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State-level abortion bans, parental involvement laws and structural barriers to abortion care create a complicated landscape for adolescents under 18 years old seeking clinic-based abortion. Because of such obstacles, adolescents may seek medication abortion from online sources. We aimed to understand their individual motivations for obtaining medication abortion from one online telemedicine service instead of in-person clinic-based care. We conducted a mixed-methods study among adolescents who requested medication abortion between 1 July and 30 November 2022 from a service providing asynchronous clinician consultation and medication dispensed by mail to people in all 50 United States (US) states. We examined demographic characteristics, reasons for request, and conducted a content analysis of a subsample of anonymised email communications. Over a 5-month period, 558 adolescents requested medication. The most frequently selected motivations were: I would rather keep my abortion private (66%); I would be more comfortable at home (64%); I need to keep my treatment a secret from my partner/family (64%); Pills at home are more affordable (47%); I prefer to take care of my own treatment (47%); and I want to have my partner/friend with me (45%). In email communications, adolescents expressed an urgent need for abortion and articulated additional barriers including the high cost of the service and lack of access to credit cards or digital payment methods. Our results provide insights into why adolescents in the US pursue online medication abortion services and raise the need to address cost and payment barriers to telehealth abortion.

Integrating research into medical education fosters critical thinking and evidence-based practice. However, student participation in research can be limited by the lack of centralized, up-to-date project opportunities and mentor availability. Although Baylor College of Medicine established the Student Opportunities for Advancement in Research (SOAR) database to connect students with faculty-led projects, limited faculty participation persisted. An intervention was designed to increase faculty engagement in medical student research. The SOAR office developed and implemented an eLearning module supported by a multipronged marketing campaign. This intervention aimed to increase awareness of SOAR resources, clarify mentorship expectations, and streamline project submission. The module was developed using Backward Design and consisted of seven lessons incorporating multimedia elements in a 15-30 minute learning experience. The marketing campaign included emails, newsletter announcements, and flyers. The eLearning and marketing campaign were implemented over a six-week period from October 1 to November 11, 2024. Faculty engagement was evaluated using project submission records and Kirkpatrick-based surveys. After launching the SOAR database in 2021, an average of 5 projects were submitted per month. In the six weeks following the October 2024 eLearning implementation, 178 projects were submitted. Of these submissions, 69.7% (124/178) were from faculty who completed the module, 7.9% (14/178) from faculty who viewed but did not complete the module, and 22.5% (40/178) from faculty with no interaction. At the participant level, 85.0% (108/127) of faculty who completed the module submitted at least one project. Over the subsequent ten-month period (December 2024 to September 2025), submissions increased to 14 projects per month. Future efforts include longitudinal evaluation of mentor recognition, project submissions and project updates over time, and the impact of outreach strategies on sustained faculty participation in medical student research.

Bullying, discrimination, and harassment (BDH) are prevalent in medicine and are more commonly experienced by women. The Australia New Zealand Women in Cardiology (WIC) working group sought to assess the current prevalence of BDH among females in cardiology through a snapshot survey. The survey was developed by 2 women cardiologists and distributed to members of the WIC email list (180 members). The survey was also rolled out at a simultaneously held WIC meeting in Sydney and Melbourne, Australia, in April 2024. The data were received anonymously and summary data tabulated and presented. The survey was completed by 105 individuals (58.33% completion rate). Approximately 89.52% reported experiencing at least 1 negative behavior at any stage in their career, and 59.1% reported at least 1 negative behavior within the last 12 months. Majority (75.2%) of these behaviors were displayed by cardiology consultants. Of the respondents, 29.5% did not know how to react to the behavior and 17.1% reported the behavior higher up but no action was taken. Nearly half (47.6%) of the respondents were worried about the effect of reporting on day-to-day work or training. About 39.1% felt the hospital executive would be most effective in minimizing BDH. BDH was noted to be highly prevalent from this snapshot survey of women in cardiology. Urgent measures are required to mitigate and abolish these negative behaviors, a process that requires significant changes from all stakeholders involved in cardiology workplaces.

