Articles

Meigs’ syndrome is a rare triad of a benign ovarian fibroma (or fibroma‑like tumor), ascites, and pleural effusion that resolves after tumor resection. A 53‑year‑old multiparous woman presented with progressive exertional dyspnea and right‑sided pleuritic chest pain. Respiratory and cardiac evaluations were initially unrevealing. Bedside assessment identified mild right basal dullness, and point‑of‑care abdominal ultrasound demonstrated mild free fluid and a solid right adnexal mass. Chest radiography confirmed a small right pleural effusion. Without computed tomography and without diagnostic paracentesis or thoracentesis, Meigs’ syndrome was suspected. The patient underwent laparotomy with total abdominal hysterectomy and bilateral salpingo‑oophorectomy. Histopathology confirmed an ovarian fibroma. Postoperatively, symptoms resolved dramatically, and follow‑up imaging demonstrated complete resolution of the pleural effusion and ascites. This case highlights the importance of considering gynecologic etiologies in unexplained pleural effusion and dyspnea, especially when accompanied by abdominal distension or pelvic pressure.

<b>Introduction:</b> Ovarian torsion is a rare gynecological emergency that can result in permanent ovarian loss if not promptly recognized and managed. Cases involving multiple rotations of the ovary are highly unusual and pose a significant risk for ovarian viability. <b>Clinical Description:</b> A 33-year-old P2 woman presented with sudden severe lower abdominal pain. Imaging showed a complex midline adnexal mass, more towards left and mild free fluid with suspected torsion. Emergency laparotomy showed a sixfold torsion of the right ovary with a dermoid cyst. Detorsion and cystectomy were performed with preservation of the ovary. Postoperative recovery was uneventful and histopathology further confirmed a benign dermoid cyst. <b>Discussion:</b> Ovarian torsion with multiple rotations is extremely rare so early recognition and timely surgical intervention enable ovarian salvage even in severe cases. Moreover, Dermoid cysts are the most common predisposing factor. <b>Conclusion:</b> This case highlights the importance of prompt diagnosis and immediate management of ovarian torsion to prevent complications, preserve ovarian integrity and fertility.

<b>Background:</b> The sacroiliac joint (SIJ) plays a crucial role in transmitting axial loads and maintaining pelvic stability. Sacroiliac joint arthropathy (SIJA) accounts for 10%–30% of low back pain cases but remains underrecognized due to overlapping pain referral patterns and nonspecific imaging findings. Diagnosis relies primarily on characteristic pain distribution and provocative maneuvers, with image-guided intra-articular block serving as the diagnostic gold standard. This study aimed to characterize the clinical profile of block-confirmed SIJA, emphasizing referral pain distribution, triggering position, and provocative test responses<b>. Methods:</b> A cross-sectional study was conducted on 98 patients with diagnostic block–confirmed SIJA at Siloam Hospital Lippo Village, Indonesia. Demographic data, referral pain sites, sitting duration, and results of FABER, compression, and distraction tests were analyzed descriptively. <b>Results:</b> The mean age was 52.07 ± 14.17 years, with 72.4% females. Referral pain most frequently involved the lower back (28.6%) and thigh (28.6%), with occasional extension to the groin (8.2%) or calf (4.1%). Over half of patients (55.1%) reported sitting more than six hours daily. Pain was predominantly triggered during sit-to-stand transitions (85.7%) and while sitting (74.5%). SIJ tenderness (98.0%) and FABER positivity (75.5%) were most consistent. <b>Conclusion:</b> The dominant referral pain in SIJA involves the lower back and posterior thigh. Sit-to-stand transition is the most frequent triggering position, while FABER testing demonstrates the highest diagnostic yield among provocative maneuvers. These consistent patterns may serve as practical clinical indicators to improve diagnostic accuracy in suspected SIJ-related pain.

