Contemporary guideline-based assessment of left ventricular diastolic function and filling pressure requires multiple echocardiographic parameters that may not be routinely acquired in real-world clinical practice.

The aim of the study was to compare the prognostic and diagnostic performance of a previously validated deep learning (DL) model for left ventricular diastolic function assessment with those of the 2016 ASE (American Society of Echocardiography)/EACVI (European Association of Cardiovascular Imaging) and 2025 ASE guidelines.

The DL model and the guidelines were compared in the ARIC (Atherosclerosis Risk In Communities) cohort (n = 5,450) for prognostication and in 2 hemodynamic validation cohorts from the United States (n = 83) and Japan (n = 130) for diagnosing elevated left ventricular filling pressure. In all 3 cohorts, ≥1 guideline-recommended parameters were unavailable in a substantial proportion of patients.

In the ARIC cohort, the DL model achieved a higher C-index than both the 2016 ASE/EACVI and 2025 ASE guidelines (0.676 vs 0.638 and 0.602, respectively; both P < 0.001). In the United States cohort, the DL model achieved a higher area under the receiver operating characteristic curve (AUC) than the 2025 ASE guidelines (0.879 vs 0.822; P = 0.041) and a similar AUC to the 2016 ASE/EACVI guidelines (0.879 vs 0.812; P = 0.138). In the Japanese cohort, the DL model achieved a higher AUC than both guideline versions (0.816 vs 0.694 and 0.634, respectively; both P < 0.05).

In settings where not all guideline-recommended parameters are available, the DL model may improve prognostic and diagnostic performance compared with both guideline versions. Nevertheless, these exploratory findings require further validation to confirm that the observed advantages persist when all guideline-recommended parameters are systematically acquired.

The liver transplantation (LT) program was established at Hannover Medical School in 1972. The aim of the study was to assess graft and patient survival, organ function, and active life throughout ≥3 decades after LT, with a special focus on recipients surviving ≥30 y after transplantation.

Clinical data from all consecutive patients undergoing LT between 1972 and 1994 were collected in a prospective design, and outcome data were complemented retrospectively.

Nine hundred LTs performed on 756 patients were included in the study. Survival increased with growing experience during the study period. One hundred thirty-eight patients survived ≥30 y, of whom 35 (25%) received >1 graft. Chronic kidney disease was observed in 96 recipients (70%), necessitating additional kidney transplants in 16 patients (12%). De novo malignancy was diagnosed in 31 patients (23%; 4% after pediatric and 33% after adult LT, P < 0.001) during the long-term follow-up. The leading cause of death beyond a 30-y survival was cardiovascular. Twenty-seven patients (38%) had a child after LT; 33 pediatric transplant recipients (89%) engaged in professional employment posttransplant.

This is the first study offering detailed insight into LT survival beyond 30 y. The data show that 30-y survival after LT is reachable in relevant numbers, with stable graft function and the opportunity to live an active, self-directed life.

Renal ischemia-reperfusion injury (IRI) is a leading cause of acute kidney injury and is associated with mitochondrial dysfunction, excessive reactive oxygen species (ROS) production, and tubular cell apoptosis. Sigma-1 receptor (Sigma1R), an intracellular chaperone, helps maintain mitochondrial homeostasis and cell survival. Here, Sigma1R expression was significantly downregulated in renal IRI. Fluvoxamine treatment ameliorated renal dysfunction and reduced apoptosis in vivo, whereas Sigma1R overexpression preserved mitochondrial membrane potential and attenuated ROS accumulation in HK-2 cells subjected to hypoxia/reoxygenation. The findings support the functional involvement of Rac1 in Sigma1R-mediated enhancement of PINK1/Parkin-mediated mitophagy, which may facilitate the clearance of damaged mitochondria and restore mitochondrial quality control. Overall, Rac1 is involved in Sigma1R-mediated mitophagy and mitochondrial protection, highlighting Sigma1R as a potential therapeutic target for renal IRI.

