Background/Objectives: Chronic kidney disease (CKD) progresses with the gradual and irreversible loss of renal function. In Romania, given the increasing number of patients undergoing hemodialysis (HD), the prevalence of psychiatric symptoms and disorders in this population has become particularly significant. Although important advances have been made in the management of psychiatric conditions in HD patients, their mental health remains relatively poor. The aim of this study was to observe the severity temporal trends of depression, anxiety and stress symptoms and correlations among HD patients. Methods: A total of 173 patients, underwent a detailed anamnesis, with emphasis dialysis duration, comorbidities and a complex psychiatric evaluation, followed by the application of the Socio-economic Scale (SES-3); Mini Mental State Examination (MMSE); and the Depression, Anxiety and Stress Scale 21R (DASS-21R). The dialysis performance (spKt/V) and Charlson Comorbidity (CCI) indices were provided by DIAVERUM Nephrology and Dialysis Center in Craiova. Results: The severity of depression and anxiety symptoms significantly increased over six months, 0.248 ± 1.432 vs. 0.453 ± 1.488 (p < 0.0001; r_rb = 0.296) for depression, and -0.090 ± 1.004 vs. 0.089 ± 1.047 (p < 0.0001; r_rb = 0.252) for anxiety; while stress-like symptoms remained stable 0.080 ± 1.318 vs. 0.164 ± 1.357 (p = 0.0661; r_rb = 0.123), despite improvements in dialysis adequacy (spKt/V). Depression scores were moderately correlated with anxiety and weakly correlated with stress and spKt/V. Anxiety results were moderately correlated with stress, while both anxiety and stress showed negligible correlations with spKt/V. Clinical variables assessed showed moderate predictive value for psychological outcomes in this cohort. Conclusions: Our study confirms the temporal trend of severity of mental symptoms and their persistence among HD patients, highlighting the urge to integrate mental health screening and intervention programs and a multidisciplinary team adapted for each case.

Trauma care demands rapid decision-making under uncertainty and time pressure, where maintaining situational awareness becomes challenging. Artificial intelligence offers potential to augment clinical judgment by processing complex physiological signals, predicting clinical trajectory, and enhancing shared mental models across care phases. This review examines recent developments in artificial intelligence-enabled triage and decision support across prehospital, emergency department, and mass-casualty settings.

Machine learning models now predict lifesaving intervention needs from early prehospital data with performance comparable to expert judgment. Deep learning systems detect intracranial hemorrhage in real time, while dynamic risk scores continuously update mortality predictions during resuscitation. Artificial intelligence-enabled worklist triage accelerates critical imaging interpretation and procedural team activation. In mass-casualty scenarios, wearable sensors with automated triage algorithms maintain live patient classification, while drone-based computer vision enables contactless vital sign assessment. However, prospective evaluations reveal variable translation to measurable clinical benefit, requiring careful attention to usability, workflow integration, and ongoing calibration monitoring.

Artificial intelligence has the potential to strengthen trauma triage by supporting cognitive work under pressure, but realizing this benefit requires rigorous evaluation extending beyond discrimination metrics to include calibration, clinical utility analysis, and human factors assessment. The most meaningful role for artificial intelligence is augmentation rather than automation, protecting clinicians' cognitive capacity for sound judgment.

Social anxiety is a common and impairing condition that often emerges in adolescence.

This study aimed to examine the prevalence and severity of social anxiety among Chinese youths in the post-COVID-19 era, and to develop a predictive model identifying key factors associated with social anxiety severity.

A total of 555 youths aged 15-25 years completed an online survey via WeChat on social anxiety (Social Phobia Inventory), depressive symptoms (Patient Health Questionnaire), sleep problems (Pittsburgh Sleep Quality Index), social support (Multidimensional Scale of Perceived Social Support) and internalised stigma (Internalized Stigma of Mental Illness Scale). Social anxiety severity and rates were described, and comparisons were made across sociodemographic groups. Hierarchical multiple regression was used to predict social anxiety severity from depression, sleep, social support and stigma. An additional regression examined which components of social anxiety (fear, avoidance, physical symptoms) predict internalised stigma.

