Long-distance relationships (LDRs) reduce opportunities for physical intimacy, often prompting individuals to seek alternative sexual activities such as masturbation. Although common, its influence on sexual satisfaction, sexual health, psychological well-being, and relational stability in LDRs remains understudied. Moreover, cultural and population differences shape diverse meanings and perspectives on masturbation.

We employed a systematic review approach to explore the role of masturbation within long-distance relationships. Specifically, this review aims to examine how masturbation is associated with sexual, relational, and psychological outcomes and how these perspectives vary across cultural contexts.

A systematic review was conducted following the PRISMA guidelines, compiling both quantitative and qualitative studies on masturbation as an alternative sexual activity in LDRs as well as its implications for sexual satisfaction, relationship satisfaction, and psychological well-being.

Fourteen studies were eligible for further analysis in which men reported higher frequencies of masturbation compared to women, with significant increases observed in the context of long-distance relationships and during COVID-19 quarantine periods. Men were mainly motivated by biological release, orgasm, and stress reduction, often with pornography, whereas women reported broader motives such as relaxation, better sleep, stress relief, and emotional closeness. The effects on sexual satisfaction were mixed: masturbation was reported to be associated with greater body awareness, self-esteem, and relational harmony, yet excessive frequency was linked to lower satisfaction and arousal. Mutual, technology-mediated practices helped maintain intimacy, while excessive solitary use undermined relationship quality. From a sexual health perspective, moderate masturbation may be associated with indirect benefits through improved body awareness, whereas frequent use was linked to poorer experiences. Psychologically, it served as a coping strategy for sleep and stress, but excessive engagement increased anxiety and reduced emotional well-being.

Masturbation appears to be a common and potentially adaptive alternative sexual activity in the context of LDRs and during the COVID-19 pandemic. However, in Eastern contexts, its meaning and impact are strongly shaped by sociocultural and religious norms.

The ULTRA trial evaluated the impact of ultra-early and short-term tranexamic acid (TXA) treatment in patients with subarachnoid hemorrhage (SAH) and found no clinical benefit at six months. This post-hoc analysis examines whether TXA improves quality of life (QoL) at three and six months.

The ULTRA trial was a randomized, controlled, multicenter study conducted from July 2013 to July 2019. Patients received either TXA or standard care. This analysis included patients who completed at least one QoL questionnaire. The primary endpoint was QoL, assessed using the EQ-5D-3L questionnaire at three and six months. Linear mixed models adjusted for confounders were used to analyze the association between TXA and QoL.

Of the 955 ULTRA patients, approximately 25% died, and 63% completed at least one QoL questionnaire. At three months, the TXA group had a mean EQ-5D index score of 0.75 versus 0.71 in the control group (p = 0.11) and a mean EQ-5D Visual Analogue Scale (VAS) score of 89 versus 86 (p = 0.10). At six months, the mean EQ-5D index score was 0.84 in the TXA group compared to 0.82 in the control group (p = 0.23), and the mean VAS was 92 in the TXA group compared to 89 in the control group (p = 0.13).

Ultra-early and short-term TXA did not result in a significant improvement in QoL at three or six months in patients with SAH. Given the lack of benefit on both clinical outcome and QoL, routine use of TXA is not recommended.

Netherlands Trial Register: NTR3272.

gov: NCT02684812.

Brain arteriovenous malformations (BAVMs) are increasingly recognized as dynamic vascular diseases driven by endothelial genetic alterations and dysregulated signaling pathways, rather than as static structural anomalies. Accumulating evidence from both hereditary and sporadic forms of BAVMs has established endothelial signaling dysfunction as a central pathogenic mechanism underlying aberrant angiogenesis, progressive lesion remodeling, and vascular instability that predisposes to hemorrhage. These insights have fundamentally shifted the conceptual framework of BAVMs toward a pathway-driven disease model. Despite this progress, direct access to biologically informative molecular material from living AVM lesions remains limited, posing a major barrier to detailed mechanistic interrogation and the translation of molecular insights into clinical decision-making. Historically, molecular characterization of AVMs has relied almost exclusively on surgically resected tissue, restricting analyses to selected patient populations and frequently reflecting late-stage disease biology. Such approaches provide limited insight into disease initiation, temporal evolution, or treatment-induced molecular changes. Recent advances in minimally invasive biopsy strategies, particularly those leveraging endovascular access, have begun to overcome these limitations by enabling molecular interrogation of AVMs in vivo. In this mini review, we summarize emerging approaches for molecular profiling of AVMs, with a primary focus on BAVMs, while also drawing on relevant studies in extracranial and other arteriovenous malformations that share common endovascular access routes, technical principles, and translational implications.

