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In 2023, a majority (86%) of open-heart surgeries was performed at Thorax Centrum Twente (TCT) via a full median sternotomy. Currently, there is no consensus on postoperative sternal precautions following full median sternotomy. Research from the USA and Canada suggests that existing restrictive sternal precautions may not be necessary. More lenient sternal precautions, such as the "Keep Your Move in the Tube" principle, have shown positive outcomes, with no significant complications. Patients following this approach experienced fewer mobility issues and reported improved quality of life and reduced anxiety. This study explores the potential benefits of fewer restrictions, which could reduce patient anxiety and lead to fewer follow-up visits. This study aims to determine whether the Thoracic Surgical Rehabilitation Experts Twente (T-REX Twente) sternal precautions have a small positive effect on the Modified MacNew Quality of Life after Myocardial Infarction questionnaire (QLMI-2), physical activity, and reduction of movement-related anxiety in patients after full median sternotomy, compared to standard restrictive sternal precautions. It also assesses whether the T-REX sternal precautions result in no negative effects on pain, wound healing, or postoperative complications. This prospective, randomized, controlled, single-blind study will include adult patients undergoing full median sternotomy at TCT between June 2024 and June 2026, all participating in outpatient cardiac rehabilitation. Exclusion criteria include intensive care unit stays over 72 h, delirium, dementia, severe cognitive impairments, language barriers, or treatment by an external referring cardiologist. The control group will adhere to current restrictive sternal precautions, whereas those in the intervention group will follow the T-REX sternal precautions, which allow lifting, pushing, or pulling as long as arm movement remains within a defined "tube." The primary endpoint is the change in QLMI-2 from baseline (T0) to start of phase II cardiac rehabilitation (T4). The T-REX Twente sternal precautions may improve quality of life, physical activity, and reduce movement-related anxiety, supporting the idea that less restrictive postoperative sternal precautions can enhance patient outcomes. CCMO Trial Register NL78107.100.23, registered on 29 February 2024. gov: NCT06115759.

Loot boxes are virtual chests containing randomized in-game items. Given their structural similarities, loot boxes have been argued to be a form of gambling. Indeed, previous meta-analytic studies suggest that loot boxes are associated with problem gambling severity and act as a "gateway" to gambling. Yet, little is known about loot box purchasing among individuals who already gamble. In the present study, we assessed the demographic characteristics and addictions and mental health comorbidities of adult loot box purchasers, through a nationally stratified sample of regular gamblers who also regularly play video games (N = 3709). We also investigated whether loot box engagement is associated with problem gambling severity and gambling harms when controlling for traditional gambling activities. Of the total sample, 1,922 reported having purchased loot boxes (Mage = 38.72, 61.3% male). Loot box purchasers were more likely to be younger, single, employed, have a college degree or higher, and report upper-middle income. Loot box purchasers were significantly more likely to endorse addictions and mental health comorbidities (e.g., substance use, depression). When controlling for other forms of gambling (e.g., electronic gambling machines, sports betting), both the frequency of loot box purchasing and money spent were associated with problem gambling severity and gambling-related harms. The results from the present study provide further support that loot boxes when purchased with money may be conceptualized as a form of gambling and contribute to problem gambling risk and harms. Given the popularity of loot boxes and relative lack of age restrictions, jurisdictions may wish to regulate the purchase of loot boxes similarly to traditional forms of gambling.

As adolescents grow older, they increasingly engage with the food environment. Our study aimed to: 1) assess the contribution of prepared out of home (POH) foods to the healthiness of adolescent diets and 2) identify socio-demographic factors associated with POH foods intake in a rural, a peri-urban, and an urban area of Vietnam. We conducted a cross-sectional survey among 11-19-year-old adolescents (n = 2,861) and collected socio-demographic and dietary intake data (24-hour recall). The healthiness and micronutrient adequacy of diets was assessed using the Global Diet Quality Score (GDQS) and the micronutrient adequacy ratio (MAR) respectively. We used regression analyses with robust standard errors (to account for school-level clustering) to assess the consequences and identify the drivers of POH food intake. Over 80% of adolescents consumed foods POH on the previous day, contributing 22-26% of daily energy intake. Healthy food groups were underrepresented in POH foods, which were higher in fat, saturated fat, and sodium, but also had higher micronutrient density than foods prepared at home. POH intake was associated with higher energy intake and micronutrient adequacy, but lower diet healthiness. Socioeconomic status, female sex, pocket money, and smartphone ownership were associated with POH consumption, with site-specific differences. Food environments should be made healthier through front-of-package warning labels, reformulation (e.g., reducing milk fat and sugar), and restrictions on the marketing and availability of unhealthy foods combined with the promotion of healthy foods, snacks and meals.