Background: Skin-to-skin care promotes physiologic stability, growth, bonding, and stress reduction for infants and parents. A skin-to-skin-a-thon is a structured event designed to increase awareness and implementation of skin-to-skin care through staff and family education and engagement. A coordinated, multicentre skin-to-skin-a-thon, focused on infants with CHD, has not previously been described.Methods: Participating sites were recruited through a national collaborative and participated in coordinated planning and implementation supported by shared resources. Sites implemented the skin-to-skin-a-thon within their hospital's existing skin-to-skin care guidelines using shared resources from a standardised "site champion bundle," which included educational materials, promotional posters, and printable tools. Site leaders reported educational initiatives and promotional strategies used locally.Results: All 22 participating sites had existing holding or skin-to-skin care guidelines at the time of the actual event; however, 9 of 22 sites developed or updated guidelines in the months leading up to the skin-to-skin-a-thon in preparation for the event. Sites adapted materials to local policies, provided staff education, and hosted awareness activities within their cardiac intensive care and/or step-down units. Internal email communication was the most common promotional strategy, while staff education approaches varied. The perceived difficulty of organising the event ranged from very difficult to easy across sites.Conclusions: This skin-to-skin-a-thon successfully united 22 hospitals nationwide, with 42% of Cardiac Neurodevelopmental Outcome Collaborative-affiliated centres participating. This initiative demonstrates the feasibility of leveraging multicentre collaboration infrastructure and virtual media to support evidence-based practice implementation.

To determine whether the regular use of structured communication tools is associated with greater communication openness among small animal specialty practitioners and emergency providers. A cross-sectional, anonymous, and voluntary survey of veterinary providers. Two hundred forty-seven survey responses were received across three specialty veterinary college email listservs, including the American College of Veterinary Surgeons, the American College of Veterinary Internal Medicine, and the American College of Veterinary Emergency and Critical Care. Descriptive statistics were used to determine respondents' awareness and use of communication tools, as well as perceptions of team communication openness. Most respondents (n = 201 [85.9%]) were unaware of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). Less than one-third (n = 72 [30.8%]) reported that they or one of their colleagues had undergone formal training to enhance teamwork and communication in the hospital. Despite not being aware of specific TeamSTEPPS communication tools when referred to by name, many reported the use of communication tools when descriptions were provided. The call out, Situation-Background-Assessment-Response (or similar method), and handoff were the most commonly used communication tools. The debrief and huddle were the least frequently used at a regular interval. The check back and brief were variable in their frequency of use. Multivariable ordinal logistic regression analysis of communication tool utilization and communication openness found that frequent use of structured communication tools was associated with respondents reporting greater team communication openness. Awareness of specific TeamSTEPPS communication tools was low among specialty and emergency veterinarian respondents; however, many respondents reported consistent use of analogous structured communication techniques. Frequent use of structured communication tools was associated with communication openness.

Nurses are expected to apply the best available evidence in their clinical decision-making processes to enhance patient safety and reduce the risk of medical errors. This study aimed to examine the effect of nurses' attitudes toward EBP on their tendency to commit medical errors. A descriptive, cross-sectional, and correlational design was used with a sample of 412 nurses. To reach nurses in public hospitals, we adopted a census sampling approach. Data were gathered through face-to-face interviews using a Google Forms questionnaire-accessible via QR codes and email-which incorporated the Attitude Toward Evidence-Based Nursing Scale and the Medical Error Tendency Scale in Nursing. Descriptive statistics and structural equation modeling (SEM) were conducted to test the hypothesized model in accordance with the STROBE guidelines. Nurses reported moderately positive attitudes toward EBP and comparatively low tendencies to commit medical errors. Postgraduate education was significantly associated with more positive EBP attitudes and lower error tendencies. The SEM results revealed a significant association between more positive EBP attitudes and reduced medical error tendencies (&#x3b2;&#x2009;=&#x2009;0.41, p&#x2009;<&#x2009;0.001). The proposed model showed acceptable fit indices. Positive attitudes toward evidence-based nursing were significantly associated with a reduced tendency to commit medical errors. Nursing leaders and policymakers should implement strategies to strengthen nurses' EBP attitudes and mitigate the risk of errors through targeted education, mentorship, and supportive organizational policies and practices. Not applicable.

