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This article challenges the assumption that the longstanding 'Big, Black and Dangerous' stereotype is irrelevant to current racial disparities in psychiatry. Despite its absence from mainstream discussions of inequality, I argue that this stereotype continues to shape inequalities in access, diagnosis and treatment across mental health services. The belief that this stereotype no longer matters is itself part of the problem. Drawing on historical and contemporary evidence, this article argues that meaningful reform requires confronting psychiatry's racist legacy, and advocates for the inclusion of the history of racism in psychiatry within training curricula, alongside compulsory anti-bias education for psychiatrists.
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This study aimed to develop a nomogram for predicting the 1-year volume reduction ratio (VRR) of the ablated area after thermal ablation of benign thyroid nodules (BTN) based on preoperative clinical, ultrasound, and serological features, and to explore the role of the ablation volume ratio (AVR). This retrospective study included 243 BTN patients who underwent ultrasound-guided radiofrequency or microwave ablation between January 2020 and December 2024. Clinical, ultrasound, serological, and procedural data were collected. Contrast-enhanced ultrasound was performed immediately after ablation to assess the ablation zone and calculate AVR. Patients were followed at 1, 3, 6, and 12 months and classified as favorable (VRR ≥80%) or unfavorable. The cohort was randomly divided into training (70%) and validation (30%) sets. Logistic regression identified independent predictors, and a nomogram was constructed and evaluated using ROC, calibration, and decision curve analyses. Among 243 patients, 142 (58.4%) achieved VRR ≥80%. Significant differences were observed in BMI, nodule size, vascularity, morphology, FT3 level, and location within the dangerous triangle (all p < 0.05). AVR was higher in the favorable group but was not an independent predictor. Multivariate analysis identified BMI, maximum diameter, FT3, morphology, vascularity, and dangerous triangle location as independent predictors. The model showed good performance (AUC 0.904 training, 0.815 validation). A nomogram based on preoperative factors provides a noninvasive tool for predicting 1-year outcomes after BTN ablation. AVR reflects procedural adequacy but has limited prognostic value. Further multicenter validation is needed.
Pulse oximetry devices systematically overestimate blood oxygen saturation (SaO2) in hypoxemic patients, potentially masking critical conditions. We hypothesize that this bias stems from wavelength-dependent differences in optical pathlength (OPL), which vary with SaO2 levels. This Letter investigates the change in photon pathlength in tissue between different wavelengths and proposes the iso-pathlength (IPL) point, an angular position identifiable by constant intensity between media of varying scattering coefficients, as a solution. Using Monte Carlo (MC) simulations on a finger model (5% blood volume, 60-100% SaO2), we analyzed the OPL ratio at various exit angles for the standard 660/940 nm wavelength pair and a closer pair with 760/840 nm. Analysis revealed that at the standard pulse oximetry transmission position, the OPL ratio for the 660/940 nm pair is highly variable, ranging from 1.25 to 1.45 across SaO2 levels, while the OPL ratio for the alternative 760/840 nm pair changed from 1.05 to 1.12. In contrast, the OPL ratio at the IPL point remains stable, not exceeding 1.05 across all SaO2 levels. These MC results provide mechanistic insight into pulse oximetry bias and demonstrate that the IPL technique could help in the detection of critical hypoxemia, where current devices are most prone to dangerous overestimation.
Hazard perception is a crucial skill for drivers and is typically measured using computer-based hazard perception tests. In these tests, drivers identify potential hazards in video clips recorded from the driver's perspective. Recently, researchers have also focused on another driver attribute called "hazard prediction." In hazard prediction tests, each scenario pauses just before a potentially dangerous event, and drivers must predict the subsequent events. Urban bus rapid transit (BRT) systems in Iran operate on dedicated routes that present specific hazards, such as sudden pedestrian crossings, motorcycle traffic, and emergency vehicles. Therefore, investigating the hazard perception and prediction abilities of BRT drivers can yield valuable insights to improve safety and reduce accidents. This study was conducted in Tehran, Iran, involving 187 urban BRT drivers. Hazard perception and prediction tests were designed, and demographic as well as cognitive questionnaires were administered to assess driver characteristics. The data were analyzed using SmartPLS software and structural equation modeling. The final structural equation model for hazard perception indicated that social cognition, planning, and inhibitory control were the most influential factors. For hazard prediction, sustained attention, cognitive flexibility, inhibitory control, decision-making, and memory emerged as the most significant variables. The results of this research can inform the training, testing, and evaluation of urban BRT drivers.