Nonpharmacological therapies are widely used for adult myogenic temporomandibular disorders (TMD), but their comparative effectiveness for pain and mandibular function remains uncertain. This study compared multiple interventions using a frequentist random-effects network meta-analysis. MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar were searched from inception through October 31, 2025, without language restrictions. Randomized controlled trials enrolling adults (≥ 18 years) with myogenic TMD were included if they compared at least one predefined nonpharmacological modality (including photobiomodulation therapy [PBMT], manual therapy [MT], exercise therapy [EX], occlusal splint therapy [OST], acupuncture [ACU], electrotherapy [ELEC], combined therapy [COMB], cognitive behavioral therapy [CBT], central neuromodulation, or extracorporeal shock wave therapy) with sham or placebo control, usual care or no-treatment control, or another predefined active nonpharmacological modality. Primary outcomes were pain and maximum mouth opening, and outcome data were extracted at the short-term assessment closest to completion of the intervention. Effects were summarized as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using a frequentist random-effects model implemented in Stata. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA), which provides a probabilistic ranking rather than a direct measure of treatment superiority. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (RoB 2.0). Forty-one trials (2021 participants) were included. For pain, PBMT ranked highest (SUCRA, 88.9%) and was superior to CBT (SMD, - 2.00; 95% CI, - 2.99 to - 1.00), ELEC (SMD, - 1.64; 95% CI, - 2.55 to - 0.73), conventional care (SMD, - 1.49; 95% CI, - 2.07 to - 0.91), OST (SMD, - 1.43; 95% CI, - 2.29 to - 0.56), and ACU (SMD, - 1.07; 95% CI, - 1.93 to - 0.21). MT (SUCRA, 79.9%) and COMB (SUCRA, 72.5%) also showed significant analgesic advantages versus several comparators. For maximum mouth opening (31 trials; 1463 participants), MT ranked highest (SUCRA, 92.9%) and improved opening more than conventional care (SMD, 2.79; 95% CI, 1.33 to 4.26), PBMT (SMD, 2.23; 95% CI, 0.19 to 4.28), ACU (SMD, 2.01; 95% CI, 0.12 to 3.90), and EX (SMD, 1.85; 95% CI, 0.05 to 3.64). Inconsistency was detected for pain in the ELEC versus MT comparison; no significant inconsistency was observed for maximum mouth opening. Among adults with myogenic TMD, PBMT showed the most favorable short-term comparative profile for pain relief, whereas MT ranked highest for improving maximum mouth opening. These findings support targeted selection of specific nonpharmacological modalities, prioritizing PBMT when pain reduction predominates and MT when restoration of mandibular mobility is the primary goal. PROSPERO (CRD420261278458).

Pregnancy in Eisenmenger syndrome (ES) confers high risk of fetal, obstetric, and maternal complications including death. A previously healthy nulliparous 22-year-old woman underwent a caesarean section at 37 weeks because of intrauterine growth restriction and preeclampsia. Postpartum, she developed hypoxia and was found to have differential cyanosis and suprasystemic pulmonary pressures because of an unrepaired patent ductus arteriosus. Pulmonary vasodilator therapy was commenced. She was discharged from hospital at day 12 postpartum and remained stable when reviewed as an outpatient 6 months postdischarge. Decompensation postpartum is common given hormonal and hemodynamic changes in patients with ES and requires meticulous management. This case highlights clinical findings that should prompt investigation for ES including digital clubbing, secondary erythrocytosis, and right ventricular hypertrophy on electrocardiogram. Pregnancy may unmask undiagnosed ES. Risk of complications remains high in the postpartum period.