<b>Introduction:</b> Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and management are crucial and remain challenging for optimizing maternal and fetal outcomes. <b>Clinical Description:</b> A case of 39-year-old gravida 5 para 4 at 24 weeks+1 day with chronic hypothyroidism, longstanding anemia and a one year history of epigastric + right upper quadrant pain with suspected hemorrhage from a known liver hemangioma. Further imaging suggested a malignant hepatic lesion where colonoscopy and biopsy confirmed stage IV metastatic colon adenocarcinoma with liver and adrenal metastases. Her condition deteriorated and delivered a stillborn infant at 26 weeks of 780 grams following placental abruption. She continued to decline despite supportive care and died. <b>Conclusion:</b> This case illustrates the diagnostic challenges of colorectal cancer in pregnancy where nonspecific symptoms and inaccurate imaging results contributed to delayed diagnosis. The aggressive nature of the disease emphasizes the importance of prompt diagnosis and integrated care approach to improve both maternal and fetal outcome.

<b>Introduction:</b> Stroke remains one of the leading causes of death and disability worldwide, with ischemic stroke accounting for most cases. Structural vascular factors such as carotid artery tortuosity have gained attention as potential markers of vascular aging and cerebrovascular risk. The carotid tortuosity index (CTI), defined as the ratio of actual vessel length to the straight-line distance between two fixed points, provides a quantitative measure of arterial curvature. A CTI value of ≥1.2 indicates pathological tortuosity. Although noninvasive modalities such as CTA and MRA are frequently used, digital subtraction angiography (DSA) remains the gold standard for evaluating vessel geometry due to its higher spatial precision. This study aimed to determine the association of age, sex, and hypertension with CTI measured by DSA.<b> </b><b>Methods:</b> A cross-sectional study was conducted from November to December 2025 at the Neurointervention Clinic, RS Pelni Jakarta, Indonesia, involving 61 adult patients who underwent carotid DSA. CTI was measured bilaterally using digital imaging software and classified as <1.2 (non-tortuous) or ≥1.2 (tortuous). Clinical data, including age, sex, and hypertension status, were collected from medical records and analyzed using bivariate tests. <b>Results:</b> Older age (≥65 years), female sex, and hypertension were significantly associated with higher CTI values on both carotid sides. Tortuosity was more common among hypertensive patients and elderly females, indicating the influence of vascular remodeling and chronic hemodynamic stress. <b>Conclusion:</b> Carotid tortuosity increases with age, hypertension, and female sex. DSA-based CTI measurement provides a reliable and precise approach for evaluating vascular changes associated with cerebrovascular risk.

<b>Background:</b> Adolescence is a critical developmental stage for the emergence of major depressive disorder (MDD). Structural and diffusion neuroimaging studies have highlighted the anterior cingulate cortex (ACC) as a key region implicated in emotion regulation, stress reactivity, and mood processing. However, few studies have examined whether microstructural characteristics of the ACC, reflected by mean diffusivity (MD) within gray matter–white matter (GM–WM) contrast regions, are associated with depression in early adolescence. <b>Objective:</b> To examine whether mean diffusivity (MD) within the GM–WM contrast of the left caudal anterior cingulate cortex (ACC) is associated with a past diagnosis of MDD among adolescents in the Adolescent Brain Cognitive Development (ABCD) Study, after accounting for demographic, socioeconomic, and adversity-related factors. <b>Methods:</b> Data were drawn from adolescents with diffusion MRI–derived mean diffusivity measures and diagnostics. The independent variable was mean diffusivity (MD) of the GM–WM contrast in the left caudal ACC. The primary outcome was past MDD diagnosis based on structured psychiatric assessments. Covariates included age, sex, socioeconomic status (SES), and exposure to adverse childhood experiences (ACEs). Logistic regression models tested the association between ACC MD and past MDD. A secondary model evaluated the relationship between ACC MD and past suicide attempt. <b>Results:</b> Mean diffusivity of the left caudal ACC was associated with the odds of past MDD, independent of age, sex, SES, and adversity exposure. In contrast, ACC mean diffusivity was not associated with a history of suicide attempt. <b>Conclusions:</b> Increased mean diffusivity in the caudal ACC may indicate microstructural alterations associated with depressive vulnerability in adolescence. ACC tissue integrity may serve as a sensitive neural correlate of early-onset depression.

