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International students face numerous challenges in both their academic and social lives when relocating to a new country for their university studies. The foreign language can have an impact on international medical students' performance in patient encounters. Particularly in the context of psychosocial medicine, a deficiency in communication skills can negatively impact the doctor-patient-relationship. This is the first study that uses natural language processing (NLP) as well as traditional rating scales to assess the improvement of international students' communication skills after attending a communication training seminar. N = forty-two international students participated in the study, which followed a pre-post-design. Diagnostic interviews with standardized patients (SP) were videotaped before and after the three-day training seminar, which was comprised of short lectures and communication trainings with SPs regarding the topic of psychosomatic medicine. Transcripts of diagnostic interviews were analyzed with NLP. Videotaped clinical encounters were assessed by three raters with binary and global rating instruments. For the comparison between pre- and post-assessment of all NLP communication parameters and rating results, two-way ANOVAs and Wilcoxon tests were calculated, respectively. NLP communication parameter results showed a decrease in talk-turns, interruptions, number of questions and talking over, and an increase in talk-turn-length in post-assessment compared to pre-assessment. There were no significant pre-post changes observed in binary checklist results. Significant pre-post changes were observed in global rating score and ratings from global rating domains 'interview structure' and 'verbal expression'. International students significantly improved their communication style in psychosomatic medicine towards a more patient-centered approach. Changes in NLP communication parameters and improved interview style and verbal expression suggest that international students may have listened to patients more carefully. Furthermore, NLP has shown to be a viable tool to evaluate communication parameters in a doctor-patient-relationship and assess the effectiveness of communication training for international students.
The present study examined the effects of the Psychotraining-Based Communication Workshop Program on family functioning and psychological resilience among parents of children with special needs. This randomized controlled study investigated the effects of communication training therapy for parents of children with special needs. Participants were assigned to intervention (N = 21) and control (N = 21) groups. The workshop was delivered to parents of children with developmental delays over 6 weeks, consisting of two sessions per week lasting 45-60 min each, and was conducted by health and education professionals using a family-centered multidisciplinary approach. The Turkish versions of the Perceived Family Functioning Scale (PFFS) and Adult Psychological Resilience Scale (APRS) were administered in the pre- and post-tests. Following the workshop delivered by psychiatric nursing staff, the intervention group demonstrated significant improvements in family communication and positive affect (4.365 compared with 3.902, effect size = 1.02, p < 0.001), Conflicts and negative affect (1.881 compared with 2.470, effect size = 0.78, p = 0.002), and the total adult psychological resilience score (4.389 compared with 3.921, effect size = 0.74, p = 0.003). Significant increases were also observed in relational resources (4.357 compared with 4.064, effect size = 0.46, p = 0.047), cultural and contextual resources (4.429 compared with 3.743, effect size = 0.76, p = 0.002), and family resources (4.514 compared with 3.886, effect size = 0.85, p = 0.001).  The psychoeducation-based communication workshop program was effective in improving family communication and psychological resilience among parents of children with special needs.The findings of this study suggest that family-centered psychoeducational programs may be beneficial and could contribute to nursing practice. • Parents of children with special needs frequently experience challenges in family functioning and reduced psychological resilience because of long-term caregiving responsibilities. • Psychoeducational interventions may improve psychosocial outcomes; however, evidence regarding communication-based programs targeting both family functioning and psychological resilience remains limited. • This psychotraining-based communication workshop significantly improved family communication and positive affect while reducing conflicts and negative emotions among parents of children with special needs. • The intervention strengthened overall psychological resilience, particularly relational, cultural-contextual, and family resources, supporting the integration of communication-based psychoeducation into family-centered nursing practice.