Research misconduct poses a serious threat to academic integrity, particularly in medical sciences. This study aimed to estimate the prevalence of various forms of research misconduct include plagiarism, data fabrication or falsification, authorship misconduct, salami slicing, and purchasing research work among postgraduate students in Iranian medical universities using the Unmatched Count Technique (UCT). A cross-sectional survey was conducted among postgraduate students from multiple Iranian medical universities using a double-list version of the unmatched count technique (UCT). The questionnaire was administered in two sequential waves, with approximately half of participants completing List A and the remaining participants completing List B, ensuring that each respondent received only one list version. For each research misconduct behavior, prevalence was estimated by calculating the mean difference in endorsement counts between lists containing the sensitive item and corresponding control lists with only non-sensitive items. In the double-list design, prevalence estimates were computed separately for List A and List B, with sensitive items counterbalanced across list positions to control for order effects. The final prevalence was calculated as the average of the two list-specific estimates, improving precision and reducing list-order bias. The most commonly reported misconduct was using others' ideas or phrases without proper citation (43%), followed by dishonest result reporting (38%), data fabrication or deletion (34%), and authorship misrepresentation (34%). Salami slicing was reported by 26%, and 20% admitted to purchasing parts or all of a research project. The UCT survey tool demonstrated acceptable reliability, with intraclass correlation coefficients (ICCs) ranging from 0.64 to 0.84. The findings indicate a troubling level of research misconduct among postgraduatestudents in Iran's medical sciences universities. This highlights the need for effective ethics training, stronger academic integrity policies, and enforceable institutional mechanisms to promote responsible research conduct and protect the future credibility of medical professionals.

Radiometal-based radiopharmaceuticals have become central to the advancement of molecular imaging and targeted radionuclide therapy, offering powerful tools for the diagnosis and treatment of diseases affecting the brain. The unique chemical versatility of radiometals - encompassing a broad range of coordination chemistries, physical half-lives, and emission properties - combined with an expanding repertoire of targeting biomolecules enables highly tunable and increasingly modular imaging and therapeutic platforms. In particular, positron emission tomography (PET) using radiometal-labelled tracers provides sensitive, quantitative, and non-invasive assessment of molecular processes in vivo, while radiometal-based therapeutic agents enable the selective delivery of cytotoxic radiation to diseased tissue. This review examines recent progress in the application of radiometal-based radiopharmaceuticals for brain disorders, with a focus on neuro-oncology - including primary brain tumours and brain metastases - as well as neurodegenerative diseases such as Alzheimer's disease and Parkinsons disease. Key challenges unique to brain applications are discussed, including the restrictive nature of the blood-brain barrier, heterogeneous target expression, and off-target biodistribution. Recent advances in chelator development, emerging antigen targets, alternative routes of administration, and strategies to improve brain delivery are highlighted. While imaging agents continue to lead therapeutic development in this space, reflecting the need for accurate disease characterisation, recent progress underscores the potential of radiometal-based therapies for brain disease. In particular, immunoPET has emerged as a powerful tool for evaluating target expression, biodistribution, and treatment response. Collectively, these developments position radiometal-based radiopharmaceuticals as a promising and evolving platform enabling personalised treatment strategies for neurological disorders.

Oral squamous cell carcinoma (OSCC) can progress within a nutrient-limited microenvironment, especially under low-glucose conditions. However, the mechanisms enabling tumor cells to cope with glucose limitation, particularly those that counteract reactive oxygen species (ROS) accumulation, remain largely unknown. Here, we showed that dynamin-related protein 1 (DRP1)-mediated mitophagy promoted OSCC cell survival under glucose restriction. High expression of DRP1 was observed in OSCC tumor cells and identified as an indicator of poor prognosis. Either expression knockdown or pharmacological inhibition of DRP1 significantly reduced tumor cell mitophagy, leading to increased ROS production and consequently accelerating OSCC tumor cell death. The promoting effect of DRP1 on OSCC tumor growth, alongside its inhibitory effect on ROS production, was also confirmed in vivo. Furthermore, as a key nutrient stress sensor, AMP-activated protein kinase (AMPK) was activated upon glucose restriction. Pharmacological inhibition of AMPK was associated with reduced DRP1 mitochondrial translocation and diminished mitophagy. These findings collectively uncover that DRP1 contributes to mitophagy and allows OSCC cells to adapt to glucose limitation and overcome associated ROS stress, providing potential mechanistic insights for enhancing the efficiency of targeted therapies strategies.

