Heart transplantation has transformed survival in end-stage heart failure but remains constrained by donor scarcity, lifelong immunosuppression, and late graft-related morbidity. Over the next 5 decades, converging advances in immune tolerance, xenotransplantation, bioengineered organs, and fully implantable artificial hearts are likely to reshape the therapeutic landscape of cardiac replacement. Early signals of these transitions are already visible in tolerance-induction trials, first-in-human cardiac xenograft implantation, cardiac tissue engineering, and next-generation mechanical circulatory support platforms. By 2076, donor-dependent transplantation may persist but will no longer represent the singular standard of care. Instead, clinicians and patients will navigate a diversified ecosystem of biologic and synthetic heart-replacement strategies tailored to individual risk profiles, cultural context, and health-system resources. As improved early survival the dominant metric of success will shift toward long-term functional independence and freedom from therapy-related disease. The future of transplantation will therefore be defined less by technical feasibility than by its ability to evolve alongside engineered alternatives while remaining equitable and globally accessible.

Heart transplantation remains the definitive therapy for end-stage heart failure, yet graft survival continues to be limited by acute and chronic rejection and the cumulative toxicity of lifelong immunosuppression. Extracorporeal photopheresis (ECP), an immunomodulatory therapy with established efficacy in graft-versus-host disease and lung transplantation, has been investigated for more than 3 decades as an adjunctive therapy in heart transplantation. While prior reviews have summarized historical outcomes, the role of ECP in contemporary transplant practice remains incompletely defined. This state-of-the-art review examines the immunologic basis, clinical evidence, and evolving applications of ECP in heart transplant recipients, with particular focus on rejection prophylaxis, acute cellular rejection, recurrent rejection, and antibody-mediated processes. We contextualize existing evidence within modern immunosuppressive regimens and emerging noninvasive rejection surveillance tools, including donor-specific antibodies and molecular biomarkers. Beyond its role as salvage therapy, accumulating evidence suggests that ECP may function as an immunosuppression-sparing strategy, particularly in high-risk patients with recurrent rejection, infection vulnerability, or intolerance to intensified immunosuppression. We highlight unresolved knowledge gaps, propose patient selection frameworks, and identify future research directions necessary to define the role of ECP in modern heart transplantation. Overall, ECP appears to be a safe and underutilized adjunct with potential to reduce rejection burden while mitigating the long-term consequences of immunosuppression.

Heart transplantation remains the definitive treatment for end-stage heart failure, and contemporary immunosuppressive regimens, typically a calcineurin inhibitor, antiproliferative agent, and corticosteroids applied with minimal preemptive individualization, despite profound heterogeneity in recipient immune biology, pharmacokinetics, comorbidity burden, and alloimmune risk. This review examines the case for personalized immunosuppression in heart transplantation across 4 domains. First, we survey the current landscape of immunosuppression, identify key gaps, and discuss emerging strategies. Second, we review the evolving toolbox of posttransplant immune monitoring and molecular biomarkers, including donor-specific antibodies, gene-expression profiling, donor-derived cell-free DNA, and technologies in development, appraising their clinical evidence, performance characteristics, and limitations. Third, we propose a framework for integrating existing tools into composite risk assessment and for developing new approaches to individualized patient management. Finally, we outline future directions for the field, including preimplantation graft gene editing, AI-assisted donor-recipient matching, and continuous risk assessment. Realizing the potential of personalized immunosuppression in heart transplantation will require not only a broader suite of validated biomarkers and integrative risk scores but also novel pragmatic trial designs and surrogate endpoints to support the development of next-generation therapeutics.

Donor heart-allocation policies aim to prioritize patients with the greatest clinical need while ensuring equitable distribution of scarce donor organs. Although most systems adopt a "sickest-first" approach, how urgency is defined varies across countries. We performed a comparative analysis of global donor heart-allocation policies to examine how clinical urgency is defined.

Countries performing ≥50 heart transplants annually between 2018 and 2024 were identified using the Global Observatory on Donation and Transplantation database. National or international allocation policies were systematically analyzed. Urgency criteria including mechanical circulatory support (MCS) and exception pathways were extracted. A structured rubric was used to evaluate the explicitness and operational clarity of urgency criteria across domains. Hierarchical clustering explored structural similarity between systems. Qualitative thematic analysis was conducted to contextualize quantitative findings.

Twenty-nine countries representing 16 allocation frameworks were included. Most systems (93%) used tier-based urgency categorization. Temporary MCS consistently afforded the greatest urgency tier, although criteria and device definitions varied. Durable MCS complications, inotrope dependence, and refractory ventricular arrhythmias were also commonly prioritized. Rubric scoring demonstrated substantial heterogeneity in the explicitness of urgency criteria, particularly regarding exception processes and reassessment policies. Exploratory clustering identified 3 structural typologies of allocation design. Qualitative analysis highlighted variability in reliance on explicit thresholds versus clinician judgement.

