Hikikomori, first recognised and defined in Japan as a culture-bound syndrome of prolonged social withdrawal, is increasingly reported worldwide. There is now a broad consensus that hikikomori is not confined to Japan. Its relevance to the UK context is raised by the presence of approximately one million young adults not in education, employment or training (NEET).

To examine the occurrence of hikikomori and hikikomori-like behaviours among UK university students and to explore the association between mental health difficulties, neurodevelopmental traits and gaming disorder in its development.

A cross-sectional online survey was conducted, with a final sample of 105 students completing validated measures of social withdrawal, psychological distress, functional impairment and associated psychiatric traits.

One in five students (21.0%) reported some form of hikikomori behaviour; 14.3% met criteria for pathological hikikomori, although no cases of severe hikikomori (home confinement >6 months) were identified. Hikikomori tendencies correlated strongly with psychological distress (r = 0.73, p < 0.001), autism-related traits (r = 0.72 p < 0.001) and internet gaming disorder (r = 0.70, p < 0.001). Moderate positive associations were found with depression and anxiety, while weaker negative associations emerged with psychotic-like experiences, agreeableness and conscientiousness. Gaming disorder, underlying mental health difficulties and autistic traits emerged as strong predictors of hikikomori behaviours.

Hikikomori-like behaviour may be more prevalent in the UK student population than previously recognised. The findings underline the importance of screening for social withdrawal in young adults, with particular attention to gaming behaviours, mental health problems and autistic traits. Furthermore, identifying and addressing pre-hikikomori cases (social withdrawal lasting less than three months) may be crucial for early intervention and prevention.

The United Nations' Sustainable Development Goals (SDGs) provide a global framework for addressing interconnected social, economic, and environmental challenges by 2030. This review examines how the SDGs have been incorporated into interdisciplinary degree and professional training programs for the mental health workforce, broadly defined. The review systematically searched and analyzed the literature, resulting in 47 papers eligible for full-text assessment. Studies were examined for pedagogical frameworks, teaching strategies, and programmatic interventions explicitly linking SDGs to mental health workforce education. Pedagogical practices were categorized thematically, and the review identified both the educational philosophies underpinning integration efforts and the practical teaching interventions applied. Data were synthesized to describe trends, highlight gaps, and provide insights into approaches for embedding sustainability content in mental health education. Three overarching pedagogical approaches emerged from the reviewed studies: (1) active and critical learning, emphasizing reflective engagement with SDG-related issues; (2) collaborative learning, fostering interdisciplinary knowledge-sharing and teamwork; and (3) experiential and service learning, enabling applied practice in community and global contexts. While evidence showed innovative integration of SDGs into curricula, significant gaps remained in consistency and scalability. Challenges included limited programmatic coordination, insufficient training for educators, and a lack of frameworks guiding mental health-specific integration. Overall, findings indicate growing but uneven incorporation of SDGs into education for the global mental health workforce. The review shows how the SDGs can be embedded into mental health workforce education through deliberate and structured pedagogical strategies.

The American Board of Emergency Medicine gathers extensive background information on Accreditation Council for Graduate Medical Education-accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2026 annual report on the status of physicians training in Accreditation Council for Graduate Medical Education-accredited emergency medicine training programs in the United States.

Cytoreductive nephrectomy (CN) combined with thrombectomy remains controversial for metastatic renal cell carcinoma with venous tumor thrombus (mRCC-VTT), and optimal patient selection remains undefined.

We retrospectively analyzed 238 patients with RCC-VTT treated at a single center between February 2006 and December 2023. Patients were stratified as non-metastatic surgical (nmRCC-VTT-S, n = 135), metastatic surgical (mRCC-VTT-S, n = 53), or metastatic non-surgical (mRCC-VTT-NS, n = 50). Inverse probability of treatment weighting (IPTW) was used to reduce measured confounding. Perioperative outcomes, OS, PFS, subgroup heterogeneity, and 3-month landmark sensitivity analyses were evaluated.

After IPTW adjustment, perioperative outcomes were comparable between metastatic and non-metastatic surgical cohorts (all P > 0.05). In the metastatic cohort, surgery was associated with longer OS than non-surgical management (P = 0.027), and this association remained significant in the 3-month landmark analysis after re-estimating IPTW (P = 0.018). PFS showed no significant difference after primary IPTW adjustment (P = 0.517) and showed only a non-significant favorable trend after landmark IPTW adjustment (P = 0.064). Mayo level modified the association between surgery and OS (P for interaction < 0.001) and PFS (P for interaction = 0.034). For OS, surgery was associated with longer survival in Mayo 0-II thrombi (HR 0.56, P = 0.045), whereas patients with Mayo III-IV thrombi had worse outcomes after surgery (HR 6.22, P = 0.016).

CN combined with thrombectomy appeared feasible and was associated with improved OS in selected patients with mRCC-VTT, particularly those with low-level thrombi. Mayo level should inform surgical decision-making, and systemic therapy-first strategies should be considered for high-level thrombi.

