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Mood and anxiety disorders emerge predominantly in adolescence, yet they are usually identified only once symptoms have consolidated, when intervention can only be reactive. A marker that registers the loss of healthy brain function before symptoms crystallise would allow earlier and more targeted treatment, much as caged canaries once warned miners of danger before it became apparent. Here we report such a marker using a single baseline resting-state functional MRI scan in 150 adolescents in the Human Connectome Project Boston Adolescent Neuroimaging of Depression and Anxiety (HCP BANDA) cohort, allowing us to prospectively predict depression and anxiety symptoms one year later in held-out participants at r = 0.60, substantially above the effect-size ceiling reported for functional connectivity in the same data. The marker is not computed from raw functional connectivity but read out from a whole-brain generative model fitted to each individual's dynamics, which gives access to interference structure that covariance-based features cannot represent. The regions driving the prediction, including precuneus, ventromedial prefrontal and anterior cingulate cortices, are among those previously implicated in internalising disorders, and the same signature tracks cognitive variation in healthy participants and is mechanistically linked to the efficiency of task-related computation. These findings establish a mechanistically interpretable and prospectively predictive marker of adolescent mental health and define a clear path towards external validation and clinical use.

The Balearic Islands, off the NE coast of the Iberian Peninsula, have a rich and diverse history. We had previously reported that genomic diversity in one of the Balearics, Eivissa, shows the signs of a reduced effective population size and founder effect when compared not only to populations of the mainland but also to Menorca, another Balearic Island of comparable area and population size but with a more open historic trajectory. In the current work, we investigate whether the same pattern can be observed in the mitogenomes, and leverage the rich phylogeographic information contained in mitochondrial DNA (mtDNA) to detect the sources of the maternal lineages in Eivissa and Menorca. Indeed, Eivissa shows a reduced mtDNA haplotype diversity compared to Menorca and mainland populations, but similar to that in islands in other archipelagos (Canaries, Orkney, Shetland). However, other measures of diversity, such as number of segregating sites or nucleotide diversity do not show this reduction, probably because one of the founder lineages in Eivissa belongs to the deeply divergent L2c haplogroup, which is of Sub-Saharan origin and with a time to the most recent common ancestor that suggests that it was introduced during the Punic colonization of the island. Still, direct comparison with ancient DNA samples of various periods did not yield any sequence match that could indicate continuity with the population present in the islands before the Catalan-Aragonese conquest of the 13th century.

Caves and other subterranean ecosystems impose highly selective environmental filters, driving the evolution of convergent and specialized traits in subterranean organisms. Here, we present the first comprehensive checklist and trait database for subterranean spiders of Macaronesia, thereby filling a significant knowledge gap relative to continental Europe. We compiled data through direct morphological measurements and literature review, covering 64 morphological and ecological traits for 61 species (14 families) from Macaronesia, along with 66 additional species in continental Europe not included in the previous checklist. After accounting for taxonomic changes, the checklist of European subterranean spiders now lists 637 species, of which 278 are considered obligate subterranean dwellers (troglobionts). We used multidimensional hypervolumes to compare the functional spaces of Europe and Macaronesia and explore some putative eco-evolutionary patterns shaping both assemblies. The expanded trait database is a valuable resource for ecological and conservation research, highlighting the need for continued exploration and protection of subterranean biodiversity, including on oceanic islands.

Antimicrobial resistance is a major global health challenge that requires a One Health approach integrating humans, animals, wildlife, food systems and the environment. Among resistant bacteria, extended-spectrum β-lactamase-producing Escherichia coli (ESBL-producing E. coli) is particularly relevant because it is widely distributed across hosts and ecosystems, may carry mobile resistance genes and is commonly used as an indicator for antimicrobial resistance surveillance. This narrative review examines the occurrence, characteristics and transmission dynamics of ESBL-producing E. coli at the wildlife-livestock interface, with emphasis on its public health relevance and strategies for mitigation and control. The reviewed evidence indicates that livestock, wildlife and environmental matrices can be interconnected reservoirs of resistant E. coli and resistance genes. Transmission should not be interpreted as a simple linear process from livestock to wildlife or humans but rather as a bidirectional and ecological phenomenon shaped by antimicrobial use, farm management, biosecurity, wildlife ecology, environmental contamination and mobile genetic elements. Wildlife may function as a sentinel, reservoir or disperser of resistant bacteria, although detection alone does not demonstrate direct transmission. Integrated surveillance combining livestock, wildlife, food-chain and environmental sampling, supported by genomic analysis, is essential to clarify transmission pathways and guide effective control measures.