<b>Background:</b> Tobacco endgame, defined as elimination of commercial tobacco sales The U.S. tobacco control landscape is a complex, adaptive system shaped by diverse stakeholders, evolving products and regulations, shifting social norms, and the strategic countermeasures of a powerful industry. Managing such complexity requires more than isolated interventions—it demands a coordinated, enterprise-wide approach that accounts for dynamic interactions, feedback loops, and emergent risks. <b>Objective:</b> Drawing on complex systems thinking, Zachman enterprise architecture model, and public health best practices, we conceptualize tobacco control as an evolving enterprise progressing through six interconnected phases: (1) Conception &#x26; Initiation, (2) Policy &#x26; System Design, (3) Implementation &#x26; Operation, (4) Evaluation &#x26; Adaptation, (5) Consolidation &#x26; Endgame Transition, and (6) Sustainment or Sunset. Each phase incorporates governance structures, performance benchmarks, and transition criteria designed to manage interdependence and reduce systemic vulnerabilities. <b>Results:</b> The lifecycle framing emphasizes how tobacco control in the U.S. can evolve as a complex, adaptive enterprise—integrating public health objectives with legal, operational, and cultural change processes. This model supports strategic sequencing, cross-sector alignment, and risk mitigation against emergent industry tactics, enabling a resilient and measurable pathway to the endgame. <b>Conclusions:</b> Seeing tobacco control as a complex enterprise that operates under a lifecycle model may offer a roadmap for achieving and sustaining the tobacco endgame. Using this approach may enhance policy coherence, resource efficiency, and adaptability, ensuring tobacco endgame is achieved.

A man in his 60s with multiple vascular comorbidities presented with sudden, painless vision loss in one eye. Although he had a high risk for atherosclerotic events, initial evaluation for stroke was negative for acute ischemia, but found to have markedly elevated inflammatory markers. Accordingly, giant cell arteritis was investigated and Ophthalmologic findings and fulfillment of the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria supported the diagnosis of giant cell arteritis, despite a negative temporal artery biopsy. Management included high-dose glucocorticoids and delayed tocilizumab initiation due to the need for multiple vascular surgeries. Vision loss was irreversible, but systemic symptoms resolved and vascular interventions were successful. This case highlights the diagnostic and management complexities of biopsy-negative giant cell arteritis in patients with severe atherosclerotic vascular disease, emphasizing the importance of clinical judgment and established classification criteria when imaging and biopsy results are inconclusive.

Lemierre’s syndrome (LS) is a rare clinical condition characterized by septic thrombophlebitis of the internal or external jugular vein, usually following an oropharyngeal infection. Here, we present a 20-year-old male patient who developed diarrhea, nausea, and vomiting after receiving clarithromycin for an upper respiratory tract infection. On admission, he had fever, hypotension, and elevation in acute phase reactants (WBC: 20,410/µL, CRP: 197 mg/L). Empirical treatment with ceftriaxone and metronidazole was initiated. Stool and throat cultures were negative. On the second day, abdominal tenderness developed; direct abdominal radiograph showed dilated bowel loops, but toxic megacolon was excluded during follow-up. Thoracic CT revealed septic emboli in the lungs. Due to persistent fever despite ceftriaxone and metronidazole therapy, treatment was escalated to meropenem on the fifth day. On the same day, blood cultures grew <i>Fusobacterium </i><i>necrophorum</i>, raising suspicion of LS. Doppler ultrasound detected a thrombus in the left external jugular vein. Anticoagulant therapy with low-molecular-weight heparin and clopidogrel was initiated. The fever resolved by the seventh day of full antibiotherapy After three weeks of intravenous therapy, follow-up imaging showed regression of the thrombus. The patient completed a four-week course of antibiotics and anticoagulants and was discharged with full recovery. This case highlights the diagnostic challenge of LS presenting with gastrointestinal symptoms and emphasizes the importance of early blood cultures and imaging. External jugular vein involvement due to F. <i>necrophorum</i> is rare and should be considered in patients presenting with septic emboli.