Coronary heart disease is a leading cause of death worldwide, making early risk identification essential. This study compares the predictive performance of FINDRISC and the Framingham model in the Kharameh Cohort.

This prospective cohort study included 9,469 participants aged 40-70 years from the Kharameh cohort (a branch of the PERSIAN study) who were free of CHD at baseline and were followed for 6 years to identify incident CHD events. Data on FINDRISC components, as well as laboratory and demographic variables, were collected at enrollment. Logistic regression models were developed using the total FINDRISC score and its individual items, and their predictive performance was compared with the Framingham non‑laboratory risk score using 10‑fold cross‑validation and metrics including AUC‑ROC, sensitivity, and specificity.

During a six‑year follow‑up of 9,469 participants (mean age 51.6 years, 55.6% female), 540 incident CHD events (5.7%) were identified. The total FINDRISC score was significantly higher in individuals who developed CHD (11.35 vs. 9.59, P<0.001). However, the total FINDRISC score alone showed weak discriminatory power (AUC=58.6%, 95% CI: 55.9-61.3%). An item-based FINDRISC model demonstrated improved performance (AUC=71%, 95% CI: 68.9-73%), and further enhancement with gender, systolic blood pressure, and total cholesterol yielded the highest predictive accuracy (AUC=75.2%, 95% CI: 73%-77%). The non‑laboratory Framingham risk score (AUC=73.3%, 95% CI: 71.4-75.1%) showed similar discriminatory performance compared with the enhanced item‑based FINDRISC models.

The enhanced item-based FINDRISC model, incorporating gender and systolic blood pressure showed comparable performance to the Framingham non-laboratory model, providing a simple, accessible screening tool for the Iranian population.

Concurrent chemoradiotherapy is the standard adjuvant treatment for cervical cancer patients with pathologically confirmed lymph node metastases (International Federation of Gynecology and Obstetrics 2018 stage IIIC1p or IIIC2p) after radical surgery. Yet distant metastasis remains the predominant pattern of failure. In recent years, Immune checkpoint inhibitors combined with platinum-containing chemotherapy has been increasingly valued in the treatment of cervical cancer. Yet the role of postoperative chemo-immunotherapy in this setting remains unclear. There is no high-quality evidence-based evidence.

This multicenter, prospective, single-arm phase II clinical trial is to evaluate the safety and preliminary efficacy of postoperative chemo-immunotherapy in cervical cancer patients with pathologically confirmed lymph node metastasis after radical hysterectomy, and to explore potential biomarkers associated with treatment response. Fifty-nine carefully selected cervical cancer patients with pathologically confirmed lymph node metastases and programmed death ligand-1 positivity (combined positive score ≥1) after radical surgery will be enrolled. Postoperative treatment is initiated 2-3 weeks after surgery. Each treatment cycle is administered every 21-28 days and consists of chemotherapy (paclitaxel 175 mg/m², cisplatin 75-80 mg/m²) combined with camrelizumab (200 mg). Patients with 3 or more positive lymph nodes or para-aortic lymph node metastases receive 6 cycles of combined chemo-immunotherapy, whereas other patients receive 3 cycles. The primary outcome is 3-year disease-free survival rate. The secondary outcomes are overall survival rate, adverse events and health-related cancer-specific quality of life.

ClinicalTrials.gov identifier: NCT07167160.

Radical inguinal orchiectomy is the gold standard surgical management for suspected testicular malignancy and is generally associated with low postoperative complication rates. Infectious complications are typically superficial and confined to the surgical incision or scrotal wall, while deep suprapubic or inguinal space abscess formation remains uncommon. We report a case of a 32-year-old man with poorly controlled type 2 diabetes mellitus who underwent a right radical inguinal orchiectomy for a testicular mass. On postoperative day 7, he developed mild inguinal swelling that was initially presumed to represent a benign hematoma. However, within days, he experienced worsening severe pain, erythema, leukocytosis, and systemic inflammatory response. Computed tomography of the abdomen and pelvis demonstrated a large loculated suprapubic fluid collection extending along the inguinal canal into the scrotum, concerning for a deep abscess. The patient underwent urgent incision and drainage with debridement and negative pressure wound therapy. Intraoperative cultures grew extended-spectrum-beta-lactamase-producing Escherichia coli and Actinomyces israelii, consistent with polymicrobial deep soft tissue infection. This case illustrates how seemingly benign postoperative changes may rapidly evolve into deep infection in high-risk patients, particularly in the setting of poorly controlled diabetes mellitus and hyperglycemia-associated impairment of host immune defenses. Furthermore, the anatomical continuity created by the inguinal approach may facilitate extension of infection beyond the superficial incision and along the spermatic cord tract. Radiographic findings may underestimate disease severity, and minimal gas does not exclude significant infection. Early operative source control and close clinical reassessment remain critical to preventing progression and optimizing outcomes in high-risk postoperative patients.

The war in Sudan, which began in April 2023, has displaced millions and severely disrupted the healthcare system. This study assessed the association between armed conflict, displacement, and glycemic control in people living with diabetes (PWD), as well as the prevalence of diabetes-related complications in this context.