Despite high symptom burden and limited lifespan associated with sickle cell disease (SCD), specialty palliative care (PC) services remain underutilized in this marginalized population.1,2 The extent of routine involvement, barriers to care, and training in the care of SCD patients at academic PC programs in the United States has not been quantified. To assess PC involvement and training in SCD care, identify barriers to access, and inform integration strategies. An anonymous Qualtrics survey, developed through literature review and expert panel, was emailed to 180 palliative medicine fellowship program directors or surrogates (June 18-July 25, 2025) in the United States. The survey included demographics, program practices regarding SCD and other chronic conditions (cystic fibrosis, amyotrophic lateral sclerosis, and chronic nonmalignant pain), frequency of routine SCD education, and perceived barriers to providing care to these patients. Fifty-one responses were received (28.3% response rate). Only 37% of programs routinely care for SCD patients (31.5% inpatient only, 10.5% outpatient, 58% both). Among these, 68% regularly prescribed opioids. Programs not routinely involved reported exceptions for patients with limited prognosis, comorbidities such as active cancer, or imminent end-of-life needs. The most common reported barriers to seeing patients with SCD were lack of outpatient resources (46%) and staffing constraints (44%). Free-text responses cited limited referrals, competing specialty ownership (hematology), institutional restrictions, and scope-of-practice limitations. Only 38% of programs included SCD in their fellowship curriculum, and 20% offered routine training for all PC team members. Fewer than half of academic PC programs routinely care for SCD patients, and most programs lack formal SCD training. Institutional and systemic barriers limit access, highlighting the need for resources and education to expand PC integration into SCD care. There is a need for consensus guidelines stratifying PC involvement in SCD patients.

The blood-milk barrier is essential for maintaining the homeostasis of the mammary microenvironment and safeguarding milk quality. Bacterial infection-induced mastitis is a major disease burden in the dairy industry. During bacterial mastitis, the blood-milk barrier is highly susceptible to disruption, and breakdown of structure integrity is among the earliest pathological events. However, the molecular regulatory mechanisms underlying this process remain poorly understood. In this study, we identify LncRNA7825 as a critical regulatory molecule, a host-protective long non-coding RNA that preserves epithelial tight junction integrity under bacterial challenge and plays a pivotal role in maintaining mammary epithelial homeostasis. By integrating MeRIP-seq and RNA-seq data from our previous studies, we found that LncRNA7825 is significantly downregulated at the transcriptional level following bacterial infection and is dynamically regulated by N6-methyladenosine (m6A) modification. Notably, elevated cellular m6A levels achieved via ALKBH5 knockdown result in reduced transcription of LncRNA7825. Functional studies showed that overexpression of LncRNA7825 restores mitochondrial potential, limits ROS accumulation, and attenuates epithelial apoptosis induced by multiple mastitis-associated pathogens. Importantly, LncRNA7825 preserves tight junction organization and effectively restricts bacterial adhesion to and invasion of mammary epithelial cells. Furthermore, LncRNA7825 is divergently transcribed with its neighboring gene DIP2A from a shared bidirectional promoter, forming a coordinated transcriptional unit that participates in regulating the pathological process of bacterial infection. Collectively, our findings demonstrate that LncRNA7825 acts as a multi-layered regulatory factor that integrates epitranscriptomic regulation, mitochondrial homeostasis, and coordinated genomic transcription to protect mammary epithelial barrier integrity during bacterial infection.

