Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening neurological emergency triggered by an adverse reaction to dopamine receptor antagonists, particularly antipsychotics. Its clinical significance lies in both its high mortality risk and the diagnostic and therapeutic challenges NMS presents. Integrated Behavioral Health (IBH) models emphasize collaborative, interdisciplinary care that unites medical and mental health providers to address the full spectrum of patient needs. Nurse practitioners (NPs), with their holistic and patient-centered framework, are uniquely positioned to lead and contribute meaningfully within IBH teams. This case highlights the application of an NP-led IBH team in the successful early recognition of NMS in a resource-limited homeless shelter setting. Despite the diagnostic complexity and significant fatality risk associated with NMS, the NP's role was central in diagnosis with timely escalation of care, care coordination, and continuity of treatment through an integrated approach.

The mental health development of preschool children has garnered increasing societal attention. However, empirical studies on mental health curriculum programs for preschool children in China remain limited. This study aims to evaluate interventions suitable for emotion regulation and stress coping strategies among preschool children and to provide a reference for early intervention that promotes their mental well-being.

This study was designed as a cluster randomised controlled trial conducted in two public kindergartens in Shanghai. Preschool children from middle and senior classes were recruited. To minimise classroom contamination, cluster randomisation was performed to assign classes to either the intervention group or the waiting-list control group. The intervention group received a 10-week Child Emotion and Stress Intervention Program (CESIP), delivered once weekly for 30 min, while the control group continued their regular kindergarten curriculum during the study period and did not receive any CESIP-related training or activities. Parents or caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and the Inventory of Callous-Unemotional Traits (ICU) at baseline (pre-intervention) and immediately after the intervention (post-intervention). Group differences in changes from pre- to post-intervention were examined using a difference-in-differences (DID) framework, operationalised through the group-by-time interaction term.

A total of 211 children (intervention group: n = 97; waiting-list control group: n = 114) completed both assessments. DID analyses showed no significant group differences in changes across SDQ subscales (all p > 0.05). In contrast, compared with the waiting-list control group, the intervention group demonstrated significantly greater reductions in ICU uncaring scores (DID estimate = -0.16, 95% CI [-0.31, -0.01], p = 0.039) and ICU total scores (DID estimate = -0.11, 95% CI [-0.20, -0.01], p = 0.035).

The CESIP intervention did not produce differential effects on behavioural difficulties but was associated with significant improvements in callous-unemotional traits, particularly uncaring characteristics, among preschool children. These findings suggest that classroom-based emotion and stress interventions may be beneficial for specific aspects of emotional development in early childhood.

Athlete burnout significantly affects both athlete well-being and performance, potentially influenced by dietary patterns, sleep quality, screen time, and stress-coping strategies. However, the mechanistic interplay among these factors remains unclear. This study utilized a cross-sectional design to examine the relationships between daily health behaviors (including diet, sleep, and screen time), stress coping strategies, perceived psychological strain and athlete burnout among Chinese competitive swimmers.

A comprehensive questionnaire was developed, encompassing demographic information, eating behavior (BEDA), sleeping behavior (ASSQ), screen time, stress coping strategies (CSCA), perceived psychological strain (APSQ), and athlete burnout (ABQ). This questionnaire was administered online and distributed to participating athletes through a snowball sampling method during the 2024 Shanghai Youth Swimming Competition to enhance the sample size.

Data from 1,071 swimmers (477 females, 44.5%) revealed through Lasso regression analysis that perceived psychological strain emerged as the strongest predictor of athlete burnout (β = 5.07), followed by age (β = 2.19) and athlete level (β = 3.76). Sleep disturbances (ASSQ) demonstrated a weaker yet significant contribution to ABQ (β = 0.92). A temporal inflection point in age-related burnout trajectories was identified at 19 years.

This study identified psychological strain (APSQ) as the strongest predictor of burnout (ABQ) among Chinese swimmers (β = 5.07), underscoring the critical need for strain-specific management in prevention strategies. The significant effects of advancing age (β = 2.19) and increased training load (β = 3.76) further revealed the developmental nature of burnout across career stages, necessitating age-targeted interventions. Although sleep disorders (ASSQ) had a weaker influence (β = 0.92), their significant role supports the integration of sleep quality enhancement into a holistic strain-sleep intervention framework. These findings provide a novel pathway for athlete mental health management through prioritized strain regulation, hierarchical age-specific interventions, and synergistic sleep-stress protocols.

The recreational use of cannabis is a significant (and growing) contemporary public health issue, confounded by the rapidly changing state and federal marijuana regulation and legislation. As of 2025, 24 states and the District of Columbia have legalized cannabis for medicinal and recreational use, and 39 of the 50 states have legalized it for medicinal use. With the increased use of recreational and medicinal marijuana, there has been an uptick in emergency department (ED) visits for cannabis-related illnesses, including gastrointestinal, cardiac, and mental health disorders. Nausea and vomiting, which are the hallmarks of cannabinoid hyperemesis syndrome (CHS), have been reported as the most common reasons for cannabis-related ED visits in nationwide ED data set analysis. Emergency department staff need to be familiar with CHS, its presentation, pathophysiology, and treatments to quickly recognize, diagnose, and triage/treat patients suffering from this acute cannabis-related GI illness.