Prehospital airway and ventilatory management is a frequent, high-stakes and technically demanding component of emergency care. Environmental constraints, limited resources, and variable provider experience make it particularly challenging, and prehospital care systems differ substantially across countries, from paramedic-based to physician-led models, contributing to heterogeneity in clinical practices and patient outcomes. In this narrative review, we discuss evidence-based best practice, including indications, timing, physiological optimization, procedural conduct, and post-intubation management of prehospital tracheal intubation or non-invasive ventilation and high-flow nasal oxygen. Tracheal intubation remains the definitive airway management strategy when performed for appropriate indications by adequately trained providers. Indications span major trauma, traumatic brain injury, out-of-hospital cardiac arrest, and comatose patients, though its role in comatose poisoned patients is increasingly questioned. Physiology optimization before intubation is a critical and frequently underappreciated determinant of outcome, encompassing preoxygenation with non-invasive positive pressure ventilation, bag-valve-mask ventilation between induction and laryngoscopy, and careful sedative selection to limit peri-intubation hemodynamic compromise. When intubation fails, a structured escalation strategy including videolaryngoscopy, supraglottic airway devices, and emergency front-of-neck access must be rehearsed and immediately available. In out-of-hospital cardiac arrest, supraglottic airways represent a valid primary alternative with equivalent neurological survival and faster placement. Non-invasive ventilation (primarily CPAP and BiPAP) has a well-established role in acute cardiogenic pulmonary edema and COPD exacerbations, reducing intubation rates and mortality. High-flow nasal oxygen is an emerging modality with strong in-hospital evidence, but prehospital data remain extremely limited and logistical constraints restrict its routine use. Non-invasive support must never delay intubation when clinical deterioration demands it. Specific contexts require tailored adaptations: altitude physiology in helicopter transport, obesity-specific positioning, cervical spine precautions in neurological injury, comfort-focused strategies in palliative patients, and proactive stabilization before prolonged transport. Evidence gaps remain, particularly regarding prehospital high-flow nasal oxygen.

Gallotia simonyi and G. bravoana are large lacertids inhabiting the islands of El Hierro and La Gomera, respectively, in the Canary Archipelago. Both species are critically endangered, but over the last several decades, they have been bred in outdoor terraria (G. simonyi since the 1990s and G. bravoana since 2000). In this study: (1) we describe all procedures carried out in the breeding centres and quantitatively analyse the long-term trajectory of breeding success throughout the study period; (2) we examine whether any parental individuals or specific pairs had a stronger influence on the number of successfully hatched offspring; (3) we report the trials of reintroducing individuals into the wild on each island in different years; (4) we provide information on several predator (cat-control) campaigns conducted on each island; (5) we detail the veterinary protocols and the results obtained when assessing the health status of breeding lizards; and (6) we report several educational activities carried out on each island. Gravid females laid eggs in suitable laying boxes; the eggs were then kept inside incubators with controlled temperature and humidity until hatching. Breeding produced 1267 offspring during the years considered for G. simonyi and 499 for G. bravoana. The mean NEL was 8.8 for G. simonyi and 5.2 for G. bravoana, and the mean HO was 6.4 and 3.54, respectively. Both NEL and HO were significantly higher in G. simonyi than in G. bravoana. NEL was significantly influenced by species and year, and by female snout-vent length (SVL) as a covariate, but not by male SVL. HO was significantly affected by year and by both male and female SVL, but not by species. There were significantly higher or lower values of both variables in specific years, but no clear long-term trend. Some breeding pairs had a greater influence on the dependent variables. Reintroduction into the wild has resulted in a currently stable population of G. simonyi on a small islet off the north-western coast of El Hierro, and some individuals are still present at an inland reintroduction site. For G. bravoana, some live specimens have recently been detected at a new reintroduction site. We conclude that: (1) captive breeding has been successfully carried out over the years in both centres; (2) there have been significant differences between the two species in NEL and HO; (3) female SVL was significantly related to both NEL and HO; and (4) reintroduction attempts have been only partially successful in each species. Veterinary monitoring revealed high dehydration tolerance, seasonal fluctuations in microbial flora, previous mineral imbalances that were corrected by improved nutrition, and effective parasite control that maintained overall lizard health. Except for a few individuals, most lizards were in good health.

