Hierarchical image classification is a fundamental challenge in medical image analysis, as tree-structured taxonomies inherently reflect biological and clinical relationships, spanning the general categorisation of disease entities and fine-grained cellular distinctions. Existing approaches primarily rely on multi-task learning and fine-grained detection, often requiring intricate model design and complex training strategies. In this paper, we aim to exploit the negative curvature property of hyperbolic space, which allows efficient representation of hierarchical structures. We propose a dual-geometry image-text framework, termed H²CL. Specifically, we introduce a lightweight classifier head on top of image backbones to extract both Euclidean and hyperbolic features, which are then combined to simultaneously preserve taxonomic consistency from an etiological perspective and enhance instance discrimination from a morphological perspective. Furthermore, a text branch is incorporated to integrate label semantics, where an entailment loss is employed to jointly model image-text alignment and inter-sample relationships. Extensive experiments on cervical cell, skin lesion, and gallbladder disease datasets demonstrate that our framework consistently outperforms advanced methods. Compared to the standard Swin Transformer, H²CL achieves an average accuracy improvement of 7% across all three datasets at the fine-grained level, with similarly consistent gains observed when integrated with other backbone models. The source code is publicly available at https://github.com/MCPathology/H2CL.

Perinatal mental health issues are a global problem that constitutes a significant part of the burden on maternal and infant health. This situation could pose a risk, especially for immigrant women, who are a vulnerable group.

This study aimed to investigate the effect of midwife-led education based on Pender's Health Promotion Model on the perinatal mental health of immigrant women.

This randomised controlled experimental study was conducted with 52 participants in the intervention group and 54 participants in the control group (n = 48 in the post-test). The study consisted of five interviews. While the pre-test was administered during the first interview in the pregnancy period, the post-test was administered in the first month postpartum. Data were collected through the Personal Information Form, the Edinburgh Postnatal Depression Scale, and the Perinatal Anxiety Screening Scale.

While the intervention group women's depression scores did not show a significant difference over time, the control group women's scores showed a significant difference. The intervention group had significantly lower depression scores in the third and fourth interviews. However, no significant difference was observed between the groups in terms of their anxiety scores.

The midwife- led education based on Pender's Health Promotion Model was found to protect and improve immigrant women's perinatal health. In light of these results, it is recommended that education programs may contribute to the development of perinatal mental health within the framework of midwifery care models should be planned and implemented in clinical practice.

With resistance to current frontline antimalarial treatments rapidly emerging in malaria endemic regions, there is an urgent need to identify new antimalarial compounds with novel mechanisms of action. Currently, no clinically used antimalarials target erythrocyte invasion, the process by which the short-lived, extracellular merozoite form of Plasmodium falciparum parasites enters a host erythrocyte. Following invasion, the parasite grows and then divides to form a schizont, containing merozoites that exit the host cell and invade new erythrocytes. To identify novel egress and invasion inhibitors, we screened the Medicines for Malaria Venture COVID Box (160 compounds) and Global Health Priority Box (240 compounds). Parasites were treated with the compounds at 1 μM during the egress and invasion period and across both libraries, 20 invasion inhibitors and two partial egress inhibitors were identified. A comparison of the growth IC₅₀ and invasion IC₅₀ of each hit compound revealed that invasion inhibition is likely central to the parasiticidal mechanism of six of the compounds, as their IC₅₀s for growth and invasion were similar. Of these six inhibitors, two (MMV006931 and MMV024850) were found to directly block the invasion of mechanically purified merozoites. We sought to identify the protein targets of these compounds through resistance selection and subsequent whole genome sequencing. We were able to select parasites with robust resistance to MMV006931 but not MMV024850. Genome sequencing of clonal MMV006931-resistant parasites identified mutations in the P. falciparum sterol exporter PfNCR1, which helps eliminate excess cholesterol from the parasite's plasma membrane. By demonstrating that MMV006931 sensitises parasites to lysis by a sterol-dependent detergent, we confirmed that PfNCR1 is the likely target of MMV006931.