This study aimed to evaluate the prognostic value of FDG-PET/CT-based radiomic signatures of bone lesions for predicting overall survival (OS) in metastatic melanoma patients treated with immune checkpoint inhibition (ICI). Thirty-six consecutive metastatic melanoma patients treated with ICI at the University Hospital Zurich were included in this study. All patients had at least one bone metastasis at baseline, and PET/CT imaging data were available. The clinical endpoint was defined as patient OS. Radiomic features were extracted from each lesion and were correlated with patient OS. For patients with multiple bone lesions, radiomic data were pooled using three methods: arithmetic mean, mean weighted by lesion volume and selection of the largest lesion. Multivariate models were internally validated with nested cross-validation, and the area under the receiver operating characteristic curve was used as the performance metric. The median OS was 5.1&#xa0;years. Among the models predicting 3-year OS post-treatment, the highest performance was demonstrated by the combined PET/CT model integrating features from all aggregation methods, achieving an AUC of 0.76 (95% CI: 0.57-0.95). For 5-year OS prediction, the best performance was also observed for the combined PET/CT model, with an AUC of 0.84 (95% CI: 0.71-0.98), using radiomic features extracted from the largest lesions. FDG-PET/CT-based radiomic signatures of bone lesions in metastatic melanoma patients show potential for predicting overall survival. These findings suggest that radiomics could serve as a tool for guiding treatment decisions in patients with bone metastases undergoing immune checkpoint inhibition.

Adolescents experience high rates of perinatal anxiety disorders. Understanding the factors that contribute to perinatal anxiety among adolescents is important to develop targeted approaches to prevention, identification, and treatment. We aimed to identify key factors associated with perinatal anxiety and related disorders in adolescents in the existing literature. In this scoping review, we systematically searched four databases (MEDLINE, CINAHL, EMBASE, PsycINFO) from their inception to December 2023. Included studies examined variables associated with perinatal anxiety (between conception and 1 year postpartum) in adolescents (19 and under and/or young mothers). Anxiety was defined as inclusive of anxiety, obsessive-compulsive and trauma- and stressor-related disorders and their symptoms. Factors associated with perinatal anxiety were organized into thematic categories and described. Of 39 included studies, 35 were conducted in higher-income countries. Factors associated with perinatal anxiety fit into 6 categories: (1) support, shame, and stigma; (2) traumatic events; (3) social determinants; (4) pregnancy and birth; (5) intrapersonal factors; and (6) psychiatric history. Variables most strongly associated with increased perinatal anxiety were a lack of positive partner and family support, pregnancy-related stigma, adverse childhood experiences, intimate partner violence, lack of knowledge around pregnancy and newborn health, fears about the capacity to raise a child, and having limited education attainment and a low income. Key protective factors included supportive partners and families, positive healthcare experiences, positive self-perception, resilience, and self-care practices. The identified factors associated with perinatal anxiety among adolescents can inform targeted interventions to improve outcomes.

To determine whether a general-purpose large multimodal model (LMM) can detect dental caries from intraoral photographs without task-specific training, evaluating image-level classification and tooth-level localisation under zero-shot (no reference examples) and five-shot (five annotated examples) conditions. This diagnostic accuracy study used the benchmark test split of 1255 publicly available intraoral photographs. Gemini 3.1 reasoning and instant were queried via Vertex AI API using stateless calls and structured prompts for sequential, tooth-by-tooth scanning. Each model under different configurations was evaluated across 10 independent inference runs. Predictions (bounding boxes) were evaluated against expert annotations using greedy Intersection-over-Union (IoU &#x2265; 0.5). True positives required spatial overlap at the tooth level, or at least one correctly localised lesion at the image level. Performance was summarised using sensitivity, precision, F1-score, and mAP@50. Performance was strongly dependent on image view and model type, with reliable results observed mainly for the reasoning models on occlusal images. At the image level, zero-shot prompting showed high sensitivity but lower precision, yielding values of 0.95, 0.80, and 0.87 for sensitivity, precision, and F1-score, respectively. Five-shot prompting produced a more balanced profile, with corresponding values of 0.88, 0.87, and 0.87. At the tooth level, zero-shot reasoning showed a similar sensitivity-prioritised pattern, with sensitivity, precision, F1-score, and mAP@50 of 0.88, 0.49, 0.63, and 0.62, respectively. Five-shot prompting improved precision and produced a more balanced localisation profile, with corresponding values of 0.77, 0.57, 0.64, and 0.63. General-purpose LMMs such as Gemini show potential as a scalable, automated caries screening tool for teledentistry without domain-specific fine-tuning. Although prompt engineering effectively modulates the sensitivity-precision trade-off, the model's tendency toward over-detection requires rigorous clinical validation and governance before real-world deployment as a public screening tool.