Psychological distress is prevalent among young adult (YA) patients with cancer, yet the role of couples' communication in this specific population remains underexplored. This study aimed to investigate the status of couples' communication and examine its independent association with depression and anxiety in YA patients with cancer. A cross-sectional survey was conducted among YA patients with cancer. Participants completed the Cancer-Related Communication Problems Scale, PHQ-9 (depression), and GAD-7 (anxiety). Hierarchical linear regression analyses were performed to determine the association between communication barriers and psychological outcomes after controlling for demographic and clinical variables. A total of 202 married YA patients with cancer participated in this study. The mean age was 34.69 ± 4.11 years (Range: 22-39 years). Participants reported a mild level of overall communication barriers (Total Score Mean ± SD: 13.41 ± 3.93; Range: 1-22). The mean anxiety and depression scores were 6.43 ± 5.16 (Range: 0-21) and 6.97 ± 5.47 (Range: 0-27). The top five specific barriers were difficulty with partner understanding of body image changes (Item 11, Mean ± SD = 1.46 ± 0.69), difficulty discussing worsening conditions (Item 13, Mean ± SD = 1.30 ± 0.68), difficulty sharing worries about treatment effectiveness (Item 9, Mean ± SD = 1.28 ± 0.71), avoidance of discussing sexual experience (Item 15, Mean ± SD = 1.11 ± 0.72) and selective disclosure to protect the spouse (Item 14, Mean ± SD = 1.07 ± 0.70). Univariate analysis indicated that unemployment and female sex were significantly associated with higher depression scores (P < 0.05), while no demographic variables were significantly associated with communication barriers. After adjusting for sex and unemployment status, communication barriers remained independently associated with depression (B = 0.26, 95% CI: 0.08, 0.44, P = 0.008), but not with anxiety (P > 0.05). Communication barriers were independently associated with depressive symptoms, but not anxiety, after adjustment for sex and employment status. These item-level findings suggest that body image and intimacy may be key topics for future dyadic communication interventions. Future psychosocial interventions may consider addressing open spousal dialogue about body image and sexual concerns in this population.
To examine the most common factors influencing the selection of Geriatric Medicine as a specialty among medical residents, and to assess whether receiving specific exposure to Geriatric Medicine during training influences these factors. A qualitative descriptive study was carried out using intentional sampling, involving anonymous completion of a questionnaire distributed to accredited Spanish Geriatric Medicine teaching units during the 2023/2024 academic year. A total of 129 medical residents participated in the survey. Eighty-nine per cent were already familiar with the specialty and 46% had received theoretical and practical Geriatric Medicine training during medical school. The most frequently reported factors were affinity with older persons (95%), communication with patients and families (90%), multidisciplinary work (86%), clinical complexity of older adult patients (84%), multimorbidity (82%), and relationships with older relatives (76%). Participants who had received complete training in Geriatric Medicine (46%) were more likely to have considered Geriatrics as a potential specialty (75% vs. 54%, p = 0.02). The clinical complexity of the older adult patients was significantly more relevant among those with complete Geriatric training (92% vs. 77%, p = 0.027). Interest in Geriatric Medicine is shaped by a combination of personal motivations and factors directly related to the specialty and the characteristics of the older adult population. Comprehensive training in Geriatric Medicine has the potential to transform commonly perceived barriers into rewarding aspects of the field.
This study explored challenges experienced by healthcare providers (HCPs) in intensive care units (ICUs) during the COVID-19 pandemic, focusing specifically on communication and care interactions, and examined how these experiences impacted ICU practices and provided opportunities for improvements. Semi-structured interviews were conducted with 16 ICU physicians and nurses from October 2022 to March 2023. Interview data were analyzed through thematic analysis. Nine themes emerged, categorized into three key areas. (1) "Challenges and Adaptations Experienced by HCPs" described how stringent infection-control measures created emotional and practical difficulties, prompting adaptive strategies to maintain effective care. The pandemic reinforced the critical role of interdisciplinary cooperation; in response, an interdisciplinary conference was organized, and HCPs intentionally sought closer collaboration than was usual to ensure coordinated decision-making and the continuity of care. (2) "Interactions Among Patients, Families, and HCPs" emphasized that visitation restrictions impaired family involvement, although proactive measures by nurses, such as the introduction of remote visits, significantly facilitated family engagement and emotional support. (3) "Lessons Learned from the Pandemic" highlighted improved healthcare practices and reinforced the value of interdisciplinary collaboration and family-centered approaches in ICU care. The findings underscore the necessity of robust communication practices and interdisciplinary teamwork within ICUs. These pandemic-related experiences offer valuable insights for improving communication, supporting flexible visitation policies, and promoting patient- and family-centered approaches. Collectively, these lessons offer essential guidance for developing more resilient and compassionate ICU care strategies, applicable in future crises and in everyday practice. The online version contains supplementary material available at 10.1007/s41649-025-00402-z.
