Parkinson's disease (PD) is a degenerative disease of the central nervous system with a high incidence in middle-aged and elderly populations. The global prevalence and incidence of PD are increasing, placing a heavy burden on the public health system. In recent years, a series of important breakthroughs have been made in the field of multi-modal imaging diagnosis, specific biomarker screening, genetic susceptibility analysis, and pathological mechanism exploration, which provide a key basis for the early and accurate diagnosis, subtype identification, and disease monitoring of PD. Acupuncture and moxibustion, as core therapies in traditional medicine, have become important adjuvant treatments for PD. This paper systematically reviews the latest research results in the field of PD diagnosis and treatment; expounds the theoretical basis of traditional Chinese medicine and modern pathophysiological mechanisms of acupuncture and moxibustion in the treatment of PD; summarizes the individualized treatment strategies, clinical application status, and guidelines recommended at home and abroad for acupuncture and moxibustion; and looks forward to future research directions and development prospects in this field. To provide a theoretical reference and practical basis for the precise diagnosis and treatment of PD using integrated traditional Chinese and Western medicine.

Aortic valve repair is a complex and evolving field that requires multidisciplinary teamwork among heart specialists to diagnose and treat various causes and mechanisms of aortic regurgitation and proximal thoracic aortic aneurysms across all age groups. From a surgical standpoint, aortic valve repair includes all procedures aimed at restoring or maintaining native valve function. This European Association for Cardio-Thoracic Surgery (EACTS) Expert Consensus Document critically evaluates the current evidence on the common causes and mechanisms of aortic regurgitation, the use of echocardiographic parameters in patient selection, intraoperative assessment, and prognostic evaluation as well as the surgical techniques in practice. It outlines fundamental surgical principles shared across different repair methods and provides consensus statements to guide clinical practice. These statements are intended for a broad audience, including paediatric and adult cardiologists, echocardiographers, cardiovascular imaging specialists, and cardiac surgeons. Where high-quality evidence is unavailable, the guidance relies on the collective experience and expert judgement of the multidisciplinary author team. This document presents the official stance of the EACTS and aims to promote standardized, evidence-based decision-making in the management of patients undergoing aortic valve repair.

Non-ischemic cerebral enhancing (NICE) lesions are rare delayed inflammatory brain lesions reported after flow-diverter (FD) treatment of intracranial aneurysms. We systematically reviewed their reported incidence, clinical and imaging characteristics, diagnostic findings, management, and outcomes.

We performed a PROSPERO-registered systematic review. MEDLINE, Embase, Scopus, and Cochrane CENTRAL were searched for reports of delayed NICE lesions after FD treatment of intracranial aneurysms that were not better explained by infarction or alternative causes. Two reviewers independently screened studies and extracted data. Findings were synthesized narratively because heterogeneity precluded meta-analysis.

Twenty-two studies met inclusion criteria; seven reported incidence data. One multicenter survey provided the only FD-specific denominator (12 NICE cases among 1201 FD-treated aneurysms; 1.0%), but the true incidence remains uncertain. Other estimates, using all aneurysm endovascular procedures as denominators, ranged from 0.05% to 1.3%. Overall, 40 unique FD-associated NICE patients were identified. Among cases with available individual data, median age was 54 years; all patients with reported sex were women, and all aneurysms with reported location involved the anterior circulation. NICE lesions appeared after a median of 73 days, most often with headache, focal deficits, or seizures, and as multifocal, predominantly ipsilateral enhancing lesions with edema on MRI. Brain biopsy was performed in six patients and identified hydrophilic polymer or other foreign material in four; in one additional case, device-coating detachment was observed directly. Both coated and uncoated FDs were represented, although the source component was usually undetermined. Systemic corticosteroids were administered in 22/24 cases with treatment data. Radiologic improvement or resolution occurred in 12/25, recurrent or fluctuating activity in 11/25, and 19/23 patients with reported functional outcomes were asymptomatic or independent at last follow-up.

Reported NICE lesions after flow diversion appear uncommon, but the true incidence remains uncertain. The available evidence supports a foreign-body inflammatory mechanism potentially related to hydrophilic coatings or other materials within the endovascular construct, without establishing a single culprit device. Corticosteroid-associated improvement is common, but relapsing or fluctuating courses require prolonged clinical and imaging follow-up.

PROSPERO CRD420251186127.