Reirradiation for locally recurrent rectal cancer (LRRC) has historically been restricted by concerns regarding significant adverse effects, particularly with reirradiation doses (in EQD2Gy) ≥ 30 Gy. Advances in radiation technology now enable safer delivery, renewing interest in (chemo)reirradiation as part of multimodal management. Given the scarcity of prospective data and the considerable variability in radiotherapy approaches, there is a clear need for recommendations to enhance treatment homogeneity and quality. A writing committee was established by the Lower Gastrointestinal Cancer Sub-Committee of the European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee. We performed a systematic literature review following PRISMA guidelines; aiming to answer 14 key questions regarding the indications, planning and delivery of reirradiation in LRRC. Recommendations were based on available evidence or expert consensus and graded using the American Society for Radiation Oncology (ASTRO) grading system. Careful patient selection, consideration of treatment intent, treatment planning taking into account prior rectal cancer treatment, organ dose guidance and patient goals are essential to optimize outcomes and minimize adverse effects. The key questions guided a summary of appropriate literature and a series of recommendations to support the implementation of reirradiation in LRRC into routine clinical care. Almost all levels of evidence were low with recommendations mostly based on low quality of evidence or expert opinion, underscoring the urgent need for prospective studies and registry data. (Chemo)reirradiation in LRRC can be applied in the context of neoadjuvant treatment, definitive treatment and palliation, to increase radical resection rate, enhance local control and improve symptom control. Optimal patient selection, along with advanced imaging and precision techniques, is essential to maximize the therapeutic benefit while minimizing harm. In the absence of high-level evidence, these recommendations represent expert consensus and provide practical guidance to ensure the safe and consistent delivery of (chemo)reirradiation in routine clinical practice.

Post-mastectomy breast reconstruction (PMBR) plays a critical role in restoring physical appearance and psychosocial well-being. However, pronounced geographic and socioeconomic disparities in PMBR access persist worldwide, largely driven by insurance coverage variations. We reviewed English-language literature examining regional insurance disparities in PMBR access through PubMed searches and reference screening. Access to PMBR varies dramatically across regions. Africa demonstrates the lowest utilization; fewer than 10% of eligible women undergo reconstruction, primarily through out-of-pocket payments. In Asia, South Korea's national insurance coverage achieves 77% PMBR rates, whereas limited coverage in China and India restricts access to affluent urban populations. Europe, Australia, New Zealand, and Brazil provide universal coverage with variable utilization. North America demonstrates legislative mandates in the United States, yet socioeconomic disparities persist, while Canada offers universal coverage with underutilization. Policy interventions requiring legislative mandates, guideline-based surgical counseling, and rural outreach are essential to address these equity gaps.

A potential interaction between citrate and lactate metabolism may exist in critically ill patients receiving continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA). Although prior studies have investigated the relationships of initial lactate levels and lactate kinetics with citrate accumulation and clinical outcomes, the prognostic significance of lactate kinetics during RCA-CRRT remains inadequately defined. Critically ill patients undergoing CRRT (CRRT cohort) and those receiving RCA (Lactate Kinetics cohort) were identified from the MIMIC-Ⅳ (v3.1) database, as well as from the MIMIC-Ⅲ (v1.4) database (Lactate Kinetics Validation cohort). Propensity score matching, Kaplan-Meier survival curves, and Cox regression models were employed to assess the association between RCA use and 7-day and 28-day all-cause mortality. Latent growth mixture models, receiver operating characteristic curves, and restricted cubic splines were applied to identify lactate kinetics during RCA-CRRT. The association between lactate kinetics and mortality was evaluated using Kaplan-Meier survival curves and Cox regression models. LASSO-logistic regression analysis was applied to identify clinical characteristics associated with lactate kinetics. A total of 1,952, 1,064, and 209 patients were included in the CRRT cohort, Lactate Kinetics cohort, and Lactate Kinetics Validation cohort, respectively. The adjusted 7-day all-cause mortality risk was lower in patients who received RCA compared to those who did not, whereas no significant association was observed for 28-day mortality risk. Four distinct lactate trajectories during RCA-CRRT were identified: Class 1, low lactate with a stable trend; Class 2, high lactate with an improving trend; Classes 3-4, moderate lactate with gradually or rapidly worsening trends. Patients in Classes 3-4 exhibited significantly higher 7-day and 28-day mortality risks compared with Class 1, whereas Classes 2 showed no significant difference. SOFA score, respiratory failure, baseline lactate level, and mean daily citrate consumption were associated with an increased risk of lactate worsening, whereas pH and total carbon dioxide levels were associated with a decreased risk of lactate worsening. Patients with an increase in lactate greater than 1 mmol/L had significantly higher 7-day and 28-day mortality risks compared to those with an increase of less than or equal to 1 mmol/L. Although RCA may not increase overall mortality risk in critically ill patients, lactate worsening during RCA-CRRT has been observed and is strongly associated with adverse outcomes in certain patient populations. Timely clinical evaluation and individualized treatment adjustments are appropriate for these patients.