Patient-reported experience measures (PREMs) are widely used for quality improvement, benchmarking, and physician compensation, yet few large-scale studies have examined interventions to improve scores. We examine the association of an annual, mandatory, peer-led continuing professional development (CPD) program at a large, multispecialty group practice aimed at enhancing patient-clinician communication. This quality improvement study analyzed ambulatory pre-post patient experience surveys from January 2018 to October 2022 for top box ratings for four PREMs focusing on provider communication for "explains", "listens" to them, "overall provider rating," and would "recommend" the practice were modeled using generalized estimating equations, adjusting for patient and provider characteristics. Over 1 million surveys per year were analyzed and the likelihood of top-box response in all four domains increased post implementation in 2019- 2022 compared to 2018 with all adjusted odds ratios > 1.0 and p ≤ 0.001. Our findings suggest CPD programs may improve PREMs in a large healthcare system, across all communication-related domains. However, there could be limits and a plateau to how much a CPD intervention can improve PREMs.
Triple-negative breast cancer (TNBC) is an aggressive subtype with limited therapeutic options. Although anti-angiogenic agents like Axitinib are used in cancers, resistance emerges through poorly understood mechanisms involving stemness and vasculogenic mimicry (VM). Here, we investigated the regulatory role of thrombospondin-1 (THBS1), an anti-angiogenic protein, in Axitinib-mediated signaling and its impact on TNBC. The effects of Axitinib on VM, angiogenesis, and stemness in TNBC were investigated through in vivo models and in vitro endothelial-supernatant cultures. Bioinformatics analyses (GSE230643 and CellChat), immunohistochemistry of clinical samples, exosome transfer assays, and xenograft models were employed to explore how Axitinib regulates THBS1-mediated endothelial-TNBC intercellular communication. Further bioinformatics analyses, combined with in vitro and in vivo experimental validations, were performed to elucidate the mechanism of the THBS1-CD47 axis in TNBC. Axitinib treatment increased stemness and promoted VM in TNBC models, despite tumor growth inhibition. Bioinformatics analyses revealed the Axitinib-dependent THBS pathway between endothelial and endothelial-like tumor cells. Axitinib-induced downregulation of THBS1 expression in HUVEC cells promoted stemness and angiogenesis of recipient TNBC cells via exosomes. Mechanistically, endothelial-derived THBS1 promoted CD47 expression in recipient TNBC cells, thereby attenuating the activity of PI3K/Akt and MAPK/ERK signaling pathways, and inhibiting stemness, angiogenesis, and VM. Importantly, Axitinib disrupted this THBS1-CD47 axis by downregulating endothelial-derived THBS1 expression. Axitinib induces the suppression of THBS1 expression in endothelial cells, thereby enhancing stemness and VM in recipient TNBC via disruption of the THBS1-CD47 axis. Restoring THBS1 signaling may represent a promising strategy to overcome Axitinib resistance.
Uric acid (UA) is an endogenous antioxidant that protects against neuroinflammatory diseases. Although irritable bowel syndrome (IBS) is considered a disorder of gut-brain interaction, the role of UA in IBS remains unclear. An experimental rat model of IBS was induced using laser-induced shock waves (LISW) applied to the head. Hyperuricemia (HUA) was induced by intraperitoneal administration of inosine monophosphate and potassium oxonate. Visceral hypersensitivity was assessed by colorectal distension. Ileal mucosal permeability was measured using the Evans blue method. CRFR1 mRNA expression in the rectum, IL-10 and TGF-β1 expression in the ileum, and IL-1α, IL-1β, and TNF expression in the medial prefrontal cortex (mPFC) and paraventricular nucleus (PVN) were quantified by qRT-PCR. Vagal involvement was assessed using subdiaphragmatic vagotomy or atropine treatment. LISW increased visceral hypersensitivity, ileal mucosal permeability, and rectal CRFR1 expression and reduced IL-10 expression in the ileum. HUA significantly ameliorated these changes. HUA was also associated with reduced IL-1β expression in the mPFC and reduced IL-1α and IL-1β expression in the PVN in LISW-treated animals. Importantly, the ameliorative effects of HUA on visceral hypersensitivity were abolished by vagotomy or atropine treatment. Hyperuricemia ameliorated LISW-induced visceral hypersensitivity, improved ileal mucosal permeability, restored IL-10 expression in the ileal mucosa, and reduced proinflammatory cytokine expression in the brain. The loss of HUA-induced suppression of visceral hypersensitivity after vagotomy or atropine treatment suggests the possible involvement of vagal and cholinergic brain-gut communication. Irritable bowel syndrome (IBS) is a common disorder in which people experience abdominal pain and bowel problems, often worsened by stress. We examined whether uric acid, a major endogenous antioxidant in the human body, can protect against changes seen in a rat model of IBS. An experimental model of IBS was created by applying laser‐induced shock waves to the head, leading to increased sensitivity to colorectal distension (a measure of visceral hypersensitivity), impaired barrier function of the lower small intestine, and reduced a protective anti‐inflammatory signal (IL‐10) in the gut. Increasing blood uric acid levels reduced visceral hypersensitivity, improved the barrier function of the lower small intestine, and restored IL‐10 levels. Importantly, the uric acid–induced suppression of visceral hypersensitivity was lost when vagus nerve signaling was disrupted, indicating that vagal and cholinergic signaling is involved in this effect.
