Background/Objectives: Psychosocial factors are not routinely screened for during the perioperative period, even though they significantly influence overall health. This study aimed to inventory the psychosocial vulnerabilities among patients undergoing cancer surgery. Methods: We conducted a cross-sectional analysis of a researcher-administered psychosocial screener implemented within a statewide health system between July 2023 and August 2025. A 45 min screener was offered to consecutive adult patients within two weeks before their major elective cancer surgery. Residential addresses were geocoded to assign neighborhood deprivation percentiles for the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI). Elevated psychosocial vulnerability was determined based on a model-based clustering approach, and a high deprivation index was defined as ≥75th percentile. Results: A total of 383 patients (37% response rate) completed the screener, including colorectal (40%), thoracic (36%), and surgical oncology (24%) patients, with a median age of 66 years (IQR, 57–73). Over half (52.0%, n = 199) reported ≥2 psychological and ≥2 social vulnerabilities. Younger patients (p = 0.021), non-white patients (p < 0.001), patients identifying as non-heterosexual (p = 0.014), without a partner (p < 0.001) or private insurance (p = 0.040), and those with lower household income (p < 0.001) were more likely to report elevated psychosocial vulnerability. Patients with elevated psychosocial vulnerability were more likely to reside in deprived neighborhoods (ADI: 34.0 vs. 29.0, p = 0.035; SVI: 0.35 vs. 0.27, p = 0.005). Conclusions: Patients undergoing major cancer surgery experience substantial psychosocial vulnerabilities, particularly those from socioeconomically disadvantaged neighborhoods. Future work should identify the psychosocial factors most predictive of poor surgical outcomes to guide targeted preoperative interventions.

We sought to delineate neural mechanisms underlying the effects of controlled breathing in humans, such as in meditation or breathwork, which can reduce depression, anxiety, stress, and pain. Thus, we developed a murine model, where breathing frequency in awake mice can be substantially slowed. When done for 30 min/day for 4 weeks, these mice had significant reductions in stress-related changes in behavior compared to control mice. We conclude that slow breathing effects on emotional state are present in mice, and which cannot be attributed directly to top-down influences such as volitional or emotional control or placebo effects. Our study paves the way for investigations of the neural mechanisms underlying body-brain interactions related to the effects of controlled breathing as well as a platform for optimization of its therapeutic use for amelioration of ordinary and pathological stress and anxiety in humans.

BACKGROUND: Socioecological comorbidity is associated with suboptimal cancer care. Prior studies are limited to area-level rather than patient-level data. OBJECTIVE: This study aimed to evaluate whether patient-level socioecological comorbidity is associated with delays in multimodal treatment for colorectal cancer. DESIGN: This was a prospective cohort study. Study participants completed a comprehensive survey across 20 socioecological domains. High socioecological comorbidity was defined as a composite score at or above the 75th percentile. SETTINGS: Single-center study across 3 hospitals within a statewide health care system. PATIENTS: Adult patients with known or suspected primary colorectal adenocarcinoma across all stages who underwent curative-intent treatment from June 2023 to December 2025. MAIN OUTCOME MEASURES: Time from cancer diagnosis to treatment initiation. RESULTS: Of 145 patients, the median age at cancer diagnosis was 65 years, 50.3% were women, and 6.9% self-identified as Black. Kaplan-Meier analysis revealed a longer duration of untreated status among patients with high socioecological comorbidity ( p = 0.02). In adjusted Cox proportional hazards regression, high socioecological comorbidity was associated with a significantly longer time to treatment initiation (HR 0.54; 95% CI, 0.33–0.89; p = 0.016). Patients with high socioecological comorbidity who were referred from outside the health system experienced substantially longer delays to treatment initiation than those with low comorbidity (115 days [interquartile range, 84–154.3] vs 46 days [interquartile range, 38.3–61.5]; p = 0.002). Area-level deprivation indices were not significantly associated with time to treatment initiation. LIMITATIONS: Socioecological comorbidity was treated as a non–time-varying exposure. CONCLUSIONS: Patients with high socioecological comorbidity were half as likely to have initiated colorectal cancer treatment compared to those with low comorbidity, particularly among patients referred from outside the health system. Area-level indices failed to capture these delays. These findings support perioperative screening at the individual level. Future research should evaluate targeted interventions to reduce barriers to timely cancer care. See Video Abstract. COMORBILIDADES SOCIOECOLÓGICAS A NIVEL DEL PACIENTE Y TIEMPO HASTA EL INICIO DEL TRATAMIENTO CON INTENCIÓN CURATIVA PARA EL CÁNCER COLORRECTAL: ANTECEDENTES: La comorbilidad socioecológica se asocia con una atención subóptima del cáncer. Los estudios previos se limitan a datos de nivel geográfico (área) en lugar de datos a nivel del paciente. OBJETIVO: Este estudio tuvo como objetivo evaluar si la comorbilidad socioecológica a nivel del paciente se asocia con retrasos en el tratamiento multimodal del cáncer colorrectal. DISEÑO: Estudio de cohortes prospectivo. Los participantes completaron una encuesta exhaustiva que abarcaba 20 dominios socioecológicos. Se definió una comorbilidad socioecológica alta como una puntuación compuesta igual o superior al percentil 75. ENTORNO: Estudio realizado en un único centro que abarca tres hospitales dentro de un sistema de salud de ámbito estatal. PACIENTES: Pacientes adultos con adenocarcinoma colorrectal primario confirmado o sospechado, en cualquier estadio, sometidos a tratamiento con intención curativa entre junio de 2023 y diciembre de 2025. PRINCIPALES MEDIDAS DE RESULTADO: Tiempo transcurrido desde el diagnóstico del cáncer hasta el inicio del tratamiento. RESULTADOS: De los 145 pacientes, la mediana de edad al diagnóstico fue de 65 años; el 50,3 % eran mujeres y el 6,9 % se autoidentificaron como negros. El análisis de Kaplan-Meier reveló una mayor duración del periodo sin tratamiento entre los pacientes con comorbilidad socioecológica alta (p = 0,02). En el modelo de regresión de riesgos proporcionales de Cox ajustado, la comorbilidad socioecológica alta se asoció con un tiempo significativamente mayor hasta el inicio del tratamiento (HR: 0,54; IC del 95 %: 0,33-0,89; p = 0,016). Los pacientes con comorbilidad socioecológica alta derivados desde fuera del sistema de salud experimentaron retrasos sustancialmente mayores en el inicio del tratamiento en comparación con aquellos con baja comorbilidad (115 días [RIC: 84–154,3] frente a 46 días [RIC: 38,3–61,5]; p = 0,002). Los índices de privación a nivel de área no mostraron una asociación significativa con el tiempo hasta el inicio del tratamiento. LIMITACIONES: La comorbilidad socioecológica se trató como una exposición que no variaba en el tiempo. CONCLUSIONES: Los pacientes con comorbilidad socioecológica alta tuvieron la mitad de probabilidades de haber iniciado el tratamiento para el cáncer colorrectal en comparación con aquellos con baja comorbilidad, especialmente entre los pacientes derivados desde fuera del sistema de salud. Los índices a nivel de área no lograron detectar estos retrasos. Estos hallazgos respaldan la realización de cribados perioperatorios a nivel individual. Las investigaciones futuras deberían evaluar intervenciones dirigidas a reducir las barreras para recibir atención oncológica oportuna. (AI-generated translation )

