated with superior peri-operative outcomes, earlier radiographic union, and a less invasive planned removal procedure compared with ORIF-P, while functional recovery was similar. A post-hoc analysis demonstrated statistical comparability in fracture complexity within the 2B subgroup, partially mitigating concerns regarding selection bias. However, these findings remain hypothesis-generating and subject to residual confounding; prospective randomized trials with stratification based on fracture morphology are required before any change in routine practice can be recommended. The limited revision experience (2 cases) is insufficient to endorse threaded K-wire fixation as a routine salvage strategy.

Frail older patients with non-ST-elevation myocardial infarction (NSTEMI) experience an increased risk of major adverse cardiovascular events. The beneficial role of an invasive strategy over a conservative strategy among frail patients with NSTEMI is unclear. To compare the clinical outcomes of an invasive strategy with those of a conservative strategy among older patients with NSTEMI stratified by frailty status. In this prespecified exploratory subgroup analysis from the SENIOR-RITA randomized clinical trial, patients were screened across 48 National Health Service trusts in England and Scotland from November 1, 2016, through March 31, 2023. The SENIOR-RITA trial included patients with NSTEMI aged 75 years or older, randomized to an invasive strategy with coronary angiography, revascularization if needed, and optimal medical therapy vs a conservative strategy with optimal medical therapy only. In this analysis, frailty status was defined using the Fried frailty criteria (frail, ≥3 criteria present). Statistical analysis was performed from March through November 2025. Invasive vs conservative strategy. The primary composite outcome was the time to cardiovascular death or nonfatal myocardial infarction. All participants were analyzed according to the intention-to-treat principle. Fried frailty criteria were available for 1446 of the 1518 randomized patients (95.3%), of whom 469 (32.4%; median age, 83 years [IQR, 80-86 years]; 240 women [51.2%]) met criteria for frailty. The primary outcome among frail patients occurred among 87 of 231 patients (37.7%) in the invasive group and 70 of 238 patients (29.4%) in the conservative group (hazard ratio [HR], 1.21; 95% CI, 0.88-1.67) over a median follow-up of 4.1 years (IQR, 2.8-4.6 years). When frailty was analyzed as a continuous variable, there was a significant interaction with treatment such that patients at the highest levels of frailty had a potential signal for harm with routine invasive strategy. There were no significant treatment differences across frailty categories for cardiovascular death (HR, 1.44; 95% CI, 0.97-2.10) or nonfatal myocardial infarction (HR, 1.00; 95% CI, 0.61-1.63). In this subgroup analysis of a randomized clinical trial, an invasive strategy did not reduce the risk of a composite outcome of cardiovascular death or nonfatal myocardial infarction compared with a conservative strategy, with a potential signal for increased risk of harm among those at the highest levels of frailty. These findings underscore the need for individualized, frailty-informed treatment strategies. isrctn.org Identifier: ISRCTN11343602.

Turner syndrome (TS) is achromosomal disorder of females due to the partial or complete absence of an Xchromosome. Growing evidence suggests asignificant association between TS and autoimmune disorders, especially rheumatic diseases like juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE). Recognition of this association is important for early detection, timely intervention, and avoidance of complications. The aim of this narrative review is to analyze the association between TS and rheumatic diseases in terms of epidemiological, clinical, and pathophysiological aspects as well as therapeutic options. The narrative review was performed by combining information from published case reports, case series, and population-based studies reporting on the association of TS with autoimmune rheumatic diseases. Juvenile idiopathic arthritis was the most frequently described rheumatic disease in TS, mostly as oligoarticular but also as severe polyarticular forms. Systemic lupus erythematosus was less common, but most patients had severe systemic disease with lupus nephritis. Other manifestations were psoriatic arthritis; ankylosing spondylitis in adult and pediatric cases; and systemic sclerosis as avery rare exception, likely reflecting the scarcity of reported cases rather than adefined protective effect in TS. Apopulation-based study revealed that women with TS are at aprofoundly increased risk of autoimmune rheumatic diseases as compared to the general female population. In conclusion, these findings suggest increased autoimmune susceptibility in Turner syndrome and underscore the need for heightened clinical awareness. Current evidence remains limited, underscoring the need for heightened clinical awareness rather than routine screening strategies.