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Cannabinoid receptor 1 (CB1) mediate cannabinoid-induced analgesia, yet CB1-targeted therapies show poor clinical efficacy against neuropathic pain (NP). The present study aimed to elucidate the molecular mechanism of CB1-mediated analgesia in sensory neurons and to identify potential therapeutic targets. We established a chronic constriction injury (CCI) model in male mice and evaluated pain-related behaviors using von Frey filament and hot plate tests. Transcriptome sequencing was performed to screen differentially expressed genes (DEGs) in the dorsal root ganglia (DRG) following CB1 conditional knockout and nerve injury, with key DEGs validated by qPCR and immunofluorescence. The transcriptional interaction between activating transcription factor 3 (ATF3) and neuropeptide Y (NPY) was further verified using ChIP-qPCR and luciferase reporter assays.We demonstrated that sensory neuronal CB1 plays a vital analgesic role under both physiological and neuropathic conditions. CCI-induced CB1 downregulation in the DRG impairs the analgesic efficacy of CB1 agonists. Genetic deletion of CB1 in sensory neuron activates ATF3 and NPY transcription, causing persistent hyperalgesia. After nerve injury, the expression of CB1 is suppressed in DRG, while the transcription of ATF3 and NPY is activated. ATF3 translocates into the nucleus and subsequently drives the transcription of NPY. Consistently, silencing ATF3 or NPY effectively alleviated hyperalgesia induced by CCI or CB1 conditional knockout. Collectively, our results indicate that CB1 may exert analgesic effects by indirectly inhibiting the ATF3/NPY signaling cascade. Targeting ATF3/NPY signaling provides a promising alternative therapeutic strategy for neuropathic pain, overcoming the clinical limitations of conventional CB1 agonists.

Thyroid nodule classification in ultrasound imaging is challenged by entangled visual patterns and distribution shifts across multi-center data due to variations in devices, protocols, and gain settings. We propose a Prior-Guided Multi-Expert Consensus Fusion Network (PMCF) for robust cross-center classification. The Prior-Guided Routing Mechanism leverages structure-aware spatial priors from fixed operators and learnable filters to modulate deep features across multiple expert branches, encouraging complementary spatial responses and implicit feature disentanglement. The Consensus Fusion Mechanism models inter-expert agreement together with adaptive gating information to aggregate expert outputs, enhancing robustness under domain shifts. Experiments on three multi-center thyroid ultrasound datasets demonstrate that PMCF outperforms state-of-the-art methods in classification accuracy and generalization. Ablation studies confirm that prior-guided feature modulation improves representation diversity, while consensus-based fusion enhances prediction stability, highlighting the effectiveness of combining structured priors with expert collaboration for multi-center diagnosis. Code is available at https://github.com/guangguangLi/MultiExpert.

Abscisic acid (ABA) coordinates plant development and water-stress responses through mechanisms that extend beyond local biosynthesis and signaling. Increasing evidence indicates that ABA function depends on the spatial organization of hormone production, transport, catabolism, and perception across tissues. In this review, we highlight how ABA is synthesized mainly in vascular-associated cells and redistributed to distal target sites in leaves, roots, and seeds. We discuss recent findings showing that both ABA and its precursor, abscisic aldehyde, can move between tissues, thereby expanding the routes by which bioactive hormones accumulate. We further consider how transporters, tissue-specific sinks, and environmental cues shape ABA gradients, and highlight outstanding questions regarding the cellular pathways and regulatory mechanisms that determine ABA action in planta.

