The current study examined the association between weekly video game engagement and mental health, specifically Internet Gaming Disorder (IGD), loneliness, and depression. We recruited 377 U.S. adults through CloudResearch Connect using gaming-frequency quotas, resulting in a sample representing a wide range of weekly gaming duration (range = 0-80 hours, M = 14.62). Analyses revealed that weekly gameplay hours did not consistently predict depression and loneliness. In contrast, people with higher IGD scores tended to have higher weekly playtime, more depressive symptoms, and greater feelings of loneliness. We readministered the same survey 2 years later (N = 172 or 45.6 percent of baseline sample). Here, we found that both higher weekly hours and higher IGD scores at baseline predicted increases in depressive symptoms 2 years later, controlling for their baseline depression. We did not find that gaming was predictive of loneliness longitudinally. These findings are particularly relevant given the American Psychiatric Association's interest in IGD in the DSM-5 coupled with the ongoing public debate about the benefits and ills of video games. Our findings suggest that people who struggle to balance gaming with other life demands may experience more depressive symptoms over time. Thus, clinicians may opt to focus on helping clients with IGD better balance their priorities.

Epilepsy, a prevalent chronic neurological disorder, has significant neurobiological, cognitive, psychological, and social implications. The American Heart Association (AHA) introduced Life's Essential 8 as a key metric for assessing cardiovascular health. This study aims to investigate the association between Life's Essential 8 and epilepsy prevalence, offering population-level evidence on the potential clinical and public health relevance of cardiovascular health in individuals with epilepsy. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2013 to 2018. A cross-sectional design was used, and logistic regression models, subgroup analyses were utilized to assess the association between LE8 and the prevalence of epilepsy. Restricted cubic splines were utilized to examine the nonlinear correlations. A total of 9408 participants were included in the study. After adjusting for potential confounding factors, LE8 showed a significant inverse association with the odds of epilepsy (odds ratio = 0.98, 95% confidence interval [CI]: 0.96-0.99). Restricted cubic spline analysis revealed a linear relationship between LE8 and the odds of epilepsy (P for nonlinearity = .658). Further analysis indicated that the diet score was significantly inversely associated with the odds of epilepsy (odds ratio  = 0.99, 95% CI: 0.98-0.99). Subgroup analysis showed no significant interaction between confounding factors and LE8 on the odds of epilepsy (all interaction P values > .05). Higher LE8 scores were independently associated with lower odds of epilepsy. Despite the modest effect size, these findings suggest potential clinical and public health implications, highlighting the importance of promoting cardiovascular health behaviors, particularly dietary improvements, in relation to epilepsy prevalence.

Flap transplantation is a crucial reconstructive surgical technique, yet public understanding of its principles and postoperative management remains limited. With the rapid rise of short-form video platforms, social media has become an important medium for disseminating medical information. This study aimed to evaluate the content characteristics, educational quality, and reliability of flap transplantation surgery videos on TikTok and Bilibili. A cross-sectional content analysis was conducted to evaluate short videos related to flap transplantation surgery on TikTok and Bilibili. Videos were retrieved on September 25, 2025, using the Chinese keyword "" ("flap transplantation surgery"), and searches were performed on the same day to reduce algorithm-related bias. After excluding duplicate, irrelevant, and commercial content, 236 videos were included. Two independent researchers extracted and verified data on video characteristics and engagement metrics. Educational content and information quality were assessed using the Global Quality Scale (GQS), modified DISCERN (mDISCERN), and Journal of the American Medical Association (JAMA) criteria. Statistical analyses were performed using Statistical Package for the Social Sciences version 27.0 with the Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation. Statistical significance was set at P < .05. Overall, the videos demonstrated moderate quality, with median scores of 3.00 (interquartile range 3.00-4.00) for GQS, 3.00 (2.00-3.00) for mDISCERN, and 3.00 (3.00-4.00) for JAMA. TikTok videos were significantly shorter (52.50 seconds vs 162.00 seconds, P < .001) but achieved higher GQS, mDISCERN, and JAMA scores (P < .001) compared with Bilibili. Specialist physicians accounted for 69.1% of uploaders and produced videos with significantly higher quality than science communicators or institutional/patient accounts (all pairwise P < .05). Engagement indicators such as likes and shares were strongly correlated with each other (up to r = 0.92) but not with video quality (P > .05). TikTok and Bilibili play an increasing role in disseminating surgical knowledge about flap transplantation. Although TikTok videos were shorter, they demonstrated higher structural clarity and informational reliability. Videos uploaded by physicians showed the highest accuracy and transparency, while nonprofessional content exhibited lower educational value. These findings highlight the need for improved content regulation, professional participation, and evidence-based design to enhance the educational impact of medical short videos.