More than two millennia ago, Plato's Allegory of the Cave illustrated how humans may mistake shadows for reality. Over the last decade, radiology has experienced a similar phenomenon with Artificial Intelligence (AI). Early narratives, often promoted by opinion leaders and commercial stakeholders, portrayed AI as an imminent replacement for radiologists, fostering unrealistic expectations, regulatory minimalism, and a climate of urgency. With increasing evidence and clinical experience, these shadows have gradually dissipated. AI has not supplanted radiologists but has demonstrated value when applied to well-defined tasks such as triage, workflow optimization, image quality enhancement, and quantitative analysis. At the same time, limitations have become evident, including hallucinations, lack of transparency, security risks, and the restricted clinical relevance of most marketed solutions. This decade of exaggerated promises has carried tangible costs, from damaged professional perception to adoption skepticism. As radiology enters the era of agentic AI, critical realism, transparency, and radiologist-led development are essential to avoid repeating past illusions.

Multiple sclerosis (MS) is a significant cause of neurological disability in young adults. Siponimod, a potent sphingosine-1-phosphate (S1P) receptor modulator, is used to treat MS by reducing T-cell recirculation and central inflammation. The presented work includes clinical data describing the impact of the CYP3A4 inhibitor clarithromycin on siponimod metabolism and the results of updated physiologically based pharmacokinetic (PBPK) modeling. A clinical drug-drug interaction (DDI) study assessed the effect of clarithromycin on siponimod pharmacokinetics in healthy participants with the CYP2C9*1*3 genotype. Results revealed minimal differences in PK: a 2% increase in Cmax, an 8% increase in AUClast and a 9% increase in AUCinf, confirming no clinically relevant drug-drug interaction (DDI). The existing siponimod PBPK model was updated using these DDI study data, estimating a CYP3A4 fraction metabolized of 6.4% in the CYP2C9*1*1 genotype. Simulations using the updated PBPK model in the absence and presence of the restricted co-medication (CYP2C9 and CYP3A perpetrators) were conducted. There was no clinically relevant DDI with moderate and strong CYP3A4 inhibitors across CYP2C9 genotypes with a predicted maximum net AUC increase of 1.33. Co-administration of fluconazole, a moderate CYP3A4 and CYP2C9 inhibitor, was predicted to result in <&#x2009;2-fold net AUC increase, except for the genotype CYP2C9*2*2, where a 2.2-fold net AUC increase compared to the CYP2C9 wild type without fluconazole co-treatment was observed. Siponimod Cmax and AUC were comparable across CYP2C9 genotypes during dose titration in the absence or presence of fluconazole, suggesting no impact on the effectiveness of the dose titration regimen.

