The growing burden of cognitive decline represents a significant public health concern in aging populations, particularly in China. Social participation is a modifiable factor that may protect against cognitive decline, yet its long-term dynamic association with cognitive impairment remains insufficiently characterized.

This study aimed to delineate long-term trajectories of social participation and determine their association with cognitive impairment in Chinese older adults.

Longitudinal cohort study.

The study utilized data collected in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study.

We included 3074 Chinese adults aged ≥60 years who were free of cognitive impairment in 2013, had complete social participation data in 2013/2015/2018, and completed cognitive assessments in 2018 INTERVENTION(S): Not applicable.

Social participation was derived from CHARLS self-reported activity items and frequency and summed into a composite score (range 0-33). Cognitive performance was assessed using episodic memory (immediate and delayed 10-word recall) and mental status (orientation, serial subtraction, and figure drawing), yielding a global score (range 0-31); cognitive impairment was defined as a score <11. Group-based trajectory modeling identified five social participation trajectories. Multivariable logistic regression estimated odds ratios (ORs) for cognitive impairment adjusting for sociodemographic, health, and behavioral covariates.

Five distinct social participation trajectories were identified. In the fully adjusted model, relative to the "stable low" group, those in the "low baseline-increasing" (OR = 0.66, 95% CI: 0.47-0.92), "stable intermediate" (OR = 0.75, 95% CI: 0.58-0.97), and "stable high" (OR = 0.41, 95% CI: 0.22-0.76) groups had markedly reduced chances of cognitive impairment, while no significant link was found for the "moderate decline" group (OR = 0.90, 95% CI: 0.71-1.17).

Maintaining or increasing one's social activities was linked to a notably lower likelihood of cognitive decline. These results highlight the importance of social involvement patterns as a modifiable factor for fostering cognitive strength. Interventions to maintain or enhance participation are therefore a viable strategy for the primary prevention of cognitive decline in older adults.

Social media is a powerful tool also for discussing mental health. The conversations that take place in these spaces provide a unique insight into how users talk about the issue. This study uses fine-tuned pretrained transformer models (BERT and MentalBERT), to classify Reddit posts about anxiety, depression, bipolar disorder and borderline personality disorder (BPD) in specialised subreddits. By assessing how well subreddit conversations align with their intended mental health focus, the analysis ensures that these communities are effectively serving their purpose as support spaces. Our classification models achieve an average accuracy of 82%, with MentalBERT slightly outperforming BERT. To ensure transparency, we use Local Interpretable Model-agnostic Explanations (LIME) to identify key linguistic patterns that influence the model predictions. The outcome reveals distinct language use across conditions: as examples, discussions in bipolar disorder subreddits often refer to mood instability, while BPD communities emphasise challenges in emotional regulation. By integrating classification with explainability, this study offers insights into thematic patterns in online discourse that can support mental health professionals in identifying trends. While our models are not diagnostic tools, they function as subreddit-alignment classifiers, helping to uncover how different topics are discussed across communities. These insights may inform human-in-the-loop community management strategies and contribute to raising awareness and reducing stigma around mental health issues, ultimately fostering more supportive digital environments.

Exposure to war increases the risk for emotional and psychological distress, especially among people with pre-existing vulnerabilities. According to life history models of development and psychopathology, unpredictability experienced in the first years of life should forecast greater vulnerability to emotion dysregulation and psychological symptoms in adulthood. Moreover, the sensitization hypothesis posits that such effects should be particularly manifested in currently stressful environments. The present research investigated trajectories of emotion dysregulation and psychological distress experienced by adult Israeli Jews before and during the Israel-Hamas war that started on October 7, 2023, as well as the moderating role of early-life unpredictability. The participants (N = 720) were assessed twice before the war and twice during the first six months of the war. In each assessment, they completed measures of emotion dysregulation (DERS-18) and general psychological distress (SCL-10R). Retrospective reports of early-life unpredictability were collected at T1 regarding the first 10 years of life. Multilevel models indicated that psychological distress and emotion dysregulation increased co-dependently after the war started. Early-life unpredictability was associated with greater psychological distress and emotion dysregulation before the war and a larger increase in psychological distress after the war started. Moreover, early-life unpredictability was associated with a greater increase in psychological distress among war-exposed individuals. These findings indicate that the Israel-Hamas war exerted an emotional and psychological toll on Israeli adults. They further suggest that early-life unpredictability is a general risk factor for emotion dysregulation and psychological distress in adulthood and predicts worse mental health in war-exposed individuals.

Borderline personality disorder (BPD) is a severe psychiatric condition marked by disturbances in self-image, affect regulation, and interpersonal functioning. Up to 54% of individuals with BPD experience psychotic symptoms, particularly auditory verbal hallucinations (AVH). While AVH's neural correlates have been studied in schizophrenia (SZ), their structural basis in BPD remains poorly understood within a transdiagnostic framework.