Abstract Introduction Potentially inappropriate prescribing (PIP) in adults is associated with adverse drug reactions, increased healthcare utilisation, and mortality. PIP occurs when the potential risk of medicines outweighs their potential benefit. Adults with cardiovascular risk factors (e.g. hypertension and hyperlipidaemia) are particularly susceptible to PIP, given the high prevalence of polypharmacy (defined as 5 or more medicines) and multimorbidity in this cohort. STOPP/START (V3.0)[1] and Beers Criteria (2023)[2] are widely used tools to identify PIP, but their comparative effectiveness in predicting clinical outcomes in patients with cardiovascular risk factors remains unclear. Aim This study aimed to (a) assess PIP prevalence using both STOPP/START (V3.0) and Beers Criteria (2023) and (b) determine their predictive value on hospitalisation and mortality in adults with cardiovascular risk. Methods This retrospective cross-sectional analysis included 1247 participants (mean age 65.4 ± 10.1 years, 48.8% female) from the St Vincent’s Screening TO Prevent Heart Failure (STOP-HF) clinic database. The STOP-HF programme provides structured BNP-guided screening and long-term follow-up of patients with cardiovascular risk factors, offering a well-characterised group for evaluating prescribing safety. PIP was assessed using STOPP/START (V3.0) and Beers Criteria (2023) through rule-based algorithms written in R programming language that incorporated ATC codes, ICD-10 codes, and clinical parameters, and was applied at baseline and follow up. STOPP and Beers were applied to identify potentially inappropriate medications, while START was applied to capture potential prescribing omission. Primary outcomes were all-cause hospitalisation and mortality. Multivariable logistic regression models were used to examine associations between PIP and outcomes, adjusting for age, sex, and Charlson Comorbidity Index. Results A total of 55.1% (n = 687) had at least one instance of PIP according to STOPP, 70.0% (n = 873) according to START, and 66.0% (n = 823) according to Beers. The most common PIP according to STOPP (V3.0) was aspirin for primary prevention (41.5%), while the most frequent prescribing omission according to START (V3.0) was lack of antihypertensive therapy despite elevated blood pressure (17.7%). During follow-up, 392 patients (31.4%) experienced hospitalisation and 80 (6.4%) died. STOPP-defined PIP was consistently associated with increased hospitalisation risk, with moderate exposure (2–3 criteria) conferring 75% higher odds (OR 1.75, 95% CI 1.18–2.60, p = 0.005). Comparison of those with ≥2 STOPP criteria versus &amp;lt;2 STOPP criteria showed further elevated risk (OR 1.57, 95% CI 1.12–2.20, p = 0.008). START omissions were inversely associated with hospitalisation (OR 0.87, 95% CI 0.77–0.97, p = 0.013). Beers Criteria showed no significant association with hospitalisation. None of the PIP tools were independently associated with mortality after adjustment. Conclusion Among the frameworks, only STOPP (V3.0) criteria were independently associated with hospitalisation risk in patients with cardiovascular risk, whereas START and Beers criteria showed no such association. These findings support integrating STOPP assessments into routine medicines optimisation strategies to improve patient safety and prevent hospital admissions in cardiovascular care settings. A key strength of this study was the use of a large, real-world cohort with comprehensive prescribing data, while a main limitation is the reliance on explicit criteria that was coded without full clinician review which may misclassify rates of PIP.

The pilot implementation of the RTSS/AS01E (RTS,S) malaria vaccine in Ghana, Kenya, and Malawi marked a significant step in the fight against malaria. Given the scale of the rollout, which far exceeded the controlled environment of clinical trials, establishing a robust pharmacovigilance (PV) system to monitor rare but potentially serious adverse events following immunization (AEFIs) was a critical component of the program's design. In collaboration with technical partners, national health authorities monitored the safety of the RTS,S/AS01E vaccine through strengthened existing routine pharmacovigilance systems and strategies in the three participating countries. Causality assessment of serious AEFIs by national expert advisory committees did not reveal any new safety concerns associated with the RTS,S/AS01E vaccine or confirm the safety signals observed in the Phase 3 clinical trials. The PV efforts successfully supported the safe rollout of the vaccine, contributing to substantial public health benefits in these endemic regions. Challenges encountered included underreporting of AEFIs, delays in data submission and in investigating serious AEFIs, and poor report quality despite targeted investments to strengthen the systems. The pilot program highlighted PV challenges in resource-limited settings and provided useful insights for future vaccine rollouts. The lessons learned from these challenges emphasize the importance of sustained investment, particularly for AEFI investigations, and the need for innovations to improve health worker reporting. Research is needed to identify effective strategies for increasing reporting. Key recommendations include training and capacity building, resource allocation, surveillance and reporting, raising and maintaining public awareness, and collaboration and information sharing to ensure sustained PV efforts and robust safety surveillance in similar contexts.

