Older adults with atrial fibrillation (AF)-associated acute ischemic stroke are prone to disability, depressive symptoms, and falls; the prognostic value of vitamin D status is uncertain.

We conducted a single-center prospective cohort study of patients aged ≥65 years with ECG-confirmed AF and imaging-confirmed acute ischemic stroke at a tertiary hospital in China (January 2022-August 2024). Serum 25-hydroxyvitamin D [25(OH)D] within 48 hours was modeled per 10 ng/mL decrement and as <20 vs ≥20 ng/mL. Outcomes were 3-month modified Rankin Scale (mRS) shift, Barthel Index (BI), and PHQ-9 ≥10, plus 12-month time to first fall (death as a competing event) and total falls rate. Models adjusted for prespecified baseline confounders.

Among 802 participants, median age was 76.2 years (IQR, 71.6-80.6); 60.7% had 25(OH)D <20 ng/mL. Three-month mRS/BI, 3-month PHQ-9, and falls follow-up data were available for 776 (96.8%), 762 (95.0%), and 742 (92.5%) participants, respectively. Each 10 ng/mL lower 25(OH)D was associated with worse 3-month mRS shift (common OR 1.17, 95% CI 1.05-1.31) and lower BI (β -3.9, 95% CI -6.2 to -1.6). Depressive symptoms occurred in 16.8% and were more common with 25(OH)D <20 ng/mL (OR 1.54, 95% CI 1.07-2.22). Among 742 with falls follow-up, low 25(OH)D predicted first fall (HR 1.29, 95% CI 1.07-1.55) and a higher recurrent falls rate (IRR 1.33, 95% CI 1.10-1.61).

Lower baseline 25(OH)D was consistently associated with poorer functional recovery, greater depressive symptom burden, and higher fall risk and recurrence, supporting 25(OH)D as a pragmatic prognostic marker; multicenter validation and targeted trials are warranted.

Inflammatory activation is involved in the pathogenesis of heart failure (HF). ATPase H+-Transporting Accessory Protein 2 (ATP6AP2) is an auxiliary subunit of the V-ATPase, and its role in HF is not fully understood. To assess the role and regulatory mechanisms and therapeutic potential of ATP6AP2 in HF, we used a cardiac-specific ATP6AP2 conditional knockout (CKO) mouse model and observed spontaneous cardiac dysfunction, myocardial fibrosis and cardiomyocyte apoptosis in mice. Further studies showed that ATP6AP2 promoted stimulator of interferon genes (STING) degradation through the lysosome-dependent pathway. ATP6AP2 knockdown significantly upregulated STING protein levels, activated the STING-TBK1-IRF3 signaling axis, and promoted pro-inflammatory factor expression and cardiomyocyte apoptosis. In mice with myocardial infarction (MI), myocardial overexpression of ATP6AP2 or treatment with H-151 inhibited the activation of the STING signaling pathway, ameliorated cardiomyocyte apoptosis and inflammatory responses, thereby improving cardiac function. In addition, in macrophages treated with conditioned medium from hypoxia-exposed cardiomyocytes, the levels of pyroptosis-related proteins were markedly increased, whereas ATP6AP2 overexpression or STING inhibition reduced pyroptosis. ATP6AP2 likewise attenuates inflammation and pyroptosis caused by hypoxia in cardiac organoids. In conclusion, activating ATP6AP2 could serve as a promising therapeutic option in HF.

Children and young people (CYP) with life-limiting conditions (LLCs) comprise a clinically heterogeneous population with diverse disease trajectories and survival patterns. However, studies evaluating long-term survival according to disease group and sociodemographic characteristics remain limited.

We assessed long-term survival patterns among CYP with LLCs and evaluated differences in mortality outcomes according to disease group and selected sociodemographic characteristics.

Cohort study.

Using the Korean National Health Insurance database, we identified individuals aged 0-24 years who were newly diagnosed with LLCs between 2011 and 2013. Patients were followed from the date of diagnosis until death or December 31, 2020. Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate long-term mortality outcomes according to disease groups and sociodemographic indicators, including insurance premium-based income categories and residential area.

In total, 175,813 CYP with LLCs were included. Survival patterns differed significantly across disease groups, age groups, and income levels. Disease group distribution varied by age, with premature and neonatal conditions predominating in infancy. Survival probabilities were lowest among children aged < 1 year and among medical aid beneficiaries. Premature and neonatal disorders and cardiovascular diseases were associated with the shortest observed survival durations. Male patients demonstrated a higher hazard of death from cancer (hazard ratio [HR] 1.83), metabolic diseases (HR 1.61), and neurologic and neuromuscular diseases (HR 1.33) compared to female patients. Higher hazard ratios among medical aid beneficiaries were observed primarily in patients with metabolic, neurologic and neuromuscular diseases, whereas residence-related differences in survival were observed among patients with cardiovascular diseases.