The socio-economic situation in Lebanon has been dramatically deteriorating over the years affecting food insecurity (FI), psychological distress, and health-related quality of life (HRQoL). Therefore, the objectives of the study are to estimate the prevalence and severity of FI among Lebanese residents; evaluate the association between FI and psychological distress; and examine the association between FI and HRQoL.

A cross-sectional study was conducted among residents of Lebanon aged 18 years or older in 2024. The final sample included 519 participants. The Food Insecurity Experience Scale, Beirut Distress Scale (BDS), and EQ-5D-5 L were used to assess FI, distress, and HRQoL levels, respectively. The questionnaire also included sociodemographic and general health-related questions. Regression analysis was applied to explore the association of FI with psychological distress and HRQoL after adjustment for relevant covariates.

14.3% of the participants exhibited moderate to severe FI. A moderate level of HRQoL was shown with a mean of 74.18 (SD = 19.0) for the EQ-VAS. Moreover, FI was significantly associated with HRQoL and psychological distress. FI (B = 5.183), age (B = 0.092), gender (B = 3.998), employment status (B = 0.558), and job loss (B = 6.021), were significant predictors of the BDS (p < 0.05). Whereas FI (B = - 8.490), age (B = - 0.461), job loss (B = - 4.659), and household income (B = 1.466) were significant predictors of EQ-VAS (p < 0.05).

FI was associated with poorer mental health and lower HRQoL among Lebanese residents. This highlights the impact of the socio-economic crisis and provides data that could guide efforts to improve population health, especially for NGOs that are providing support to local communities.

To examine sociodemographic, clinical, and healthcare-related factors associated with preoperative health-related quality of life (HRQoL) among patients undergoing surgery for degenerative lumbar spine conditions in a multi-ethnic Asian population.

This cross-sectional study used baseline data from the Spine PROM Surgery Registry, including 1194 patients scheduled for surgery within a Singapore healthcare cluster between 2017 and 2022. HRQoL was measured using the EQ-5D-3L, with utility scores crosswalked to the EQ-5D-5L index using the van Hout crosswalk. Hierarchical linear regression assessed factors associated with HRQoL across three blocks: sociodemographic, clinical, and healthcare/lifestyle. Multivariable logistic regression identified factors associated with reporting problems within each EQ-5D dimension.

Mean age was 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities problems (84.3%) were most commonly reported. Lower EQ-5D scores were independently associated with non-outpatient presentation (β = -0.37), non-Chinese ethnicity (e.g., Malay: β = -0.10), secondary education (β = -0.15), and accident/trauma history (β = -0.11). Dimension-level analyses showed secondary education was associated with higher odds of problems in mobility (OR = 2.72), self-care (OR = 1.87), usual activities (OR = 1.80), and anxiety/depression (OR = 1.97). Non-outpatient presentation was associated with markedly higher odds of self-care problems (OR = 2.98).

Patients awaiting lumbar spine surgery appear to have impaired preoperative HRQoL. Although the modest explained variance limits robust risk prediction, preoperative profiles may still help inform clinical discussions and shared decision-making. Non-outpatient presentation may help identify patients who could benefit from enhanced preoperative support, although this requires prospective validation. Differences by ethnicity and education suggest opportunities for culturally tailored counselling. EQ-5D dimension profiles may indicate targets for prehabilitation and provide Singapore-based benchmark data for a lumbar spine surgery cohort for patient-centred care, service benchmarking, and health technology assessment.