Pulmonary embolism (PE) may be associated with antipsychotics or an underlying serious mental illness (SMI). This pharmacovigilance study in VigiBase studied the association between 6 antipsychotics and PE by using statistical analyses: (1) from VigiBase, or (2) developed by the authors based on fatal outcomes. VigiBase PE data are included from the onset through July 1, 2025, for 6 antipsychotics (clozapine, olanzapine, risperidone, quetiapine, aripiprazole, and haloperidol). The disproportionality analyses used the information component (IC) and its confidence intervals (CIs). An IC=0 indicates no association. Logistic regression models explored PE fatal versus nonfatal outcomes. Olanzapine had the highest IC=1.2 (1.1 to 1.3) with 592 PE cases (257 expected). Clozapine's IC=0.93 (0.85 to 1.0) with 1314 PE cases (688 expected). Other antipsychotics provided very low signals. The percentage of fatal outcomes was 41% (538/1313) on clozapine, 28% (161/579) on olanzapine but no clozapine, and 21% (225/1092) on other antipsychotics but no clozapine or olanzapine. In the logistic regression model of 2984 PEs, the adjusted odds ratios (ORs) for fatal outcomes were 1.5 (95% CI: 1.2-1.9) for olanzapine and 2.5 (95% CI: 2.1-3.0) for clozapine. This large sample from VigiBase, despite its limitations, including using voluntary reports, provided a PE signal that was statistically significant for olanzapine and clozapine, while not significant for other antipsychotics. Future studies will need to explore the contribution of SMI versus olanzapine and clozapine. Clinicians need to be aware that the proportion of fatal outcomes is around 40% in patients on clozapine and those on complex antipsychotic polytherapy.

Compassion fatigue is a common condition among healthcare professionals continuously exposed to patient suffering, especially in high-pressure care settings such as those experienced during the COVID-19 pandemic. Evidence highlights its negative impact on mental health of staff and quality of care, as well as the need to implement effective preventive programs. Therefore, the aim of this study was to evaluate the impact of a pilot program of secondary prevention of compassion fatigue in healthcare professionals working in COVID-19 units at the Nuestra Se&#xf1;ora de Candelaria University Hospital Complex (CHUNSC). A quasi-experimental, longitudinal and prospective study was carried out, with pretest-posttest measures in a single group. By initial screening with the IDE-ESAPE and ProQOL-IV tools, 30 professionals with high scores of compassion fatigue or burnout were selected. The psychoeducational program, consisting of five group sessions, included mindfulness, emotional regulation and self-care. The results were evaluated at six months. Significant reductions in compassion fatigue (p&#x2009;<&#x2009;0.01; r&#x2009;=&#x2009;0.48) and burnout (p&#x2009;<&#x2009;0.01; r&#x2009;=&#x2009;0.53) were observed, as well as an increase in compassion satisfaction (p&#x2009;<&#x2009;0.01; r&#x2009;=&#x2009;0.46). A total of 100% of the participants completed the intervention. Improvements were maintained at six-month follow-up. The program was associated with significant reductions in compassion fatigue and burnout, together with an increase in compassion satisfaction. This suggests its feasibility and potential usefulness for integration into institutional strategies aimed at supporting professional well-being.

