Evidence on milnacipran exposure during pregnancy is sparse, complicating treatment decisions when maternal stability depends on this antidepressant. We report a 31-year-old primigravida with severe post-traumatic stress disorder and a severe major depressive episode with psychotic features in the context of a chronic, difficult-to-treat psychiatric course marked by self-harm, dissociation, and recurrent suicidal behavior. Milnacipran 150 mg/day led to marked clinical improvement before pregnancy. After pregnancy confirmation, treatment was changed to sertraline plus quetiapine because of limited pregnancy safety data, but depressive symptoms and suicidal behavior reemerged within 2 weeks. Milnacipran was therefore re-established after risk-benefit evaluation and shared decision-making, with renewed improvement. Moderate hyperemesis gravidarum during the second trimester led to discontinuation of milnacipran by gestational week 22. Delivery occurred at gestational week 38 via primary cesarean section. No congenital anomalies or neonatal adaptation problems were observed. At 3-year follow-up, pediatric developmental screenings remained within expected limits. This case illustrates the challenge of balancing relapse risk, prior treatment response, and treatment feasibility during pregnancy when evidence for the effective medication is limited.
Electrophysiological and morphological alteration in the visual pathway of children with attention-deficit/hyperactivity disorder
IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Optical Coherence Tomography (OCT) and Visual evoked potentials (VEP) are common non-invasive diagnostic techniques. Researchers can use these techniques to identify possible biomarkers and explore the neurodevelopmental mechanisms underlying ADHD.MethodsThe ADHD group (37 cases, average age 8.81 ± 1.44 years) and the healthy controls (38 cases, average age 8.97 ± 1.43 years), had the OCT and VEP. The retinal nerve fibre layer (RNFL), optic disc parameters, and macular parameters were measured through OCT. The latencies of P100 and the amplitudes of N75-P100 and P100-N135 waves at three different spatial frequencies (visual angles of 15’, 30’, and 60’) were tested through VEP.ResultsThe average RNFL and RNFL in each quadrant between the two groups were no statistically significant (all p > 0.05). The optic disc area, average cup-to-disc ratio, and cup volume in the ADHD group were all significantly larger than those in the control group (all p < 0.05). At three visual angles (15’, 30’, 60’), P100-latency in the ADHD group were all more significant than those in the control group (all p < 0.05). The amplitudes of N75-P100 and P100-N135 in the ADHD group were all statistically significantly lower than those in the control group (all p ≤ 0.001).DiscussionFrom the perspective of electroencephalophysiology, children with ADHD may have early visual information processing disorders. This provides a theoretical and practical basis for further early intervention in children with ADHD from the field of visual perception. The study protocol followed the tenets of the Declaration of Helsinki, was approved by the local ethics committee (No 2023-2240), and was registered on ClinicalTrials.gov (ChiCTR2400086223).
From collective restriction to critical action: the indirect effects of critical motivation and radical hope
IntroductionHistorically, Women of Color (WOC) in the United States have experienced systemic restrictions to their freedom and autonomy, which can have a lasting impact on their mental health and wellbeing. Conceptually, this type of collective autonomy restriction (CAR) experience may be associated with increased critical consciousness (CC), reflected in greater awareness of social and systemic oppression, commitment to and belief in one’s capacity to address social issues, and engagement in action; however, there is a dearth of research examining this association. Building on critical consciousness and hope literatures, we hypothesized that the association between CAR and critical action would be explained through serial pathways of increased critical motivation and greater radical or collective hope.Materials and MethodsA sample of 408 WOC completed an online survey administered through Prolific and hosted on Qualtrics. The survey included indicators of CAR, critical consciousness (critical motivation and critical actions), psychological hope, and radical hope. ResultsWe conducted structural equation modeling to test a serial mediation model exploring the associations among CAR, critical motivation, hope, and critical action. Findings indicated the association between CAR and critical action was fully mediated by the proposed serial mediation pathways (CAR → Critical Motivation → Radical Hope → Critical Action). The pathway through radical hope was stronger than through psychological hope. The direct effect of CAR on critical action was non-significant, indicating full mediation.DiscussionThese results highlight the role of radical hope as a potential pathway connecting critical awareness of collective autonomy restriction and critical motivation to engage in critical action aimed at social change. We extend the existing literature by demonstrating that awareness of oppression and motivation alone may be insufficient to explain the link between the first two dimensions of critical consciousness (critical reflection and critical motivation) and critical action. Limitations and implications for research and practice are discussed.
Ngā māuiui kai: a cross-sectional study of elevated eating disorder risk and related experiences among trans people in Aotearoa
PurposeLittle is known about disordered eating and eating disorders (ngā māuiui kai) among transgender and non-binary (trans) communities in Aotearoa New Zealand. This cross-sectional study sought to provide evidence of the prevalence and experiences of ngā māuiui kai among these communities.MethodsWe analyzed data from a national trans health survey of people using chi-square tests of independence to examine associations between sociodemographic characteristics and elevated eating disorder risk measured by the SCOFF screening tool. A content analysis of open-text survey comments identified themes across participants’ self-reported experiences of ngā māuiui kai.ResultsOverall, 34.3% of participants met criteria for increased risk for an eating disorder. Age, neurodivergence, material hardship, functional impairment, and Māori ethnicity were associated with elevated risk among this sample. No associations were found for gender, self-identified disability, or other ethnicities. The content analysis found that several participants reported connections between their māuiui kai and gender incongruence, broader mental health issues, or structural barriers. Some reported challenges seeking related healthcare, and a lack of providers’ awareness of the relationship between gender-affirming healthcare needs and ngā māuiui kai.ConclusionsA high proportion of trans participants met the criteria for elevated risk of eating disorders, with higher risk among those belonging to other marginalized groups. These findings highlight the unique risk factors among trans people who belong to multiple marginalized groups. They signal need for appropriate prevention and provision of responsive care for trans people at the intersections of ngā māuiui kai and gender-affirming healthcare.
Improving metagenome binning by integrating intrinsic features and taxonomy
Nature Biotechnology, Published online: 27 April 2026; doi:10.1038/s41587-026-03098-0
TaxVAMB combines sequence features with taxonomic information for improved metagenome binning.
Ten lessons from a decade of scientific translation at the Crick
Nature Medicine, Published online: 27 April 2026; doi:10.1038/s41591-026-04355-0
Ten lessons from a decade of scientific translation at the Crick
The arrival of digital twins and in silico trials in drug development
Nature Medicine, Published online: 27 April 2026; doi:10.1038/s41591-026-04344-3
The regulatory landscape for drug evaluation is shifting. For digital twins and in silico trials to become reliable evidence for drug approvals, these digital tools will require input from regulators and the public sector to ensure safe and responsible adoption.
The TARGET guideline for reporting observational studies of interventions
Nature Medicine, Published online: 27 April 2026; doi:10.1038/s41591-026-04358-x
The TARGET guideline for reporting observational studies of interventions
The All of Us Research Program’s wearables dataset
Nature Medicine, Published online: 27 April 2026; doi:10.1038/s41591-026-04352-3
The authors present the All of Us Research Program dataset, containing Fitbit data from 59,000 participants spanning 14 years, 39 million steps and 31 million sleep observations.
Brain motion is driven by mechanical coupling with the abdomen
Nature Neuroscience, Published online: 27 April 2026; doi:10.1038/s41593-026-02279-z
Using two-photon imaging in mice, Garborg et al. show that brain movement within the skull is driven by abdominal muscle contractions through mechanical coupling with the abdomen. Simulations suggest that this brain motion could contribute to cerebrospinal fluid circulation.