A residual-set framework is introduced for analyzing additive prime conjectures, with particular emphasis on the Strong Goldbach Conjecture (SGC). For each even integer <math><semantics><mrow><msub><mi>E</mi><mi>n</mi></msub><mo>&#x2265;</mo><mn>4</mn></mrow></semantics></math>, the residual set <math><semantics><mrow><mi>&#x211B;</mi><mrow><mo>(</mo><mrow><msub><mi>E</mi><mi>n</mi></msub></mrow><mo>)</mo></mrow><mo>=</mo><mo>&#x007B;</mo><msub><mi>E</mi><mi>n</mi></msub><mo>&#x2212;</mo><mi>p</mi><mo>&#x2223;</mo></mrow></semantics></math> <math><semantics><mrow><mi>p</mi><mo>&#x003C;</mo><msub><mi>E</mi><mi>n</mi></msub><mo>,</mo><mi>p</mi><mo>&#x2208;</mo><mi>&#x2119;</mi><mo>&#x007D;</mo></mrow></semantics></math> is defined, and the universal residual set <math><semantics><mrow><msub><mi>&#x211B;</mi><mi mathvariant='double-struck'>E</mi></msub><mo>=</mo><msub><mrow><msup><mstyle mathsize='140%' displaystyle='true'><mo>&#x222A;</mo></mstyle><mtext>&#x200B;</mtext></msup></mrow><mrow><msub><mi>E</mi><mi>n</mi></msub></mrow></msub><mi>&#x211B;</mi><mrow><mo>(</mo><mrow><msub><mi>E</mi><mi>n</mi></msub></mrow><mo>)</mo></mrow></mrow></semantics></math> is constructed. It is shown that <math><semantics><mrow><msub><mi>&#x211B;</mi><mi mathvariant='double-struck'>E</mi></msub></mrow></semantics></math> contains infinitely many primes. A nontrivial constructive lower bound is derived, establishing that the number of Goldbach partitions satisfies <math><semantics><mrow><mi>G</mi><mrow><mo>(</mo><mi>E</mi><mo>)</mo></mrow><mo>&#x2265;</mo><mn>2</mn></mrow></semantics></math> for all <math><semantics><mrow><mi>E</mi><mo>&#x2265;</mo><mn>8</mn></mrow></semantics></math>, and that the cumulative partition count satisfies <math><semantics><mrow><munder><mstyle mathsize='140%' displaystyle='true'><mo>&#x2211;</mo></mstyle><mrow><mi>E</mi><mo>&#x2264;</mo><mi>N</mi></mrow></munder><mi>G</mi><mrow><mo>(</mo><mi>E</mi><mo>)</mo></mrow><mo>&#x226B;</mo><mfrac><mrow><msup><mi>N</mi><mn>2</mn></msup></mrow><mrow><msup><mrow><mtext>log</mtext></mrow><mn>4</mn></msup><mi>N</mi></mrow></mfrac></mrow></semantics></math>. An optimized deterministic algorithm is implemented to verify the SGC for even integers up to 16,000 digits. Each computed partition <math><semantics><mrow><msub><mi>E</mi><mi>n</mi></msub><mo>=</mo><mi>p</mi><mo>+</mo><mi>q</mi></mrow></semantics></math> is validated using elliptic curve primality testing, and no exceptions are observed. Runtime variability observed in the empirical tests corresponds with known fluctuations in prime density and modular residue distribution. A recursive construction is formulated for generating Goldbach partitions, using residual descent and leveraging properties of the residual sets. The method extends naturally to Lemoine's Conjecture, asserting that every odd integer <math><semantics><mrow><mi>n</mi><mo>&#x2265;</mo><mn>7</mn></mrow></semantics></math> can be expressed as <math><semantics><mrow><mi>n</mi><mo>=</mo><mi>p</mi><mo>+</mo><mn>2</mn><mi>q</mi></mrow></semantics></math>, where <math><semantics><mrow><mi>p</mi><mo>,</mo><mi>q</mi><mo>&#x2208;</mo><mi>&#x2119;</mi></mrow></semantics></math>. A corresponding residual formulation is developed, and it is proven that at least two valid partitions exist for all <math><semantics><mrow><mi>n</mi><mo>&#x2265;</mo><mn>9</mn></mrow></semantics></math>. Comparative analysis with the Hardy-Littlewood and Chen estimates is provided to contextualize the cumulative growth rate. The residual-set methodology offers a deterministic, scalable, and structurally grounded approach to additive problems in prime number theory, supported by both theoretical results and large-scale computational evidence.