In total, 69.55% of participants reported at least mild social anxiety, with 20% reaching severe or very severe levels. Female, younger participants and those with fewer close friends reported significantly higher anxiety. Depressive symptoms (β = 0.31, P < 0.05) and internalised stigma (β = 0.40, P < 0.05) were strong predictors of anxiety severity, while sleep problems and social support were not significant after controlling for these factors. Among social anxiety dimensions, only avoidance significantly predicted higher stigma (β = 0.17, P < 0.01).

The high post-pandemic prevalence of social anxiety among youths highlights the need for early identification, stigma reduction and interventions targeting depression and avoidance to prevent long-term impairments.

Available data about sex differences in patients with acute aortic dissection (AAD) are scant and conflicting. The aim of this study is to assess sex-related differences in clinical characteristics, presentation, diagnostic findings, management, and outcomes among patients with type A (TA-AAD) and type B AAD (TB-AAD).

Data about 11 586 patients enrolled in the IRAD (International Registry of Acute Aortic Dissection) from 1996 to 2022, were analyzed; 7819 (67.5%) experienced TA-AAD and 3867 (33.0%) TB-AAD. Men and women were compared with regard to diagnosis, treatment, and in-hospital and long-term survival.

One third of patients were women (TA-AAD, 34.4%; and TB-AAD, 34.5%). Women were older than men for both types of AAD. The median time from hospital admission to diagnosis was longer in women for both TA-AAD and TB-AAD (P<0.001). For TA-AAD, symptoms of hypotension and coma/altered mental status were more common in women, whereas for TB-AAD women were more likely to present with congestive heart failure. Surgical repair for TA-AAD was less frequent in women than men (84.6% versus 89.0%; P<0.001). For both types of AAD, medical management was more common among women than men (TA-AAD, 16.5% versus 11.6%; P<0.001; TB-AAD, 65.6% versus 54.2%; P<0.001). The overall as well as surgical in-hospital mortality rate was higher among women with TA-AAD compared with men (P<0.001), whereas it was similar in those managed medically (P=0.23). No difference in overall (P=1), medical (P=0.38), endovascular (P=1), and surgical (P=0.51) mortality rates was observed for TB-AAD between men and women. After TA-AAD, women showed lower 4-year survival compared with men (81.4% versus 86.6%, P<0.001).

The present study highlights important sex-related differences in AAD; there is a need to design tailored aortic disease management programs to improve outcomes in women.

Stark disparities in the outcome of myocardial infarction (MI) persist, with large unexplained variations affecting younger Black women. Mental stress-induced myocardial ischemia (MSIMI) is an emerging mechanistic pathway that may help explain excess risks in this group. We sought to determine whether MSIMI is more common in Black women with recent premature MI than other demographic groups.

We cross-sectionally studied 602 individuals 61 years and younger who were hospitalized for MI in the previous 8 months. Participants underwent 99mTc-sestamibi myocardial perfusion imaging at rest and after mental stress (speech task). A summed difference score was used to quantify ischemia. Clinically significant MSIMI was defined as a summed difference score ≥3. Log-binomial and robust Poisson regression were used to adjust for sociodemographic, lifestyle, clinical, and psychosocial factors.

The mean age of patients was 51 years (range, 25-61 years), 46% were women, and 59% self-identified as Black. Black women had a more adverse psychosocial profile and higher rates of obesity and diabetes but a less severe index MI. The incidence of MSIMI was approximately doubled in Black women than the other groups (P<0.001 for interaction). Clinical and psychosocial risk factors did not explain these differences. In a fully adjusted model, the risk ratio of MSIMI for Black women was 2.2 (95% CI, 2.0-2.5) compared with Black men, 2.3 (95% CI, 1.8-2.9) compared with non-Black women, and 1.8 (95% CI, 1.4-2.2) compared with non-Black men.

