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The rapid expansion of wireless data traffic is placing increasing strain on the energy consumption of current communication networks, intensifying the tension between performance and sustainability objectives. In interference-intensive multiple access scenarios such as power-domain non-orthogonal multiple access (NOMA), energy-efficient optimization is particularly challenging due to the strong coupling between power control and resource allocation decisions. In order to solve this issue, this paper introduces an AI-Enhanced Energy Optimization Framework (AEEOF), which uses deep spatio-temporal learning and reinforcement learning to provide adaptive and energy-aware network control. The proposed framework incorporates a Spatio-Temporal Graph Convolutional Network (ST-GCN) to learn spatial interference relationships and a Gated Recurrent Unit (GRU) to capture temporal traffic dynamics, embedding the resulting representations into a Multi-Agent Deep Deterministic Policy Gradient (MADDPG) controller to support sequential decision-making. Such a design provides the framework with the ability to dynamically distribute power and timing policies based on changes in network conditions. Extensive simulations in a realistic 5G-oriented environment of high interference levels prove the significant performance improvement. The suggested solution can save up to 15% of energy and make the energy use more efficient by about 40%, which is the number of bits delivered per joule. The overall system throughput goes up by 6.25%, the cell-edge user data rate goes up by up to 60%, the fairness goes up by 20%, and the chance of an outage goes down by 70%. A systematic ablation study with three architectural variants validates the individual contribution of each core component - the ST-GCN spatial module, the GRU temporal module, and the MADDPG reinforcement learning controller. Comparative evaluation against conventional orthogonal and non-AI-assisted baselines further supports the effectiveness of the proposed framework within the studied setting. These findings indicate that intelligent spatio-temporal learning is a promising approach for improving energy efficiency and network performance in interference-intensive wireless environments, as demonstrated within the studied 5G-oriented simulation setting.

Endometriosis is a chronic inflammatory disease characterised by ectopic endometrial tissue, progressive fibrosis and chronic pain, with a pathogenesis that goes beyond oestrogen dependence. The central question this review seeks to answer is: are steroidal alkaloids - nitrogenous plant-derived steroids with a unique structure - a mechanistically sensible, non-hormonal alternative that can simultaneously target the inflammatory, fibrotic and epigenetic drivers of endometriotic lesion persistence, while preserving fertility and avoiding systemic hormonal suppression? A growing body of evidence points to non-hormonal molecular networks including immune dysregulation, angiogenesis, and resistance to apoptosis as drivers of lesion persistence [1]. These molecular disturbances are associated with treatment resistance and limit the long-term efficacy of hormone-based therapies. This review synthesises recent mechanistic advances that describe the non-hormonal signalling pathways that maintain endometriotic lesions, with a specific emphasis on NF-κB-mediated sterile inflammation, inflammasome activation, PI3K/Akt/mTOR-dependent survival signalling, Hedgehog-driven fibrosis and epigenetic repression of progesterone receptor expression. Steroidal alkaloids are critically reviewed as multitarget modulators suppressing inflammatory signalling, inhibiting invasive and fibrotic remodelling, and restoring apoptotic sensitivity in this pathophysiological context, without direct systemic oestrogen deprivation. Structural determinants of steroidal alkaloid activity, including glycosylation status, nitrogen topology and configuration of the steroidal scaffold, are discussed in the context of pathway selectivity, pharmacokinetics and toxicity. Preclinical in vitro and in vivo evidence is critically reviewed in the context of key translational limitations such as bioavailability constraints, narrow therapeutic index and teratogenic risk from developmental pathway inhibition. This review highlights steroidal alkaloids as a mechanistically rational, non-hormonal approach to target lesion persistence and fibrosis in endometriosis, integrating molecular, pharmacological and structural insights, and outlines the major hurdles that must be overcome for clinical translation. The main objective of this review is to address a specific unanswered question: can steroidal alkaloids with their multitarget pharmacology offer a biologically coherent, non-hormonal strategy for the treatment of endometriosis that goes beyond oestrogen deprivation to target the molecular machinery of lesion survival, fibrosis and immune dysregulation. This question is addressed by reviewing the nonhormonal signalling networks that support ectopic lesions, the structural and pharmacokinetic properties of steroidal alkaloids that are relevant to these pathways, and the translational challenges that need to be addressed for clinical translation.