Schools are critical settings for supporting student mental health; research is needed to identify key levers for addressing the impact of Adverse Childhood Experiences (ACEs) on students' relationships.

Drawing on survey data from rural high school students (N = 2902), we examine the associations between ACEs scores and multiple developmental relationships (parenting adults, teachers, peers, neighbors, program leaders). School-level engagement and support, and teacher relationships were also examined as potential protective factors.

Higher ACEs scores were associated with weaker developmental relationships across all groups. However, positive relationships with teachers and supportive school engagement and support slightly moderated the negative influence of ACEs on youths' relationships with parenting adults.

District and school leaders should support educators in building strong relationships with students by protecting their capacity, providing trauma-informed professional development, and ensuring access to mental health services for students and staff.

Building strong relationships with teachers and fostering a supportive and engaging school environment can be key strategies for buffering the risks associated with adversity and ultimately supporting young people's development of strong, healthy relationships.

Periodontitis, a chronic inflammatory disease, is increasingly prevalent among young people and impairs their quality of life. Adverse childhood experiences (ACE), depressive symptoms, and suboptimal health status (SHS) are linked to health risks and chronic diseases, but their interrelationships with periodontitis in Chinese young adults remain unclear. This study aimed to explore associations among these factors.

From December 2024 to May 2025, 2,888 participants (aged 18-35) from Tongji Hospital completed surveys on demographics, ACE, depressive symptoms, and SHS. Periodontitis was diagnosed according to the 2018 criteria. Simple, parallel, and chain mediation models were used, controlling for age, sex, marital status, and smoking.

Periodontitis prevalence was 25.00% and higher in married individuals (P < 0.001) and smokers (P = 0.004). ACE correlated positively with depressive symptoms (r = 0.28, P < 0.001), SHS (r = 0.19, P < 0.001), and periodontitis (r = 0.16, P < 0.001). Mediation analyses showed: Simple model: Depressive symptoms and SHS partially mediated the effect of ACE on periodontitis (indirect effect = 0.011 for both). Parallel model: Only SHS significantly mediated the effect (indirect effect = 0.011). Chain model: ACE was related to periodontitis via "depressive symptoms → SHS" (indirect effect = 0.010), with significant direct and indirect effects.

ACE associated with higher periodontitis risk in young people. This association included both a direct link between ACE and periodontitis, and an indirect link through the chain pathway of "depressive symptoms → SHS"; among these pathways, SHS was a key mediator.

The study was registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2500103464.

Incarcerated populations face greater health challenges, including higher rates of communicable and mental diseases. However, traditional health measures like disease prevalence and life expectancy do not capture their physical, mental, emotional, and social well-being. This scoping review will summarize the health-related quality of life (HRQoL) outcomes in incarcerated populations using preference-based HRQoL instruments (and measures that can be used to derive utility scores), providing insights for health policies and economic evaluations.

A scoping review was conducted following PRISMA-ScR guidelines. Six electronic databases and three health technology assessment agencies were searched for peer-reviewed studies reporting preference-based HRQoL or HRQoL scores that can be used to generate health state utility values in incarcerated populations. Eligibility and data extraction were performed by two independent researchers.Findings were synthesized to identify knowledge gaps.

Twenty-two articles met the inclusion criteria, primarily focusing on male and white populations. Ten studies targeted disease-specific populations, with mental health disorders (n = 7) being the most prevalent. Across studies, inmates generally reported lower HRQoL scores than the general population, especially those with mental health issues. Female and Indigenous inmates had lower HRQoL scores than male and non-Indigenous inmates.

The variety in HRQoL instruments used, with each assessing different domains, hinders direct comparisons between studies. Validating instruments specific to incarcerated populations may be needed for future research. Overall, incarcerated populations, especially women and Indigenous inmates, demonstrate poorer HRQoL than the general population. There is a need for more diverse, inclusive studies to address these gaps.