This cross-sectional study used voxel-based morphometry (VBM) on MRI data to assess gray matter volume (GMV) in BPD patients with AVH (n = 20), without AVH (n = 26), and healthy controls (HC; n = 30). The Psychotic Symptom Rating Scale (PSYRATS) assessed AVH severity. Analyses included factorial group models, small-volume correction for regions of interest, and regression analyses.

Compared to HC, BPD patients exhibited GMV reductions in primary motor, frontal, parietal, cingulate, and cerebellar cortices. BPD with AVH showed additional reductions in primary motor, frontal, parietal and occipital cortices relative to those without AVH and HC. In BPD with AVH, PSYRATS total scores negatively correlated with GMV in temporal, parietal, cingulate, primary motor, and cerebellar regions.

These findings reveal structural correlates of AVH in BPD, implicating sensorimotor, executive, and affective networks. The overlap with SZ-associated cortical patterns suggests transdiagnostic neural mechanisms and shared pathophysiological substrates of AVH.

Suicide is the leading cause of death among Asian Americans ages 15-24 years in the US. Sexual minority youth (i.e., Lesbian, Gay, Bisexual, and Questioning [LGBQ]) also face an elevated risk for suicidal thoughts and behaviors (STBs). This study explores the intersection of racial and sexual identity among Asian American LGBQ youth with STBs in a nationally representative sample of high school students.

Participants include N = 1294 US Asian American high school students. We conducted multivariate logistic regression models to examine the association between sexual identity (i.e., heterosexual, gay/lesbian, bisexual, questioning, other) and STBs (hopelessness, suicidal ideations, planned attempts, past attempts). We explored sex as a modifier of this effect using interaction terms and sex-stratified regressions. Models controlled for sex, grade, race, ethnicity, and bullying victimization.

Asian American youth who identify as bisexual had significantly greater odds of reporting hopelessness (aOR: 6.53; 95%CI: 4.26-9.99) and suicidal ideation (aOR: 6.64; 95%CI: 4.27-10.33), whereas gay/lesbian youth reported higher odds of suicide plans (aOR: 6.12; 95%CI: 2.41-15.5), and suicide attempts (aOR: 5.47; 95%CI: 2.39-12.52) relative to heterosexuals. Disparities in STBs by sexual identity were equivalent by sex.

The intersection of race and sexual orientation plays a critical role in mental health risk among Asian American youth. Designing, implementing culturally appropriate, and identity-relevant prevention programs is essential to address the unique needs of this population. Policy and advocacy efforts should address stigma, reduce suicide risk, and promote mental health across diverse youth populations.

While the accelerated approval (AA) program in the United States expedites the availability of drugs based on preliminary evidence to fulfill unmet medical needs, it has also raised significant concerns, including a lack of robust evidence of efficacy and subsequent withdrawals. Although drug lag and drug loss are growing regulatory concerns in Japan, considering the stricter withdrawal criteria in Japan, careful evaluation of clinical evidence of accelerated approval and approval timing differences is necessary. Here, we aimed to investigate differences in approval timing between the U.S. and Japan, as well as the clinical evidence of accelerated approval drugs that have not yet been approved in Japan. Using the U.S. Food and Drug Administration (FDA) and Japanese Pharmaceuticals and Medical Devices Agency (PMDA) databases, we examined the Japanese and U.S. regulatory status of cancer drugs granted accelerated approval in the U.S. between 2012 and 2022 and the characteristics of evidence for drugs not yet approved in Japan. Of 132 drug-indication pairs that received accelerated approval between 2012 and 2022, 72 (54.5%) were approved in Japan by June 2024. Of the remaining 60 (45.5%) drugs not yet approved in Japan, the majority had methodological limitations, including a lack of comparators (93.2%) and scarcity of phase III trials (8.5%), as permitted by the accelerated approval program. Our findings suggest the need for an approach that addresses drug lag while ensuring both careful regulatory review and generation of robust evidence for efficacy and safety.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, and despite advances in frontline therapies such as rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone, approximately 30%-40% of patients develop relapsed or refractory (rel/ref) disease. This subgroup has historically faced poor prognoses with limited treatment options, prompting the development of novel immunotherapeutic strategies. Chimeric antigen receptor T-cell (CAR T) therapy and bispecific antibodies (BsAbs) have emerged as transformative approaches in this setting.

This narrative review compares these therapies across multiple domains, including mechanisms of action, clinical efficacy, safety profiles, logistics, cost, and accessibility.

CAR T therapies have demonstrated durable complete response rates (40%-60%) and extended progression-free survival (median 11-12.5 months), but they are limited by complex manufacturing, high cost, and potentially severe toxicities. In contrast, BsAbs offer immediate, off-the-shelf availability, with promising efficacy and a more favorable safety profile that enables outpatient administration, although long-term durability remains under investigation.

This review provides clinicians with a comprehensive comparison to support evidence-based treatment selection in rel/ref DLBCL.

Delayed breast cancer diagnosis in low- and middle-income countries (LMICs) reduces the survival rates. This review identifies the causes of these delays to inform strategies for improving early detection.