Men attending ART clinics often have poor fertility awareness and are typically overlooked for psychological support. Recent developments in understanding the link between sub-fertility, healthspan and lifespan enforce the need for comprehensive health assessments of men attending ART clinics. Evidence now suggests paternal factors including genetics, epigenetics, paternal age, oxidative stress and DNA damage contribute to embryo development and the health of the offspring. With the described decline in global sperm counts, overall male reproductive health and the increased utilisation of ART, it is imperative that research focuses on improving ART protocols for male factor infertility and investigates novel treatments for patients. Sperm contributions in ART are often overlooked, leading to optimisation of the clinical environment to focus on oocytes and embryos. Research into improving ART protocols for sperm is growing, but the clinical implementation has been slow. In parallel, current treatment options for male infertility are limited to procedures like ICSI, which bypass the underlying physiological causes of infertility. Ongoing research into sperm in clinical settings, as well as better patient psychosocial care, is therefore key to improving patient outcomes and wellbeing.

This review aims to evaluate the current standing of male reproductive health management in ART clinics with a unique focus on integrated patient care from men's fertility awareness, through to psychosocial support and targeted education. Additionally, this review aims to identify major barriers that currently prevent rapid integration of novel technologies for male infertility diagnostics and treatments into ART clinics.

PubMed searches were performed to identify peer-reviewed articles and reviews using the following terms: 'sperm preparation/selection', 'male reproductive health', 'male infertility', 'diagnostics', 'cryopreservation', 'ART', 'fertility education', 'fertility awareness', 'artificial intelligence', and 'sperm' in combination with other key words related to the subject. No restriction was placed on date; all relevant studies up until March 2026 were evaluated and discussed. References within articles were also searched.

In an ART setting, men rarely receive routine healthcare follow-up after providing a sample for assisted reproduction. Through integration of several underrepresented aspects of male health care, this review concludes that male reproductive health should be managed more collaboratively by medical specialists, including general practitioners, urologists, endocrinologists and andrologists, to understand the underlying cause of male infertility and determine an appropriate treatment. Moreover, this review finds that the integration of mental health professionals into the ART clinic environment is urgently needed to ensure appropriate counselling and care for people during and following fertility treatment. Finally, we determined that a lack of direct collaboration between researchers and clinical practitioners may be partly responsible for the slow uptake of novel technologies into the ART clinic.

Further research needs to be undertaken to improve public health messaging and education for men about their fertility. An overarching theme identified by this review is the need for targeted collaboration between research scientists and clinicians to improve men's reproductive care, in turn, culminating in faster clinical adoption of beneficial techniques and products to improve patient outcomes. This review highlights an urgent need for more integrated models of fertility care that extend from men's fertility awareness and education, through to improvements of 'in clinic' appraisal of the underlying causes of male infertility, and finally, better inclusion of men's psychosocial support into reproductive care.

n/a.

Canada's agri-food system relies on temporary migrant workers (TMW), yet many experience precarious conditions and barriers to accessing adequate, nutritious food during their stay. Despite advocacy for improved conditions, empirical data on TMWs' food insecurity, and on several social determinants of health (SDoH), remain limited in Canada. We address this gap by comparing SDoH, including TMW living and working conditions, food insecurity, and health in Québec's agriculture and food manufacturing sectors.

A cross-sectional survey was embedded within a multiple case study, with agriculture and food manufacturing selected as sectoral cases characterised by similar and different structural SDoH. A total of 283 TMW (152 agriculture, 131 food manufacturing) completed interviewer-administered questionnaires covering the Household Food Security Survey Module, SDoH, and health.

Agricultural TMW were more often housed by employers (98.7% vs. 36.6%; p < 0.001) and living on-site than food manufacturing TMW (77.0% vs. 13.7%; p < 0.001). Agricultural TMW shared housing with more people (9 vs. 3; p < 0.001), and their employers decided more frequently when and how to get food (30.9% vs. 6.1%; p < 0.001). Food insecurity was more prevalent among agricultural TMW (66.4% vs. 41.9%, p < 0.001). Perceived health, mental health, and life stress were similar across sectors.

Although TMW in both sectors experience troubling SDoH and high food insecurity, agricultural TMW have more disadvantaged profiles. Findings underscore how the very agri-food system that TMW sustain also determines the conditions that constrain their food security in Canada. Action on modifiable SDoH may reduce inequities.