This systematic review with meta-analysis examines mortality, disease burdens, and systemic public health challenges following climate-related hazards and climate-sensitive disasters in Latin America and the Caribbean (LAC) between 2007 and 2022. A comprehensive search across 6 databases and gray literature sources identified 673 articles, with 5 studies meeting criteria for quantitative meta-analysis and 3 additional reports incorporated for qualitative synthesis. Meta-analysis revealed substantial heterogeneity across studies (I 2 = 81%, P < .001), with a pooled estimate of 6.2 excess deaths per 1000 population (95% CI: 2.1-10.3) following major disasters-equivalent to an 84% increase in mortality risk compared to baseline. Individual studies documented over 4600 excess deaths following Hurricane Maria in Puerto Rico, with 78% of casualties concentrated in low-income municipalities. Age disparities were evident: 65.9% of earthquake-related deaths in Haiti occurred among children under 12 years, while 48% of tsunami victims in Chile were aged ⩾ 80 years. Waterborne disease outbreaks surged post-disaster, including a 300% increase in cholera cases following Hurricane Matthew in Haiti and Legionella contamination in 86% of cisterns in St. Thomas. Critical gaps in standardized mortality reporting and longitudinal data hinder comprehensive risk assessment. Strengthening climate-resilient health infrastructure, integrating Indigenous knowledge, and establishing regional data standardization protocols are imperative to mitigate adverse health outcomes in LAC. How Climate Disasters Harm Health in Latin America and the Caribbean: Deaths, Diseases, and Unequal Impacts Disasters like hurricanes, floods, and earthquakes are hitting Latin America and the Caribbean harder and more often, worsened by climate change. This study combined data from past research to understand how these events harm people’s health. We found that disasters lead to increased deaths—approximately 6 additional deaths per 1,000 people—especially among children, older adults, and poor communities. They also cause dangerous outbreaks of diseases like cholera when water systems are damaged. The mental health toll is severe and long-lasting, with high rates of trauma and depression after disasters. The study shows that current systems for warning, healthcare, and clean water are too weak. To protect people, the region must build stronger, fairer health systems, invest in early warnings, fund mental health support, and include Indigenous knowledge in disaster planning.
The rapid expansion of synthetic biology has transformed research and innovation but has also created profound biosecurity challenges. Synthetic nucleic acid (SNA) technologies, which allow genetic material to be synthetically created, enable scientific progress but also lower the barriers to constructing or enhancing dangerous pathogens. This article argues that the governance of SNA should be grounded in a transnational new governance approach that combines binding international obligations with harmonized technical standards. It assesses the fitness of current regimes-the International Health Regulations, the Biological Weapons Convention (BWC), UN Security Council Resolution (UNSCR) 1540, and national biosecurity laws-and finds that while these instruments already impose binding obligations to prevent misuse of biological agents, their terms remain outdated and their application fragmented. Most states lack explicit SNA order screening requirements, and voluntary private standards such as those of the International Gene Synthesis Consortium and ISO 20688-2 remain inadequate for managing this global risk. The article recommends modernizing international law by clarifying that existing treaties cover synthetic biology, developing harmonized global screening standards, and updating national legislation to mandate and incentivize SNA order screening. It further proposes leveraging market access and funding power to drive global practice. Ultimately, safeguarding innovation in the age of SNA requires aligning law to manage the risks of emerging biotechnologies.
Artificial intelligence (AI) is rapidly entering clinical practice, yet the governance models needed to ensure its safe, ethical, and equitable use have not kept pace-particularly in community and safety-net settings. Existing frameworks, designed for large academic systems, are often impractical for frontline physicians, creating a dangerous gap between AI adoption and oversight. This article reframes AI governance as a clinician-centered enabler rather than a compliance burden. We propose a pragmatic model built on clear accountability, defined use guardrails, basic safety and bias checks, transparency, and lightweight workflows-supported by a scalable hub-and-spoke approach leveraging trusted professional organizations. Without intentional governance, AI risks amplifying disparities and eroding trust. Done well, it becomes a force multiplier-extending high-quality, equitable care into the communities that need it most. For community physicians, AI governance is not optional; it is essential to protecting patients, preserving clinical judgment, and ensuring that innovation advances equity rather than harm.