This is a cross-sectional study. Using systematic random sampling, 385 displaced adults living with diabetes, aged 19 years or older, were recruited. The study was conducted at the diabetes center in Port Sudan from October 2024 to May 2025. Data on sociodemographic characteristics, clinical history, and barriers to care were collected through structured questionnaires. Bivariate analyses and binary logistic regression were used to identify factors associated with uncontrolled diabetes.

Participants had a mean age of 53 ± 12 years; 51.4% were female. All were displaced because of the armed conflict. The mean HbA1c was 9.38% (± 2.42); only 16.6% of participants achieved glycemic control (HbA1c < 7.0%). Poor adherence to diabetes management was reported by 15.8% of patients, with an average HbA1c of 12.09% in this group. A high prevalence of complications was observed, with 26.5% and 20.8% of patients having diabetic foot and diabetic retinopathy, respectively. In regression analysis, poor adherence was the sole factor significantly associated with uncontrolled diabetes (OR 41.96, 95% CI [11.04, 159.52], p < 0.001). Female gender and higher education were associated with higher mean HbA1c in bivariate analysis (9.63% vs. 9.11%, p = 0.015; p = 0.007, respectively) but were not independent predictors in the multivariate model. Stress exposure was nearly universal (99.2%) but not significantly associated with glycemic control in this sample.

In this cross-sectional study of displaced PWD, the context of armed conflict in Sudan was associated with a high prevalence of poor glycemic control; diabetic foot syndrome was present in 26.5% and retinopathy in 20.8% of participants; as these were self-reported and patient overlap was not assessed, these figures represent individual prevalences rather than cumulative burden. Adherence to management was the key modifiable factor correlated with glycemic outcomes. These findings highlight an urgent need for conflict-sensitive diabetes management strategies. Humanitarian responses should consider ensuring reliable, affordable access to care and support programs as a potential means to address the cascade of diabetes-related complications in conflict settings.

The online version contains supplementary material available at 10.1007/s40200-026-02009-z.

Actinomyces europaeus is an uncommon cause of human infection and a rare cause of septic arthritis. We report an 81-year-old woman with diabetes mellitus, chronic kidney disease, gout, and dementia who developed septic arthritis of the distal interphalangeal joint of the right third finger during hospitalization for Escherichia coli bacteremia. Computed tomography demonstrated erosive joint destruction with an adjacent abscess. Surgical incision, drainage, and arthrotomy revealed septic arthritis with associated abscess formation and degeneration of the terminal extensor tendon. Operative cultures grew A. europaeus together with multiple anaerobic organisms. The patient underwent surgical debridement, followed by prolonged oral doxycycline therapy and a short course of metronidazole for polymicrobial anaerobic coverage, resulting in complete clinical resolution. This case highlights an uncommon cause of native joint septic arthritis and emphasizes the importance of considering unusual pathogens in patients with pre-existing joint disease and atypical clinical presentations.

Pulmonary nocardiosis is an uncommon but potentially serious infection caused by aerobic actinomycetes of the genus Nocardia. It predominantly affects individuals with impaired immunity or underlying structural lung disease, but can also occur in apparently immunocompetent hosts. The clinical and radiological features often overlap with tuberculosis and fungal infections, particularly in endemic regions, leading to frequent misdiagnosis and delay in appropriate therapy. We present a series of three patients with microbiologically confirmed pulmonary nocardiosis, each representing different clinical backgrounds. The first case involved a middle-aged male with poorly controlled diabetes mellitus presenting with chronic cough and bilateral pulmonary infiltrates. Imaging revealed patchy peribronchial opacities, and bronchoalveolar lavage (BAL) demonstrated filamentous, weakly acid-fast organisms on modified acid-fast staining. The second case was an elderly female with underlying bronchiectasis who presented with increased cough and expectoration; imaging showed bronchiectatic changes with superimposed infiltrates, and BAL confirmed Nocardia infection. The third case involved an elderly male with recent immunosuppressive therapy who presented with acute respiratory symptoms and radiological evidence of multifocal consolidation; microbiological evaluation confirmed nocardiosis. All patients were treated with appropriate antimicrobial therapy, including trimethoprim-sulfamethoxazole as the backbone, with additional agents such as imipenem or linezolid in selected cases. Clinical improvement was observed in patients who adhered to therapy, with symptomatic relief and partial radiological resolution on follow-up. This case series underscores the varied clinical presentation and imaging spectrum of pulmonary nocardiosis. Diabetes mellitus, structural lung disease, and immunosuppressive therapy emerged as key predisposing factors. The condition often mimics tuberculosis or bacterial pneumonia, making microbiological confirmation using modified acid-fast staining crucial. Early diagnosis and prompt initiation of appropriate therapy significantly influence patient outcomes. Pulmonary nocardiosis should be considered in patients with nonresolving pulmonary infiltrates, especially in the presence of risk factors such as diabetes, bronchiectasis, or immunosuppression. A high index of suspicion, combined with timely microbiological diagnosis and appropriate antimicrobial therapy, is essential to improve prognosis and reduce morbidity.