This study aimed to determine the prevalence of burnout and its associated factors among postgraduate trainee physicians in Bangladesh.

A multicentre cross-sectional study.

Three public tertiary-care academic institutions across the country (Dhaka Medical College Hospital, Chittagong Medical College Hospital and Rangpur Medical College Hospital).

Study participants were 703 postgraduate trainee physicians from the Departments of Medicine, Surgery and Gynaecology & Obstetrics who were undergoing training programmes entitled Fellowship of the College of Physicians and Surgeons (FCPS), Doctor of Medicine/Master of Surgery (MD/MS) and Diploma/Master of Philosophy (MPhil).

Burnout was assessed using the Abbreviated Maslach Burnout Inventory, which evaluates burnout through three domains: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). In this study, weighted prevalence estimates were calculated where burnout was defined as a high EE score (≥9) combined with either a high DP score (≥6) or a low PA score (<12).

The mean age was 30.9±3.6 (SD) years, with females comprising 56% of participants. Studied postgraduate trainees were enrolled in FCPS (62.2%), MD/MS (27.2%) and Diploma/MPhil (10.6%) courses. Overall, the prevalence of burnout was 70%, with high EE (68.3%), high DP (57.8%) and low PA (94.7%). Univariate analysis showed burnout was significantly associated with shorter sleep duration (<7 hours: 74.9% vs ≥7 hours: 61.4%, p<0.001) and lack of additional employment (73.5% vs 65.5%, p=0.036). However, multivariate logistic regression showed only shorter sleep duration was the independent predictor of burnout (OR 1.83, 95% CI 1.25 to 2.69, p=0.002).

This study demonstrates a high prevalence of burnout among postgraduate trainee physicians in Bangladesh. Targeted interventions addressing modifiable associated factors-particularly sleep deprivation, financial stress, and work structure-are urgently needed to promote mental well-being and sustain professional performance.

Problematic internet use (PIU) is a prevalent and heterogeneous mental health problem among university students, associated with significant psychological distress and functional impairment. Although various psychosocial interventions have demonstrated efficacy, existing randomised controlled trials (RCTs) are frequently limited by small sample sizes, single-component designs and insufficient investigation of underlying psychological mechanisms. This study aims to evaluate the effectiveness and psychological mechanisms of IMPROVE (Identify, Monitor, Plan, Real-world activities, Observe emotion, Vulnerability and Emotion regulation), a manualised, multimodal group-based psychotherapy integrating cognitive-behavioural strategies with motivational elements, mindfulness training and socially interactive exercise for the treatment of PIU among university students.

This single-blind RCT will recruit 600 university students with moderate-to-severe PIU (Internet Addiction Test (IAT) ≥50) from multiple campuses. Participants will be randomised (1:1) to either an 8-week IMPROVE intervention or an enhanced waitlist control condition. The primary outcome is change in PIU severity (IAT score) from baseline to post-intervention. Secondary outcomes include remission rates, internet-related behaviours, craving, functional impairment, comorbid psychopathology and well-being. Candidate psychological mediators-maladaptive cognitions, self-efficacy, emotion regulation, mind wandering, anhedonia, resilience and perceived stress-will be assessed longitudinally to support formal mediation analyses. Prespecified moderation analyses will examine treatment heterogeneity across PIU subtypes and baseline characteristics.

The study was approved by the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (approval no. 2026-0152). Written informed consent will be obtained from all participants prior to enrolment. Study findings will be disseminated through peer-reviewed publications and conference presentations.

NCT07434778 (https://clinicaltrials.gov/study/NCT07434778).

Parents are crucial as providers of nurturing care for their children to grow and thrive. A community-based multicomponent intervention for women's health and early childhood health and development was conducted in rural Vietnam, spanning from mid-pregnancy through the first postpartum year. A cluster-randomised controlled trial of the programme conducted between 2018 and 2021 found that children aged 2 years whose parents were in the intervention group and had received the programme had higher cognitive, language and motor development than those in the control group who had received the usual standard of care. The intervention was also found to be cost-effective and improve equity. The aim of this follow-up study is to examine the mid-term effects of the intervention and describe the views of caregivers, service providers and policymakers on the programme, the evidence of its impact and its translation into policies and practice.