Prolonged labour in Somalia becomes dangerous not only because of the clinical risks of obstructed or non-progressive labour, but because the pathway from community-based labour care to facility-based emergency obstetric and newborn care is often slow, fragmented, and unreliable. Although maternal health literature has long described the "three delays", the specific implementation gap between trusted community birth attendants and functionally ready emergency obstetric care remains insufficiently emphasized in discussions of prolonged labour in fragile settings. This commentary argues that delayed referral during prolonged labour in Somalia should be understood as a systems failure at the interface between community childbirth support and emergency obstetric care, rather than simply as a problem of home birth or poor knowledge. Studies describe low and unequal use of antenatal and facility-based delivery care, transport and referral barriers in displaced and urban populations, negative prior experiences of facility-based birth, and weaknesses in hospital collaboration and referral readiness. These findings support a more operational interpretation of maternal delay: one that links community recognition, transport feasibility, communication, and facility functionality into a single time-critical continuum. Drawing on Somalia-specific evidence, comparable referral literature, and WHO guidance on emergency obstetric care signal functions, intrapartum care, and the Labour Care Guide, this commentary proposes five operational commitments: standardized community referral triggers for prolonged labour; formalized traditional birth attendant (TBA)-to-facility communication and feedback; transport financed as part of clinical care; verification of referral destinations by actual emergency obstetric functionality; and respectful maternity care as a prerequisite for timely care-seeking. The commentary's contribution is therefore not to restate known barriers, but to provide an implementation-oriented framework for closing the referral gap during prolonged labour in Somalia.
Cancer increases the risk of developing dangerous and sometimes deadly blood clots, which are known as cancer-associated thrombosis (CAT). While direct oral anticoagulants (DOACs) can be considered for CAT, evidence is limited regarding their use in comparison to low molecular weight heparin (LMWH). To compare the efficacy, bleeding risks, reoccurrence rate, and patient-reported outcomes of DOACs compared to LMWH in CAT of different cancer types. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist was followed during the search and screening of publications. Articles were searched systematically through biomedical databases such as PubMed, Scopus, and Cochrane covering studies published from January 1, 2003 to December 31, 2024. Articles were carefully chosen and studied according to the set Population Intervention Comparator Outcomes criteria. The research we analyzed examined the use of anticoagulants in cancer patients with venous thromboembolism (VTE) in comparison LMWH. The outcomes were cases of bleeding, VTE recurrence in patients, and their level of satisfaction with the treatment results. The 21371 cancer patients were included in 29 studies (15 randomized clinical trials and 14 observational studies). Rates of VTE recurrence between DOAC (5.6%-11%) and LMWH (7.9%-11%) in major trials were similar. There was a lot of difference to bleeding risks based on subtypes of cancers. In upper gastrointestinal (6.2%) and genitourinary (4.5%) cancers, the rate of significant bleeding was greater with DOACs, and the risk ratio compared to LMWH was 1.5 or 3-fold. Conversely, the rate of bleeding was lower in remitting patients (2.1% DOACs vs 3.0% LMWH). DOACs consistently outperformed LMWH in terms of patient satisfaction (75%-83% vs 45%-65%), as well as quality of life indicators (48%-57% vs 29-39%), and medication adherence (15%-25% improvement). Doctors use both LMWH and DOACs for CAT, the decision of which patient to use DOACs depends on bleeding risk, with a specific focus on the risk by cancer subtypes. CAT management needs to be tailored to the specific cancer sub-type (especially upper vs lower gastrointestinal cancers), the risk of bleeding, and the patient's preferences or abilities.