Ten-eleven translocation (TET) enzymes are critical epigenetic regulators, which oxidize the methylated cytosine nucleobase 5-methyl-dC (mdC) in the genome to 5-hydroxymethyl-dC (hmdC) in an α-ketoglutarate-dependent manner. Because the presence of mdC in the promoter region of a given gene silences its expression, this oxidation goes in hand with the reactivation of such silenced genes. In different highly aggressive cancers such as acute myeloid leukemia (AML) and glioblastoma, loss of TET enzyme function, and therefore reduced hmdC levels pave the way for tumor development. Impairment of TET activity can occur through metabolic inhibition, through loss-of-function mutations in TET genes themselves, and finally through suppression of TET-expression via epigenetic silencing. Reactivation of TET enzyme expression represents a major aim of epigenetic cancer therapy. Here we show that the carbocyclic antimetabolite 5-aza-2'deoxycytidine (cAzadC), which is supposed to suppress the methylation of DNA during replication, leads to a substantial increase of TET2 expression and strongly increasing hmdC levels. We show that the treatment with cAzadC goes in hand with the broad reactivation of the cellular antitumor responses. With patient-derived xenograft AML-mouse models, we show that this translates into a strongly improved anticancer effect in vivo.

The article analyzes the cultural, social, and historical role of alcoholic beverage consumption within the Mediterranean diet, highlighting that drinking goes beyond nutrition and reflects factors such as social status, economy, and culture. It explains various factors influencing alcohol consumption: its relationship with agriculture (use of surpluses), religion (rituals and ceremonies), social life (rules and customs), pleasure (taste and enjoyment), health, and environmental impact. All these aspects shape how, when, where, and with whom alcohol is consumed. The text also points out that there are different patterns of consumption depending on the type of drink, context, and purpose, and it distinguishes between the cultural acceptance of alcohol and individual risks such as addiction or excessive consumption, which can lead to diseases and injuries. From a historical perspective, it shows that alcoholic beverages have been important since ancient civilizations, such as in Mesopotamia and Egypt, where they were part of daily life and diet, although their risks were already recognized. Within the Mediterranean diet, alcohol consumption is integrated into a social and cultural context, especially linked to shared meals. However, recommendations regarding its consumption have evolved over time. Finally, the text concludes with current guidelines: do not start drinking if you do not already do so, drink responsibly and in moderation if you choose to, always with food and in social settings, avoid it in risky situations, and remember that not all alcoholic beverages are the same in terms of composition and effects.

Alzheimer's disease (AD) diagnosis requires analysis of diverse data types to capture the heterogeneous factors underlying its development and progression. Magnetic resonance imaging (MRI) and positron emission tomography (PET) noninvasively measure brain structure and neuronal activity, respectively, and can serve as early indicators of AD onset and future progression. We propose V3D-MMoE, an interpretable framework to adaptively integrate incomplete multimodal 3D neuroimaging for AD diagnosis prediction and biomarker discovery. It goes beyond prior approaches by leveraging (1) a sparse mixture-of-experts formulation to account for variation in the importance of different modality combinations, (2) modality alignment to enhance cross-modal learning, and (3) cross-encoders to dynamically handle missing modalities. When applied to MRI and PET scans to predict two-year AD diagnosis, V3D-MMoE outperformed state-of-the-art multimodal 3D neuroimaging methods. Interpretability analyses revealed subject-specific MRI and PET biomarkers consistent with the known biology of AD. Ablation experiments demonstrated the benefit of leveraging multimodal neuroimaging.

Post-liver transplant (LT) alcohol relapse complicates long-term outcomes and organ allocation. The traditional "six-month abstinence rule" remains widely used, but relapse risk is also shaped by psychosocial, socioeconomic, and psychiatric factors. We examined the impact of pre-LT abstinence duration on post-LT alcohol relapse and developed a multivariable risk model integrating abstinence, psychosocial assessment, and socioeconomic status. In this single-center retrospective study, 383 adults undergoing LT for alcohol-related liver disease were included. Any post-LT alcohol relapse occurred in 20.9% (n = 80). Relapse phenotypes were non-mutually exclusive: sustained alcohol use (77.5%), harmful drinking (68.8%), and recurrent ALD (46.3%). On multivariable analysis, shorter pre-LT abstinence, higher Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores, and higher educational attainment were independently associated with relapse. Each additional month of abstinence reduced relapse odds by 4%, whereas each one-point increase in SIPAT increased relapse odds by 3%. Cumulative risk curves demonstrated a non-linear relationship between abstinence duration and relapse, with risk peaking around 9 months and declining thereafter across all relapse phenotypes. A prediction model combining abstinence duration, SIPAT score, and education achieved an area under the receiver operating characteristic curve (AUC) of 0.70, with consistent performance on fivefold cross-validation. These findings support a multifactorial approach to relapse risk stratification that goes beyond a fixed 6-month abstinence rule. Incorporating abstinence duration together with structured psychosocial assessment and education level may better inform both transplant listing decisions and the intensity of post-LT addiction care for patients.