Among midlife individuals with a recent MI, Black women have a disproportionately higher risk of MSIMI. Targeted interventions for this high-risk group are needed.

Neutrophil granulocytes actively contribute to tissue damage after ischemic stroke. The membrane protein CD177 is detectable on variable neutrophil numbers in most individuals (CD177 wild-type [CD177^WT] genotype), whereas ≈5% of the general population completely lack CD177 (CD177-deficient [CD177^null] genotype). Despite its known relevance in vasculitis, the role of ischemic stroke remains unknown.

In 2 prospective cohorts of patients with first-ever ischemic stroke (PROSCIS-B [Prospective Cohort With Incident Stroke Berlin], NOFF-S [Neutrophils: Origin, Fate & Function Stroke]), we assessed the effect of CD177^null and CD177^WT status on stroke severity and outcome (National Institutes of Health Stroke Scale and modified Rankin Scale) over 1 year or 3 months poststroke, respectively. By flow cytometry, we stratified CD177 expression level as CD177^neg, CD177^dim, and CD177^high. The predictive value of the CD177 state was evaluated by multivariable regression and discrimination analyses.

In PROSCIS-B (n=579; mean age, 68.1 years; 38.5% women) and NOFF-S (n=236, 68.4 years, 36.9% women), similar rates of patients were CD177^null (n=26 [4.5%] and n=10 [4.2%], respectively). Patients with CD177^null had a higher probability of unfavorable stroke outcome (modified Rankin Scale score 3-6) than patients with CD177^WT (n=8 of 21 [38.1%] versus 90 of 462 [19.5%] with follow-up, P=0.05, in PROSCIS-B; n=8 of 10 [80.0%] versus n=23 of 142 [16.2%] with follow-up, P<0.0001, in NOFF-S). This association remained when adjusted for age, sex, initial stroke severity defined by National Institutes of Health Stroke Scale score, stroke subtype defined by TOAST (Trial of ORG 10172 in Acute Stroke Treatment), and reperfusion treatment (risk ratio, 3.8 [95% CI, 2.0-7.1]; P<0.001, in NOFF-S). In NOFF-S, the proportion of CD177^dim neutrophils at admission was negatively associated with stroke severity at admission, while that of CD177^high neutrophils predicted a favorable clinical outcome after 3 months. CD177 expression level significantly improved the prediction of stroke outcome in addition to clinical adjustment variables in area under the curve, net reclassification improvement, and integrated discrimination improvement analyses (P=0.004, P=0.001, and P<0.001, respectively, for CD177^high).

CD177 expression at admission is an easy-to-measure biomarker for patient stratification. CD177 holds potential as a therapeutic target to modulate immune responses after stroke.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01363856.

Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing autoimmune disorder predominantly driven by anti-aquaporin-4 immunoglobulin G (AQP4-IgG), which mediates astrocyte injury, neuroinflammation, and demyelination. Satralizumab and Inebilizumab represent two promising therapeutic options with distinct mechanisms of action and clinical profiles. This study conducted a retrospective pharmacovigilance analysis of data from the U.S. FDA Adverse Event Reporting System (FAERS) from January 2020 to June 2025 to assess and compare adverse event (AE) reporting signals associated with Satralizumab and Inebilizumab. The analysis revealed a higher number of reported adverse events for Satralizumab compared to Inebilizumab (1,114 cases vs. 349 cases). A higher reporting proportion of AEs was observed in female patients for both drugs, with no statistically significant difference between them (exploratory p = 0.760). The reported AEs for both agents were primarily categorized under System Organ Classes (SOCs) such as infections and infestations and nervous system disorders. Urinary tract infection and pneumonia were among the most frequently reported preferred terms (PTs) for Satralizumab, whereas headache and COVID-19 were prominent for Inebilizumab. Reports classified as serious were more frequent for Satralizumab than for Inebilizumab (exploratory p < 0.01), noting that "seriousness" in FAERS may encompass outcomes related to underlying disease activity. This signal detection study highlights distinct adverse event reporting profiles for these biologics and offers insights that may inform clinical monitoring and personalized treatment strategies in NMOSD. Further studies with rigorous prospective designs are recommended to validate these findings and elucidate the mechanisms underlying the observed adverse events.