Although wildfire smoke is a major public health concern, relatively little is known about individual avoidance behavior. In this paper, we use smartphone-location data to study behavioral responses to smoke during the 2018 California wildfire season, one of the deadliest in recent US history. Using individual-level data, we construct daily measures of when and where California residents spend their time. We find that high levels of smoke increase time spent at home and indoors, while decreasing mobility and time at work. However, we find adaptation starts at relatively high levels of smoke-significantly higher than when smoke becomes dangerous-suggesting a gap between the levels of smoke that trigger adaptation and those that are harmful to human health. While we observe broad-based responses across most demographics, we find much stronger responses among high-SES residents, driven primarily by differences in education rather than income or other characteristics. We compare responses to smoke to those of rainfall, another disamenity to time outside whose costs are more obvious and immediate. While time at home and indoors increases with rain, these responses do not display the same socioeconomic gradient as smoke. Taken together, our results suggest that differential responses by education are unlikely to reflect differences in ability to adjust time and activities. Instead, they likely arise from differences in awareness of the health risks associated with wildfire smoke exposure.
Fumonisin B1 (FB1) is a secondary metabolite produced by Fusarium species and is considered one of the most dangerous mycotoxins. It is widely present in maize and other agricultural commodities, posing severe threats to human health and animal husbandry. Consequently, the development of a convenient and rapid detection method is of paramount importance. In this work, a metal-organic framework (MOF)-based aptamer biosensor was constructed for the detection of FB1, in which aptamer-regulated nanozyme activity was employed to modulate both colorimetric and fluorescent signals. The synthesized Zr-Ce-MOF exhibits intrinsic peroxidase-like activity and fluorescence properties, enabling the catalytic oxidation of colorless o-phenylenediamine (OPD) into yellow oxidized OPD (oxOPD), thereby generating a measurable colorimetric signal. Simultaneously, the oxOPD quenches the inherent fluorescence of the MOF via a fluorescence resonance energy transfer (FRET) effect. Upon target recognition, the aptamer competitively dissociates from the MOF surface, restoring the catalytic activity of the nanozyme and resulting in an increased colorimetric signal and a decreased fluorescence signal, thereby enabling effective dual-mode detection.Under optimized conditions, the limits of detection (LODs) for FB1 were 5.97 ng/mL in colorimetric mode and 1.2 ng/mL in fluorescent mode. The recovery rates for the colorimetric and fluorescent assays ranged from 101.43% to 105.80% and 99.62% to 110.60%, respectively. This proposed dual-mode aptasensor demonstrates excellent analytical performance and provides a robust strategy for the future development of sensing platforms for agricultural contaminants and antibiotic residues.
Rapid and accurate identification of intracellular pathogenic Brucella species and biovars is essential for effective public health surveillance, outbreak control, and preservation of animal and human health. While traditional biotyping remains the gold standard for biovar classification, it is time-consuming, technically demanding, dangerous, and costly. We validated artificial intelligence (AI)-coupled Fourier-transform infrared (FTIR) spectroscopy for Brucella biotyping as a faster, automated, and cost-effective alternative. One hundred and sixty-three strains of different species and biovars, originating from humans and animals, were assessed. The FTIR achieved high accuracy across all assessed species, achieving 95-100% sensitivity and specificity. On the biovar level, differentiating also vaccine from wild type strains, it achieved 80-100% sensitivity and specificity, depending on the species and the number of available strains for different biovars. Our research shows the identification of the FTIR as a highly robust and automated high-throughput method. This approach generates real-time data that shows potential for real-time epidemiological surveillance and allows early detection of outbreaks caused by zoonotic pathogens. By integrating classical microbiological methods with AI, the method shows great promise for its applicability in routine laboratory work and a high-throughput, fast, simple, safe, and cost-effective strategy for epidemiological surveillance of intracellular pathogenic Brucella bacteria on a global scale.