Gastrointestinal mucus is the first line of defense against bacteria, and it acts as a responsive biomaterial to multivalent ions. However, their phase behaviors and related physical mechanisms with multivalent ions are still poorly understood. Here, we reveal the order of ion binding affinity to gastrointestinal mucins, which goes against the Hofmeister series. We also provide a map of their phase diagrams with different multivalent ions, including re-entrant phase behaviors with trivalent and tetravalent ions and irreversible phase separation with divalent ions except Mg2+, which rather stabilizes mucin solutions. Surprisingly, our results in an extremely complex biological system can be well described by theories of simple polyelectrolytes, providing insights into the underlying physics. Combined with theory and the proof-of-concept studies, we reveal the physical mechanisms in the phase transition, including the bridging effect, the charge-reversal mechanism, and self-redissolution with trivalent ions due to the disruption of coordination complexes. Additionally, redissolution of the mucin-rich solid phase by exogenous ions is dominated by competitive ion condensation over the Debye electrostatic screening. This work could provide physical strategies to develop new methods and drugs for gastrointestinal mucus health improvement and therapeutics, such as enhancing the absorption of essential trace elements through gastrointestinal mucus by utilizing competitive ion condensation.

Dear Readers, Welcome to this new issue of the International Maritime Health Magazine. Maritime medicine often advances not in times of stability but through the careful analysis of events that test existing systems. Whether we are managing a complicated medical repatriation, responding to an infectious disease outbreak, or striking a balance between clinical requirements and operational realities, dealing with a difficult situation will provide us with a lesson. This issue reflects that principle. An analysis of the outbreak onboard the MV Hondius included in this issue goes beyond the clinical aspects of infectious disease to examine the more general issues of operational decision-making, international coordination, communication, and public health responsibility at sea. Events such as this one remind us that, at times, the effectiveness of international frameworks depends not only on their existence, but also on how they perform under the pressures of real-world operations. This issue also marks the introduction of our new The Decision Deck section. The aim of this section is to encourage reflection and clinical reasoning, particularly in situations where decisions must be made with limited resources or conflicting operational priorities. In many respects, both the analysis of the MV Hondius and the case presented in The Decision Deck reflect the same principle: maritime medicine evolves through the continuous examination of difficult situations. Through this process of reflection and debate, our field continues to strengthen and adapt to a complex and constantly evolving maritime environment. We hope that this issue will foster an ongoing dialogue among the various disciplines that contribute to our maritime and hyperbaric medicine community.

Intimate partner violence (IPV) is a major public health concern and a human rights problem worldwide, leading to severe effects on women's physical, mental, economic, and reproductive health. Despite its prevalence, particularly in low- and middle-income countries such as Papua New Guinea (PNG), IPV often goes unaddressed during pregnancy, even though it is linked to adverse maternal and neonatal outcomes. This study explores the perspectives of senior clinical healthcare providers, managers, and administrators regarding the integration of IPV screening into routine antenatal care in PNG, identifying key barriers and facilitators to implementation. This qualitative study utilised in-depth interviews with senior clinical healthcare providers, health service managers, and administrators working in antenatal care settings across PNG. Thematic analysis identified major themes related to knowledge, attitudes, readiness, and perceived challenges regarding IPV screening. Multiple barriers to the implementation of IPV screening in antenatal care were identified. Barriers included cultural norms, resource constraints, and insufficient provider training. Participants highlighted limited awareness of IPV's health impacts and inconsistent protocols for routinely addressing these issues. Despite recognising the importance of addressing IPV, respondents noted significant gaps in systems and intersectoral collaboration. Successful implementation of routine IPV screening during antenatal care in PNG requires targeted interventions such as provider education, capacity-building, and the development of context-specific protocols. Multisectoral collaboration and increased resource allocation are essential to strengthening healthcare responses, improving identification and support for women experiencing IPV, and ultimately advancing maternal and child health outcomes.