ABSTRACTWest Nile virus (WNV) is a pathogen belonging to the family Flaviviridae and the genus Flavivirus. This study examined WNV IgG antibodies in healthy blood donors at Hitit University Blood Centre in Corum, Türkiye, during 2019–2020 using ELISA, thereby providing seroepidemiological data on WNV in northern central Anatolia. It also investigated the associations between ABO (antigens A and B) and Rhesus (D antigen) blood group system and WNV seropositivity. Blood samples from 500 individuals (155 women, 345 men) aged 18 years or older who visited the Blood Transfusion Centre were tested using the Anti‐West Nile Virus ELISA kit (IgG) (EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany). Donor epidemiological and demographic info was recorded via the hospital system. WNV IgG antibody was detected in seven (1.4%) donors, comprising five females and two males, while one (0.2%) male donor had a borderline test result. Of the 500 donors, 428 (85.6%) were residents of Corum province (40°32′56″ N‐34°57′12″ E), while 72 (14.4%) came from other regions. Within the Corum group, 4 donors (0.8%) were seropositive, with no borderline results. When comparing individuals by gender, the positivity rate was 3.4% in females and 0.6% in males, a difference that was statistically significant (p = 0.032). WNV seropositivity was highest (5 out of 7) in the 26–45 age group, although this was not statistically significant (p = 1.000). The highest WNV seroprevalence was observed in donors with the O Rh(D) blood group, but this difference was not statistically significant (p = 0.292). WNV is circulating in our region. Additionally, women appear to be at higher risk for WNV. Our study is the first research on this subject in our area and has made a significant contribution to the literature. Clinicians in North Central Anatolia should consider this disease when assessing potential cases and adjust their diagnoses and treatments accordingly. More detailed research using advanced methods is needed to explore its seroprevalence, reservoir, and vector in the region, as well as to evaluate the implementation of routine WNV screening strategies.

To compare the incidence of meconium aspiration syndrome (MAS) among neonates born through meconium-stained amniotic fluid (MSAF) before and after discontinuation of endotracheal suctioning for non-vigorous neonates. We conducted a multicenter retrospective cohort study across three centers comparing two eras. Neonates born through MSAF at ≥36 weeks' gestation were included. Multivariable regression adjusted for sex and birth center. Among 8635 neonates (5554 Era 1; 3081 Era 2), including 1053 non-vigorous neonates, unadjusted MAS incidence did not differ between eras overall (4.8% vs. 5.5%, p = 0.17) or among non-vigorous neonates (21.0% vs. 22.8%, p = 0.55). After adjustment, Era 2 was associated with higher odds of MAS overall (aOR 1.37, 95% CI 1.11-1.69) and among non-vigorous neonates (aOR 1.54, 95% CI 1.07-2.22). Respiratory distress was higher in Era 2, while other outcomes assessed were unchanged. Discontinuation of routine suctioning was associated with increased MAS incidence among neonates born through MSAF.

Given the genetic predisposition to myopia, polygenic risk scores (PRS) have been proposed as a tool for early risk identification. This study assessed the discriminatory ability of PRS in myopia prediction systematically and compared the performance of different PRS models. This systematic review followed PRISMA guidelines and was preregistered in PROSPERO (CRD420251180577). Five databases (PubMed, Web of Science, Cochrane Library, EMBASE and Scopus) were searched from inception to October 11, 2025. Eligible studies were required to develop or validate myopia prediction models that incorporated PRS and to report at least one discrimination metric. The methodological quality and risk of bias were assessed independently using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Ten studies met the inclusion criteria. The discriminatory performance of PRS-only models ranged from an area under the receiver operating characteristic curve (AUC) of 0.51-0.80, whereas combined models integrating PRS with clinical or other factors demonstrated a higher performance range (AUC 0.57-0.99). Predictive performance varied according to myopia phenotype, ancestry, and PRS construction strategy. Models tended to achieve stronger discrimination for high or moderate myopia compared with low myopia, and performed better in European populations than in other ancestry groups. Increasing the number of single-nucleotide polymorphisms included in the PRS yielded only modest incremental improvements in predictive accuracy. Across all comparisons, combined models consistently outperformed PRS-only models. PRS contributes to myopia risk prediction, particularly when integrated with clinical or other risk factors, and its predictive performance varies across myopia phenotype, ethnicity, age and the number of single-nucleotide polymorphisms. Further large-scale, multi-ancestry validation and evaluation of implementation feasibility are needed before PRS can be incorporated effectively into routine myopia prevention and risk stratification strategies.