Lung cancer is the leading cause of cancer related mortality in the United States. The standard of care for early-stage non-small cell lung cancer (NSCLC) is surgical resection. However, with the increasing usage of sublobar resections for small stage IA tumors and neoadjuvant chemoimmunotherapy for resectable stage IB-IIIA tumors, the selection of appropriate patients and the prediction of how they might respond to such therapies is vital. Radiomics is the usage of extracted imaging features as analyzable data. Radiomic modeling with machine learning and artificial intelligence can be used to provide non-invasive and predictive information about tumor biology and aggressiveness before treatment is initiated. Radiomic modeling has been utilized to identify NSCLC histopathological features, proteomic mutational burden, responsiveness to surgical and immunotherapy interventions, and occult lymph node metastasis. This review article provides an overview of studies using radiomic features to model risk and radiomic predictive tools such as the Computer-Aided Nodule Assessment and Risk Yield (CANARY) that have been developed to provide insight and pre-operative risk stratification for resectable NSCLC.

It is estimated that between 20% and 80% of Proton Pump Inhibitor (PPI) prescriptions worldwide lack an appropriate clinical indication. Since their introduction in 1989, PPIs have proven highly effective for treating acid-related digestive disorders. However, over three decades of global use have revealed notable side effects, notwithstanding their overall safety profile. The chronic and indiscriminate use of PPIs by millions of people without proper indications represents a substantial public health issue and threatens the sustainability of health services worldwide. To evaluate the clinical and economic outcomes of deprescribing PPIs that are indefinitely and incorrectly prescribed in primary care centres across the Canary Islands after an educational intervention. An online training course was developed to educate family physicians on deprescribing PPIs in accordance with internationally recognized guidelines. Indications for PPI prescriptions were assessed and compared among an intervention group and two control cohorts: physicians interested in but not participating in the training, and those who did not express any interest on it. Following an initial assessment at twelve weeks, the second interested group received the same training. Chronic prescribing practices were then evaluated for all three groups at twelve and twenty-four weeks post-study initiation. Before the intervention the 8% of indefinite PPI prescriptions in the primary care setting met the appropriate criteria according to the guideline used. This percentage did not increase in the groups of trained physicians. However, PPI-related expenditures were significantly lower in the intervention group compared to both control groups at 24 weeks, with the intervention group showing a median reduction of &#x20ac;82 per physician, while the control and anonymous groups showed increases of &#x20ac;15 and &#x20ac;160 respectively (p&#x2009;=&#x2009;0.020 for the initial to 12-week comparison). Given the high volume of use of these medicines, any strategy aimed at improving their management by physicians can have a significant beneficial effect on the health of the population, and an exponential impact on the consumption of public resources. Longer-term follow-up, improved documentation of indications, and increased longitudinal patient care may play a critical role in the impact of educational interventions.

Microsatellite markers are invaluable tools for assessing genetic diversity and elucidating population structure across any species. This study reports the development and application of ten novel polymorphic microsatellite loci for Tectarius striatus, a littorinid species native to the shores of Macaronesia, a geographical region that includes the archipelagos of the Azores, Madeira, Selvagens, Canary Islands, and Cabo Verde. These markers together with a portion of the COI gene were used to genotype 65 individuals, using Illumina amplicon -sequencing across five geographically distinct populations. Our analysis shows moderate to high levels of allelic diversity across all populations. Furthermore, microsatellite markers supported genetic structure between a distant population of Cabo Verde Archipelago and the northern Macaronesian archipelagos. Conversely variation of the COI showed high levels of homogeneity across the sampled populations. While the presence of null alleles and moderate levels of missing data at several loci represent challenges to this study, the overall consistency of our results with earlier research underscores the reliability of microsatellite markers for population genetic inference in this marine gastropod. Nevertheless, our findings highlight the need for cautious interpretation of diversity estimates and population structure metrics, particularly when null alleles are frequent, and underscore the value of expanding the panel of available microsatellite markers for Tectarius striatus and related taxa to improve resolution and accuracy for future studies.