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Unregulated peptide use is emerging as a digitally mediated public health concern. Although peptide-based medicines have important therapeutic roles when developed, prescribed, manufactured, and monitored through regulated pathways, online biohacking and wellness spaces increasingly promote experimental or weakly evidenced peptides for fat loss, recovery, aesthetics, cognition, performance, and longevity. This narrative review examines how digital promotion, gray-market access, self-injection, stacking, informal titration, product-quality uncertainty, regulatory ambiguity, and weak pharmacovigilance interact to normalize poorly traceable peptide products outside clinical supervision. The central concern is not legitimate peptide medicine, but consumer experimentation with products of uncertain identity, purity, potency, sterility, and safety. Improved clinician awareness, adverse-event reporting, product-quality monitoring, digital risk communication, and proportionate regulatory oversight are needed to distinguish evidence-based peptide therapy from unregulated consumer use.
Pathogenic variants (PVs) in the BRCA1 and BRCA2 ( BRCA1/2) genes increase lifetime risk of several cancers including breast and ovarian. Communicating complex genetic risk and management strategies can be challenging. Digital education tools, like short videos, can provide standardized, accessible information to support patient understanding and family communication. A short educational video reviewing BRCA1/2-associated cancer risks, guideline-based screening, and risk-reduction strategies was developed using National Comprehensive Cancer Network (NCCN) recommendations in patient-centered language. From July-August 2024, patients with known BRCA1/2 PVs attending a gynecologic oncology clinic were offered video access via a QR code and invited to complete a voluntary survey assessing usability, satisfaction, perceived usefulness, trustworthiness, and potential value for family communication. Survey responses were summarized descriptively. Of 34 patients offered the video, 32 (94%) viewed it, of which 28 (88%) completed the survey. Median age of participants was 43 years (interquartile range, [IQR]: 35-60 years). All participants were female, 68% White, 11% Hispanic or Latino, 46% BRCA1 PVs, and 54% BRCA2 PVs. Most participants rated the video as very easy to use (96%), very understandable (96%), and satisfying (86%), with 79% finding the content useful and 64% finding the video helpful for communicating risk with relatives. Qualitative feedback highlighted clarity and usefulness for newly diagnosed individuals. These findings suggest that a brief educational video on BRCA1/2 risk was feasible, highly acceptable, and perceived as useful by participants. Video-based education may serve as an effective adjunct to clinical counseling and facilitate communication of hereditary cancer risk with relatives.