Stroke is a major public health concern and a leading cause of disability and death in aging populations. Intrinsic capacity (IC), a concept introduced by the World Health Organization, reflects anindividual'soverall functional ability across multiple domains including cognition, psychological well-being, mobility, vitality, and sensory function. IC has emerged as a core metric within the healthy aging framework, but its prospective relationship with stroke risk remains unclear. A deeper understanding of this link may inform early, function-based prevention strategies. This study used data from 10,751 participants aged 45 years or older from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to estimate the association between IC and incident stroke, with stepwise adjustment for demographic, behavioral, and health-related covariates. Modeling IC as a continuous variable enabled examination of linear trends, while quartile-based classification allowed evaluation of potential non-linear associations and improved interpretability. Kaplan-Meier curves and log-rank tests were used to compare stroke-free survival across IC quartiles. Restricted cubic spline analysis was performed to explore the presence of a non-linear association between IC and stroke risk. Robustness was tested through sensitivity analyses excluding participants with baseline cognitive impairment and those aged ≥80 years. Statistical analyses were conducted using Stata and R. Over a 7-year follow-up, 243 participants (2.26%) experienced incident stroke. Stroke incidence decreased progressively with increasing IC levels, from 4.84% in the lowest quartile to 0.46% in the highest. Kaplan-Meier analysis showed significantly lower cumulative stroke incidence among individuals with higher IC (log-rank p < 0.001). In fully adjusted Cox models, each one-point increase in IC was associated with a 35.1% reduction in stroke risk (HR = 0.649; 95% CI: 0.599-0.702). Compared to the lowest IC quartile, the highest quartile had an 89.6% lower stroke risk (HR = 0.104; 95% CI: 0.055-0.197). Restricted cubic spline models confirmed a predominantly linear inverse association, with a steeper risk gradient at lower IC levels. Subgroup analyses revealed stronger protective associations in women, older adults (≥60 years), urban residents, and non-smokers or non-drinkers. Results remained consistent across all sensitivity analyses. Higher IC was independently associated with a significantly reduced risk of incident stroke, underscoring IC's potential as a holistic, function-based indicator of cerebrovascular vulnerability. These findings provide empirical support for the World HealthOrganization'shealthy aging framework, emphasizing IC as a modifiable reserve that reflects early, multidomain functional decline before clinical disease onset. Incorporating IC into routine screening and prevention strategies may enhance early identification of high-risk individuals and enable more targeted, function-oriented interventions, thereby promoting healthy aging and helping to reduce the future burden of stroke.

Respected Madam, Pakistan’s polio eradication program, led by the Expanded Program on Immunization (EPI) under the Ministry of National Health Services, implements mass and routine immunization strategies in collaboration with WHO, UNICEF, and global health partners.[1] National and Sub-National Immunization Days are conducted alongside routine immunization to increase coverage, while surveillance measures, such as environmental sampling and epidemiological monitoring, help detect outbreaks early, ensuring prompt response and control. Additionally, community engagement initiatives address vaccine hesitancy and enhance immunization uptake, contributing to Pakistan’s ongoing polio eradication efforts. Polio vaccination in Pakistan faces significant challenges, including security threats, vaccine hesitancy, misinformation, and logistical barriers. Geographic inaccessibility and mistrust further hinder immunization progress. Recently, Pakistan’s polio eradication efforts face a surge in cases in Baluchistan, worsening existing challenges. In 2024, 74 polio cases were reported nationwide, with 27 from Baluchistan, including 7 from district Killa Abdullah, highlighting the region’s vulnerability.[2] New socio-political unrest, protests, and security threats in the region have further disrupted vaccination campaigns, limiting access to high-risk populations and compounding existing barriers.[3] Addressing the surge in polio cases in Baluchistan amid security challenges and socio-political unrest requires a multi-faceted, adaptive approach. Ensuring the security of vaccination teams through coordination with local authorities is essential, while integrating polio vaccination into routine healthcare services ensures continuity during disruptions. Engaging local leaders and influencers can help reduce vaccine hesitancy and counter misinformation, fostering trust within communities. A holistic, security-focused, and community-driven strategy by the government is essential for eradicating polio in Baluchistan.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain major public health concerns worldwide, particularly in developing countries where asymptomatic infections often go undetected. Hospital-based screening provides an opportunity to assess the burden of these infections in the general population. Objectives: To estimate the seroprevalence of hepatitis B and hepatitis C among hospital attendees and to study their distribution according to age and gender. Materials and Methods: This cross-sectional study was conducted over a period of one year (2024–2025) at Darbhanga Medical College and Hospital (DMCH), Bihar. A total of 1,000 hospital attendees were screened for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies using enzyme-linked immunosorbent assay (ELISA). Demographic details were recorded and statistical analysis was carried out using the chi-square test. Results: The overall seroprevalence of HBV and HCV was 3.6% and 1.8%, respectively. HBV infection was more common among males and in the 31–50-year age group. A statistically significant association was observed between HBV positivity and male gender (p&lt; 0.05). Conclusion: The study demonstrates a moderate prevalence of hepatitis B and a lower prevalence of hepatitis C among hospital attendees. Routine screening and preventive strategies remain essential for early detection and control of viral hepatitis.