Normalized quality of life represents a crucial long-term treatment goal in Crohn's disease (CD). We evaluated the effect of risankizumab (RZB) versus ustekinumab (UST) on achieving clinically meaningful improvements in patient-reported outcomes (PROs) in the phase 3b head-to-head SEQUENCE study.

Adults with moderate-to-severe CD who have failed prior anti-tumor necrosis factor therapy were randomized 1:1 to recommended induction and maintenance doses of RZB or UST. The proportion of patients who achieved Inflammatory Bowel Disease Questionnaire (IBDQ) response, IBDQ remission, and improvements in 36-item Short-Form Health Survey (SF-36v2) physical and mental component summary (PCS and MCS, respectively) scores was evaluated at weeks 24 and 48. The proportion of patients experiencing improvement in select symptoms of the IBDQ was reported.

Analysis included 520 patients (RZB: N=255; UST: N=265). At week 24, greater proportions (all P≤.01) of RZB- versus UST-treated patients achieved IBDQ response (75.3% vs 64.2%), IBDQ remission (52.5% vs 30.9%), and improvements in SF-36v2 PCS (65.9% vs 53.2%). At 24 weeks, lower proportions (all P≤.05) of RZB- versus UST-treated patients experienced fatigue (51.4% vs 69.1%), difficulty sleeping (37.7% vs 54.3%), depression (34.1% vs 42.6%), anxiety (34.1% vs 49.8%), and bowel urgency (27.1% vs 40.0%) "all of the time to some of the time." Improvements were sustained through week 48.

RZB was more effective than UST in achieving sustained clinically meaningful PRO improvements including IBDQ response and remission, and in reducing frequency of select symptoms of the IBDQ through week 48 among patients with moderate-to-severe CD.

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is an uncommon malignancy caused by textured implants. Specific implant characteristics or replacement patterns were investigated in relation to BIA-ALCL onset.

In this multicenter, retrospective case-control study, data were collected from 327 women (39±13 years) with breast implants and no malignancy, and 94 age-matched BIA-ALCL cases (1:4 matching), across one U.S. and two European centers. Surgery indication, implant manufacturer, volume, surface texture, indwelling time, and history of replacements were analyzed. Associations with BIA-ALCL were assessed using conditional logistic regression analysis.

All BIA-ALCL cases were linked to implant roughness >10µm. Implant volume was positively associated with 81% higher likelihood of BIA-ALCL (OR per 100cc= 1.81, 95%CI [1.35, 2.44]). Breast reconstruction was associated with 47% lower odds of BIA-ALCL compared to cosmetic augmentations (OR= 0.53, 95%CI [0.33, 0.85]). One implant replacement was associated with 82% lower likelihood of BIA-ALCL compared to no replacement (OR= 0.18, 95%CI [0.10, 0.31]). Replacing from textured to smooth (OR= 0.06; 95% CI [0.013, 0.303]) or smooth to textured implants (OR= 0.06; 95% CI [0.013, 0.303]) had significantly lower likelihood of BIA-ALCL, compared to receiving another textured implant.

Study findings of no BIA-ALCL association to specific manufacturers or to implant roughness <10µm, support the evidence that surgeons and patients should consider breast implant roughness in treatment decisions among primary or secondary asymptomatic patients.

Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy caused by loss-of-function variants in SCN1A, with seizures typically emerging during the first year of life. Although DS pathophysiology has largely been attributed to inhibitory network dysfunction underlying seizures, early developmental alterations in inhibitory interneurons remain poorly understood.

We generated inhibitory interneuron-enriched subpallial organoids from patient-derived induced pluripotent stem cells carrying an SCN1A loss-of-function variant and the corresponding isogenic control. Using complementary molecular and functional approaches, including quantitative polymerase chain reaction, bulk RNA sequencing, whole-cell patch-clamp electrophysiology, and two-photon calcium imaging, we investigated early inhibitory interneuron development and functional maturation in a human cellular context.