Middle meningeal artery embolization (MMAE) is increasingly being used for adjunctive and standalone treatment of chronic subdural hematoma (cSDH). The Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee set out to provide up-to-date recommendations on the use of MMAE for the treatment of cSDH. A structured literature review was performed pertinent to the use of MMAE. The strength and quality of evidence were graded according to established criteria. Recommendations were developed by consensus of the writing committee with input from the SNIS Standards and Guidelines Committee and the SNIS Board of Directors. Highlighted recommendations are as follows. Recommendation 1: MMAE as an adjunct to surgical drainage is recommended to decrease the risk of recurrence requiring a further intervention and should be balanced against the risk of the procedure (class I, level A). Recommendation 2: standalone MMAE for cSDH in special circumstances/populations such as high-risk surgical patients, those with bleeding diathesis including thrombocytopenia or coagulopathy, or the elderly is reasonable (class IIa, level B-NR). Recommendation 3: practitioners should assess for dangerous collaterals prior to embolization (class I, level C-EO). The strongest recommendation currently is for MMAE as an adjunct to surgical drainage of cSDH to decrease the risk of recurrence. Ongoing studies will continue to address standalone MMAE, special populations, and technical nuances.
Air pollution is responsible for millions of global deaths annually. The most dangerous pollutants for health are particulate matter (PM), nitrogen oxides (NOx), sulfur dioxide (SO2), and carbon monoxide (CO). Recent studies have demonstrated an increased probability of cardiac arrhythmias, such as atrial fibrillation (AF). AF is the most common type of sustained cardiac arrhythmia, characterized by a process of atrial remodeling, where fibrosis is a hallmark of arrhythmogenic structural remodeling, which alters tissue composition and function. In addition to AF, both the genesis and aggravation of fibrosis have been reported as an effect of exposure to air pollutants. However, since most studies are epidemiological, the pathophysiological mechanisms by which pollutants aggravate AF in humans remain unclear. In this study, the effects of major atmospheric pollutants on the aggravation of AF were evaluated. Mathematical formulations describing pollutant-induced alterations in ionic currents were incorporated into a Courtemanche human atrial myocyte model previously remodeled for AF, which was then coupled to a three-dimensional atrial model. Structural remodeling was represented using the MacCannell fibroblast model. Electrogram recordings from virtual basket catheters were analyzed, and approximate entropy was computed. Results showed that pollutant exposure produced a marked loss of the action potential plateau and, at high concentrations, reduced action potential duration by approximately 35% in both atria. Likewise, pollutants favor the aggravation of AF, characterized by a greater number of reentries, in a concentration-dependent manner. The left atrial electrograms exhibited significantly increased approximate entropy; the effect was larger as the concentrations of the pollutants increased. These findings provide mechanistic insights into the effect of pollutants on the aggravation of atrial arrhythmias and may support public policies aimed at mitigating air pollution.
Chronic pain following nerve injury (neuropathic pain), is notoriously difficult to treat, with current analgesics showing limited efficacy and adverse or dangerous side effects. One new candidate analgesic target is the TRPM8 ion channel, identified as the peripheral detector for innocuous cool sensation and reported to attenuate spinal cord pain processing by processes involving inhibitory metabotropic glutamate (mGlu) receptors. Highly selective Group II/III mGluR antagonists and allosteric modulators were used in a nerve injury model to identify the specific receptor subtypes mediating TRPM8-mediated attenuation of nociceptive (pain) processing through peptidergic and non-peptidergic afferent inputs (associated with thermal and mechanical nociception respectively). Integrated experimental approaches involved immunofluorescence histochemistry, functional Ca2+ fluorescence responses of ex vivo synaptoneurosomes and in vivo reflex pain behaviours. Differential expression of TRPV1 and MrgprD was demonstrated in peptidergic and non-peptidergic afferents and their selective activation by capsaicin and β-alanine characterised to interrogate transmission at the first central synapses from these afferents in dorsal spinal cord synaptoneurosomes. TRPM8-evoked attenuation of nerve injury-induced increments in capsaicin responses was selectively modified by mGlu8-targetting agents whereas the equivalent effect on β-alanine responses was selectively modified by mGlu2-targetting agents. Other Group II/III mGluR subtypes appeared not to be involved. Reflex pain behaviour assessments correspondingly pointed to mGlu8 and mGlu2 being selectively involved in TRPM8 attenuation of thermal and mechanical hypersensitivity respectively. Spinal administration of mGlu2 and mGlu8 antagonists impacted TRPM8 attenuation of nerve injury-induced synaptic hypersensitivity at spinal and also supraspinal regions of the CNS associated with pain processing. Our findings clarify the roles of specific Group II/III mGluRs in the antinociceptive effects of TRPM8 activation against nerve injury-induced hypersensitivity. The mGluRs involved in impacting peptidergic (thermal-associated) nociceptive inputs and non-peptidergic (mechanical-associated) nociceptive inputs appear quite distinct - mGlu8 and mGlu2, respectively. This provides robust evidence to support the fundamental concept of distinct parallel processing and differential modulation of these classes of inputs. This work extends our understanding of the basis for TRPM8 analgesia, identifies distinct modality-specific processes and points to the possibility of refined therapeutic interventions using mGluR modulators as adjunct promoters of particular elements of analgesia.