Young carers-youth aged 15 to 24 years who provide unpaid care to older adults-represent an essential yet often invisible component of Canada's caregiving landscape. Over one million young Canadians provide unpaid care to family members, with approximately 40% caring for older adults such as grandparents. As Canada's population ages and chronic illness prevalence rises, the number of young people assuming caregiving responsibilities continues to grow. Despite their significant contributions, young carers face unique challenges including impacts on mental health, educational attainment, and social development, often without formal recognition or support. This Perspectives article reviews the current evidence on young carers of older adults in Canada, examines their lived experiences, and identifies systemic gaps in health, education, and social systems. Unlike the United Kingdom, which has enacted legislation formally recognizing and supporting young carers, Canada lacks comprehensive policies and support structures for this population. Innovative programs are emerging, including foundational training for health professionals, online peer support communities, and cross-sector collaborations between health-care providers, educators, and community organizations. The article recommends actionable steps including legislative recognition of young carers, improved data collection and monitoring, expanded professional training, investment in peer support programs, and implementation of family-centered care models. Primary care teams are uniquely positioned to identify young carers, recognize their contributions, and connect families with available supports. Without adequate recognition and intervention, young carers remain at risk of long-term social, academic, and mental health difficulties affecting both themselves and those for whom they care.

Psychosocial interventions targeting cognition improve objective cognitive test performance, strategy use, emotional well-being, and quality of life in individuals with mild cognitive impairment and early dementia. These interventions have been labeled as cognitive training, cognitive remediation, cognitive rehabilitation, cognitive stimulation, and overlap with cognitive (psycho)therapy. The inconsistent labeling of the interventions has resulted in ambiguity of what a cognitive intervention entails and limits the translation of interventions into clinical practice. To address this, we propose a new framework, "PICC-M", that classifies cognitive interventions based on five active ingredients or the mechanisms resulting in clinically significant change. These ingredients are psychotherapeutic support (P), individualized patient goals (I), cognitive exercises (C), compensatory strategies (C), and metacognitive strategies (M). We examine three intervention programs to illustrate how this framework clarifies each intervention's active ingredients and their relation to cognitive, psychological, and functional outcomes. The PICC-M framework lays the foundation for dismantling studies to isolate and test the effectiveness of specific active ingredients and ultimately support clinical delivery of evidence-based interventions for older individuals with neurocognitive deficits.

To examine the effectiveness of Quality Control Circles (QCC)in remote Electrocardiography (ECG) network management, with a particular focus on evaluating their impact on improving operational standardization.

Electrocardiogram data from Qingdao Central Hospital was selected as the research subject. Among them, 402 cases collected from January to April 2024 were before the implementation of QCC activities, and 356 cases collected from January to April 2025 were after the implementation of QCC activities. The irregularity rates of the electrocardiogram data between the two groups were compared. By establishing QCC teams, issues related to non-standardized operations at the 12-lead ECG acquisition endpoints were analyzed, and targeted improvement measures were developed.

Following QCC implementation, the non-compliant operation rate at 12-lead ECG collection endpoints within the network system significantly decreased, from 17.66% to 6.17% (P<0.05), After QCC activities, members' team spirit, QC techniques, mental development, communication and coordination, activity confidence, responsibility and honorall show positive improvement.

QCC activities can effectively standardize ECG network operational procedures, enhancing the level of operational standardization and reducing the risk of misdiagnosis and missed diagnoses caused by non-standardized operations, thereby demonstrating clinical application value.