International donor heart-allocation systems share common urgency principles but differ substantially in how these are operationalized. These findings provide a reference for allocation policy design and highlight the trade-offs between standardization and clinical flexibility that may influence future policy development.

Stroke is the second leading cause of mortality in the general population. Spatial neglect syndrome is one of the most common complications following stroke and is associated with poor prognosis, including prolonged hospitalization.

To examine the main clinical signs and symptoms associated with spatial neglect in stroke patients in the literature.

The present systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to assess the certainty of evidence, and the data were processed with RevMan Web (The Cochrane Collaboration).

A total of 362 articles were assessed, out of which 23 were included. A strong correlation was observed between clinical events and the presence of spatial neglect syndrome compared to control groups (oculomotor exploratory behavior [p < 0.00001; 95% CI 4.03-22.41], difficulty detecting stimuli on the left side (p < 0.0001; 95% CI 3.20-24.89), and prolonged reaction time to left-sided stimuli (p = 0.004; 95% CI 1.11-273.20). The present study confirms that spatial neglect syndrome presents as a clinically diverse condition. The quantitative analysis demonstrated that abnormal oculomotor behavior is the most robust and consistent clinical predictor for diagnosis. Other frequent symptoms included delayed reaction times and impaired detection of stimuli in the left visual field. Additionally, the presence of hemianopia and the crossed legs sign were also associated with spatial neglect syndrome among others.

The symptomatology described may serve as an indication of spatial neglect syndrome. Therefore, the present meta-analysis highlights the clinical importance of early identification and targeted evaluation in stroke cases.

Candida bloodstream infection (C-BSI) is a rare infection in patients with left ventricular assist devices (LVADs). We aim to describe the characteristics and outcomes of C-BSI. We performed a retrospective search for C-BSI in patients with LVADs at our institution from January 2012 to May 2024. We then performed a literature review using the keywords 'fungemia ventricular assist device', 'candidemia ventricular assist device', 'Candida bloodstream infection ventricular assist device,' or 'Candida endocarditis ventricular assist device' from 1990 to 2024. Clinical characteristics and outcomes were extracted. We identified three institutional cases along with 21 additional cases from the literature. The incidence of candidemia was 3.1% (3/97) and 1.8% (16/867), respectively, in the case series and literature review. Mean age was 45.6 years (range 19-73 years), and average body mass index (BMI) was 31.8 kg/m². There was a 100% mortality rate in our cohort and 62.5% in the literature review cohort. Among the surviving patients in the literature review, 66.7% underwent heart transplantation, and 33.3% were discharged on antifungal therapy. 41.2% experienced right heart failure, with four requiring temporary mechanical circulatory support post-operatively. Obesity was present in 75.0% of patients, and 42.1% had an LVAD-related infection. C-BSI developed after an average of 426 days of LVAD support, with 33.3% occurring within 30 days postoperatively. The average duration of C-BSI was 29 days. Candida auris was the most common species. C-BSI is a rare fatal complication in LVAD patients. Obesity, delayed sternal wound closure, and right heart failure may contribute to these poor outcomes.

There has been an increasing prevalence of mental and behavioral health conditions in children and adolescents in the United States, which has been exacerbated by the COVID-19 pandemic. However, many youth struggle to access behavioral health care. Tele-behavioral health, the delivery of mental health services through videoconferencing and other digital technologies, has emerged as a strategy to facilitate access. There is broad evidence supporting clinical effectiveness of tele-behavioral health across multiple psychiatric and behavioral health conditions. Multiple established care models exist for the delivery of tele-behavioral health. Here, we discuss key facilitators and barriers to implementation of tele-behavioral health, with important considerations including clinical appropriateness, provider training, and organizational support, in addition to essential safety and confidentiality considerations in care delivery with children and adolescents. There are also health equity implications in the use of tele-behavioral health, which can potentially reduce disparities in access to behavioral health care. However, important considerations remain to ensure that telehealth use is accessible and does not exacerbate inequities. Finally, there are emerging directions in the field of tele-behavioral health, particularly in the integration of artificial intelligence (AI).