Precise assessment of body composition is fundamental for monitoring training adaptations, guiding nutritional strategies, and informing performance-related decision-making in elite female soccer. Dual-energy X-ray absorptiometry (DXA) is considered a reference method; however, its limited accessibility restricts routine use in high-performance settings. Existing anthropometric equations often lack population-specific validation, particularly for elite Mexican female soccer players. This study aimed to derive and internally validate an anthropometric equation for estimating body fat percentage (%BF) and to evaluate its agreement with DXA. Twenty-seven elite players from the Mexican Women's National Team underwent DXA assessment and International Society for the Advancement of Kinanthropometry (ISAK)-standardized anthropometry during a training camp. Sample-size adequacy was assessed a posteriori. A multiple linear regression model was derived using the sum of eight skinfolds (&#x3a3;8SF) and waist girth (WG) as predictors. Regression assumptions were verified through residual diagnostics, and multicollinearity was assessed using variance inflation factors. Predictive performance was evaluated using mean absolute error (MAE), root mean square error (RMSE), and standard error of estimate (SEE). Agreement with DXA was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Internal validation was performed using leave-one-out cross-validation (LOOCV). The six historical anthropometric equations were additionally refitted to the present sample to enable a like-for-like comparison of predictor structures. The Mexican Footbal Federation equation (%BF&#x2009;=&#x2009;0.12&#x2009;&#xd7;&#x2009;&#x3a3;8SF&#x2009;+0.39&#x2009;&#xd7;&#x2009;WG - 17.0) demonstrated moderate agreement with DXA (ICC&#x2009;=&#x2009;0.71; mean bias: -0.05%; 95% LOA: -4.61% to&#x2009;+4.70%). The model explained 54% of the variance in DXA %BF (R&#xb2;&#x2009;=&#x2009;0.54; R&#xb2;-adjusted&#x2009;=&#x2009;0.50) and showed acceptable predictive performance (LOOCV Q&#xb2;&#x2009;=&#x2009;0.50; RMSE&#x2009;=&#x2009;2.33%; MAE&#x2009;=&#x2009;1.86%; SEE&#x2009;=&#x2009;2.47%). After refitting each of the six historical anthropometric equations to the present sample, the Mexican Footbal Federation predictor combination retained the lowest RMSE (2.33% vs. 2.55-2.93%) and the highest ICC (0.71 vs. 0.44-0.63), supporting that the model's advantage stems from its predictor structure rather than calibration on the test data. The Mexican Football Federation equation provides a population-specific, field-applicable tool for estimating %BF in elite Mexican female soccer players. External validation in larger and more diverse cohorts is required before its widespread application.

Psychiatric intensive care units have significant implications for patient safety and clinical outcomes. Understanding the demographic and clinical characteristics of restrained patients is essential for developing evidence-based protocols and reducing unnecessary restraint use. The aim of this retrospective descriptive cross-sectional study was to determine the clinical and demographic characteristics of patients subjected to physical restraint in a psychiatric intensive care unit. This descriptive cross-sectional study analyzed 138 patients subjected to physical restraint in a psychiatric intensive care unit between January 2023 and December 2023. Data were collected through systematic chart review using a standardized physical restraint monitoring form from the Hospital Quality and Standards System, designed specifically for type 2 (behavioral safety) restraint documentation. Variables included demographic characteristics, primary diagnoses, restraint indications, and clinical outcomes. Statistical analysis was performed using SPSS, version 28.0. The study followed STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Statistical analysis was performed using descriptive statistics. Out of 138 patients, 95 (68.8%) were male with a mean age of 51.48 &#xc5;} 15.02 years. Primary restraint indications included noncompliance with medical treatment (39 patients, 28.3%), severe agitation (37 patients, 26.8%), orientation disturbances (32 patients, 23.2%), and self-harm behaviors (30 patients, 21.7%). The most common primary diagnoses were nonorganic psychosis (55 patients, 39.9%), bipolar disorder (30 patients, 21.7%), and delirium tremens (20 patients, 14.5%). Mean intensive care unit length of stay was 11.87 &#xc5;} 14.04 days. This study provides essential baseline data on physical restraint use in psychiatric intensive care, demonstrating male predominance and identifying key clinical indicators. These findings support the development of targeted interventions and evidence-based restraint protocols to optimize patient care while minimizing restrictive practices. Cite this article as: Cengisiz C, Nehir S. Clinical and demographic characteristics of patients subjected to physical restraint in a psychiatric intensive care unit: A retrospective descriptive cross-sectional study. Eurasian J Med. 2026, 58(3), 0961, doi: 10.5152/ eurasianjmed.2026.25961.