Red cell antibodies can cause severe or fatal hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. Screening for antibodies, such as anti-D, has been applied over decades for any transfusions and pregnancies. A comparison of sensitivities across laboratories is lacking for such antibody assays. We investigated the detection rates for defined antibody concentrations of anti-D, the most common trigger of adverse outcomes. In a concerted effort among 10 providers of external quality assessment and proficiency testing programs, 4 spiked samples were tested by exactly 2,500 laboratories applying their clinical routine procedures, covering 4 test principles, more than 24 test cells, and diagnostic devices from 5 manufacturers. The sensitivity of the assay depended on the test principle. Detection rates correlated with anti-D antibody concentrations: 0.1 IU/mL and 0.025 IU/mL can reliably be recognized. Some assays enabled detection at 0.01 IU/mL, and only a few at 0.005 IU/mL. Erythrocyte-magnetized technology and solid phase red cell adhesion performed better than various modifications of the column agglutination technology. The conventional test tube technology, depending on visual reading, was least sensitive. The results show options for action to improve antibody detection, may support a practice change to optimize routine strategies of red cell antibody screening, and can guide studies to evaluate the clinical impact.

Adolescent and young adult (AYA) cancer survivors experience unique psychosocial needs during and after treatment. Mobile health (mHealth) interventions are an emerging area of research to help address unmet psychosocial needs. However, few studies have examined provider perspectives on the design-to-implementation pipeline. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aimed to examine provider perspectives on facilitators and barriers to implementing mHealth apps in routine clinical care. AYA oncology providers participated in a semistructured 1:1 interview on facilitators and barriers to incorporating mHealth apps as psychosocial standard of care. We conducted a directed content analysis of the interviews using a standardized CFIR codebook and construct definitions, with codebook adaptations for mHealth innovations and the population of AYAs with cancer. A total of 20 providers (mean 39, SD 7.0 years; 80% female and 70% non-Hispanic White) representing various medical and psychosocial roles participated in the interviews. The data were analyzed with 16 CFIR constructs. We identified the following facilitators to mHealth implementation across four CFIR domains: (1) Innovation: alignment with patient needs, patient-centered co-design, strong research evidence, and user-friendly design; (2) Outer Setting: shared commitment to addressing mental health needs and openness to mHealth use; (3) Inner Setting: openness to training on mHealth use; and (4) Individuals: engaging key implementation partners such as bedside nurses and social workers and strong clinical team buy-in. We identified the following barriers to mHealth implementation across three CFIR domains: (1) Innovation: associated costs, (2) Outer Setting: heavy clinical workloads, and (3) Inner Setting: lack of cross-team collaboration and communication and clinical workflow integration. Our findings highlight key considerations for mHealth co-design, the adoption of mHealth apps into routine care, implementation strategies, and provider training opportunities in the context of AYA cancer care. Partnering with AYA cancer survivors, families, and providers will be crucial for developing and implementing mHealth apps with the ultimate goal of advancing universally accessible evidence-based digital health care.