This is a follow-up study of participants in a cluster-randomised controlled trial to examine the mid-term effects of the intervention when children are 7 and 9 years old in Vietnam. We will re-enrol mother-child dyads from the original trial (622 women and their children in the intervention; 546 dyads in the control group). The primary outcome is children's intellectual ability. Secondary outcomes include children's emotional and behavioural development, quality of life, anthropometric indices, health conditions, health behaviour and education and parenting, maternal mental health, maternal quality of life, cardiovascular health and biomarkers of ageing together with women's and children's experiences of family violence.Outcomes will be measured using culturally and linguistically adapted standardised tools and study-specific structured questions. Differences in outcomes between trial groups will be assessed using mediation analyses and mixed-effects models, including a fixed effect for the trial group and adjusting for cluster effects as a random effect based on the intention-to-treat principle. An economic evaluation will estimate the cost-effectiveness of the intervention in improving child development at ages 7 and 9 years from healthcare and societal perspectives. A qualitative study will be conducted alongside the follow-up study using purposive sampling to describe the perspectives of caregivers, service providers and policymakers on the intervention, the evidence about its impact and its integration into national policies and services.

Ethics approval was obtained from the Monash University Human Research Ethics Committee (2025-46034-125952). Study findings will be disseminated through multiple channels, including peer-reviewed publications, national and international conference presentations, seminars, policy briefings, lay language summaries to communes and media reports.

ACTRN12625001113448.

Digital assistance systems based on artificial intelligence are increasingly discussed as tools to address growing demands in mental health care. However, their acceptance among future and practising psychotherapists remains insufficiently understood. In a pre-post online survey, N = 317 participants (predominantly psychology students, with smaller groups of trainee psychotherapists and licensed psychotherapists) completed questionnaires assessing perceived usefulness (PU), work-related stress, technological affinity, professional self-efficacy, data protection concerns and prior knowledge. Between assessments, participants watched a video demonstrating a digital assistance system. An open-ended item captured perceived barriers. PU increased significantly after the video (p < 0.001, d = 0.29), with subgroup differences across professional groups. Effects were largest among trainee psychotherapists (d = 0.59) and negligible among licensed psychotherapists (d = 0.06). Work-related stress was positively associated with PU, whereas age was negatively associated. Technological affinity, prior knowledge, professional self-efficacy and data protection concerns showed no significant associations with PU. Open-ended responses highlighted concerns regarding data protection, usability, time demands and professional autonomy. Brief, targeted demonstrations may increase PU of digital assistance systems among psychology students, although effects appear minimal in licensed psychotherapists. The mechanisms underlying the video effect and the positive association between stress and PU warrant further investigation.

HIV molecular epidemiology (HIV-ME) uses genetic sequencing to study viral evolution, detect transmission clusters, and guide public health responses. Ethical, legal, and social implications of HIV-ME have been raised, yet quantitative evidence on community perspectives remains limited. We quantified community priorities for HIV-ME program features and examined their heterogeneity.

Adult cisgender men who have sex with men, including people living with HIV (PLWH), were recruited from the 2023-2024 American Men's Internet Survey. Best-worst scaling assessed the importance of 11 HIV-ME features across 11 choice tasks using a Youden experimental design. Aggregate results were estimated using conditional logit models and rescaled to importance scores summing to 100%. Heterogeneity in priorities was assessed using stratified models and latent class analysis.

Among 747 people who completed the survey, 18% were PLWH, 35% were under 40, 34% reported concern about stigma, and 38% resided in states with active HIV criminalization statutes. "Ensuring privacy" was the most important feature, followed by HIV-ME uses for cluster detection and response, studying viral evolution, and evaluating prevention. Priorities did not differ when stratified by HIV status (p<0.01). Two latent classes emerged: a larger "Use the Data" group (n=472, 63%) placed 64% of importance on HIV-ME uses, and a smaller 'Protect the Data' group (n=275, 37%) placed 26% of importance on HIV-ME uses and 64% on: ensuring privacy, obtaining permission for and providing disclosure about data use, and limiting law-enforcement access.

Community support is broad for HIV-ME uses, particularly with protections for data privacy, access, and use.