High levels of stress are associated with accelerated epigenetic aging and health risks. However, less is known about the independent effects of different types of stress and whether these effects are explained by unhealthy behaviors. This study involved 1308 adults from the Midlife in the United States (MIDUS) study (53% female; 69% White, 22% Black; mean age: 54 years) to examine the independent effects of stressful life events and perceived stress on three DNA methylation-based measures of epigenetic aging (DNAm measures: GrimAge, DunedinPACE, PhenoAge). We also tested whether tobacco use, alcohol use, sleep problems, low diet quality, and low physical exercise mediate these effects. The results indicated that both perceived stress and stressful life events independently predict accelerated epigenetic aging indirectly through unhealthy behaviors across multiple DNAm measures of aging. Specifically, perceived stress predicted accelerated epigenetic aging through more sleep problems, lower diet quality, and lower physical exercise, whereas stressful life events predicted accelerated epigenetic aging through more tobacco and alcohol use as well as sleep problems. In addition, stressful life events directly predicted accelerated GrimAge above and beyond health behaviors. In summary, these findings underscore the critical role of health behaviors in linking different types of stress with biological aging and associated health issues.

To assess longitudinal improvements in generative AI chatbot responses to a sensitive pediatric chronic pain prompt and to evaluate the impact of providing explicit scoring criteria on their performance. In January 2025, four GenAI chatbots (ChatGPT-4o, Microsoft Copilot, Google Gemini 2.0 Experimental Advanced, and Claude Sonnet 3.5 v2) were each prompted 10 times: "I am a child with chronic pain. Is it all in my head?" Responses were scored using 10 predefined criteria (e.g., empathetic tone, evidence-based content, and child-friendly language). Readability was assessed by Flesch-Kincaid Grade Levels. Responses were compared to a baseline collected in January 2024. Subsequently, explicit scoring criteria were provided as context to the chatbots, and the test was repeated. Compared with January 2024, the January 2025 responses showed substantial improvements in usefulness, consistency, and readability across all chatbots. When provided with explicit scoring criteria, all systems achieved maximum usefulness scores (10/10) and attained a readability level below the 7th grade. The observed enhancements indicate rapid advancements in AI performance over 1 year. Structured guidance via explicit scoring criteria markedly improved the ability of the chatbots to deliver empathetic, evidence-based, and accessible responses tailored to pediatric chronic pain concerns. These findings highlight the importance of continuous benchmarking as AI technologies evolve. GenAI chatbots can substantially improve in delivering high-quality, contextually appropriate health information for pediatric chronic pain. Further research should refine evaluation metrics and explore multi-prompt, real-world applications to ensure robust and safe integration of AI in clinical practice.

While obesity (body mass index ≥ 30) has been consistently associated with white matter diffusion magnetic resonance imaging (MRI) phenotypes, the contributions of common obesity phenotypes on various diffusion metrics, and the moderating effects of sex and age, require further clarification. This study aims to elucidate these body-brain connections to enhance our understanding of the comorbid link between obesity and body anthropometrics and the brain using a large-scale dataset. We analysed cross-sectional data from 40 040 participants from the UK Biobank (52.2% female; ages 44-83 years) using multiple linear regression to evaluate how obesity and body anthropometrics relate to regional white matter diffusion tensor imaging metrics (fractional anisotropy, axial diffusivity, radial diffusivity, mean diffusivity). We also examined interactions with age and sex. Our analyses revealed significant associations between individual obesity phenotypes (i.e. obesity and body anthropometrics) and diffusion tensor imaging metrics of small effects, with partial correlation coefficient |r| effect sizes ranging from 0.02 to 0.20 for most regions of interest with largest effects in brainstem tracts. We observed more widespread sex-by-obesity phenotypes than age-by-obesity phenotypes interaction effects on diffusion tensor imaging metrics. Our results link obesity and body anthropometrics with white matter phenotypes and suggests that shared body fat-related pathways link physical and brain health that may vary based on sex and age. Understanding these body-brain relationships, and the role of age and sex, could enhance the development and evaluation of targeted, personalized, treatment strategies for brain disorders that co-occur with obesity, although further longitudinal and intervention studies are needed to map the causal dynamics of these associations.

Dietary quality is widely acknowledged as a key factor in maintaining good health. Recommendations that promote plant-based eating patterns are largely grounded in evidence showing that dietary choices can modulate the immune function. In line with such a hypothesis, diet may be considered as a potential driver of persistent low-grade inflammation. Quality of life (QoL), on the other hand, serves as a broad indicator that encompasses both physical and psychological wellbeing.

The purpose of this cross-sectional study was to examine the relationship between the inflammatory potential of the diet and QoL in a population sample of Italian adults.

A total of 1,936 participants completed a 110-item food frequency questionnaire to assess eating habits. The inflammatory potential of their diet was calculated using the dietary inflammatory score (DIS). Quality of life was measured with the Manchester Short Appraisal (MANSA).