Indigenous communities face disparities in sleep outcomes, which may contribute to broader health inequities. Existing reviews of Indigenous sleep health adopt a regional focus or limit attention to specific sleep disorders. The objective of this scoping review was to describe patterns of sleep problems and sleep health in Indigenous peoples globally. MEDLINE, Embase, and Web of Science were searched from inception to February 25, 2025. Any studies that described the prevalence of a sleep problem in an Indigenous sample were included. A total of 47 studies were included in the review, with sample size ranging from 50 to 810,168. Most studies were conducted in community settings (85%), with self-report questionnaires being the most common method used to assess sleep problems (83%). Prevalence estimates of sleep problems among Indigenous samples ranged widely, with Indigenous communities having generally higher prevalence of sleep problems relative to non-Indigenous comparator groups. Socioeconomic deprivation, housing conditions, mental health comorbidities, behavioral factors, and systemic barriers to health care access were consistently reported as factors associated with sleep health. The findings of this review highlight a disproportionate burden of sleep problems as well as sleep health disparities in Indigenous communities around the world. PROSPERO: CRD420251018819.

Motor skills are integral to numerous developmental domains throughout infancy and childhood. In autism, motor impairments are prevalent and pervasive, often appearing before core symptoms. These motor difficulties have a cascading effect on a child's broader physical and psychological health, including social, cognitive, emotional and behavioural functioning. Accordingly, researchers are increasingly interested in interventions that improve motor functioning, as these may have a downstream effect on broader developmental domains. One intervention that could address motor difficulties is the AllPlay Dance programme, which provides inclusive dance classes to children in community settings, with pilot data demonstrating acceptability and feasibility among parents and their children with autism and cerebral palsy. This pragmatic randomised controlled trial (pRCT) is thus designed to evaluate whether the AllPlay Dance programme creates the conditions for motor, cognitive and social abilities to thrive in children with autism.

This pRCT intends to enrol 70 families of children with autism, aged 7-12 years, living in Victoria, Australia. We will also enrol up to 60 participants with previous dance experience, called buddies, to support the participation of our dancers with autism. We will use our clinical, research, university and community networks to recruit participants. Interested families will complete an online screening survey, followed by questionnaires that parents complete and assessments of the motor functioning in the children. Interested buddies will also complete an online screening survey followed by a baseline questionnaire. Families will be randomly allocated to the intervention group or the treatment-as-usual waitlist control group. The intervention group will attend 9 weeks of community-based dance classes led by disability and dance experts and supported by buddies. The primary outcome is change in motor functioning, as assessed through performance-based measures, with parent reports providing complementary information about everyday motor functioning. Secondary outcomes include improvements in the executive, social, emotional and behavioural functioning of the children, as well as decreases in the stress of parents. We will also evaluate the acceptability and feasibility of this programme, as well as whether families decide to enrol and engage with other dance programmes in the community following the intervention.

The study has received approval from the Monash University Human Research Ethics Committee and the Deakin University Human Research Ethics Committee. Findings will be disseminated through a PhD thesis, peer-reviewed publications, presentations at scientific conferences and reports to participants, community organisations and the wider community.

Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12625000600448; registered on 11 June 2025; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=389672.

Deliberate self-harm (DSH) is a major public health concern among patients with schizophrenia spectrum disorders (SSDs). Although forensic patients with SSD show high rates of DSH, they remain under-represented in suicidology research, and differences in risk profiles compared with non-forensic patients are poorly understood.

To compare sociodemographic, clinical, neuropsychological and criminological correlates of lifetime DSH between forensic and non-forensic patients with SSD and identify subgroup-specific vulnerability markers.

Data were drawn from the multinational EU-VIORMED study across five European countries. Participants (N=392) aged 18-65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis of SSDs completed standardised assessments. Lifetime DSH was measured dichotomously. Separate LASSO logistic regression models identified the strongest correlates of DSH in forensic and non-forensic subsamples.

Lifetime DSH prevalence was high in both groups (45.9% forensic; 39.5% non-forensic). In forensic patients, the strongest correlate was comorbid personality disorder (β=0.78), followed by functional impairment (β=0.02-0.26). In non-forensic patients, interpersonal victimisation (β=0.85) was the strongest correlate, followed by personality disorder (β=0.71), male gender (β=0.69), lifetime substance use (β=0.37) and psychopathological indicators (PANSS (Positive and Negative Syndrome Scale) items; β=-0.10-0.32). Overall, DSH in forensic patients was more strongly associated with personality pathology and functioning, whereas in non-forensic patients it was linked to trauma, clinical severity and sociodemographic factors.

Despite similar DSH prevalence, forensic and non-forensic SSD patients showed distinct patterns of associated factors, suggesting different mechanisms of risk.

Suicide prevention in SSD should adopt tailored risk formulations, emphasising personality pathology and functioning in forensic settings and trauma-informed, integrated care in non-forensic services.