ABSTRACT A robust body of research links greater sleep duration and quality to improved athletic performance and competitive outcomes. However, many athletes, particularly collegiate football players, struggle to achieve optimal sleep and accurately assess its quality. Despite the known sleep—performance relationship, little is known about how these variables manifest in real time among student-athletes. This study examined daily associations between objectively measured sleep and athletic performance in National Collegiate Athletic Association Division I football players. Sixty-five athletes aged 17 to 23 years (M = 19.88, SD = 1.41), representing a range of academic years and position groups, wore sensor-based devices over a three-week period to capture sleep metrics (sleep efficiency, latency, and total sleep time) and performance indicators (maximum acceleration, maximum velocity, and explosive movement). Multilevel modeling revealed no significant between-person effects, suggesting that athletes who slept better on average did not necessarily perform better on average. However, within-person analyses indicated that nights with longer sleep latency (estimate, −.007; 95% BCI, −.013, −.003) or lower sleep efficiency (estimate, .005; 95% BCI, .001, .010) predicted reduced maximum acceleration the next day. Conversely, days with lower maximum acceleration predicted shorter sleep latency (estimate, 6.869; 95% BCI, 3.998, 9.269) and higher sleep efficiency (estimate, −5.289; 95% BCI, −10.170, −1.027) that night. These findings underscore a dynamic, bidirectional relationship between sleep and performance at the daily level and highlight the need for individualized, athlete-centered sleep interventions that extend beyond sleep duration to include routine assessment, comprehensive education, and strategies to mitigate sleep disruptors.

Abstract Background: Local anesthesia with sedation (LAS) is widely used in other surgical disciplines but remains underutilized in breast-conserving surgery (BCS), where general anesthesia (GA) is still the standard [1, 2]. Recent reports have demonstrated the potential of LAS in selected breast surgery cases [3-5]. We aimed to evaluate the feasibility of systematically performing BCS under LAS in a high-volume breast cancer center. Methods: We conducted a retrospective study including all patients who underwent BCS ± axillary surgery from September 2021 to December 2023 in our institution. Patients operated under GA during the initial period (Sept 2021-March 2022) were compared to those under LAS (June 2022-Dec 2023), excluding the transition phase. LAS combined intravenous sedation (midazolam, dexmedetomidine, ketamine, remifentanil) with local infiltration (naropeine, lidocaine with epinephrine, saline). Feasibility endpoints included conversion to GA, intraoperative tolerance, and early surgical complications. Results: Of the 948 BCS procedures performed during the study period, 708 (75%) were carried out under LAS. Among the eligible patients during the LAS period, 12 refused local anesthesia and were operated under GA. Only 2 conversions to GA occurred during LAS procedures (0.3%), confirming excellent feasibility. We planned more preoperative wire in the LAS group (80% vs. 59%) because of the aqueous environment making small lesions more difficult to feel. Re-operation rates (for positive margins, hematoma, or infection) did not differ between LAS and GA groups (11% in LAS group vs. 13% in GA group, p=0.34). Axillary procedures were performed in both groups (52% in LAS group and 58% in GA group, n=0.06). Oncoplastic techniques were successfully performed under LAS without compromising safety or outcomes. Conclusions: Our results confirm that systematic BCS under LAS is feasible, safe, and applicable to a wide range of breast surgical procedures, including oncoplastic and axillary surgeries. To our knowledge, this represents the largest reported single-center series of breast-conserving surgery performed under LAS, supporting its broader implementation in routine clinical practice and perioperative optimization strategies.

Follicular lymphoma is the most common indolent non-Hodgkin's lymphoma subtype. Newer therapies have improved outcomes leading to longer survival in 80% of follicular lymphomas. Only 20% patients have either early relapses or undergo transformation to more aggressive forms. Hence, using routine surveillance strategies for all follicular lymphomas is not likely to be cost-effective. Prior prognostication models, including IPI, FLIPI, and FLIPI 2 have limitations in predicting the behavior of these subtypes. Attempts have been therefore made to improve their ability to characterize follicular lymphomas that are likely to have adverse outcomes. These newer models improve upon clinical outcome indicators by adding molecular and genetic markers. These include PRIMA23, ICA13 (Independent Component Analysis 13), and POD24-PI (Progression of Disease Within 24 Months-Prognostic Index). These augmented prognostic models increase the sensitivity and specificity of predicting adverse pathologic behavior. In this paper we look at prevalence of these molecular and genetic markers before treatment and then looked for their presence in patients who experienced early relapses to define their utility in developing selective surveillance strategies. Over 10 molecular and genetic markers were uniquely present in patients who relapsed and these were also different from those who had disease transformation. These markers likely indicate clonal remnants that evade initial treatment causing early relapses. A selective surveillance strategy is therefore possible using molecular and genetic markers. This will help create a more cost-effective surveillance strategy in patients with follicular lymphomas.