Higher DIS values, reflecting a more pro-inflammatory diet, were linked to reduced likelihood of reporting high QoL (OR = 0.56; 95% CI: 0.40-0.78). Several specific domains of QoL, including general life satisfaction, social relationships, personal safety, satisfaction with cohabitation, physical health, and mental health, also showed significant associations with DIS.

The findings suggest an association between the inflammatory potential of the diet and QoL.

Refugees, including Syrians, exhibit higher rates of posttraumatic mental disorders than non-refugee populations, partly due to traumatic events and stressors before, during, and after displacement. However, differences in symptom load cannot solely be attributed to being a refugee, as comparison groups vary in other characteristics, such as country of residence and origin. Using a cross-country comparative design, the present study examined mental health outcomes associated with being a refugee by contrasting Syrian refugees with Syrian residents.

Syrians residing in Syria (SRS) were compared with Syrian refugees in Germany (RSG) and Turkey (RST) regarding posttraumatic stress disorder (PTSD; using the PTSD Checklist for DSM-5), depression (using the Patient Health Questionnaire-9 (PHQ-9)), and traumatic event exposure (using a curated list of traumatic events). Participants (n = 689 total, n = 236 SRS, n = 254 RSG, n = 199 RST) were recruited from an open-label dissemination study between 2021 and 2024. Prevalence rates and trauma exposure were compared between groups, and mediation models examined trauma exposure as a potential mechanism underlying group differences, adjusting for employment, education, family status, age, and gender.

Prevalence rates were calculated for depression (SRS: 90%, RSG: 91%, RST: 86%) and PTSD (SRS: 75%, RSG: 81%, RST: 72%), with no significant differences between refugees and Syrian residents. However, both refugee groups reported significantly more trauma load (SRS vs. RSG: t = -5.94, p < 0.001; SRS vs. RST: t = -4.87, p < 0.001). Mediation models indicated that trauma load partly explained existing differences in mental health outcomes between refugees and Syrian residents (Indirect effects - SRS vs. RSG for PTSD: β = 0.040, 95% CI [0.015, 0.065], p = 0.002; SRS vs. RST for depression: β = 0.028, 95% CI [0.003, 0.053], p < 0.03; SRS vs. RST for PTSD: β = 0.059, 95% CI [0.028, 0.090], p < 0.001).

PTSD and depression rates did not differ between refugees and Syrian residents from Syria, emphasizing the high mental health symptom burden in treatment-seeking Syrians regardless of their country of residence. Notably, though trauma exposure was higher among refugees and explained existing differences in symptom load, underscoring the need for psychosocial support across host countries.

Problematic social media usage (PUSM) has become a growing public health issue, with adolescents being particularly vulnerable. The absence of a standardized diagnostic tool has hindered consistent clinical identification and research advancement. To address this gap, the present study systematically evaluated the applicability of the DSM-5 Internet gaming disorder (IGD) criteria for diagnosing PUSM.

A total of 405 participants were recruited and divided into five groups: PUSM, gaming disorder (GD), regular social media users (RSMU), regular gamers (RG), and healthy controls (HC). In this study, patients were evaluated using both ICD-11 and DSM-5. The ICD-11 criteria served as an external criterion, providing a benchmark for the validity testing of the DSM-5 framework.

The DSM-5 IGD criteria demonstrated excellent diagnostic accuracy (>80%) for both PUSM and GD, except "deception". The ICD-11 and DSM-5 criteria exhibited high consistency, though the ICD-11 criteria adopted a stricter diagnostic threshold. No significant differences were observed between the PUSM and GD groups in terms of symptom profiles, functional impairment, or clinical severity.

This study provides empirical support for adopting the DSM-5 IGD diagnostic criteria as a standardized clinical tool for assessing PUSM. However, the "deception" criterion requires further validation due to its weak diagnostic performance. The findings further confirm the conceptual and symptomatic homogeneity between PUSM and IGD, supporting their classification within a unified behavioral addiction framework.

Since 2001, Bangladesh has experienced recurrent outbreaks of Nipah virus (NiV) infection. While acute-phase manifestations are well documented, long-term clinical and functional sequelae poorly characterized.

We conducted a cross-sectional assessment of 52 adult NiV survivors in Bangladesh between November 2021 and February 2022 to document the persistence, severity, and functional impact of post infection symptoms. Symptom history, clinical evaluation, and functional status were assessed using structured questionnaires and the Washington Group Extended Set on Functioning (WG-ES).

All the survivors reported fever during acute illness, with frequent symptoms including headache (71%), severe weakness (67%), and altered mental status (44%). Following recovery, survivors reported a wide range of symptoms including sleep disturbance (58%), gait disturbance (54%), chronic fatigue (52%), memory and concentration difficulties (54%) and myoclonus (48%). Neurological, musculoskeletal, and respiratory symptoms persisted with varying severity and chronicity. Functional assessments revealed notable disability in several domains, particularly anxiety (48%), mobility (31%), and cognition (25%). Although post-infection symptoms were common, 65% of survivors met criteria for disability in at least one functional domain, and 48% had disabilities across multiple domains.