Distinct survival trajectories exist across disease groups among CYP with LLCs. Early mortality predominates in premature and neonatal disorders and cardiovascular diseases, whereas more prolonged survival patterns are observed in cancer and neurologic disorders. These findings may inform the development of disease-specific integrated treatment strategies, long-term care planning, and supportive care policies for CYP with LLCs and their families.

Statins are the primary treatment for hypercholesterolemia and a cornerstone of atherosclerotic cardiovascular disease prevention. Although generally safe, serious adverse effects may occur in selected patients, particularly when statins are used at high doses or without medical supervision. We describe a 66-year-old man with hypertension and hyperlipidemia who developed syncope after self-adjusting atorvastatin from 20 mg daily to 80 mg daily for two weeks. On admission, electrocardiography showed sinus arrest with a ventricular escape rhythm, accompanied by acute hepatic and renal dysfunction, electrolyte abnormalities, coagulation abnormalities, and elevated inflammatory markers. Common reversible causes, including thyroid dysfunction, structural heart disease, acute myocarditis, Lyme disease, and the use of negative chronotropic drugs, were not supported by the clinical evaluation. After temporary pacing and supportive treatment, liver and kidney function, electrolytes, and coagulation function returned to normal; however, symptomatic sinus arrest persisted, and a permanent pacemaker was implanted. During follow-up, the electrocardiogram showed recovery of sinus rhythm. Pacemaker interrogation at 1 year showed a pacing burden of approximately 80% when the lower rate limit was programmed at 70 beats per minute; after the lower rate limit was reduced to 50 beats per minute, the pacing burden decreased to approximately 20% at the subsequent follow-up. This finding suggests partial recovery of intrinsic sinus rhythm but persistent or intermittent sinus node dysfunction. The case supports a cautious interpretation of possible atorvastatin-associated severe bradyarrhythmia mediated by multiorgan dysfunction rather than definitive direct statin-induced sinus node injury. Clinicians should carefully educate patients not to self-adjust statin doses and should monitor for serious adverse events when high-dose statin exposure is suspected.

Termination for medical reasons (TFMR) is an essential aspect of reproductive healthcare. While physical and emotional care of the birthing parent is central within healthcare systems, less is known about the experiences and support needs of non-birthing partners during this process.

To explore fathers' and non-birthing partners' perceptions and experiences of support (covering clinical, psychological, and social support) during a TFMR.

A qualitative study using semi-structured interviews.

Ten fathers/non-birthing partners who had experienced TFMR in the last 7 years, identified via social media or snowball sampling, were interviewed.

Data were analysed using inductive thematic analysis and a mixture of semantic and latent coding of the data.

An overarching theme of Support in the shadows was identified, capturing how non-birthing partners were consistently present but rarely the focus of explicit or sustained care or support. Three themes were developed under the main theme of support in the shadows: (a) Feeling invisible, (b) seeking whole-person support and (c) partners as a support rather than being supported.

In common with other forms of pregnancy loss, fathers/non-birthing partners described a pattern of silent responsibility, emotional invisibility and a lack of meaningful recognition of their needs. When care was individualised and specific to non-birthing partners, it was experienced as supportive.

The support that fathers/non-birthing partners experienced during TFMR was largely incidental rather than embedded. Partners desired care and support that was deliberate, inclusive and individualised and covered clinical, psychological and social aspects.

A parent with lived experience of TFMR was involved in the study conception and methodology. The lived experience parent advised on study design and the presentation of participant information. Parents who had lived experience of TFMR in the last 7 years were interviewed for the study as participants.