Combination therapies with immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have revolutionized the landscape of cancer treatment, improving the quality of life and overall survival of patients. A deep knowledge of the side effects of ICIs and TKIs combination therapy is mandatory to ensure patient compliance and improve clinical outcomes. Both ICIs and TKIs may cause endocrinopathies such as thyroid dysfunction, adrenal insufficiency, hypophysitis, and diabetes mellitus. To avoid life-threatening conditions and improve patient’s compliance and outcomes, an early diagnosis of endocrine toxicity should be achieved and a multidisciplinary approach involving both endocrinologists and oncologists may be beneficial. This review specifically examines the endocrine adverse events reported in the clinical trials of ICI plus TKI combined treatment, their underlying mechanisms, and practical management guidelines.

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Approximately 10% of cancers are attributable to heritable germline variants, yet identification of individuals at risk remains suboptimal.

To assess the feasibility of personal history and family health history (FHH) risk assessment technology via the electronic medical record (EMR) to enhance identification of patients at risk for a broad array of inherited cancer syndromes.

This single-arm, nonrandomized clinical trial was completed from October 1, 2021, to September 1, 2023, with no follow-up period in unselected patients receiving care at Vanderbilt University Medical Center. Adult patients (aged ≥18 years) were invited through their EMR patient portals to complete an eligibility survey. Eligible participants completed the survey, were English speaking, and had no prior genetic counseling. The data analysis was performed between August 15 and November 7, 2025.

Electronic medical record-integrated risk assessment platform that collected self-reported personal history and FHH to assess risk for 24 hereditary cancer syndromes.

The primary outcome was the completion rate of the risk assessment platform. Secondary outcomes included the percentage of newly identified participants meeting guideline criteria for genetic counseling and whether previsit FHH collection increased genetic counseling capacity by decreasing time spent in counseling.

A total of 1685 patients were consented to participate (mean [SD] age, 55.4 [15.1] years; 1217 female [72.2%]; 95 of Black or African American [5.6%] 1405 of White [83.4%], and 181 of other [multiracial, other, or unknown] [10.6%] race; 38 of Hispanic or Latino [2.3%], 1388 of non-Hispanic or Latino [82.4%], and 111 of unknown [6.6%] ethnicity). Among participants consented, 1483 (88.0%) were provided access to the risk assessment, 1106 (74.6%) started the assessment, 636 (57.5%) completed it, and 544 (49.1%) received a risk report. Younger age and unknown race and ethnicity were the only significant variables associated with completion (mean [SD] age, 53.5 [15.3] vs 56.9 [14.8] years for completers vs noncompleters, respectively; unknown race, 77 [14.2%] vs 43 [7.6%] for noncompleters; unknown ethnicity, 49 [9.0%] vs 20 [3.6%] for completers vs noncompleters, respectively). Among participants who completed the risk assessment, 155 (28.5%) met guideline criteria for genetic counseling, yet 74 (47.7%) were previously identified as at risk by billing codes. A total of 31 participants (20.0%) eligible for genetic counseling attended. Manual outreach efforts and counseling duration did not differ between risk assessment-assisted and usual care visits.

In this nonrandomized clinical trial, almost one-third of the population met national genetic counseling criteria for an inherited cancer syndrome, highlighting a substantial gap in usual care identification. Integrating patient-facing FHH collection and assessment tools for primary care patients improves inherited cancer risk identification and highlights opportunities to further enhance both risk assessment processes and genetic counseling attendance.

ClinicalTrials.gov Identifier: NCT05079334.

Intravesical bacillus Calmette-Guérin (BCG) therapy remains the standard adjuvant treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), yet real-world maintenance delivery is frequently incomplete. Contemporary benchmarks that link BCG exposure patterns to clinically meaningful outcomes are needed. We evaluated real-world BCG treatment delivery and oncological outcomes in a tertiary cancer center cohort.

We retrospectively analyzed 120 consecutive patients with NMIBC who initiated intravesical BCG between June 2019 and May 2025. The institution-defined minimum BCG exposure was induction (≥5/6 instillations) plus initial maintenance (≥2/3 instillations) or re-induction (≥2/6 instillations). High-risk recurrence-free survival (HR-RFS) was defined as time from BCG initiation to high-risk NMIBC recurrence or pathological upstaging. Progression-free survival (PFS), metastasis-free survival (MFS), and overall survival (OS) were estimated using the Kaplan-Meier method.

Median age was 73 years; pT1 disease occurred in 45.8%, concomitant carcinoma in situ in 29.2%, and high-grade tumors in 98.3%. Induction (≥5/6) was delivered in 94.2% of patients, and an initial maintenance cycle (≥2 instillations in cycle 1) in 68.3%; 73.3% achieved the minimum BCG exposure. Only 2.5% completed maintenance through cycle 7. At a median follow-up of 33.5 months, median HR-RFS, PFS, MFS, and OS were not reached. One-, three-, and five-year HR-RFS rates were 91.4%, 76.7%, and 73.0%; corresponding PFS rates were 98.3%, 92.5%, and 92.5%; MFS rates were 99.2%, 93.3%, and 93.3%; and OS rates were 98.3%, 97.3%, and 86.2%.