Background: Chikungunya virus (CHIKV) is a mosquito-borne alphavirus transmitted predominantly by Aedes aegypti and Aedes albopictus. Infection is characterized by an acute febrile illness accompanied by debilitating polyarthralgia, myalgia, and cutaneous manifestations. Although the acute syndrome is usually self-limited, a substantial proportion of patients experience persistent musculoskeletal symptoms that may progress to chronic inflammatory arthritis, resulting in prolonged disability and impaired quality of life. Objective: To summarize current evidence on the epidemiology, virology, immunopathogenesis, clinical manifestations, laboratory diagnosis, prevention, and vaccine development of CHIKV, with particular emphasis on its implications for public health policy and immunization strategies in Mexico. Methods: This position paper was developed through a structured narrative review of the scientific literature. Publications indexed in PubMed, Scopus, and Embase, together with documents issued by the World Health Organization (WHO), Pan American Health Organization (PAHO), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and European Medicines Agency (EMA), were critically reviewed. Evidence was selected according to its scientific quality and relevance to Mexico and Latin America. Because this work represents an expert consensus rather than a systematic review, no formal risk-of-bias assessment was performed. Results: CHIKV circulates through both urban and sylvatic transmission cycles and continues to expand into regions where competent mosquito vectors are established. Disease progression is driven by complex innate and adaptive immune responses, with exaggerated inflammatory activation contributing to chronic rheumatologic sequelae. Laboratory confirmation relies primarily on molecular assays during the viremic phase and serological testing thereafter. Recent advances in vaccine development-including live-attenuated and virus-like particle (VLP) platforms-have demonstrated favorable immunogenicity and acceptable safety profiles. However, vaccination should be considered one component of an integrated prevention strategy that also includes vector surveillance, environmental control, and rapid outbreak detection. Conclusions: Chikungunya remains an emerging global public health challenge because of its expanding geographic distribution, epidemic potential, and long-term clinical consequences. Incorporating vaccination into comprehensive arboviral control programs, together with strengthened surveillance and integrated vector management, may substantially reduce disease burden. This position paper provides evidence-based recommendations to support future chikungunya prevention and vaccination policies in Mexico.

Anaplasma phagocytophilum is a tick-borne bacterium and the causative agent of human granulocytic anaplasmosis. Two major variants have been identified in North America: a human pathogenic variant (Ap-ha) that is maintained by small mammals and a nonpathogenic variant (Ap-v1) that is maintained by white-tailed deer (Odocoileus virginianus). Despite white-tailed deer being recognized as the main reservoir of Ap-v1, few studies have directly demonstrated transmission of Ap-v1 from white-tailed deer to feeding I. scapularis ticks, and transmission to feeding larvae remains undescribed. In this study, we collected samples from an outdoor white-tailed deer research facility during an I. scapularis larval questing season in the eastern United States to investigate the variants infecting white-tailed deer and acquisition by feeding larvae. Although both variants were present in questing ticks onsite, white-tailed deer were persistently infected with only Ap-v1 and transferred this variant to feeding I. scapularis larvae with high efficiency. These results support the concept that white-tailed deer play a role in the maintenance of Ap-v1 in nature and highlight the utility of captive white-tailed deer research facilities for studying vector-pathogen-host biology.