<b>Objective:</b> This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. <b>Methods:</b><b> </b>A systematic review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, targeting studies published between 2015 and 2025. Articles were selected based on their contribution to understanding the clinical, microbiological, and surgical aspects of PJI in THA. Fifty-five studies met the inclusion criteria and were analyzed descriptively.<b> </b><b>Results:</b><b> </b>PJI in THA is influenced by multifactorial risk profiles, including obesity, diabetes, and immunosuppression. Staphylococcus aureus, particularly MRSA, remains the most frequently isolated pathogen, followed by Gram-negative organisms and fungal species. Diagnostic innovations such as next-generation sequencing have enhanced pathogen detection, while two-stage revision remains the gold standard for chronic infections. Emerging strategies—such as antimicrobial coatings, tailored antibiotic protocols, and multidisciplinary care models—demonstrate promise in improving clinical outcomes. <b>Conclusion:</b><b> </b>Managing PJI in THA necessitates a comprehensive and individualized approach, integrating early and accurate diagnosis, pathogen-specific treatment, and advanced preventive measures. The integration of emerging technologies and personalized care pathways is critical to optimizing outcomes and reducing the clinical and economic burden of PJI.

This study investigated the pedagogical implications of out-of-field teaching in Social Studies. The Out-of-field Social Studies teachers could encounter several challenges in their preparation and the implementation of the integrated Social Studies curriculum. This study sought the lived experiences of the out-of-field teachers concerning the causes of out-of-field teaching in social studies, problems encountered by the out-of-field teachers and the mechanisms they employ to cope with the teaching of Social Studies. The study chose the qualitative phenomenological research design. Data were collected from all the 17 out-of-field Social Studies teachers through in-depth structured interview. Data were transcribed and analysed, through the inductive thematic analysis approach, unveiling of themes and concepts from the narratives of the research participants. The study revealed that out-of-field teaching in Social Studies occurs as a result of teacher shortage in integrated social studies programme. It is also caused by the perception that any teacher could teach Social Studies irrespective of the teachers’ qualification. Out-of-field teacher encounter problems such as inadequate content and pedagogical knowledge, lack of classroom managerial techniques and inability to deliver lessons through the integrated approach. Engaging in professional development courses, peer coaching, in-service training and workshops were some of the mechanisms employed by out-of-field teachers to cope with the teaching of Social Studies. The pedagogical implications of this phenomenon are that when teaching the Social Studies, the out-of-field teachers place more emphasis on aspects of the Social Studies curriculum where they have much knowledge and skip or put less emphasis on other aspects they lack in-depth knowledge, thus, the integrated approach to teaching Social Studies is not adopted effectively by out-of-field teachers. This waters down the content of Social Studies at the Senior High School level. Addressing the problem of out-of-field teaching in Social Studies requires training and recruiting more teachers who have background training and experience in the integrated approach to the teaching of Social Studies.

The commentary paper reviewed the above research study conducted by Wang et al. (2025), and the investigators examined the association between nurse staffing, job satisfaction, and work engagement, and how these variables impact the quality of care provision provided among the Chinese hospitals. Despite knowing that low staffing within the healthcare facilities is a global issue, Wang and colleagues believed that low staffing is negatively and significantly associated with nurse’s welfare and patient care outcome. This issue causes an increase in burnout and decreased retention of healthcare providers within the clinical setting. It is important to consider and focus on improving and fostering job satisfaction and work engagement among nurses to provide better quality care even within a low staffing environment. According to Wang and colleagues, low staffing outcomes could be mitigated by encouraging workplaces to create healthy and supportive environments for the engaged and satisfied nurses. These would result in better out among patients and increase job fulfilment and welfare among nurses.