These data provide contemporary real-world benchmarks for outcomes achieved with conventional intravesical BCG in high-risk NMIBC when long-term maintenance completion is uncommon.

DICER1 syndrome is a complex autosomal dominant tumor predisposition disorder characterized by a distinct chronological progression of benign and malignant lesions. By mapping the transition from early-childhood pulmonary and renal manifestations to the adolescent emergence of endocrine and reproductive neoplasms, this review provides a longitudinal framework for clinical vigilance. Central to this analysis is the molecular "two-hit" mechanism, specifically investigating how somatic hotspot mutations in the RNase IIIb domain disrupt the miR-140/FGF9 signaling axis and the let-7 feedback loop. The review identifies the neomorphic "Argonaute strand switch" as a primary driver of pathogenesis, resulting in a diagnostic 3p-strand bias that fuels sarcomatous transformation. Beyond the molecular substrate, we define the critical radiographic and clinical markers of malignancy, such as rapid volumetric growth, cystic solidification, and the detection of somatic hotspots via high-sensitivity droplet digital PCR. By integrating the 2024 international surveillance standards with emerging technologies, including Vision Transformer-based radiographic analysis and circulating tumor DNA monitoring, this review offers a proactive, evidence-based roadmap for identifying the predictors of malignancy and better management of the disease. Ultimately, this synthesis aims to equip clinicians and other healthcare profesionals with the predictive tools necessary to achieve definitive cures while minimizing the cumulative clinical and psychological burden on this genetically vulnerable population.

Nurses are one of the professional groups most exposed to psychosocial risks. Excessive responsibilities, time pressure, the need to make quick decisions, shift work, lack of adequate rest, contact with death and human suffering - all these factors can significantly affect the mental state and result in the development of health problems among nursing staff.

The study was conducted among 193 nurses working at the University Clinical Hospital No. 2 of the Pomeranian Medical University in Szczecin. Participation in the study was anonymous and voluntary. The study used a proprietary questionnaire and the following standardized tools: PSS-10, FAS, AIS and MBI.

The aim of the study was to identify psychosocial health risks among nursing staff working in a shift system.

More than half of the respondents (52.85%) showed moderate fatigue according to FAS. It was found that 66.32% of respondents suffered from insomnia according to AIS, 66.84% of respondents experienced high levels of stress according to PSS-10. It was shown that 45.60% of respondents had high levels of emotional exhaustion, 43.01% had high levels of depersonalization, and as many as 73.06% had high levels of lack of accomplishment according to MBI. Fatigue (FAS) and insomnia (AIS) showed significant positive correlations with emotional exhaustion and depersonalization, as well as negative correlations with a sense of professional achievement.

Overall, the findings indicate that shift work constitutes a significant psychological health risk for nurses, with stress, fatigue, sleep disturbances, and burnout forming a closely interrelated cluster of adverse outcomes. The observed associations suggest that chronic occupational strain may reinforce emotional exhaustion, depersonalization, and reduced professional efficacy. Moreover, work organization and length of service appear to play an important role in shaping nurses' vulnerability to these risks. These results highlight the need for targeted organizational and preventive strategies aimed at reducing psychosocial burden and supporting mental well-being among shift-working nursing staff.

Due to its long-term effectiveness in weight control and cost-efficiency, bariatric metabolic surgery (BMS) has emerged as a promising treatment option for patients with severe obesity. However, its impact on certain mental health disorders remains unclear.

This study aimed to utilize a deep learning (DL) model, DeepBiomarker2, which integrates social determinants of health (SDoH) and electronic health records (EHR), to identify clinical features associated with new-onset anxiety disorder following BMS.

We conducted a case-control study using longitudinal EHR data from the University of Pittsburgh Medical Center (Jan 2004-Oct 2019) on patients who underwent bariatric surgery. DeepBiomarker2, a DL model integrating diagnoses, medications, lab tests, and neighborhood socioeconomic status, predicted new-onset anxiety. Perturbation-based contribution analysis identified key predictive features.

A total of 14,856 eligible patients who underwent BMS without a prior history of anxiety disorder were identified. DL models outperformed traditional logistic regression in predicting post-BMS anxiety, yielding area under the curve (AUC) values exceeding 0.89. Key features associated with post-BMS anxiety included abnormal urine and blood lab results, opioid and psychiatric medication use, frequent emergency department (ED) visits, and pre-existing mental health conditions. Potential protective indicators included omega-3 fatty acids, vitamin B12, calcium citrate, and pravastatin. Inclusion of nSES data led to marginal improvements in model performance.

Our DL models successfully identified clinical features potentially associated with new-onset anxiety following BMS, offering valuable insights to support early intervention and personalized mental health strategies for postoperative care.