Background: The International Association for the Study of Pain defines pain as a sensory and an emotional experience, yet no instrument in routine practice quantifies affective hypersensitivity to low-intensity interpersonal stimuli, a pattern we term emotional allodynia, a construct transposed from thermal stimuli in major depression, which this study sets out to validate rather than assume. The Emotional Allodynia Questionnaire (AEQ), an 11-item self-report measure, was preliminarily validated in a single-center fibromyalgia sample, showing excellent internal consistency and a unidimensional structure. This protocol describes the multicenter validation phase. Methods: PEARL is a prospective, multicenter, observational case-control study at five Italian tertiary pain centers. Cases are adults with fibromyalgia diagnosed by the 2016 American College of Rheumatology (ACR) criteria; controls are adults with chronic non-cancer pain of defined nociceptive or neuropathic origin. All participants complete the AEQ together with the Central Sensitization Inventory (CSI), Pain Catastrophizing Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Difficulties in Emotion Regulation Scale and a pain visual analog scale, and are reassessed once at 40 ± 10 days. The targets are 274 cases and 151 evaluable controls, sized respectively for the precision of internal consistency within depression strata and for a 95% confidence interval of width 0.10 around an area under the curve of 0.80. Analyses cover internal structure, convergent and discriminant validity, test-retest reliability, AEQ-CSI phenotyping and covariate-adjusted discrimination. Results: Results are not yet available; recruitment began on 10 September 2025 and should be complete by approximately December 2027. Conclusions: The preliminary phase could not say whether the AEQ separates fibromyalgia from other chronic pain, whether the construct holds over time, or whether it survives adjustment for depression, anxiety, catastrophizing and emotion dysregulation. PEARL is designed to test these three questions, and to examine whether the AEQ-CSI phenotypes replicate. Registered on ClinicalTrials.gov (NCT07677631).

Soil microbial functional potential is crucial to maintaining forest productivity and ecosystem functions. However, how microbially mediated soil nutrient cycling responds to environmental changes, particularly those caused by variations in elevation, remains poorly understood. Using the natural temperature gradient in a temperate mountain forest, this study investigated the differences in functional microbial groups and functional genes involved in soil carbon, nitrogen and phosphorus cycling along the elevation gradient, and analyzed the associations between environmental factors and these differences. The results showed that the low-elevation gradient (LE) had significantly higher abundances of genes involved in carbon degradation (pfkC, pgi1, and LSC1) but significantly lower abundances of those involved in carbon fixation (K18602, K18603, and K18604). Compared with the high-elevation gradient (HE), the LE had a significantly higher abundance of the nitrogen-cycle gene involved in organic degradation and synthesis (nao), but significantly lower abundances of denitrification (norB) and dissimilatory nitrate reduction genes (narG, narI, and napC). The abundances of the key genes involved in phosphorus metabolism (aphA and purO) were significantly higher at HE than at LE, whereas the abundance of the key gene associated with phosphorus transport (phnT) was significantly lower. The composition of the microbial community at the phylum level involved in carbon, nitrogen and phosphorus cycling at different elevations was similar, but the relative abundance of Thermoproteota and Nitrospirota increased significantly at HE. The annual average temperature, pH and carbon acquisition enzymes (β-glucosidase and β-D-cellobiosidase) were significantly associated with microbial community composition and functional genes related to carbon, nitrogen and phosphorus cycles. Additionally, genes involved in the carbon, nitrogen and phosphorus cycles were closely related through synergy and antagonism, especially the metabolic pathways encoded by purO, phnT and nrfA. These results provide metagenomic insights into the response patterns of microbial functional potential associated with soil carbon, nitrogen, and phosphorus cycling along an elevational gradient in a warm-temperate forest.