Human brain organoids (HBOs) are three-dimensional structures derived from human stem cells that model aspects of brain development and function, offering potentially unprecedented opportunities for studying neurological disorders and for developing treatments. This consensus paper presents recommendations from the Asia Pacific Neuroethics Working Group, developed through interdisciplinary collaboration among scientists, bioethicists, philosophers, and legal scholars who convened in Singapore in November 2024. We provide a comprehensive analysis of the ethical, legal, and sociocultural dimensions of HBO research, addressing both current realities and future possibilities. The paper examines key ethical considerations, including the potential moral status of HBOs, particularly regarding sentience and consciousness, while identifying and dispelling common misconceptions and "ethical red herrings" arising from sensationalized portrayals. We analyze consent frameworks for cell donation, privacy concerns, dual-use risks, and questions of distributive justice. Legal challenges are explored, including the categorical ambiguity of HBOs within existing regulatory frameworks, intellectual property issues, and cross-border inconsistencies in standards. Sociocultural perspectives emphasize the importance of public understanding, cross-cultural engagement, and empirical research on diverse community attitudes toward HBO research. In our recommendations, we advocate for evidence-based ethical discussions, anticipatory frameworks addressing potential future developments, contextualized analysis comparing HBOs to related experimental models, robust informed consent processes, proportionate responses to consciousness concerns, development of adaptive regulatory frameworks, responsible science communication to manage public expectations, and sustained interdisciplinary collaboration. We emphasize a balanced approach that promotes scientific innovation while maintaining rigorous ethical oversight, recognizing HBOs' significant potential for advancing neuroscience and medicine. This represents the first comprehensive ethical framework for HBO research from the Asia Pacific region, helping to establish foundational principles for responsible development of this rapidly advancing field.
Increasingly, hospitals are recognizing the need to address the high mental health care needs of individuals with chronic illness, including congenital heart disease (CHD). This qualitative study explored health professionals' views on integrated mental health care in CHD. Individual, semi-structured interviews were conducted with health professionals from diverse disciplines at five CHD centers in the United States, Australia, and Switzerland. Each center had a distinct model of mental healthcare integration and a unique healthcare ecosystem. The Consolidated Framework for Implementation Research was used to guide study design and analysis. Verbatim transcriptions were analyzed thematically using MAX Qualitative Data Analysis (MAXQDA) software. Health professionals representing medicine, psychology, nursing, social work, education, and healthcare administration participated (N = 46, 58% response rate, 72% women, M = 15.5 ± 8.0 years of professional experience, interview duration: M = 47.9 ± 18.8 min). Five key themes were identified: (1) high need and demand for mental health care among individuals with CHD and their families; (2) multiple, inter-related barriers to care, including stigma and socioeconomic factors; (3) barriers to mental healthcare integration for CHD centers, including understaffing, time and fiscal constraints, and lack of clear referral pathways; (4) strategies to promote integration, including interdisciplinary teamwork and regular communication with mental health professionals embedded in cardiac care; and (5) facilitators of access to care, including routine mental health screening, multiple entry points across the medical trajectory, a preventive focus, and skills-based staff training. Results highlight the need for innovative implementation strategies to accelerate access to integrated mental healthcare for individuals with CHD across the lifespan.
Childbirth is a crucial experience that impacts women's lives, and the choice between vaginal delivery and cesarean section (C-section) is a critical decision in obstetrics. Maternal satisfaction is influenced by multiple factors since the childbirth experience is a composite of physical, emotional, and social components. Understanding patient evaluation is crucial for providing patient-centered care and improving maternity and neonatal care services. This systematic review aimed to compare patient satisfaction between vaginal and cesarean delivery patients and identify influencing factors. We performed a thorough search of databases for studies published between 2000 and 2024 on patient-reported satisfaction with vaginal delivery vs. C-section interventions. Eligible studies were assessed for methodological quality and relevance. The findings indicated that most women were satisfied with their delivery experience, with vaginal delivery leading to higher satisfaction than C-sections. Factors influencing satisfaction include maternal education, domicile, planned delivery care, healthcare professional gender, complications, partners' education, pain control measures, Apgar scores, and injuries. However, satisfaction levels were not significantly different across other maternal demographic factors or pregnancy-related characteristics. Certain features, such as planned pregnancy and excellent prenatal care, improved satisfaction with both vaginal and cesarean deliveries. The presence of a supporting companion during birth significantly boosted satisfaction levels, especially in primary care settings. Inadequate communication is associated with decreased maternal satisfaction. Therefore, healthcare practitioners should prioritize patient-centered care, good communication, and support. Targeted interventions are recommended, considering factors that influence the delivery of maternal and child care services.