Diabetes mellitus is a rapidly growing global health challenge and a major driver of atherosclerotic cardiovascular disease (ASCVD). Dyslipidaemia, highly prevalent in both type 1 and type 2 diabetes, plays a central role in this excess cardiovascular risk and often persists despite statin therapy. Although statins remain the cornerstone of lipid management, many patients with diabetes do not achieve recommended low-density lipoprotein cholesterol (LDL-C) goals. Therefore, there is a need for effective, safe, and practical adjunctive therapies. Bempedoic acid is a first-in-class oral ATP-citrate lyase inhibitor with liver-specific activation, resulting in significant LDL-C reduction without relevant muscle-related adverse effects. Across clinical trials, including the CLEAR programme, bempedoic acid has demonstrated consistent LDL-C lowering, as well as reductions in apolipoprotein B and non-HDL-C, and favourable effects on the inflammatory marker high-sensitivity C-reactive protein (hs-CRP), with similar efficacy in patients with and without diabetes. Importantly, the CLEAR Outcomes trial showed a significant reduction in major adverse cardiovascular events in statin-intolerant patients, almost half of whom had diabetes, without adverse effects on glycaemic control. This article summarises the evidence supporting the use of bempedoic acid in people with diabetes, proposes its therapeutic positioning within contemporary lipid-lowering algorithms, and highlights its role as an effective oral option, aiming to provide practical and nationally relevant guidance for lipid management in people with diabetes. By helping to reduce residual cardiovascular risk and bridge treatment gaps in patients who may not be eligible for or have access to PCSK9 inhibitors, bempedoic acid represents a valuable addition to personalised lipid management strategies aimed at lowering cardiovascular morbidity and mortality in this high-risk population.

Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus characterized by impaired wound healing and high amputation risk. Current treatments remain unsatisfactory, necessitating exploration of novel molecular mechanisms. The transcription factor CCAAT enhancer binding protein delta (CEBPD) regulates inflammatory responses and cellular stress pathways implicated in diabetic complications. However, its specific role and mechanism in DFU pathogenesis are poorly understood. Human umbilical vein endothelial cells (HUVECs) were exposed to high glucose (HG) to mimic diabetic conditions. C-X-C motif chemokine ligand 10 (CXCL10) and CEBPD mRNA expression were analyzed by quantitative real-time polymerase chain reaction. The protein expression of CXCL10, CEBPD, and glutathione peroxidase 4 (GPX4) was detected by western blotting assay. Cell viability was analyzed by a cell counting kit-8 assay. Cell proliferation was analyzed by a 5-ethynyl-2'-deoxyuridine assay. Cell apoptosis was detected by flow cytometry. Cell migration was analyzed by a wound-healing assay. Tube formation was analyzed by a tube formation assay. Fe²⁺ and malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity were analyzed by colorimetric assays. Reactive oxygen species (ROS) levels were analyzed by fluorometric assay and flow cytometry. The chromatin immunoprecipitation (ChIP) assay and dual-luciferase reporter assay were used to analyze the association of CXCL10 and CEBPD. The effect of CEBPD knockdown on HG-induced cell injury was further analyzed using a DFU rat model. CXCL10 and CEBPD expression were significantly upregulated in DFU patients and HG-stimulated HUVECs. CXCL10 knockdown reversed HG-induced cellular damage, restoring proliferation, migration, and tube formation while suppressing apoptosis and altering ferroptosis-related indicators (evidenced by reduced Fe²⁺/MDA/ROS and elevated SOD/GPX4). Crucially, CEBPD transcriptionally activated CXCL10, confirmed by promoter binding (ChIP) and luciferase activity. Silencing CEBPD replicated the protective effects of CXCL10 knockdown, and CXCL10 overexpression attenuated CEBPD knockdown-induced effects in HG-treated HUVECs. In vivo, CEBPD knockdown accelerated diabetic wound closure in rats, enhancing collagen deposition and tissue regeneration. CEBPD exacerbated human umbilical vein endothelial cell dysfunction at least partly through the transcriptional regulation of CXCL10, and CEBPD knockdown accelerated diabetic wound healing in vivo, suggesting that targeting the CEBPD/CXCL10 interplay may serve as a potential therapeutic strategy for DFU.