The pharmaceutical industry is undergoing a profound transformation driven by advancements in Information Technology (IT), with Enterprise Resource Planning (ERP) systems playing a pivotal role in reshaping operations. These systems offer integrated solutions that streamline key business processes, such as production, inventory management, supply chain optimization, regulatory compliance, and data integration, contributing significantly to operational efficiency and organizational agility. This paper explores the evolution and impact of ERP systems within the pharmaceutical sector, highlighting their contributions to overcoming the industry’s inherent challenges, including complex regulatory requirements, the need for accurate and real-time data, and the demand for supply chain resilience. The integration of cloud-based ERP solutions, the incorporation of emerging technologies like Artificial Intelligence (AI), Machine Learning (ML), and the Internet of Things (IoT), and enhanced data analytics capabilities have revolutionized pharmaceutical IT. These advancements not only reduce operational costs, improve forecasting accuracy, and enhance collaboration but also ensure compliance with stringent global regulations, such as Good Manufacturing Practices (GMP) and FDA guidelines. Moreover, ERP systems have been instrumental in managing the pharmaceutical supply chain, ensuring product traceability, and improving inventory control and order fulfillment processes. This manuscript examines how ERP systems enable pharmaceutical companies to maintain high standards of product quality, improve decision-making, and ensure the safety and efficacy of drugs through robust tracking and auditing mechanisms. A case study of a pharmaceutical company that implemented an ERP system demonstrates the tangible benefits, including increased operational efficiency, improved compliance rates, and enhanced customer satisfaction. However, despite the clear advantages, challenges such as customization complexities, data integration issues, and resistance to change remain. As the pharmaceutical industry continues to evolve, ERP systems will remain a cornerstone of digital transformation, facilitating smarter decision-making, better resource management, and enhanced collaboration across global operations. This paper also identifies future trends, including the potential of AI and blockchain technologies in further strengthening ERP systems and transforming the pharmaceutical landscape.

<b>Background</b><b>: </b>Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between multiple epigenetic age acceleration measures and three key health indicators, including self-rated health, depressive symptoms, and body mass index (BMI), in a nationally representative sample of U.S. middle-aged and older adults. <b>Methods</b><b>: </b>We analyzed data from 4,018 adults in the 2016 wave of the Health and Retirement Study (HRS), which included several epigenetic age acceleration measures: HORVATH, HANNUM, LEVINE, HORVATHSKIN, LIN, WEIDNER, VIDALBRALO, YANG, ZHANG, BOCKLANDT, GARAGNANI, and GRIMAGE. Linear regression models were used to assess the associations between epigenetic age acceleration and self-rated health (poor health), depressive symptoms, and BMI, adjusting for age and sex. <b>Results</b><b>: </b>We found significant positive associations between epigenetic age acceleration and worse self-rated health, higher depressive symptoms, and increased BMI. However, these associations varied across different epigenetic clocks, with some measures potentially having more consistent utility for specific health outcomes than others. <b>Conclusion</b><b>: </b>Epigenetic age acceleration is linked to poorer self-rated health, greater depressive symptoms, and higher BMI, but choosing which epigenetic clock(s) to use is also important. These findings underscore the need to consider multiple epigenetic aging markers when assessing health risks and highlight the potential for particular clocks to serve as more sensitive indicators of physical and mental health outcomes.

Data acquisition serves as a critical component of modern data architecture, with REST API integration emerging as one of the most common approaches for sourcing external data. This study evaluates the efficiency of various methodologies for collecting data via REST APIs and benchmark their performance. It explores how leveraging the Spark distributed computing platform can optimize large scale REST API calls, enabling enhanced scalability and improved processing speeds to meet the demands of high volume data workflows.