Vibrio parahaemolyticus is an important foodborne and aquaculture-associated pathogen, and its increasing antimicrobial resistance threatens shrimp production, seafood safety, and public health. Although bacteriophages have emerged as a potential solution to the growing challenge of antimicrobial resistance, whether antibiotic resistance is associated with phage tolerance remains unclear. This study characterized antimicrobial resistance profiles and resistance genes in Vibrio parahaemolyticus isolates from Zhanjiang shrimp aquaculture farms and evaluated their association with bacteriophage susceptibility. A total of 132 isolates were tested against 18 antibiotics, while molecular and phage-related analyses were performed on 132 isolates. High resistance was observed against kanamycin (95.5%), sulfamethoxazole (94.7%), cefazolin (78.8%), imipenem (78.8%), amoxicillin (70.5%), and ampicillin (65.2%). Multidrug resistance was detected in 131/132 isolates (99.24%), indicating an extensive resistance burden. PCR analysis showed high detection rates of aphA (100.00%), sul1 (99.24%), blaTEM (98.48%), blaOXA (73.48%), blaCTX-M (53.03%), qnrA (45.45%), tetA (37.88%), and tetB (21.21%). Phage response analysis showed that 70.45% and 68.18% of isolates were phage-resistant at 4 h and 5 h, respectively. Genes potentially associated with phage-host interactions were also detected, with luxS showing the highest frequency (85.61%). Association analysis revealed significant links between tetA, tetB, blaOXA, and bacteriophage responses. These findings suggest that antimicrobial resistance and reduced phage susceptibility can co-occur among V. parahaemolyticus isolates recovered from shrimp farms in Zhanjiang, highlighting the need for regional resistance surveillance and careful phage selection.

Alzheimer's disease (AD) continues to be one of the greatest challenges in public health due to its multifactorial and heterogeneous nature, involving multiple physiological axes that encompass a large number of genetic, metabolic, vascular, and inflammatory interactions. In current clinical practice, medical specialties, mainly neurology and psychiatry, still rely on targeted gene panels for genetic evaluation. Although these panels remain effective for certain predefined hypotheses, their restricted and predefined nature limits the detection of the broader spectrum of genetic variation that may contribute to the complex biological interactions underlying neurodegeneration. Whole-exome sequencing (WES) is, from our clinic-based perspective, one of the most comprehensive genomic approaches currently available, since it allows the analysis of the ~19,500 protein-coding regions, and depending on the library approximately 5500 additional clinically relevant genomic loci, including splice sites, untranslated regions, long non-coding RNAs (lncRNAs), pseudogenes, regulatory elements and mitochondrial DNA (mtDNA). It enables the identification of pathogenic variants and variants of uncertain significance (VUS) under the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) classification frameworks. It also expands biological interpretation to variants conventionally classified as benign, which, when interpreted collectively, may contribute to pathway-level contextualization within the hypothesis-generating theoretical framework proposed in this review without implying pathogenicity, causal inference, or immediate clinical actionability. Additionally, WES enables the identification of secondary and incidental findings that may provide clinically relevant information beyond the primary phenotype, thereby supporting preventive surveillance and clinical risk management. This review analyzes the use of WES as a strategic platform for personalized decision-making in contemporary practice given the multifactorial and heterogeneous complexity of AD. It also addresses the complexities and limitations of the ACMG/AMP recommendations for filtering and classification of variants, the lack of standardization between reports and platforms, and the need for physician training, which constitute a great challenge for the translation of data to therapeutic decision-making. While the clinical utility of whole-exome sequencing (WES) in genetic diagnosis and precision medicine is well established, this review additionally proposes a hypothesis-generating theoretical framework whereby variants conventionally classified as benign or of uncertain significance may contribute to pathway-level biological contextualization in Alzheimer's disease.

Background/Objectives: Tobacco use remains the leading cause of preventable disease, with persistent health disparities for underserved populations. Health literacy may influence tobacco use and cessation. This study examined associations among health literacy, sociodemographic characteristics, and tobacco use behaviors among adults who smoke cigarettes. Methods: Baseline data were drawn from a clinical trial among adults who smoked cigarettes and wanted to quit. Participants (N = 498) completed the Brief Health Literacy Screener as well as sociodemographic and tobacco use behavior variables. T-tests, chi-square tests, and logistic regression analyses examined associations among health literacy, sociodemographic variables, and tobacco use. Results: Compared to participants with adequate health literacy, those with low health literacy were older (p < 0.001), had lower socioeconomic status (SES, p < 0.001), and were more likely to identify as African American (p = 0.005). In bivariate analyses, participants with low health literacy were more likely to smoke within 5 min of waking (p = 0.02), indicating higher nicotine dependence. Recent cigar or cigarillo co-use was more common among participants with low health literacy, although not statistically significant (p = 0.055). Participants with adequate health literacy were more likely to use electronic vapor products (p = 0.03), and this association remained significant after controlling for sociodemographic variables (p = 0.03). Conclusions: Low health literacy was associated with lower SES, with greater nicotine dependence observed in bivariate analyses. Electronic vapor product use was more common among participants with adequate health literacy. Findings underscore the intersection of health literacy, SES, and broader social determinants of health. Further research is needed to inform health literacy-responsive smoking cessation interventions.