Introduction The use of health services expanded during the pandemic and became a regular part of healthcare. There is not a lot of information about how these services are used over the long term and how patients engage with them. This study examined how patients used telemental health services at King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia, from 2019 to 2025. Objectives To evaluate how telemental health services were used and how patients engaged with them during the time before the pandemic, during the pandemic, and after the pandemic. The study also compared how many appointments were completed and the characteristics of patients who had virtual appointments versus in-person appointments. Methods This was a retrospective, repeated cross-sectional census study of electronic health record data on all scheduled mental health appointments, virtual and in-person, at KAMC from January 1, 2019, to December 31, 2025. All eligible encounters and unique patients across 12 facilities were included using total enumeration rather than sampling. Data were cleaned and analyzed in Python using Google Colab. Descriptive statistics were used to summarize appointment and patient characteristics. Chi-square tests were used to compare categorical variables, including appointment completion by encounter type, and the Mann-Whitney U test was used to compare patient age between virtual and in-person appointments. A binary logistic regression model was used to identify factors associated with appointment completion, including encounter type, pandemic period, and patient demographics. Results The study included 479,643 appointments with 51,323 patients at 12 facilities. Overall, 9% of the appointments were virtual. In 2019, there were no appointments, but their use increased during the pandemic and then stayed steady at around 11% to 12% per year after 2021. Overall, 55% of appointments were completed. Virtual appointments had a higher completion rate than in-person appointments, with 60% of virtual appointments being completed compared to 54% of in-person appointments. We also found that patients who had virtual appointments were substantially older and that virtual appointments were mostly used for follow-up visits rather than new patient appointments.  Conclusion Telemental health services went from being an emergency solution during the pandemic to a part of mental health services at the facility. The study found that virtual appointments were associated with patient engagement, which means that patients were more likely to complete their appointments. These findings support the continued use of a hybrid of in-person and virtual mental health services. The findings provide information to support the planning and development of telemental health services. Telemental health services are a part of the healthcare system, and they can be an effective way to deliver the services.

An intracranial abscess is a rare but life-threatening complication of otitis media (OM) and mastoiditis that requires rapid diagnosis and intervention. We present the case of a 43-year-old woman who presented with acute altered mental status and aggressive behavior following recent treatment for OM. Physical examination revealed a perforated, purulent right tympanic membrane, and neuroimaging confirmed bilateral mastoiditis and a right temporal lobe brain abscess with midline shift. Following treatment with broad-spectrum intravenous antibiotics, the patient underwent a successful craniotomy for abscess evacuation, a mastoidectomy, and tympanostomy tube placement. Postoperatively, her behavioral and neurological symptoms fully resolved, and she was discharged to complete a prolonged course of antimicrobial therapy. This case underscores the importance of maintaining a high index of suspicion for otogenic intracranial complications in patients presenting with acute behavioral changes, emphasizing that early, multidisciplinary surgical and medical management is essential to optimize patient outcomes.

Migrants often experience mental health challenges associated with acculturative stress. Dispositional traits, such as optimism and pessimism, may shape how individuals appraise and cope with these challenges, influencing their psychological distress.

This study aimed to analyse the role of three dimensions of acculturative stress: integration difficulties, nostalgia, and structural barriers, in the relationship between optimism, pessimism and mental health symptoms among Venezuelan migrants living in Chile.

A two-wave longitudinal study was conducted with 223 Venezuelan migrants residing in Chile. Participants completed validated measures of optimism, pessimism, acculturative stress, and psychological distress. A structural equation model was conducted to analyze the data.

Optimism (T1) was negatively associated with integration difficulties (T2) and structural barriers (T2). Pessimism (T1) was positively associated with three dimensions of acculturative stress (T2). Integration difficulties was positively associated with psychological distress (T2). Optimism and Pessimism at Time 1 were not associated with psychological distress (T2). The model explained 43.2% of the variance in psychological distress.

These results highlight the importance of both individual dispositions and contextual stressors in understanding the psychological adjustment of migrants. Interventions targeting acculturative stress and fostering adaptive cognitive dispositions may be effective in promoting migrant mental health.

First, to summarize the development of Sleep MAPP, a decision support tool designed to facilitate guideline-concordant sleep disorder care in the Veterans Health Administration (VHA) Polytrauma/Traumatic Brain Injury System of Care (PSC). Second, to assess usability, acceptability, and feasibility.

We iteratively designed Sleep MAPP, including algorithms determining eligibility for guideline-concordant care using medical record data. A convergent parallel mixed-methods design elicited prototype feedback from VHA clinicians (n = 7). Qualitative themes were derived from semi-structured interviews and quantitative data were obtained from standardized assessments of usability, acceptability, and feasibility. A joint display was used to derive conclusions.

Clinicians found Sleep MAPP easy-to-use, highlighting its intuitive functionality, but suggested increased customizability. Sleep MAPP was seen as acceptable, facilitating time-efficient sleep care while improving clinical outcomes. Changes to algorithm specifications were recommended. Sleep MAPP was considered feasible due to alignment with PSC clinical workflows. Educational meetings and developing an implementation plan were recommended to enhance implementation.

Sleep MAPP was considered usable, acceptable, and feasible to implement. Feedback will guide revisions to the tool and development of an implementation blueprint to integrate Sleep MAPP into routine PSC services, enhancing sleep care and rehabilitation outcomes among Veterans with TBI.