The ends of human chromosomes are capped by specialized nucleoprotein structures, termed telomeres, which are essential for genome stability. Recent advances in long-read sequencing have enabled allele-specific telomere length measurements at nucleotide resolution, uncovering extreme heterogeneity in telomere length between alleles. The progressive telomere shortening over time makes steady-state telomere length in human somatic cells a promising biomarker for age-associated diseases. However, the mechanisms underlying allele-specific telomere maintenance and its stability remain poorly understood. Here, we developed a high-resolution workflow combining PacBio and Nanopore long-read sequencing platforms to map allele-specific telomere length in human blood samples as well as cultured cell lines. By tracing allele-specific telomeric sequence in family members across multiple generations, we show that the allele-specific telomeric variant sequences (TVSs) are heritable and underlie the extreme heterogeneity of telomere length between alleles. Continuous cell proliferation likely drives the slow but stochastic evolution of allele-specific TVSs, resulting in asymmetry in telomere inheritance from father and mother (p-value = 2.354e-7). Targeted deletion of allele-specific TVSs using CRISPR-Cas9 resets telomere length, further confirming their causal role in the control of allele-specific telomere maintenance. These results indicated that TVSs are heritable genetic elements underlying the allele-specific telomere length.

Objectives. To determine whether mental health has changed among lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual or gender minority (LGBTQIA+) people in the United States since the November 2024 election. Methods. This longitudinal observational cohort study of LGBTQIA+ people in the United States (n = 2150) examined changes in mental health symptoms (depression, anxiety, posttraumatic stress disorder) from before (June 2023-May 2024) to after (November 2024-July 2025) the November 2024 election using fixed-effects models. Results. Individuals without clinically significant symptoms before the election evidenced worsening in these symptoms after the election, whereas those who screened positive before the election saw an improvement in these symptoms or conditions after the election (though still reflecting mean scores consistent with clinically significant symptoms). Transgender and gender-diverse people without clinically significant symptoms before the election experienced a greater worsening of anxiety and posttraumatic stress symptoms compared with cisgender people. Conclusions. Mental health symptoms have worsened since the November 2024 election among LGBTQIA+ people in the United States who did not have prior clinically significant symptoms. Public Health Implications. Health care providers and systems should be prepared to check on the mental health of LGBTQIA+ people who did not previously have mental health concerns. (Am J Public Health. 2026;116(11):1786-1789. https://doi.org/10.2105/AJPH.2026.308631).

Children with ADHD face significant unmet needs for timely post-diagnostic support in UK NHS services. Nature-based interventions represent a promising under-researched adjunct to conventional treatment. The CONIFAS2 study will assess the feasibility and acceptability of a co-produced, home-based, nature-based intervention embedded in NHS neurodiversity services.

This is a feasibility randomised controlled trial assessing recruitment, retention, intervention fidelity, data collection and acceptability of both the intervention and trial design. Participants will be children diagnosed with ADHD and their parent/guardian recruited as a dyad from NHS neurodiversity services. Following baseline assessment, dyads will be randomised to either intervention, which consists of structured daily nature-based activities with psychoeducational support, delivered alongside treatment as usual, or treatment as usual only. A mixed methods process evaluation, will refine a programme theory and identify barriers and facilitators to intervention delivery, engagement and implementation in a future definitive trial. A feasibility health economic evaluation will assess the feasibility of collecting resource use, cost and health-related quality of life data to inform a future cost-effectiveness analysis.

Findings will inform a future definitive trial and be disseminated via peer-reviewed publications, conference presentations, and community partners.

ISRCTN ISRCTN15490570.

In Uganda and other low- and middle-income countries, access to healthcare is constrained by shortages of health workers, long travel distances, and inadequate infrastructure. Telemedicine offers a potential solution, but its effectiveness depends on how key stakeholders perceive, accept, and experience it. This study explored the acceptance and experiences of telemedicine by policymakers, healthcare providers, and service users in Kampala, Uganda. An exploratory qualitative study was conducted between November 2024 and February 2025 at four sites in Kampala: Rocket Health, Uganda Cancer Institute, Butabika National Referral Mental Hospital, and the Ministry of Health. Participants were purposively selected to ensure direct experience with telemedicine. Data was collected through 15 key informant interviews with policymakers and healthcare providers and three focus group discussions with service users (patients and caregivers) who had accessed telemedicine within the previous year. Interviews and discussions were conducted in English or Luganda, audio-recorded with consent, and transcribed verbatim. Data were analyzed thematically using Braun and Clarke's six-phase approach, supported by NVivo 12 software. Three main themes emerged: perceived benefits, perceived challenges, and recommendations for improving telemedicine. Participants described telemedicine as convenient, reducing travel and contributing to cost and time savings. It also enhanced continuity of care, flexibility, privacy, and autonomy. These benefits were particularly evident among people with disabilities and digitally literate urban users. However, challenges included poor internet connectivity, limited infrastructure, low digital literacy, concerns about diagnostic accuracy without physical examination, and variable levels of trust, with some participants preferring in-person interaction. Telemedicine was perceived as acceptable and useful. However, its broader adoption is limited by structural, technical, and trust-related barriers. Addressing these challenges will require investment in infrastructure, strengthened digital literacy, provider training, increased public awareness, and a robust national telemedicine policy to support equitable and sustainable integration into healthcare delivery in Uganda.