Chronic hemodialysis patients are at risk of Vancomycin-resistant Enterocci (VRE) and carbapenemase-producing Enterobacteriaceae (CPE) carriage. France has released guidelines to prevent the spread of VRE-CPE carriage in hospitals. However, the hemodialysis setting is confronted with specific problems that are not always addressed by guidelines. Infection control practices regarding VRE-CPE transmission in the hemodialysis setting have not been described in the literature. The aim of our survey was to assess declared practices regarding VRE-CPE identification and management in French hemodialysis units (HDU). A cross-sectional survey was conducted in a random sample of 200 French HDU (excluding peritoneal dialysis and exclusive pediatric hemodialysis units) regarding their declared organization for identifying VRE-CPE carriers, the type and duration of precautions implemented, and reported difficulties. Data were collected via an e-mail questionnaire, and completed by a short telephone interview with an infection control nurse. 103 HDU agreed to participate. A minority of HDU had implemented a system to identify patients requiring screening or were able to keep track of VRE-CPE carriers and contacts via a computerized system. When managing VRE-CPE carriers, less than one-third of HDU employed caregivers, and strategies to discontinue precautions varied widely between HDU. HDU staff complained mainly about the lack of national specific guidelines for VRE-CPE in the hemodialysis setting, insufficient information regarding patients' VRE-CPE status, and difficulties in convincing patients to accept screening. This survey highlights heterogeneous practices and routine difficulties in VPE-CPE patients' management which would probably benefit from guidelines tailored to the hemodialysis setting. Bei Patienten mit chronischer H&#xe4;modialyse besteht das Risiko einer &#xdc;bertragung von Vancomycin-resistenten Enterocci (VRE) und Carbapenemase-produzierenden Enterobacteriacae (CPE). Frankreich hat Richtlinien ver&#xf6;ffentlicht, um die Ausbreitung vvon VRE-CPE in Krankenh&#xe4;usern zu verhindern. Allerdings ist das H&#xe4;modialyse-Setting mit spezifischen Problemen konfrontiert, die nicht immer in Leitlinien behandelt werden. Infektionskontrollpraktiken im Hinblick auf die VRE-CPE-&#xdc;bertragung im H&#xe4;modialysebereich wurden in der Literatur nicht beschrieben. Unser Ziel war es, die festgelegten Praktiken zur Identifizierung und Behandlung von VRE-CPE in franz&#xf6;sischen H&#xe4;modialyseeinheiten (HDE) zu bewerten. In einer Zufallsstichprobe von 200 franz&#xf6;sischen HDE (ausgenommen Peritonealdialyse- und p&#xe4;diatrische H&#xe4;modialyseeinheiten) wurde eine Querschnittsstudie hinsichtlich der Organisation zur Identifizierung von VRE-CPE-Tr&#xe4;gern, der Art und Dauer der umgesetzten Vorsichtsma&#xdf;nahmen sowie der gemeldeten Schwierigkeiten durchgef&#xfc;hrt. Die Daten wurden &#xfc;ber einen E-Mail-Fragebogen erhoben, der durch ein kurzes Telefoninterview mit einer Krankenschwester f&#xfc;r Infektionskontrolle erg&#xe4;nzt wurde. 103 HDE erkl&#xe4;rten sich zur Teilnahme bereit. Eine Minderheit der HDE hatte ein System zur Identifizierung von Patienten implementiert, die ein Screening ben&#xf6;tigten, oder war in der Lage, VRE-CPE-Tr&#xe4;ger und -Kontakte &#xfc;ber ein computergest&#xfc;tztes System zu verfolgen. Bei der Behandlung von VRE-CPE-Tr&#xe4;gern setzte weniger als ein Drittel der HDE engagierte Pflegekr&#xe4;fte ein, und die Strategien zum Absetzen der Vorsichtsma&#xdf;nahmen variierten stark zwischen den HDEs. Das HDE -Personal beklagte sich haupts&#xe4;chlich &#xfc;ber das Fehlen nationaler spezifischer Richtlinien f&#xfc;r VRE-CPE im H&#xe4;modialysebereich, unzureichende Informationen &#xfc;ber den VRE-CPE-Status von Patienten&#x2019; und Schwierigkeiten, Patienten dazu zu bringen, das Screening zu akzeptieren. Die Umfrage beleuchtet heterogene Praktiken und Schwierigkeiten bei der Behandlung von VPE-CPE-Patienten, die wahrscheinlich von auf das H&#xe4;modialyse-Setting zugeschnittenen Leitlinien profitieren w&#xfc;rden.