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Immune cells in the tumor microenvironment are not only powerful regulators of immunosuppression and tumorigenesis but also a dominant cell population, with tumor-associated macrophages (TAMs) comprising up to 50% solid tumor mass. Immunotherapies such as immune checkpoint inhibitors derive efficacy from this cancer-immune interface; however, immune-related adverse events from systemic blockade remain a major challenge. To address this need for potent, tumor-specific immunotherapies, we developed tumor immune cell targeting chimeras (TICTACs) that selectively deplete immune checkpoint receptors such as SIRP&#x3b1; from TAM surfaces. These chimeras consist of a synthetic ligand targeting CD206, a TAM marker, conjugated to a nonblocking antibody that binds to the checkpoint receptor without inhibiting it. By engaging CD206, which constitutively recycles between the plasma membrane and early endosomes, TICTACs drive robust checkpoint degradation in CD206high macrophages, with no effect on CD206low cells. This decoupling of antibody selectivity from blocking function presents a new paradigm for tumor-specific immunotherapies.

We provide, for the first time, an annotated checklist of the beetle fauna of Crete, Greece. We present an overview of the coleopterological history of Crete, along with background information of the physical attributes of the island. Data for the checklist were extracted from the collection of the Natural History Museum of Crete, GBIF, Fauna Europaea, the Catalogue of Palaearctic Coleoptera and various revisions. We report 2201 unique taxa (species or subspecies) belonging to 63 families. We also report 355 taxa as endemic to Crete or the surrounding islets, and 48 taxa as adventive to Crete. Fourteen new species records are reported, two for Buprestidae, two for Histeridae (including a new record for Greece), one for Oedemeridae (including a new record for Greece) and nine for Scarabaeidae. We compare the beetle fauna of Crete with the beetle fauna of Cyprus, Malta, and Sardinia within the Mediterranean Sea. Additionally, we provide comparisons with the California Channel Islands, the Canary Islands, the Galapagos Islands and the Socotra Archipelago.

Laurinterol, a halogenated sesquiterpene produced by red algae of the genus Laurencia, is one of the most characteristic compounds within the laurane and cyclolaurane families. This review compiles and examines current knowledge on laurinterol, integrating evidence on its occurrence, biosynthesis, biological activities, and structural features. Within a functional and ecological framework, laurinterol is proposed as an archetypal Smart Secondary Metabolite (SSM), a concept that reflects the convergence of structural singularity, high abundance within its biosynthetic context, broad biological activity, multi-target interactions, and ecological or chemotaxonomic relevance. This perspective highlights its role in adaptive processes within producing organisms and associated trophic networks. Laurinterol exhibits a broad bioactivity profile, including antimicrobial, antimycobacterial, cytotoxic, antiparasitic, enzyme inhibitory, antifouling, and insecticidal or repellent effects. Structure-activity relationship (SAR) studies remain limited and are mainly developed in specific models, particularly against Naegleria fowleri. The current intellectual property landscape related to laurinterol, including patent applications, granted patents, and technological development trends, is also examined. Overall, this review positions laurinterol as a structurally distinctive and functionally relevant marine metabolite within chemical ecology and marine natural products research.

Oesophageal cancer remains a leading cause of cancer mortality worldwide, with marked geographical variation. This study examined sex-specific temporal trends and subnational spatial patterns in oesophageal cancer mortality across Spain from 1999 to 2023. We conducted an ecological study using province-level mortality data from the Spanish National Institute of Statistics. Sex-stratified Bayesian hierarchical spatiotemporal models were fitted using Integrated Nested Laplace Approximation (INLA) to estimate smoothed relative risks (RRs), accounting for spatial, temporal, and interaction effects. High-risk areas were identified using posterior probabilities (PP > 0.95). Between 1999 and 2023, male mortality declined significantly; the smoothed RR fell from 1.22 (95 % Credible Interval [CrI]: 1.171.26) to 0.81 (95 % CrI: 0.770.86). Female mortality remained characteristically low and stable. Spatial heterogeneity explained 60 % of total variance in men and a remarkable 92 % in women, far outweighing temporal trends. Persistent high-risk clusters traversed the northern Atlantic/Cantabrian axis and the Canary Islands, while central provinces consistently showed reduced risk. Spatiotemporal interactions revealed diverging local trajectories, including sustained excess risk in the Canary Islands despite national improvements. Spain has achieved substantial reductions in oesophageal cancer mortality, particularly among men; however, pronounced and persistent regional disparities remain. As an ecological study, these findings reflect geographically patterned exposures rather than individual-level causality. The results emphasise the need for geographically targeted prevention, strengthened surveillance, and equitable access to specialised diagnostic and surgical services to reduce inequalities and improve outcomes nationwide.