To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) in treatment of pediatric primary immune thrombocytopenia (ITP). The clinical characteristics of 41 pediatric ITP patients who received rhTPO therapy from December 2006 to September 2014 were retrospectively analyzed (as rhTPO group). During the same time another 26 pediatric ITP patients who received vindesine combined with human immunoglobulin therapy were selected as control group. The treatment outcomes were evaluated. A total of 67 cases of pediatric ITP, 31 males and 36 females with a median age 10.0(1.6-17.0) years were enrolled, including 19 cases of newly disgnosed ITP, 18 cases of persistent ITP and 30 cases of chronic ITP. Of them, 43 cases of whom were severe ITP (PLT30×10⁹/L and > 50×10⁹/L had no statistically significant differences in rhTPO group compared with the control group [52(7-608)×10⁹/L vs 40(3-152)×10⁹/L, P=0.05; 7(3-13) d vs 4(2-24) d, P=0.202; 7.5(4-15) d vs 5.5(4-23) d, P=0.557]. The mean platelet counts were 43(3-605)×10⁹/L in the rhTPO group, which were higher than the control group [32(-14-149)×10⁹/L, P=0.042]. No severe adverse effects were observed in both groups. For pediatric ITP, rhTPO has a similar outcomes with vindesine combined with human immunoglobulin, and it is an effective and safe treatment option.

The amygdala and hippocampus are key structures in emotional processing, yet the transient neural dynamics coordinating their interaction remain poorly understood. We simultaneously recorded single-neuron activity and local field potentials from these regions in epilepsy patients performing an emotional image-rating task. Neurons in both regions exhibited firing rate changes predictive of subjective emotional valence. While conventional spectral analysis revealed no valence-specific patterns, beta bursts (13-30 Hz)–transient, high-power events–were selectively modified by task features. In both regions, beta bursts were associated with increased gamma amplitude and enhanced phase coherence, with beta-gamma phase-amplitude coupling capturing emotion-related dynamics. Critically, amygdala beta bursts were associated with valence-dependent, bidirectional modulation of hippocampal interneuron firing – decreased during very unpleasant/highest arousal processing and increased during high-arousal very pleasant processing – while putative pyramidal-cell firing did not change significantly. Hippocampal bursts showed no reciprocal influence. These findings suggest that beta bursts may represent a temporally precise neural correlate of emotional appraisal and a potential target for neuromodulation in mood disorders.