<b>Background: </b>Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and their associated risks. However, it remains unclear why a group with more knowledge about e-cigarette risks would also hold more positive attitudes toward vaping and exhibit higher usage rates — a phenomenon that may represent a knowledge-behavior paradox. Understanding this paradox, along with the complex relationships between e-cigarette knowledge, attitudes, and behaviors, is critical for informing effective public health interventions, campaigns, social media messaging, and regulatory policies. <b>Objectives: </b>This study aimed to evaluate the complex relationship between SES, e-cigarette knowledge, pro-vaping attitudes, and e-cigarette use. <b>Methods: </b>The SMOKES Study (Study of Measurement of Knowledge and Examination of Support for Tobacco Control Policies) used a multi-center, cross-sectional design, collecting data from 2,403 college and university students across 15 provinces in Iran (covering nearly half of the country's provinces). The survey measured family income, age, sex, ethnicity, e-cigarette use, knowledge, and attitudes. Structural Equation Modeling (SEM) was employed to examine the interrelations between SES, knowledge, attitudes, and behavior, while adjusting for age, sex, and ethnic minority status. <b>Results</b>: SEM analysis confirmed the hypothesized paradox. Although greater knowledge about e-cigarettes was linked to less favorable attitudes toward vaping and lower use, pro-vaping attitudes emerged as the strongest predictor of vaping behavior, while knowledge played a weaker protective role. Notably, individuals with higher SES simultaneously showed higher knowledge and, paradoxically, more pro-e-cigarette attitudes and greater usage. Female students and ethnic minority students reported higher correct knowledge and lower pro-vaping attitudes and use. Although age and higher family income were associated with more favorable attitudes, they did not directly predict vaping behavior. These results suggest that for higher SES individuals, poor knowledge is not the main driver of e-cigarette use; rather, their pro-e-cigarette attitudes, which seem to outweigh the influence of knowledge, play a key role. <b>Conclusions: </b>Although individuals from higher SES backgrounds report greater correct knowledge about e-cigarettes, this knowledge does not necessarily translate into reduced positive attitudes or lower usage. This study highlights the complexity of these paradoxical effects and suggests that public health strategies need to go beyond simple education and knowledge-based interventions. Targeted approaches should address industry messaging, challenge misconceptions, and strengthen regulatory efforts to reduce e-cigarette use among young adults, including those from higher SES backgrounds.

The pharmaceutical supply chain has become increasingly complex and vulnerable to various risks, including counterfeit drugs, diversion, and fraud. As these challenges threaten patient safety and the integrity of global healthcare systems, serialization has emerged as a pivotal innovation in pharmaceutical logistics and regulatory compliance. Serialization involves assigning unique identifiers to individual drug packages, enabling precise tracking and authentication at every stage of the supply chain. This process provides unprecedented transparency, enhances product security, and facilitates real-time monitoring of pharmaceutical products as they move from manufacturers to end consumers. Despite its potential to revolutionize pharmaceutical traceability, the integration of serialization technologies faces numerous obstacles. These include high implementation costs, regulatory inconsistencies across regions, and the technological challenges of managing vast amounts of data. Moreover, the complex, multi-tiered nature of the global supply chain introduces additional risks related to data integrity, cybersecurity, and interoperability between systems. As pharmaceutical companies seek to navigate these challenges, innovations in serialization technology—such as blockchain, artificial intelligence (AI), the Internet of Things (IoT), and radio frequency identification (RFID)—are providing promising solutions to enhance efficiency, reduce fraud, and increase visibility. This manuscript explores both the innovative advancements and the key challenges associated with the integration of serialization in the pharmaceutical supply chain. It delves into the evolving regulatory landscape, highlighting the need for global harmonization of serialization standards, and examines the impact of serialization on securing pharmaceutical distribution networks. Additionally, the paper emphasizes the importance of collaboration among manufacturers, technology providers, and regulatory bodies in overcoming implementation barriers and realizing the full potential of serialization. As the pharmaceutical industry moves towards a more interconnected and data-driven future, serialization promises to play a central role in shaping the next generation of drug safety and supply chain management. By addressing the hurdles to adoption and leveraging emerging technologies, the pharmaceutical sector can create a more secure, transparent, and efficient supply chain that better serves public health and fosters greater trust among consumers and healthcare professionals alike.