Pretargeted radiotheranostics decouple tumor recognition from radionuclide delivery and utilize in vivo click chemistry to achieve targeted delivery of radioactive payloads. A major barrier to efficient radionuclide delivery via the pretargeting approach is the suboptimal pharmacokinetics of the small-molecule radioligand, which rapid clearance restricts the in vivo reaction window for bioorthogonal capture, thereby also limiting clinical translation. Herein, we investigated an in situ albumin engagement strategy to modulate the pharmacokinetics of a clickable radioligand in a PSMA-targeted, polymer-assisted bispecific antibody pretargeting system. By incorporating an albumin binder into the small-molecule radioligand, systemic circulation was prolonged to expand the bioorthogonal capture window, without perturbing target affinity or receptor biology. This design may offer a modular advantage, as the clickable radioligand can be optimized independently while different pretargeting agents may, in principle, be adapted for alternative receptor systems. Within the PSMA-targeting BsAb/HBP system, the lead candidate (DOTA-mTz-sALB), compared to the non-albumin binding construct, increased tumor-associated uptake from &#x223c;1.3 to &#x223c;4.7%ID g-1 (&#x223c;3.5-fold increase) and improved tumor-to-liver ratios from &#x223c;0.1 to &#x223c;0.6 (&#x223c;6-fold increase), while systemic background largely resolves within 24-48&#xa0;h. Together, these results support albumin engagement as a modular pharmacokinetic-tuning element to improve pretargeted radiotheranostic delivery.

Analysis of left-truncated and interval-censored survival data is challenging, particularly when the failure time and observation process are dependent. Existing methods, including Sun et&#xa0;al. (2023), model dependency via copulas, which may be restrictive in the presence of complex interval-censoring mechanisms. To address this gap, we propose the first shared frailty model specifically designed for left-truncated, interval-censored data, capturing heterogeneity and dependency between the failure time and observation processes. A sieve maximum likelihood approach is developed, using I-splines and M-splines to approximate the unknown baseline hazard and examination intensity functions. The asymptotic properties of the estimators are established, and an extensive simulation study demonstrates that the method provides consistent, efficient, and robust parameter estimates under a variety of scenarios. The approach is illustrated through a real data application to the AIDS cohort study, highlighting its ability to account for left truncation, interval censoring, and dependent observation process.

Adverse birth outcomes remain a global public health issue. RANKL participates in immune regulation and bone metabolism, but its association with adverse birth outcomes has not been fully clarified. To explore the association between maternal mid-pregnancy serum RANKL levels and adverse birth outcomes (PTB, BD, SGA, LGA, LBW, macrosomia). This was a cross-sectional study conducted in South China. Maternal serum samples were collected during the second trimester (13-20 gestational weeks). Serum RANKL levels were measured, and logistic regression and restricted cubic spline analyses were used to evaluate the associations. Maternal mid-pregnancy serum RANKL levels were significantly positively associated with SGA. ROC analysis suggested that serum RANKL had a certain discriminatory ability for SGA and LBW. Mid-pregnancy maternal serum RANKL levels are associated with an increased risk of SGA. Serum RANKL may serve as a potential indicator for risk assessment of adverse birth outcomes. These findings provide new clues for understanding the aetiology of adverse birth outcomes.

Promoting mental health literacy among adolescents is crucial for early prevention and intervention of mental health problems in school settings. This study aimed to develop and validate the Spanish Mental Health Support Scale for Adolescents (MHSSA). This study involved 578 responses (ages 13-52&#xa0;years, M&#xa0;=&#xa0;20.28, SD&#xa0;=&#xa0;6.29) from both secondary school students in Burgos and future school health education professionals in Burgos and Oviedo, Spain. The questionnaire was composed of the standardised Spanish MHSSA scale and six additional standardised scales. Exploratory and confirmatory factor analyses supported a two-factor structure (&#x3b1;&#xa0;=&#xa0;0.88), comprising helpful and harmful intentions subscales. The Spanish MHSSA also demonstrated good test-retest reliability (ICC&#xa0;=&#xa0;0.88). Initially, adolescents exhibited lower levels of mental health support behaviours compared to future school health educators, while post-intervention results showed significant improvements in support-seeking behaviours. Higher-quality support intentions were observed among women, post-test participants, individuals with prior lived experience of mental health problems, and future health professionals. These results demonstrate reasonable construct validity, further supported by the finding that scores on the Spanish MHSSA are also associated with lower social restrictive attitudes toward mental health problems (measured by the CAMI) and higher mental health literacy (measured by the MHLI). The findings indicate that the Spanish MHSSA is a valid and reliable tool for assessing both adolescents' and school health educators' intentions to engage in mental health-supportive behaviours.