Toxoplasmosis is an insidious globally distributed zoonosis accounting for approximately one-fifth of all foodborne illnesses in humans in Europe. It stands as a classic example of a disease transmitted through the close interconnection between humans, animals, and the environment. Accordingly, mitigation strategies and health management protocols demand cross-sectoral involvement from medical, veterinary, environmental, and political actors, rendering the adoption of a 'One Health' perspective essential. Despite longstanding advocacy for One Health by the WHO, WOAH, and FAO, national health authorities have yet to establish the necessary operational infrastructure. Specifically, there is a lack of tools to enable information sharing among professionals, which is essential for the synergistic management of major health issues. A four-part epidemiological data collection tool specifically developed for human toxoplasmosis is proposed here to aid in the identification of risk factors and potential sources of infection. The proposed framework comprises four sequential sections intended to be completed through contribution from the patient, the attending physician, the involved veterinarian, and the national reference laboratory for toxoplasmosis. This questionnaire serves as a conceptual, non-validated tool designed to support a One Health-oriented epidemiological investigation process. Its practical performance, feasibility, and potential usefulness in routine surveillance or prevention strategies have not yet been assessed and will require validation in future studies. Nonetheless, the framework may serve as a model for the development of similar integrative tools applicable to other zoonotic diseases.

Abstract Background In recent years, high academic pressure, information overload, and career competition anxiety have contributed to cognitive impairment among university students, manifested as reduced attention, learning inefficiency, and impaired cognitive flexibility. Studies indicate that about 20% of students experience significant learning difficulties, 30% show decreased emotional regulation, and nearly 35% report persistent inattention and weakened task execution. Without timely support, cognitive deficits and negative emotions may interact and further increase academic and psychological risks. Structured ideological and political education has the potential to strengthen value identification, self-regulation, and planning abilities, and is increasingly emphasized in the integration of mental health and ideological education in universities. Therefore, this study, grounded in the university ideological and political education context, introduces cognitive support training and quantitatively evaluates its effectiveness in reducing cognitive failures, alleviating anxiety, and enhancing self-efficacy, aiming to optimize support strategies for students at risk of cognitive impairment. Methods This study recruited 120 university students (aged 18 ~ 22) with marked learning coping difficulties or executive deficits and randomly assigned them to an intervention group (n = 60) or a control group (n = 60). The intervention group received an 8-week program combining ideological and political education with cognitive support training twice a week, including responsibility-focused case discussions, task execution training, and mindfulness-based feedback. The control group only attended regular ideological and political theory courses. The Cognitive Failures Questionnaire (CFQ) and the Generalized Anxiety Disorder 7-item scale (GAD-7) were used for assessment before intervention (T0) and after intervention (T2). Independent samples t-tests were performed with a significance level of p&amp;lt;.05, and Cohen’s d was calculated to determine effect size. Results The changes in various indicators before and after the intervention in both groups are shown in Table 1. In the intervention group, the CFQ score decreased from 49.6 ± 6.8 at T0 to 38.2 ± 5.7 at T2 (p&amp;lt;.001, d = 1.75), a decrease of approximately 23%, indicating effective relief in attention maintenance, memory processing, and task performance errors. Simultaneously, the GAD-7 score decreased from 11.9 ± 3.2 to 7.0 ± 2.8 (p&amp;lt;.001, d = 1.36), with anxiety symptoms decreasing by approximately 41%, manifested as reduced learning avoidance and increased task engagement. In contrast, the control group showed no statistically significant improvement in either indicator at T2 (both p&amp;gt;.05), maintaining the pre-intervention psychological state level. Discussion Embedding cognitive support training into ideological and political education can effectively enhance college students’ self-awareness, learning efficacy, and cognitive control, particularly in reducing cognitive failures and anxiety. The findings suggest that structured, group-based, and feedback-oriented counselor-led programs can serve as a routine strategy for mitigating cognitive impairment risks in universities. Future work may incorporate digital behavioral feedback, learning tracking, and peer support to enable more personalized and sustainable intervention, thereby improving students’ academic adaptation and psychological resilience.

