To determine whether short-term dehydration and hyperhydration affect OCT-derived retinal thickness in healthy young adults in a randomized cross-over design.

Sixty volunteers aged 18-35 years completed two morning sessions ≥7 days apart: 12-h fluid restriction, representing relative dehydration, and water loading, defined as ≥2 L within 4 h. Spectral-domain OCT (Zeiss Cirrus HD-OCT 7000) was performed by a masked examiner. Primary outcomes were central subfield thickness (CST) and mean peripapillary retinal nerve fiber layer (RNFL) thickness; secondary outcomes were cube average thickness (CAT) and ganglion cell-inner plexiform layer (GCL-IPL) thickness. Hydration was documented using a self-reported thirst scale and recorded water intake. Within-subject comparisons used the Wilcoxon signed-rank test.

Median age was 28.5 years and 65% of participants were female. Thirst was higher during dehydration than hyperhydration (P < 0.001). After review of OCT outputs and exclusion of outlying paired observations for GCL-IPL and CAT, the direction and statistical interpretation of the findings remained unchanged. CAT was slightly lower during dehydration in both eyes. CST was lower during dehydration in the left eye, with a similar non-significant trend in the right eye. RNFL thickness did not differ between hydration states in either eye. GCL-IPL thickness showed only a small right-eye difference and no significant difference in the left eye.

Acute fluid restriction was associated with small reductions in macular OCT thickness measures, whereas RNFL thickness remained stable. The magnitude of these changes was modest and close to expected OCT test-retest variability, suggesting limited clinical relevance for routine individual interpretation but potential relevance for highly standardized research or longitudinal imaging settings.

The gut microbiome is a dynamic microbial ecosystem regulating gastrointestinal, metabolic, immune, and neurobehavioral physiology. Dysbiosis has been linked to irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and systemic disorders including metabolic syndrome, autoimmune conditions, and neurodegenerative diseases. This narrative review synthesizes mechanistic, clinical, and translational evidence to delineate molecular pathways of microbiome-targeted interventions, evaluates clinical outcomes in IBS and IBD, and proposes a unified framework linking gastrointestinal modulation to systemic health. A structured literature search across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar (2012-2024) identified approximately 68 eligible sources, appraised using Cochrane Risk of Bias 2.0 and AMSTAR-2. Five principal molecular pathways were identified: competitive pathogen exclusion, epithelial barrier reinforcement, immune modulation, short-chain fatty acid (SCFA) production, and neurotransmitter signaling. Clinically, dietary strategies, biological agents (probiotics, prebiotics, synbiotics, postbiotics, and fecal microbiota transplantation [FMT]), advanced modalities (rifaximin, psychobiotics, bacteriophage therapy), and lifestyle interventions collectively engage these pathways. The same mechanisms underpin emerging applications in metabolic, autoimmune, neurological, and cardiovascular disease. We propose a three-tier model progressing from molecular mechanisms through gastrointestinal outcomes to systemic benefits, with precision medicine and standardized trial designs as prerequisites for therapeutic translation.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a central component of cardiovascular-kidney-metabolic (CKM) syndrome, reflecting shared pathways of insulin resistance, inflammation, and fibrotic injury that drive multi-organ disease. Affecting more than one-third of adults worldwide, MASLD frequently coexists with chronic kidney disease (CKD) and cardiovascular disease (CVD) and is associated with higher risks of kidney function decline, cardiovascular events, and mortality. Hepatic steatosis and fibrosis may amplify systemic metabolic stress and endothelial dysfunction, contributing to progressive kidney injury and adverse cardiometabolic outcomes. Despite this biologic and epidemiologic overlap, MASLD remains underrecognized in nephrology and cardiology practice. This gap represents a missed opportunity to identify patients at high risk of multi-organ complications early. Noninvasive liver fibrosis assessment, integrated with kidney and cardiovascular risk stratification, offers a practical approach to identifying patients who may benefit from intensified preventive strategies. Lifestyle modification remains foundational, while emerging pharmacotherapies, including glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and liver-directed agents, demonstrate potential cross-organ benefits. Coordinated management targeting metabolic dysfunction may slow the progression of kidney disease while improving hepatic and cardiovascular outcomes. This review highlights the clinical intersection of MASLD, CKD, and CVD and proposes a multidisciplinary framework for screening and management. Recognizing MASLD as part of systemic CKM disease can inform risk stratification, guide therapy selection, and support earlier intervention to mitigate the triple burden of liver, kidney, and cardiovascular complications.