The invasive nematode Angiostrongylus cantonensis (rat lungworm) can cause eosinophilic meningitis in humans. Once restricted to Southeast Asia, A. cantonensis nematodes are now widespread across the tropics and have been reported in Europe. Tenerife, in the Canary Islands, and the Mediterranean region are emerging hotspots. We surveyed gastropods, rats, and lizards across Tenerife and detected the parasite in all host groups at 2.4%-41.6% prevalence. Using species distribution models, we identified precipitation seasonality as the main driver of habitat suitability; tree cover and climatic variability primarily shaped prevalence patterns. Modeling showed suitable habitats in northeastern Tenerife and several western Canary Islands but limited overlap with areas of dense human population. Multivariate environmental similarity surface analysis comparison with another A. cantonensis hotspot, Hawaii, USA, revealed similar environments across the archipelago, except for the novel northeastern Tenerife area. Although no human infections have been reported, continued vigilance is warranted because A. cantonensis nematodes are established in Tenerife.

Follicular unit extraction with long hair, without the need to shave the donor area, is the latest innovation in transplantation techniques used for the treatment of androgenetic alopecia. This review describes its essential technical aspects, as well as its advantages, disadvantages, and main indications.

Background and Objectives: The COVID-19 pandemic was associated with major disruptions, not only at the environmental, social, and economic levels but also in the public health systems and, therefore, emergency care utilisation. Prior to the pandemic, one of the most significant issues in the ED was overcrowding, with a consequent percentage of people leaving the ED without being seen (LWBS). The aim of this study was to assess the association between the 2020 COVID-19 pandemic and the number of LWBS, compared with the rates recorded during the same period in 2019 and 2021. Materials and Methods: A retrospective comparative observational study of ED admissions was conducted in two university hospitals in Ancona (Italy) between 9 March and 3 May 2020 and in Gran Canaria (Spain) between 14 March and 10 May 2020, corresponding to the lockdown in the two countries, respectively. ED visits were assessed during the defined periods, separately for the Italian and Spanish contexts and between groups, comparing the two contexts for each year. Results: In Italy, during the 2019 timeframe, 597 (7.0%) of 8568 patients who arrived in the ED left before being seen; during the same period in 2020, 100 (3.2%) of 3100; and in 2021, 334 (6.0%) of 5555. In Spain, patients leaving the ED prior to medical consult in 2019 were 567 (4.0%) out of 14,034 visits; in 2020, they amounted to 185 (2.6%) out of 7208; and in 2021, they were 528 (4.0%) out of 13,214. The results of the logistic regression analysis for Italy and Spain showed that male sex [odds ratio (OR), 95% confidence interval (CI): 1.38 (1.24-1.53)], age group between 17 and 43 years compared to those subjects older than 74 years old [OR (95%CI): 4.04 (3.34-4.88)] and a lower priority code at triage were significantly associated with a higher odds of LWBS. Conclusions: The findings suggest that the COVID-19 pandemic was associated with changes in only some characteristics of the profiles and types of patients leaving the ED, while it had a strong impact on the number of patients who left the ED before medical examination. The observed decrease in ED visits and LWBS rates in 2020 suggests that the COVID-19 pandemic has changed the population's use of the ED, highlighting the potential need for improved public and professional awareness of appropriate care pathways and the role of health professionals in them.