Abstract Background Social awareness education strengthens adolescents’ recognition and interpretation of social–emotional cues through role-playing, emotional awareness, and interactive feedback. Surveys indicate that 30% of middle school students show moderate–high anxiety, 25% exhibit low self-esteem or social withdrawal, and over 40% experience peer conflict and reduced classroom engagement, potentially impairing long-term learning motivation and social functioning. Positive psychological training improves self-efficacy, emotional regulation, and personal strengths, and has become key in school mental health programs. Therefore, this study embeds positive psychological interventions within social awareness education and quantitatively examines their effectiveness in reducing anxiety, enhancing self-esteem, and improving emotion management, providing evidence for optimizing routine school-based mental health support. Methods This study recruited 180 middle school students (aged 12 ~ 15) with notable social anxiety or adjustment difficulties, who were randomly assigned to an intervention group (n = 90) or a control group (n = 90). The intervention group received a 10-week positive psychological intervention, three times a week, mainly including peer collaboration tasks, emotion recognition exercises, and positive self-statement feedback. The control group only participated in regular class meetings and general psychology courses. The Social Anxiety Scale for Adolescents (SAS-A), the Rosenberg Self-Esteem Scale (RSES), and the Emotion Regulation Questionnaire (ERQ) were used for assessment before intervention (T0), during intervention (week 5, T1), and after intervention (T2). Repeated measures ANOVA was used to test the interaction between group and time. Independent samples t-test was used to compare the two groups. The significance level was set at p&amp;lt;.05. Cohen's d effect size was used to evaluate the size of the intervention effect. Results The changes in various indicators before and after the intervention in both groups are shown in Table 1. After 10 weeks, the intervention group showed a significant decrease in anxiety and a marked improvement in self-esteem and emotion regulation ability. The control group showed no significant changes. The SAS-A score decreased from 67.3 ± 6.1 at T0 to 51.2 ± 5.4 at T2 (p&amp;lt;.001, d = 2.62). The RSES score increased from 21.8 ± 3.9 to 30.4 ± 3.7 (p&amp;lt;.001, d = 2.24), and the ERQ emotion regulation efficacy improved by approximately 31% compared to T0 (p&amp;lt;.001). Discussion Embedding positive psychological interventions in social perception education can significantly improve middle school students' emotional understanding, self-efficacy, and social interaction abilities, particularly in anxiety relief and self-esteem building. The results indicate that structured, group-based, and feedback-driven positive psychological training can serve as an important and routine strategy for school mental health education. Future research could further integrate digital physiological feedback, teacher-student interaction data, and peer support mechanisms to personalize and sustainably optimize intervention content, providing a more efficient pathway to enhance adolescents' psychological resilience and social adaptability. Funding No. 13XJC880004.

Loneliness and social isolation are established risk factors for adverse cardiovascular, cerebrovascular and cognitive outcomes in later life, yet the pathways underlying these associations remain underexplored. This study tests the structure of a published framework linking social isolation and loneliness to health outcomes through psychological, behavioural and physiological pathways. We analysed cross-sectional data from 1,685 Singaporean adults over the age of 60 from the Wellbeing of the Singapore Elderly study. Path analysis was used to examine the psychological (subsyndromal and syndromal anxiety and depression), behavioural (smoking, alcohol use, poor diet and sedentary lifestyle), and physiological (hypertension, obesity, diabetes and sleep disruption) pathways from social isolation and loneliness to health outcomes (cardiovascular, cerebrovascular and cognitive health). The final model fit the data well (χ²(60) = 67.62, p = .233; CFI = 0.986; TLI = 0.993; RMSEA = 0.009). Loneliness was positively associated with psychological burden (b = 0.20, p < .001), unhealthy behaviours (b = 0.06, p = .001), and physiological burden (b = 0.06, p = .005). Social isolation was positively associated with psychological burden (b = 0.07, p = .005) and unhealthy behaviours (b = 0.14, p < .001). Physiological burden was positively associated with cardiovascular disease (b = 0.22, p < .001) and cerebrovascular conditions (b = 0.34, p < .001), while unhealthy behaviours were positively associated with cerebrovascular conditions (b = 0.21, p = .003) and poorer cognitive function (b = -0.14, p = .004). Social isolation also showed direct associations with poorer cognitive function (b = -0.09, p = .007) and lower probability of cardiovascular disease (b = -0.08, p = .014). Social isolation and loneliness are associated with behavioural and physiological factors that increase vulnerability to cardiovascular, cerebrovascular and cognitive conditions. Routine screening and public health strategies to address social disconnection and associated factors can improve wellbeing and reduce healthcare burden. Longitudinal research can clarify causal mechanisms and inform targeted interventions.