Cardiovascular diseases are the leading cause of mortality worldwide, with atherosclerosis and formation of arterial plaques being a major underlying cause. Rupture or erosion of the plaque fibrous cap can result in thrombus formation, arterial occlusion, and a stroke or myocardial infarction. Plaque changes, and endothelial cell barrier leakiness, may result in material leakage, including proteins and fragments into plasma either directly or in extracellular vesicles (EVs). Here we report comparative LC-MS/MS analyses of plasma-derived EVs and plasma from subjects with impaired vascular status and healthy controls.  Analysis of plasma-derived EVs detected 7228 peptides and 763 proteins, with 87 proteins being differentially-abundant with these including arterial-cell species. Sub-group analysis based on biological sex showed no statistically-significant differences for males, whereas females exhibited 8 differentially-expressed proteins. Subject age effects were minimal. Plasma analysis detected 4366 peptides and 497 proteins, with 188 proteins being significantly altered in abundance between the groups. Subgroup analysis by biological sex revealed 103 differentially-expressed proteins in females and 84 in males. No differences were detected in specific collagen fragments. Gene Set Enrichment Analysis revealed altered biological processes related to immune regulation, humoral immune response, proteolysis, and cellular components including plasma lipoprotein particle, extracellular space, and membrane-associated structures. KEGG pathway analysis emphasized enrichment of pathways linked to complement and coagulation cascades, platelet activation, focal adhesion, endocytosis, and inflammation. Together, these data illustrate the potential of LC-MS/MS to examine the role of inflammation and arterial wall cells in shaping the proteome of EVs and plasma in health and disease.

Sexual dysfunction and distress are common among depressed patients and significantly affect their quality of life. This study aims to determine the prevalence of sexual dysfunction and distress and identify potential associated factors.

This cross-sectional study was conducted at a tertiary care hospital in Riyadh, Saudi Arabia, with data collection from April to June, 2025. The study involved 258 participants with depression aged 18-65, recruited using a convenience sampling technique. The study tool consisted of a questionnaire we developed to assess sociodemographic and other factors and the validated Arabic versions of the Female Sexual Distress Scale-Revised (FSDS-R) to measure sexual distress and the Arizona Sexual Experiences Scale (ASEX) to evaluate sexual functioning.

The ASEX mean total score was 18.04 ± 6.4, with 45.74% of participants exhibiting sexual dysfunction. A statistically significant relation was found between sexual dysfunction and female sex (p < 0.001), lower monthly income (p = 0.004), history of chronic diseases (p = 0.022), taking medications for them (p = 0.016), and experiencing physical symptoms (p = 0.001). The FSDS-R mean total score was 20.62 ± 14.4, and 72.09% were deemed to be experiencing sexual distress. A statistically significant relation was found between experiencing sexual distress and marital status (p = 0.008), having other psychiatric disorders (p = 0.048), positive history of smoking cigarettes (p = 0.010) and its duration (p = 0.024), and positive history of chronic diseases (p = 0.018).

The study highlights the concerning figures of sexual dysfunction and distress among patients with depression and that numerous factors could be associated with them. These findings underscore the need for a multidisciplinary approach involving teams from psychiatry, gynecology, and urology. The findings also reflect the need to screen for high-risk groups, such as those with other psychiatric and chronic medical illnesses. Moreover, the findings highlight the need for prevention, early detection, and effective intervention for sexual dysfunction and distress to mitigate their negative consequences.

Visual analog scales (VAS) serve as brief, informative patient reported outcome measures. The EQ VAS is an important component of EQ-5D instruments but is not currently included in the EQ-HWB-9. This study qualitatively assessed perceptions of alternative VAS constructs and recall periods for potential inclusion alongside the EQ-HWB-9 and quantitatively examined VAS ratings.

US adults who were: (1) diagnosed with chronic illness; (2) unpaid caregivers; (3) social care users (e.g., received caregiving, living with disability) completed an online survey and interview where they assessed VAS versions with health, health and wellbeing (HWB), and/or quality of life (QoL), as the specified construct. Participants discussed construct interpretation, appropriateness of recall periods (none, today, past 7 days), and whether these influenced their responses. Interviews were analyzed qualitatively through thematic analysis.

Among 34 participants, mean (SD) responses for health, HWB, and QoL were 61.9 (SD = 21.3), 60.9 (SD = 21.8) and 66.4 (SD = 21.5), respectively. All three VAS items were strongly correlated (r = 0.84-0.96). Interpretations of health focused on clinical, physical health more than mental/emotional health, HWB indicated mental/emotional health, and QoL evoked broader assessments encompassing finances or social-relationships. Most participants preferred having no specified recall period, allowing consideration of timeframes relevant to their experiences.