To explore the impact of stroke on young survivors. Qualitative study design using semistructured interviews that underwent thematic analysis. Participants were recruited globally, with the majority of data collection occurring in the UK. All participant interviews were conducted online. This study is the first to explore the poststroke impact of young stroke survivors across three key stakeholder groups: young stroke survivors (n=22), young stroke caregivers (n=5) and stroke healthcare professionals (n=9). Following 36 participant interviews, four primary themes emerged: (1) relationships and psychosocial considerations; (2) disrupted occupations and financial worries; (3) out of sight, out of mind and (4) acknowledgement of current healthcare practices and their efficacy. These results extend the findings from existing young stroke literature while providing multiple perspectives confirming that the impact is far-reaching, affecting caregivers, family and wider social circles. Participants reported a range of poststroke impacts specific to a younger cohort. These should be considered when developing and engaging in service provision for young stroke survivors to ensure an inclusive, person-led approach that goes beyond 'one-size-fits-all'.

Youth well-being interventions in digital contexts overwhelmingly target individual emotional mechanisms, yet whether these actually outperform social-structural pathways when directly compared has remained untested. Using nationally representative Chinese youth data (N = 1967; 91.4% of young adults; China Family Panel Studies 2022) and a competing-models structural equation framework with 5000-iteration bootstrap resampling, we simultaneously tested three rival pathways linking screen time to well-being. Results decisively favored the social-structural model: the social trust pathway yielded the strongest indirect association (&#x3b2; = -0.030, p < 0.001), despite the small size, nearly twice the magnitude of family-based mechanisms (&#x3b2; = -0.011, p < 0.001), while the direct emotional pathway was non-significant (&#x3b2; = -0.004, p > 0.05). Critically, negative emotions did not function as an independent parallel pathway; they emerged sequentially downstream of trust erosion. If emotional distress is downstream of trust erosion rather than a parallel input, interventions targeting emotion regulation address a symptom while the structural mechanism goes unaddressed. These findings suggest youth well-being interventions in digital contexts may benefit from rebalancing attention from individual behavioral modification toward social-structural conditions.

The Guidelines for the Management of Elevated Blood Pressure and Hypertension 2025 (JSH2025) were published last year. Additionally, the Prevention of Cognitive Impairment by Hypertension Management (PCIHM) working group of the Japanese Society of Hypertension's Academic Committee released a statement summarizing the latest basic research and clinical and epidemiological findings on "hypertensive dementia". Numerous research papers on hypertension-related dementia were published over the past year, and evidence is accumulating. Reports indicate that blood pressure variability, rather than absolute blood pressure levels, is gaining attention as a factor inducing dementia; furthermore, blood pressure targets are being set lower, and even strict blood pressure control in the elderly does not lead to cognitive decline. On the other hand, it goes without saying that we must avoid a one-size-fits-all approach for the elderly; instead, we must determine blood pressure targets on an individual basis, for example, by avoiding excessive blood pressure reduction in elderly patients who already have cerebral small-vessel disease. As a "beyond guidelines" initiative, we here summarize reports related to "hypertensive dementia" published since the guidelines were released and explore the trends. Recent reports on "hypertensive dementia" are on the rise. The number of PubMed articles found by searching for "high blood pressure" and "dementia" reached nearly 800 last year and has already exceeded 220 this year (as of the end of March). While the JSH2025 guidelines were published in August 2025, I would like to review some of the interesting basic and clinical research papers published over the past year or so, consider recent trends and future developments regarding hypertension and dementia.

In the context of the Kundu-Eckhaus equation, we study the nonlinear stage of modulational instability (MI) driven by a purely continuous spectrum and then analyze the nonlinear interactions in the presence of an additional soliton generated by the discrete spectrum. Specifically, investigating the characteristics of spontaneous oscillations generated by nonlinear MI, we show that the oscillation structure asymptotically evolves into a soliton ensemble as time goes to infinity. Meanwhile, the quintic and derivative nonlinearities can modulate the boundary expansion velocities and peak velocities of the oscillation structure, leading to the loss of spatial symmetry. When the presence of a discrete spectrum gives rise to an extra soliton independent of the initial perturbation, we identify four types of interactions between the soliton and the oscillation structure and accordingly present the partition of the discrete spectrum on the spectral plane, which varies with the strength of the higher-order nonlinearities.

Puncture wounds in children are frequently underestimated, particularly when presentation is delayed or the event goes unnoticed initially. Retained foreign bodies, such as nails or wood fragments, significantly increase the risk of deep infection, abscess formation, septic arthritis, and osteomyelitis. We present a case of a 4-year-old child who presented to the emergency department with a 10-day history of increasing pain, swelling, erythema, and purulent discharge from the right foot following a puncture wound. Aggressive debridement of devitalized tissue, removal of foreign material, and irrigation were performed. Following debridement, negative pressure wound therapy (NPWT) (VAC therapy) was applied using pediatric-appropriate settings. One month after the final dressing change and discontinuation of NPWT, the wound showed marked clinical improvement. The defect was fully covered with healthy, mature granulation tissue, with a substantial reduction in wound depth and overall dimensions. This case illustrates the effectiveness of NPWT after debridement in managing complex pediatric foot wounds and highlights the need for prompt, comprehensive care.