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Treatment decisions for microprolactinoma are based primarily on endocrine and radiographic outcomes, whereas neuropsychological changes remain underappreciated. As both bromocriptine therapy and surgery may be considered in selected patients, treatment selection can be challenging. This study aimed to provide additional evidence to inform treatment decision-making from neuropsychological perspective. This prospective study included 52 women with microprolactinoma and 39 female healthy controls. Baseline depressive symptoms and interoceptive awareness were assessed using the Beck Depression Inventory (BDI) and Body Perception Questionnaire (BPQ). Among the patients, 20 completed both baseline and post-treatment assessments after 6 months of bromocriptine therapy. Baseline between group differences were analyzed using independent samples t tests, and longitudinal changes were evaluated using linear mixed effects models. At baseline, patients had significantly higher BDI scores than controls (P = 0.011) and significantly higher BPQ scores (P = 0.049). In longitudinal analyses, bromocriptine treatment was associated with significant decreases in BPQ (P < 0.001) and BDI scores (P = 0.026). Prolactin level was significantly associated with BPQ (P = 0.001) but not with BDI (P = 0.259). When BPQ was added to the BDI model, BPQ remained a significant predictor of depressive symptoms (P < 0.001), whereas the effects of time and prolactin were no longer significant. Women with microprolactinomas showed improvements in both emotional symptoms and interoceptive awareness following bromocriptine treatment. Emotional disturbances in these patients may be more closely associated with altered interoceptive processing than with prolactin levels themselves.

Stable municipal anammox treatment requires the retention of slow-growing anammox bacteria within structurally robust granules. However, the role of background cation availability in maintaining mineral-associated granule stability remains unclear. Here, parallel continuous-flow anammox reactors were operated under contrasting cation conditions to determine how influent hydrochemistry affects granule persistence and reactor performance. The control reactor (R1) maintained stable and efficient removal of nitrogen (over 80%), whereas the cation-limited reactor (R2) showed progressive deterioration, with the total nitrogen removal efficiency (NRE) declining to a minimum of 49%. The performance deterioration of R2 was not attributed to impaired anammox metabolic activity, as evidenced by the improved specific anammox activity and consistently maintained bacterial viability. Instead, cation deficiency destabilized the mineral-associated structure, reduced surface hydrophobicity and settleability, finally triggering biomass washout. Anammox granules initiated compensatory responses characterized by upregulated EPS accumulation, and PICRUSt2 predictions suggested potential adjustments in EPS turnover and ion transport pathways. However, these adaptations were insufficient to counteract structural collapse. Community succession featured a decline in the relative abundance of Candidatus Kuenenia and the enrichment of heterotrophic nitrate-reducers in R2. Moreover, reduced background ion availability was associated with lower microbial network connectivity and a tendency toward greater contribution of stochastic processes to community assembly. Background water chemistry therefore governs whether metabolically competent anammox biomass can remain structurally retained as durable granules and sustain stable reactor function, highlighting ionic compatibility as a key consideration for robust mainstream anammox operation.