Although quantitative results suggested that the constructs of health, HWB, and QoL were similar, qualitative results found that they were perceived differently, highlighting the importance of a mixed-methods approach. Further research in larger samples and other countries could help to inform the extent to which constructs and recall periods affect VAS responses.

Up to 50% of patients treated with internet-delivered cognitive behavioral therapy (ICBT) for depression and anxiety disorders do not experience clinically significant symptom reduction. Identifying these patients prior to the initiation of ICBT can support treatment planning.

The aim of this study was to enhance baseline prediction of clinically meaningful improvement in patients treated with ICBT for common psychiatric disorders in routine care, which could ultimately inform treatment planning at intake.

We developed multimodal predictive models integrating clinical, sociodemographic, and genetic data available pretreatment to predict clinically meaningful improvement in a sample of 1790 patients treated with ICBT for major depressive disorder, panic disorder, and social anxiety disorder. We applied machine learning algorithms of varying complexity (logistic regression, random forest [RF], extreme gradient boosting, support vector machines, soft voting, and stacking ensemble), with nested cross-validation, elastic net variable selection, multiple imputation, and temporal validation in a 20% holdout test set (n=356). The primary performance measure was the area under the receiver operating characteristic curve (AUC).

All full phenotypic models showed comparable performance (AUCtest 0.732-0.749), with RF achieving the best holdout discrimination (AUCtest 0.749, 95% CI 0.698-0.797). Compared with the benchmark model based on self-reported screening data (AUCtest 0.695, 95% CI 0.637-0.748), RF and both ensemble models incorporating register data showed higher discrimination in paired DeLong tests (P=.04, P=.02, and P=.03, respectively), whereas polygenic scores added no independent predictive value in this cohort and modeling setup (P=.97).

These promising results support the feasibility of baseline prognostic prediction of clinically meaningful improvement after ICBT and provide a basis for the prospective validation of model-informed risk stratification.

Adolescents with depressive symptoms are at increased risk of social functional impairment and are more likely to develop major depressive disorder. Digital interventions offer advantages, such as high accessibility, especially for adolescents. However, evidence on the effectiveness of web-based psychological interventions in alleviating depressive symptoms among adolescents remains limited.

This study aims to develop a brief web-based psychological intervention tailored to the developmental and psychological characteristics of Chinese adolescents and to evaluate its effectiveness and influencing factors.

In a 2-arm randomized controlled trial, adolescents aged 12 to 18 years with depressive symptoms were recruited from high schools in China. Eligible participants were randomly assigned in a 1:1 ratio to the intervention group (n=212) or the control group (n=224). Participants in the intervention group received a 4-week brief web-based emotional cognitive training program, whereas those in the control group received a web-based psychoeducation program. Nonprofessional helpers provided minimal support through text messages or phone calls. The primary outcome was depressive symptom severity. Secondary outcomes included the depressive symptom remission rate, changes in anxiety symptoms, suicidal ideation, and resilience. Data were collected at baseline (T0), postintervention (T1), and at 1- and 3-month follow-ups (T2 and T3). Statistical analyses included analysis of covariance (ANCOVA), logistic regression analysis, and mediation analysis.

Two-way repeated-measures ANCOVA revealed a significant time effect (F_3,1461=82.515; P<.001; η²_p=0.140) on depressive symptom severity, with significantly lower scores at T1, T2, and T3 than at T0. No significant group effect (F_1,1461=1.039; P=.31; η²_p=0.001) or time-by-group interaction (F_3,1461=2.424; P=.06; η²_p=0.005) for depressive symptom severity was observed. Post hoc exploratory analysis showed that among adolescents with anxiety symptoms, the intervention group exhibited a higher depressive symptom remission rate at T1 than the control group (adjusted odds ratio 1.39, 95% CI 1.05-1.85; P=.02; number needed to treat=7). Additionally, the intervention group showed significantly greater improvements in the interpersonal support dimension of resilience at T1 (least squares mean difference=1.79, 95% CI 0.53-3.06; Cohen d=0.37, 95% CI 0.11-0.63; P=.006; false discovery rate-adjusted P=.04). Exploratory mediation analysis identified a significant indirect effect between the intervention and depressive symptom remission via the interpersonal support dimension of resilience at T1 (indirect effect=0.08, 95% CI 0.02-0.14; P=.009).