</b>Background: </b>The Cingulo-Opercular Network (CON) is a crucial executive control network involved in regulating actions and facilitating higher-order cognitive processes. Resting-state functional connectivity between the CON and the Default Mode Network (DMN) plays a vital role in cognitive regulation, enabling the transition between internally focused and externally directed tasks. This study investigates whether resting-state functional connectivity between the CON and DMN mediates the effects of social determinants, such as educational opportunities and family structure, on cognitive outcomes in youth. <b>Aims: </b>This study aims to explore how CON-DMN connectivity influences the relationship between social gradients and cognition in youth. Specifically, it examines whether resting-state functional connectivity between these networks mediates the effects of educational opportunities and family structure on cognitive outcomes and seeks to uncover the neural mechanisms underlying these social gradients. <b>Methods: </b>Data were derived from the Adolescent Brain Cognitive Development (ABCD) study, a large longitudinal dataset of over 11,000 children aged 9–10 years. Cognitive outcomes were assessed using standardized NIH toolbox measures: Total Composite, Fluid Reasoning, Picture Vocabulary, Pattern Recognition, and Card Sorting. Social determinants were operationalized using indicators such as parental education, family composition, and neighborhood educational opportunities (COI). Resting-state functional connectivity (rsFC) between the CON and DMN was measured using functional magnetic resonance imaging (fMRI). Structural equation modeling (SEM) was employed to test whether CON-DMN rsFC mediated the relationship between social determinants and cognitive outcomes, adjusting for potential confounders such as age, sex, and race/ethnicity. <b>Results: </b>Stable family structure and greater educational opportunities were significantly associated with improved cognitive performance. These relationships were mediated by reduced functional connectivity between the CON and DMN. <b>Conclusion: </b>Reduced functional connectivity between the CON and DMN serves as a neural mechanism linking social gradients, such as educational opportunities and family structure, to better cognitive outcomes in youth.

<b>Background: </b>While understanding how corticostriatal connectivity is associated with socioeconomic status (SES), trauma exposure, cognitive function, reward salience, impulsivity, and future substance use is essential to identifying neurobiological pathways that contribute to health disparities and behavioral outcomes, very few studies have tested the role of left caudate resting-state functional connectivity (rsFC) with the cingulo-opercular network as a proxy of corticostriatal connectivity in social, cognitive, and behavioral processes. <b>Objective: </b>This study investigates the associations between left caudate-cingulo-opercular connectivity and multiple biopsychosocial domains, including low SES, high trauma exposure (financial and life events), cognitive function, reward salience, impulsivity, depression, and future substance use (tobacco and marijuana use). <b>Methods: </b>Resting-state functional magnetic resonance imaging (rs-fMRI) data were analyzed to assess connectivity between the left caudate and the cingulo-opercular network. Data on socioeconomic status, trauma exposure, cognitive performance, and mental health were collected from participants. Future substance use behaviors were evaluated through longitudinal follow-ups. Correlation and regression analyses were conducted to examine relationships between corticostriatal connectivity and the targeted domains. <b>Results: </b>Corticostriatal hypoconnectivity was associated with lower SES, higher trauma exposure, poorer cognitive function, heightened reward salience, higher impulsivity, and history of depression. Additionally, corticostriatal hypoconnectivity at baseline predicted future tobacco and marijuana use during follow-up years. <b>Conclusion: </b>Corticostriatal hypoconnectivity, particularly the rsFC between the left caudate and the cingulo-opercular network, may represent a potential mechanism linking a wide range of social, emotional, and behavioral problems in youth. These findings suggest that corticostriatal hypoconnectivity could serve as a neurobiological marker for identifying individuals at risk for depression, low cognitive function, high reward salience, impulsivity, and substance use, emphasizing the interplay between socioeconomic and neurocognitive factors in shaping behavioral health trajectories.