Transcriptomic profiling revealed early dysregulation of ventral forebrain interneuron developmental programs, including altered expression of medial ganglionic eminence-associated transcriptional regulators, preceding inhibitory network dysfunction. Patient-derived organoids exhibited marked reductions in intrinsic neuronal excitability and synaptic activity. Acute application of fenfluramine, a clinically approved antiseizure medication for DS, partially restored neuronal activity, demonstrating the translational relevance of this model.

These findings demonstrate that SCN1A loss of function disrupts early inhibitory interneuron development and functional maturation, defining a developmental vulnerability that likely precedes the emergence of epilepsy in DS. This work establishes patient-derived inhibitory organoids as a human-relevant platform for dissecting disease mechanisms and evaluating therapeutic responses in SCN1A-related epileptic encephalopathies.

Reflective supervision (RS) is a central component of Infant and Early Childhood Mental Health Consultation (IECMHC), providing mental health consultants (MHCs) with space to slow down, reflect on practice, and cultivate professional growth. This exploratory qualitative study examined how MHCs build the capacity and skills needed to develop an equity stance through RS. Sixteen mostly white and Hispanic MHCs from a Southwestern IECMHC program participated in individual interviews about their supervisory relationships and experiences addressing equity issues. Data were analyzed inductively to identify patterns and generate an emerging framework grounded in participants' experiences. We identified a developmental and relational process in which supervisors' behaviors gradually built trust and connection, cultivating safety as the foundation for reflective and equity-focused dialogue. Two interconnected themes captured this progression: (1) supervisors' behaviors that cultivate safety and foster equity dialogue, and (2) consultants' experiences of felt safety that support their willingness and vulnerability to engage in, or withhold from, equity dialogue. These findings align with relational-developmental and parallel process models of RS, extending existing literature by illustrating how intentional, equity-centered supervision supports consultants' capacity to engage in reflection and promote equitable outcomes for diverse children and families.

Cortical traveling waves (TWs) are brain oscillation patterns that support the transfer of neural information across distinct brain regions, with their direction shaping cognitive function. However, direct evidence for their causal influence on brain dynamics and behavior remains lacking. Here, we establish such a causal link by externally applying TW-like electric field patterns. To achieve this, we develop a noninvasive brain stimulation protocol, traveling-wave transcranial alternating current stimulation (twtACS). twtACS can generate a precise directional electric field that propagates across the cortical surface, which we validate using human intracranial recordings. In monkey recordings, we show that neural spiking was directionally modulated, shifting systematically across space in line with the direction of twtACS. In humans, twtACS led to direction-dependent improvements in cognitive performance. Together, these findings demonstrate that externally imposed TWs can causally shape neural activity and cognition, highlighting the potential of twtACS as a neuromodulation technique for cognitive enhancement.

Although underground metro systems enhance urban transportation, their potential mental health impacts remain a public concern.

This study aims to investigate the association between residential floor height, subway-induced noise and vibration, and depressive symptoms, and to evaluate the accuracy of conventional floor-to-floor prediction models.

Indoor noise and vibration were measured on all floors of a multistory building adjacent to the Tehran Metro. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9).

Noise and vibration levels decreased with increasing floor height, demonstrating a clear exposure gradient. Higher exposure was significantly associated with greater depressive symptom severity. PHQ-9 scores declined with floor level in the adjusted model ( β  = -0.33 points per floor, P  = 0.011). The Federal Transit Administration (FTA) predictions closely matched measured vibration but overestimated noise, with greater deviation at higher floors ( P  = 0.002). Notably, PHQ-9 scores exceeded the clinical cutoff (≥10) on all floors, including those below FTA allowable exposure limits.

The floor-to-floor reductions averaged approximately 2 dB for vibration and 2.6 dB for noise. Current predictive frameworks and uniform allowable exposure limits may underestimate the long-term psychological impacts across building floors. Refinement of exposure criteria, together with frequency-based noise evaluation, may better protect residents' mental health.