People with mental disorders (PMD) not only face difficulties related to their mental health problems, but also suffer from the stigma and discrimination associated with them. Research on social stigma in the educational setting has been mainly focused on health sciences students. The main objective was to compare the level of social stigma toward PMD among university students, categorized by their fields of study. Additionally, the analysis considered gender, knowledge about mental health, familiarity, and contact. A cross-sectional study was conducted among all first-year undergraduate students during the 2023-24 course at the University of Valencia, who were enrolled in five study fields: Engineering and Architecture (EA), Arts and Humanities (AH), Social and Legal Sciences (SL), Sciences (SC) and Health Sciences (HS). All students completed online an initial questionnaire with socio-demographic items, as well as the following questionnaires: The Mental Health Knowledge Schedule (MAKS), the Reported and Intended Behaviour Scale (RIBS), the Scale of Community Attitudes toward Mental Illness (CAMI), and the Attribution Questionnaire (AQ-27). The final sample comprised 2,693 students. The EA students scored highest in authoritarianism and social restrictiveness, and lowest in benevolence and CMHI. Students from SL had higher levels of public stigma than those from AH, SC and HS. Considering only women, EA had the highest scores in authoritarianism. EA men had lower benevolence and lower CMHI. These findings suggest that anti-stigma programs conducted at higher education institutions, in addition to traditional health sciences students, should target students from other study fields. This paper goes a step further by proposing that university curricula should include activities to improve understanding of mental health problems and reduce social stigma associated with PMD.

Rapid Invisible Frequency Tagging (RIFT) is a recent advance in frequency tagging that exploits novel, high-frequency displays to modulate luminance at imperceptibly high frequencies. RIFT goes beyond low-frequency tagging by allowing researchers to track neural responses to rhythmic stimulation while avoiding perceptual confounds. RIFT is thus a promising method to address central questions in rhythmic cognition, including attention, multimodal integration, and the neural mechanisms underlying oscillatory coordination in perception. However, setting up a RIFT study involves several technical and conceptual considerations. In an effort to make RIFT more accessible, we provide a comprehensive guide for implementing RIFT in cognitive neuroscience. On the basis of the joint experiences and data-driven insights of multiple laboratories, we provide practical recommendations derived from empirical datasets to improve reproducibility, covering hardware requirements, stimulus design, analysis approaches, and interpretation of results. We hope that this guide helps readers to both identify the conceptual areas where RIFT offers promising insights and navigate the technical caveats that come with the approach.

Maternal nutrition during the postpartum period is a critical time for mothers as they recover from pregnancy and delivery and continue to support their infant through breastfeeding. As Mexico goes through a nutrition transition away from traditional, home-prepared meals to more processed foods, it is unknown what the current dietary choices of women are after pregnancy. This study aimed to explore the nutritional practices of women in Southern Mexico during the postpartum period. A qualitative study, guided by the Ecological Systems Theory and the Intersectionality Framework, was conducted involving 25 low-income women with children under the age of five in the cities of Oaxaca and Puerto Escondido, Oaxaca, Mexico. Data were collected through in-depth interviews between June and December 2023. Interviews were audio-recorded, transcribed verbatim in Spanish, coded, and analyzed using NVivo R1 following a grounded theory approach. Three main themes emerged: (i) maternal diet after a C-section, (ii) food practices during the breastfeeding period, and (iii) nutrition supplements after the delivery. These findings reveal that compared to women who deliver vaginally and are not advised on a specific diet during the postnatal recovery, women who deliver via C-section usually have a selective diet, based on recommendations from health providers and family members. Their diet consists mainly of fruit, vegetables, and broths with a restriction from consuming seafood and pork. A common traditional hot beverage, Atole, was frequently consumed by postnatal women to increase their milk supply. Iron and folic acid were nutritional supplements mostly consumed during the postnatal period by women with a greater need to replenish nutrients lost during childbirth or the postnatal period. This study highlighted the significance of understanding the nutritional habits that postnatal women in Puerto Escondido and Oaxaca City practice, as they are driven by customs and focus on the recovery of the mother and the development of the baby. These findings could be used to inform culturally relevant policies. Still, as postnatal care continues to be understudied in Mexico, future research is needed to identify any gaps in the nutrition of the mothers during puerperium.