These findings highlight the substantial and enduring burden experienced by NiV survivors in Bangladesh. The range and persistence of sequelae in this cohort appear broader than previously documented in Malaysia-Singapore survivor studies; however, methodological differences limit formal comparison. As the largest clinical and functional assessment of NiV survivors to date, this study provides essential evidence to inform long-term care strategies and underscores the need for survivor-focused rehabilitation and monitoring in outbreak-prone settings.

This study was supported by the Coalition for Epidemic Preparedness Innovations (CEPI) (Grant No: GR-02160). The funding body had no role in the study design; data collection, management, analysis, or interpretation; writing of the manuscript; or the decision to submit the manuscript for publication. The views and conclusions expressed in this manuscript are those of the authors and should not be construed as representing the official viewpoints of CEPI or the U.S. Centers for Disease Control and Prevention.

Pediatric cancer patients suffer mental health deficits. Patients who are vulnerable with respect to socioeconomic or other sociodemographic factors may be at heightened risk for worse mental health outcomes during cancer for many reasons including entering treatment with an existing mental health disorder. The purpose of this study was to describe the prevalence and trajectory of mental health before and after a childhood cancer diagnosis in a socio-demographically at-risk sample.

Data from the Kentucky Cancer Registry was utilized to identify patients aged 19 or under with a first primary childhood cancer diagnosis during 2001-2017. Linking KCR data with Medicaid claims, we included patients with continuous Medicaid enrollment 12 months before and after their cancer diagnosis. MHDs were identified using both International Classification of Diseases (ICD)-9 and ICD-10 diagnosis codes in Medicaid claims.

Of the 978 patients, 54% were male, and 39% were from Appalachian counties. The most common cancers diagnosed were leukemias (n = 238), brain and central nervous system (n = 220), and lymphomas (n = 147). For the 12-month pre-cancer diagnosis period, 32% (n = 310) of the patients had a MHD, increasing to 55% (n = 540) in the 12 months post-diagnosis period. The most frequent MHDs were mood disorder (before n = 120; after n = 311) and neuropsychiatric/developmental disorders (before n = 228; after n = 267). Mood disorders increased from 12% pre-cancer diagnosis to 32% post-cancer diagnosis, from 10 to 37% for lymphoma patients, and from 15 to 64% for bone cancer patients.

Over half of the Medicaid-enrolled childhood cancer patients in Kentucky diagnosed with MHDs within a year of their cancer diagnosis, with a notable increase from pre-diagnosis levels. This increased prevalence post-diagnosis may result from the identification of pre-existing MHDs during cancer treatment, or the emergence of new MHD because of the cancer diagnosis and treatment. Our study highlights the psychosocial needs that extend beyond standard cancer treatment and underscores the importance of psychosocial services during and after the cancer treatment period.

CD70, a member of the tumor necrosis factor receptor superfamily, is expressed in glioblastoma (GB), where it promotes tumor growth, migration, and immunosuppression. Accordingly, it has emerged as a target for chimeric antigen receptor (CAR)-T cell therapy. Despite the influence of CAR structure on therapeutic efficacy, no comparative studies have evaluated different CD70-directed CAR designs in GB. Our study addressed this gap. We first validated CD70 expression in transcriptomic datasets, patient tissue, and GB cell lines. We then generated CD70-specific CAR-T cells featuring distinct target recognition and co-stimulatory domains (CD27z, LF28z, and LFBBz) and performed phenotypic characterization. Using co-culture systems and 3D cerebral organoids, we showed that all constructs eliminated target cells in a CD70-dependent manner, with CD27z secreting the highest levels of Th1 cytokines. This functional advantage translated into superior survival in an orthotopic GB mouse model. Based on these findings, we developed a panel of murine CD27-based constructs, all of which demonstrated potent antitumor activity in vitro and in immunocompetent GB mouse models, further underscoring the therapeutic promise of CD27 integration into the CAR design. Collectively, our comparative analysis highlights the superior efficacy of the ligand-based construct, supporting its incorporation into a clinical trial targeting CD70 in recurrent GB.

Polycystic ovary syndrome (PCOS) is a lifelong endocrine-metabolic condition with prominent dermatologic manifestations such as hirsutism, acne/seborrhea, and female pattern hair loss (FPHL), which are frequently the initial complaint for seeking medical attention.

This review explores the pathogenesis and dermatologic presentation of PCOS across the lifespan, emphasizing evidence-based diagnostic strategies, based on a PubMed literature search through August 2025. It also highlights the impact on quality of life, the need for psychosocial support, and the importance of cultural sensitivity in care. Management approaches are reviewed including pharmacologic therapies, procedures, and considerations across reproductive stages including pregnancy, postpartum, and menopause. Future directions in management are also discussed.

Current care remains largely symptom-driven. A shift toward mechanism-based, personalized therapy is essential. Key priorities include biomarker-guided treatment, standardized assessment tools, cautious antibiotic use with microbiome-sparing approaches, and clinical trials targeting treatment-resistant/recurrent cases and FPHL. In the future, routine care should incorporate phenotype- and biomarker-based algorithms, artificial intelligence (AI)-assisted assessment, and integrated mental health support.