This scoping review followed the Arksey and O'Malley framework to explore the factors contributing to delayed breast cancer diagnosis in LMICs. Seven databases, including PubMed, Scopus, Web of Science, Cochrane Library, ProQuest, Embase, and Magiran, were searched for English and Persian studies published between January 2000 and September 2024. The search combined the keywords (e.g., "diagnostic delay," "missed diagnosis," "breast cancer," "late-stage," "barriers"), using Boolean operators. To focus on LMICs, we applied country filters, where available, and supplemented the search with manual screening of reference lists from the included studies.

The initial database search identified 5,313 records. After removing 1,036 duplicates, 4,277 studies were screened based on title, abstract, and country of origin. Of these, 4,217 were excluded for reasons including irrelevance to delayed breast cancer diagnosis, study design, population, setting (e.g., high-income countries), or publication date (outside 2000-2024). The remaining 60 studies met the inclusion criteria and were included in the narrative synthesis. Extracted data were organized and interpreted using the revised Penchansky framework (accessibility, availability, acceptability, affordability, accommodation, awareness). Additional themes included misdiagnosis, competing priorities, and personal factors.

Multiple modifiable factors contribute to diagnostic delays in LMICs. Addressing them can accelerate diagnosis, improve outcomes, and reduce harm. Targeted improvements in these areas offer significant potential to enhance breast cancer care and save lives in LMICs.

Human papillomavirus (HPV) vaccination is a cornerstone of global strategies to prevent HPV-associated malignancies; however, uncertainties persist regarding its long-term efficacy, immunogenicity, and safety across populations, vaccine formulations, and dosing schedules. We conducted a comprehensive systematic review and meta-analysis to evaluate the clinical and immunological effectiveness of prophylactic HPV vaccines.

This study followed PRISMA guidelines and was registered in PROSPERO (CRD420251050526). Randomized controlled trials (RCTs) were identified through comprehensive searches of six major databases. Risk of bias was assessed using the RoB 2 tool. Meta-analyses were performed using random- or fixed-effects models as appropriate. Subgroup and meta-regression analyses explored the effects of age, sex, vaccine type, dosing regimen, and HIV status. Certainty of evidence was appraised using the GRADE framework.

A total of 145 RCTs were included. HPV vaccination significantly reduced cervical intraepithelial neoplasia grade 1 (RR = 0.15, 95% CI: 0.09-0.24), grade 2 (0.20, 0.13-0.30), and grade 3 (0.48, 0.23-0.98). Persistent HPV16/18 infections were reduced by 84% (0.16, 0.12-0.21), and incident infections by 75% (0.25, 0.19-0.34). Immunogenicity analyses demonstrated robust antibody responses, with fold increases of 3.09 for HPV16, 3.10 for HPV18, 3.48 for HPV6, and 3.37 for HPV11. Tissue-resident CD4⁺ T cells were significantly reduced (SMD: -1.27, 95% CI: -2.24 to -0.31), while CD8⁺ T cells showed no significant change. Vaccination was not associated with an increased risk of serious adverse events (0.90, 0.82-0.99) or adverse pregnancy outcomes. Although, injection-site adverse events were modestly increased (1.26, 1.07-1.48).

Prophylactic HPV vaccination provides strong protection against HPV infections and precancerous lesions and induces robust humoral immunity with a favorable safety profile. The nonavalent vaccine, particularly when administered in a three-dose (0/1/6) regimen, offers the most comprehensive protection. These findings support the expansion of gender-neutral vaccination programs to maximize population-level cancer prevention.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251050526.

Cerebral venous sinus thrombosis (CVST) is a rare type of stroke with a variable presentation. Without a prompt diagnosis, subacute presentation can delay treatment with devastating results. Our case presents an unusual clinical pattern of a young patient presenting with audio-visual hallucinations who was diagnosed with CVST. A 26-year-old man with no neurological or psychological history presented with audio-visual hallucinations, transient uncontrolled movements of his left upper extremities, and right-sided headache. Physical examination was nonfocal, and he demonstrated normal awareness, orientation, and motor function. CT angiography, CT venography (CTV) of the head, and magnetic resonance imaging of the brain were suggestive of multiple intracranial malformations versus neoplasm. The patient underwent digital subtraction angiography, which demonstrated nonocclusive thrombi in several right posterior temporal cortical veins. There was also a nonocclusive thrombus in the right sigmoid sinus. No intracranial aneurysm, arteriovenous malformation, or arteriovenous shunting was found. The patient was started on antiseizure medication as treatment for ongoing hallucinations and convulsions. After several days of intravenous heparin, the patient was transitioned to oral anticoagulant. CVST is a rare cerebrovascular disease, accounting for 0.5% of all strokes. Diagnosis is usually made in young adults with pre-existing hypercoagulable risk factors or positive family history. With symptoms such as those mentioned above, a high degree of suspicion is required to mitigate delay in diagnosis and therapy. Our case is the first documented case of a young patient with no relevant past medical history and risk factors developing hallucinations related CVST.