The brief web-based psychological intervention showed no significant difference from web-based psychoeducation in reducing depressive symptoms across the 3-month follow-up period. Post hoc exploratory analyses detected a potential between-group difference in depressive symptom remission among adolescents with comorbid anxiety symptoms, with interpersonal support showing a significant mediating association. These exploratory findings may provide new insights into identifying the target population suitable for brief web-based psychological interventions and inform the development of tailored interventions in the future.

Chinese Clinical Trial Registry ChiCTR2400090235; https://www.chictr.org.cn/showproj.html?proj=243991.

To identify the specific support needs of Black women navigating infertility care and generate strategies to improve access, patient experience, and outcomes.

Mixed-methods observational study SUBJECTS: Black women aged 18-45 years in the US who were currently seeking or had recently sought infertility care EXPOSURE: Online survey and semi-structured interviews MAIN OUTCOME MEASURE: Quantitative data on demographics and fertility care experiences; qualitative data on perceived support needs and recommended solutions RESULTS: 176 women responded to the online survey; of these, 41 women provided consent to participate in semi-structured interviews with the study team. Most participants (74.3%) were 35-45 years of age, married or partnered, held an advanced degree, worked full-time, and had insurance that covered some or all fertility services. 25.5% of participants reported feeling under-supported by friends, family, doctors, or others during their infertility journey, with 31.3% identifying this lack of support as a barrier to initiating treatment. Participants described feelings of loneliness and isolation, with few affirming spaces or communities to find resources and connect with other Black women with infertility. They also shared examples of racism, discrimination, and a lack of compassionate care that led to dismissal of health concerns and delays in referral to reproductive endocrinologists that complicated their infertility journeys. Study participants provided several suggestions for clinics and providers to improve the support of Black women seeking infertility care, from enhancing patient-centered care to increasing access to Black reproductive medicine and mental health providers.

Understanding the specific support needs of Black women seeking infertility care will inform patient-centered, compassionate, and culturally responsive care that improves the patient's experience and outcomes.

Digital media literacy (DML) may help adolescents to handle online risks, misinformation, digital violence, and problematic media use more reflectively. However, structured interventions for adolescents in child and adolescent psychiatry (CAP), particularly in inpatient and day-treatment settings, remain scarce.

This study evaluated the feasibility, acceptability, and perceived usefulness of a manualized DML group for adolescents in CAP and explored preliminary changes in digital self-efficacy and critical media literacy (CML).

A prospective single-arm feasibility study with an embedded pretest-posttest and session-level process evaluation was conducted across 3 CAP clinics in Germany. The intervention comprised 6 weekly 60-minute, manualized modules covering data protection, social media use, and digital violence. Sessions were delivered in an open-group format by trained clinical staff. Recruitment was embedded in routine care, and clinical group participation was independent of study evaluation. Adolescents and facilitators completed paper-and-pencil questionnaires at baseline (T1), after each session, and post intervention or discharge (T2). Analyses were primarily descriptive; exploratory pre-post analyses used paired t tests.

The analytic feasibility sample comprised 121 adolescents who attended at least 1 module. T1 data were available for n=60 and T2 data for n=38. Overall, adolescents attended a median of 2 modules (IQR 1-3; mean 2.46, SD 1.65, range 1-6), and 45 attended at least 3 modules. Session-level ratings indicated moderate to high acceptability. Facilitator-rated manual fidelity was moderate to high. Retrospective T2 ratings indicated moderate to high helpfulness (n=38; mean 3.55, SD 1.18; median 4.0, IQR 3.0-4.0) and satisfaction (n=38; mean 3.79, SD 1.07; median 4.0, IQR 3.0-5.0), with no significant differences between completers and noncompleters for helpfulness (U=125.00; P=.60) or satisfaction (U=122.00; P=.53). Among completers (≥3 modules and T2 data; n=28), didactic method acceptability was moderate (mean 2.85, SD 0.60), and perceived learning was moderate to high (mean 3.33, SD 0.95). Exploratory pre-post analyses indicated an increase in perceived self-efficacy for recognizing misinformation (n=21; T1 mean 2.94, SD 0.59; T2 mean 3.38, SD 0.63; t20=2.58; Hedges g=0.56, 95% CI 0.09-1.02; P=.02). Overall CML increased descriptively (P=.07), whereas digital media self-efficacy did not change significantly (P=.27).

Our manualized DML group was feasible and acceptable in routine CAP. Open-group delivery and variable treatment stays limited intervention exposure and data completeness. Findings suggest that brief DML groups may address safety- and knowledge-oriented competencies, but controlled mixed methods studies with systematic recruitment and missing-data documentation are needed.