Early-stage chronic kidney disease (CKD), before the initiation of renal replacement therapy represents a critical period for delaying the onset of end-stage kidney failure; however, it remains underexplored. Effective management during this phase requires understanding the lived experiences of those directly involved in care. This study therefore aims to explore the experiences and perspectives of both patients and healthcare professionals (HCPs) in managing CKD prior to the routine dialysis phase. Semi-structured online interviews were conducted with 33 participants. Data were analyzed using reflexive thematic analysis to identify key themes. Two themes were identified: (1) Low engagement with early-stage CKD management, encompassing four subthemes-limited recognition of disease progression, inadequate information, role ambiguity, and discordant communication; and (2) Opportunities for improvement, highlighting the value of the partnership model and the provision of personalized advice for patients. Suboptimal early management of CKD is driven by limited awareness, poor information exchange, and unclear professional roles. Strengthening HCP competencies and adopting partnership-based communication from the early-stage of CKD may help to delay disease progression.
The increasing use of dental implants is changing the epidemiology of Odontogenic Sinusitis (ODS). Aside from endodontic causes, we frequently encounter problems caused by implant placement and bone augmentation techniques, which present a distinct pathophysiological profile compared to classic ODS. This study analyzed the clinical features of pre-implant (Group I) and implant-related ODS (Group II) to establish surgical management strategies according to the Felisati classification. This retrospective single-center study analyzed 45 patients treated between December 2020 and December 2025. Patients were classified according to the Felisati classification into Group I (preimplantological treatment complications) and Group II (implantological treatment complications). We evaluated clinical variables -etiology, osteomeatal complex (OMC) obstruction, foreign body presence, and oroantral communications (OAC)-and surgical strategies adopted: Endoscopic Sinus Surgery (FESS), exclusive oral approach, or a combined simultaneous technique. Implant-related cases (Group II; n = 37) dominated the cohort (82.2%), with 8 preimplantological complications (Group I). Females accounted for 66.7%. In Group II, chronic sinusitis affected 70.3% of patients, with high incidence of foreign bodies and OACs (64.9% each). To manage this complex scenario, we favored a combined simultaneous approach in the majority of Group II cases (59.5%); we reserved the exclusive oral approach for 27.0% of patients and limited exclusive FESS to 13.5%, primarily for implant preservation. Similarly, in Group I, where chronic sinusitis affected 75% of patients, the combined approach was performed in half the cases, while FESS alone was utilized in 37.5% to retrieve dispersed graft material. At the 3-month follow-up, primary complete resolution was observed in 44/45 patients (97.8%). Only one patient (Group II) experienced a recurrence of the oro-antral communication, which was successfully closed after a secondary surgical intervention, ultimately leading to a 100% final success rate. Implant-related and pre-implant ODS are distinct clinical entities often complicated by OMC obstruction and foreign body reactions. Although surgical planning requires case-by-case customization, in our experience, the combined simultaneous approach represented an effective primary strategy for complex cases, while exclusive approaches were reserved for selected patients. Complete short-term clinical and endoscopic resolution was observed in the cohort at the 3-month follow-up.
Falls remain a major patient safety concern among hospitalized older adults, particularly as previously independent individuals become acutely vulnerable during admission. Although falls prevention strategies are widely used, their implementation is often insufficiently patient-centered and may not reflect the cultural, linguistic, and organizational realities of healthcare settings in the United Arab Emirates (UAE). This study explored fall risk and prevention from the perspectives of hospitalized older adults, frontline healthcare professionals, and nurse managers in the UAE. A qualitative descriptive study was conducted across two acute care hospitals in the UAE. Using purposive sampling, data were collected in two phases: semi-structured interviews with hospitalized older adults aged ≥65 years (n=8); focus group discussions with nurses and allied health professionals (n=12); and nurse managers (n=15). Data was analyzed thematically, and triangulation was used to identify converging patterns across stakeholder groups. Four themes were identified: (1) autonomy versus safety, (2) gaps in patient education and engagement, (3) system and environmental barriers, and (4) opportunities for innovation and patient-centered solutions. Patients often prioritized independence despite clinical vulnerability, while staff highlighted limitations in education, delayed responses to call bells, environmental hazards, and the reduced sensitivity of current risk assessment processes to dynamic clinical change. Participants across groups emphasized the need for culturally responsive education, clearer communication, and more integrated system-level approaches. Fall risk in hospitalized older adults is shaped by the interaction of patient behavior, communication practices, environmental conditions, and organizational responsiveness. This study contributes context-specific evidence from the UAE, showing that falls prevention should move beyond standardized risk scoring toward patient-centered, culturally responsive, and system-integrated strategies. Future research should examine whether addressing these barriers improves measurable outcomes such as fall rates, reassessment compliance, and response times.