Despite advances in cancer treatment, the growing global cancer burden underscores the need for comprehensive and supportive care to address the needs of patients and their families. However, access to psycho-oncological support remains often limited across healthcare systems. This could be related to factors such as resource constraints and insufficient integration of psychological care into routine oncological pathways. Individual-level barriers also exist, including low awareness of available services, stigma, and heterogeneity in patients' perceived needs and help-seeking attitudes. Nevertheless, psychological burden can significantly influence patients' experience of the treatment pathway, influencing cognitive clarity, perceived self-efficacy, communication, risk perception, decision-making, and all areas of daily life. In this context, digital mental health solutions have emerged as promising tools to enhance accessibility, continuity of care, and personalisation of support. In this manuscript, we aim to describe the structure of the ALTHEA project ("tAckling menTal Health cancer patients and their families: digital solutions for bEtter cAre"), which focuses on the development of a novel web-based digital platform targeting cancer patients and their informal caregivers' mental health across different stages of the care pathway. ALTHEA is distinguished by the presence of screening, classification into different support profiles, and tailored interventions within a single platform, as well as by its co-creation approach involving patients and stakeholders. In this line, the ALTHEA project represents a timely opportunity to integrate digital health solutions into psycho-oncology care, improving mental health outcomes, enhancing patient empowerment, and promoting a more holistic approach to cancer care.

Contingency Management (CM) involves the systematic application of positive reinforcement (financial incentives) to promote behaviour change, to improve treatment outcomes for individuals with opioid use disorder (OUD). To better understand patient heterogeneity, this study sought to identify meaningful subgroups/classes underlying the population based on characteristic groupings, followed by determining whether CM effectiveness varied between these subgroups.

Baseline characteristics (evidenced/theorised to impact CM effectiveness) of participants with OUD from the PRAISe trial (N = 552) were empirically examined using latent class analysis. Model selection was based on fit statistics and interpretability. Class was then evaluated as a potential moderator of CM effectiveness on abstinence from heroin using a mixed effects model (consistent with the PRAISe trial analysis).

A four-class solution best described the population: (1) Less clinically complex/low alcohol dependence/high motivation to quit heroin (N = 115); (2) More clinically complex/low alcohol/high motivation (N = 287); (3) More clinically complex/high alcohol/high motivation (N = 73); and (4) More clinically complex/moderate alcohol/low motivation (N = 77). CM for Attendance, previously shown to increase heroin abstinence in the overall study sample, was more effective than no CM for participants in class (1) and (2) exclusively (OR = 5.21; 95% CI 1.25, 21.78 and OR = 1.87; 95% CI 1.03, 3.40, respectively). CM targeted at abstinence, previously shown to not be effective compared to no CM overall, was not effective in any class.

CM targeted at attendance is more effective for two subgroups of the OUD population characterised by either less complex clinical presentation and/or low dependence on alcohol. Individual differences may therefore inform a targeted CM treatment approach.

This study examined associations between adverse childhood experiences (ACEs) and anxiety symptoms, depressive symptoms, lifetime suicidal ideation, and lifetime suicide attempt among African-origin emerging adults in the United States. Data were drawn from a cross-sectional, nonprobability online panel of 537 participants aged 18-29, comprising foreign-born first-generation African immigrants and U.S.-born second-generation participants with African-born parents. We assessed ACEs using an expanded cumulative index that included conventional household adversities and four community-level adversities. We used separate multivariable linear and logistic regression models to examine associations between ACEs and each mental health outcome. We also ran generation-stratified models and formal tests of ACEs × generation interactions. Higher ACE scores were associated with greater anxiety, depressive symptom severity, and higher odds of lifetime suicidal ideation and lifetime suicide attempt. Associations were statistically significant within both generational groups. Generation significantly moderated the associations between ACEs and suicidal ideation and suicide attempt, with stronger associations among first-generation participants. Generation did not significantly moderate the associations of ACEs with anxiety or depression. Second-generation participants had higher overall odds of suicidal ideation than first-generation participants. ACEs were consistently associated with adverse mental health outcomes among African-origin emerging adults in this U.S.-based online panel. The findings support culturally responsive, trauma-informed assessment and intervention while underscoring the need for longitudinal research examining how developmental, migration-related, and sociocultural contexts may contribute to these associations.