Background/Objectives: Serum cancer antigen 15.3 (CA 15.3) is frequently measured in advanced breast cancer, but its prognostic significance after adjusting for established clinical factors remains incompletely characterized in Latin American populations. We evaluated the association of baseline CA 15.3 with metastatic burden and overall survival (OS) in hormone receptor-positive/HER2-negative advanced breast cancer and descriptively explored baseline/follow-up patterns. Methods: We retrospectively evaluated 127 women treated at a Peruvian public oncology institution between 2018 and 2024, with CA 15.3 levels ≥32.4 U/mL being considered elevated. Baseline associations were assessed using multivariable logistic regression, and OS was evaluated using Kaplan-Meier estimates and Cox proportional hazards regression adjusted for age, ECOG performance status, de novo versus recurrent disease, luminal subtype, first-line treatment, number of metastatic sites, and metastatic site. Results: Baseline CA 15.3 was elevated in 41/127 patients (32.3%) and was independently associated with postmenopausal status (OR: 3.27; 95% CI, 1.33-9.03; p = 0.014) and ≥2 metastatic sites (OR: 2.72; 95% CI, 1.24-6.10; p = 0.013). Median OS was 55 months (95% CI, 43-78), while elevated baseline CA 15.3 was associated with shorter OS (41 vs. 65 months; log-rank p = 0.024) and remained independently associated with shorter OS after multivariable adjustment (adjusted HR: 3.42; 95% CI, 1.63-7.19; p = 0.001). Conclusions: Elevated baseline CA 15.3 was associated with greater metastatic burden and shorter OS, and baseline/follow-up patterns were exploratory because the sampling was not standardized. Thus, CA 15.3 should be interpreted as an adjunct to clinical and radiological assessment.

Cancer genomics and precision oncology are increasingly central to cancer care, but many health systems struggle to implement them equitably, effectively, and sustainably. This Commission defines the current global precision oncology landscape and analyses the scientific, structural, and health-system challenges shaping its delivery and impact. Findings indicate that access to cancer genomics and precision oncology remains profoundly unequal across and within countries, leaving millions of patients without guideline-indicated interventions each year. These disparities extend to research, with genomic studies and clinical trials concentrated in high-income settings and among populations of predominantly European ancestry. At the same time, fragmented and poorly integrated data ecosystems restrict evidence generation, knowledge sharing, and clinical impact. Beyond questions of access and implementation, the clinical benefit of precision oncology is highly heterogeneous. The greatest and most consistent gains are confined to a few well validated biomarker-treatment pairings, typically supported by companion diagnostics; broader approaches such as comprehensive genomic profiling and tumour-agnostic strategies, might expand options for selected patients, but only a few patients receiving matched therapy derive meaningful benefit. The Commission also identifies a paradox of success: rapid expansion of precision oncology has increased cognitive, organisational, data, workforce, and financial burdens, while evidence of broad population-level benefit has lagged behind. In response, the Commission offers a comprehensive and context-responsive approach for integrating cancer genomics and precision oncology into health systems effectively, equitably, and sustainably. The Commission developed a value-based resource-stratified implementation framework, a system-readiness assessment tool, a precision oncology workforce competency-based framework, a precision oncology monitoring and evaluation framework, and principles for responsible data sharing and health-system learning. Cancer genomics and precision oncology can improve outcomes and strengthen health systems if scaled equitably, sustainably, and according to evidence, public value, national context, and patient needs. This Commission offers a basis for global consensus on a more equitable, evidence-informed, and sustainable path forward.