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by persistent deficits in social communication and interaction, alongside restricted and repetitive behaviors. Despite substantial advances in genetics, neurobiology and neuroimaging, no pharmacological treatment currently addresses the core symptoms of ASD. Existing medications primarily target associated behavioral disturbances such as irritability, aggression and hyperactivity. This narrative review synthesizes contemporary neurobiological findings, methodological challenges and evolving clinical trial frameworks relevant to the evaluation of emerging pharmacotherapies in ASD. Particular emphasis is placed on biomarker-informed stratification, rigorous trial design and developmental timing as critical determinants of therapeutic success. Advances in molecular genetics, systems neuroscience and multimodal biomarker integration highlight the need for precision medicine approaches that align pharmacological targets with underlying neurodevelopmental mechanisms. Strengthening methodological rigor while maintaining ethical and neurodiversity-affirming principles will be essential to advancing effective pharmacological interventions for ASD.
The liver-brain axis (LBA) represents a bidirectional communication network between the liver and the central nervous system (CNS), governed by integrated neural, humoral, and immune signaling pathways. Emerging evidence indicates that the liver functions not merely as a passive metabolic organ subordinate to central commands, but rather as a dynamic hub that actively senses and modulates peripheral neuroimmune responses. We here first delineate the fundamental communication mechanisms and the transport kinetics of signaling molecules governing LBA interactions. We then examine the profound species-specific disparities between humans and mice-particularly regarding signaling mediators, blood-brain barrier (BBB) architecture, and the hepatic immune microenvironment. From a pathophysiological perspective, we establish that LBA dysfunction serves as a core driver of obesity, diabetes, and their multisystemic sequelae, including cardiovascular diseases and psychiatric disorders such as anxiety and depression. Finally, we highlight recent therapeutic advances targeting the LBA for the management of metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated steatohepatitis (MASH), atherosclerosis, and associated psychiatric conditions, thereby underscoring the immense clinical potential of LBA-targeted interventions.
Oxidative stress, characterized by the systemic imbalance between reactive oxygen species and antioxidant defenses, is increasingly recognized as a central pathological nexus driving the dysregulation of the brain-bone axis. Despite the accumulation of empirical evidence, a systematic characterization of the field's intellectual structure and thematic progression remains absent. This study employs a multi-database bibliometric approach to map the research landscape of oxidative stress-mediated neuro-skeletal crosstalk and identify emerging research frontiers. A systematic search was performed across the Web of Science Core Collection, Scopus, and PubMed databases from their inception to April 30, 2025. Following a rigorous screening process based on predefined criteria, 717 relevant publications were included. Bibliometric mapping and network analyses were conducted using CiteSpace, VOSviewer, and the Bibliometrix R-package to evaluate collaboration patterns, co-citation structures, and keyword evolution. The analysis reveals a steady increase in research output since 2009, marked by distinct developmental phases. Early investigations primarily focused on fundamental oxidative damage mechanisms, while subsequent research transitioned toward systemic disease associations (e.g., Alzheimer's disease and osteoporosis) and targeted intervention strategies, including mesenchymal stem cell therapy and melatonin. Recent trends indicate a methodological and thematic shift toward high-resolution translational themes, such as neuroimmune regulation and the "gut-brain-bone" axis. Notably, "gut microbiota" and "extracellular vesicles" have emerged as high-centrality nodes, reflecting an increasing focus on inter-organ communication and systemic redox modulation. This study provides the first comprehensive mapping of the research trajectories within the oxidative stress-mediated brain-bone axis field. The findings delineate a clear progression from isolated mechanistic studies toward integrated, multi-system frameworks, underscoring the shift toward precision medicine and translational applications. By identifying current research gaps and emerging hotspots, this analysis offers a systematic reference for future interdisciplinary investigations and the development of targeted therapeutic strategies for neuro-skeletal comorbidities.