Background/Objectives: Influenza remains a primary cause of severe illness and death in adults over 60. In this group, immunosenescence and existing health conditions make infections more dangerous and traditional vaccines less effective. The MF59-adjuvanted vaccine was specifically designed to overcome these limitations by enhancing the body's immune activation and antigen presentation. While the vaccine shows clear benefits, some recent concerns regarding vaccine safety have been raised without supporting scientific evidence. Therefore, this systematic review focuses on providing a comprehensive evaluation of its safety outcomes compared to standard vaccines. Methods: Following the PRISMA guidelines, a systematic review and meta-analysis were conducted; two researchers independently assessed the eligibility of the studies, and the risk of bias was assessed using RoB2 and ROBINS tools for randomized clinical trials and observational studies, respectively. Pooled risk estimates were calculated using a random-effects model. Results: Ten RCTs and three non-RCTs meeting the inclusion criteria were included. No significant differences were found for severe systemic outcomes: Guillain-Barré syndrome (RR 1.01, 95% CI 0.64-1.80) and encephalitis (RR 1.23, 95% CI 0.85-1.78). For other systemic adverse effects, there were no significant differences between adjuvanted and non-adjuvanted vaccines; only myalgia showed a small but significant increase with adjuvanted vaccines (RR 1.35, 95% CI 1.02-1.78) compared with non-adjuvanted vaccines. Conclusions: MF59-adjuvanted influenza vaccines have a favorable and well-characterized safety profile in adults aged 60 years and older. Adverse events are predominantly mild and transient, with no evidence of increased risk of serious or immune-mediated outcomes compared with non-adjuvanted vaccines.
Current real-time crash prediction models (RTCPMs) for freeway diverging areas primarily rely on macroscopic traffic parameters, which inadequately capture how vehicle interactions escalate into crash risks. This study analyzed 12 interchange diverging areas from two multilane freeways in China, employing image recognition technology to extract 48 vehicle motion parameters and surrogate safety measures (SSMs). Extended Time-to-Collision (ETTC)-a validated two-dimensional metric for lateral conflicts-was innovatively applied to establish a refined database with longitudinal/lateral conflict labels at 30-second intervals. Following spatiotemporal conflict analysis, four RTCPM types-Random Forest, Neural Network, Support Vector Machine, and XGBoost-were developed, with SHAP interpretability framework analyzing key risk factor contributions. Results showed: 1) XGBoost achieved optimal performance; 2) lateral conflicts exhibited longer durations and higher crash risks than longitudinal conflicts, with severe conflicts concentrated within 200 meters upstream of exit ramps; 3) SSMs including Modified Time-to-Collision (MTTC)-which incorporates relative acceleration-alongside Stopping Headway Distance and Time-to-Collision, emerged as decisive factors for both crash types, ranking highest in predictive contribution. These findings provide scientific foundations for designing dangerous driving warning systems and implementing proactive traffic safety management at interchange diverging areas.
Threat detection in X-ray security screening is critical for preventing concealed threats in airports and other high-security venue where Improvised Explosive Devices (IEDs) remain among the most persistent and dangerous threats. The lack of a representative, and publicly available IED dataset has limited the development of machine-learning based automated threat detection systems. To address these issues, we propose an open access dataset, called IEDXray constructed for automated detection of IEDs. The dataset comprises 17,360 X-ray images captured under a strategic concealment protocol, covering scenarios ranging from isolated threats to heavily cluttered baggage environments. It includes diverse IED types-homemade explosives, batteries, and modified devices such as laptops, mobile phones, pagers, and walkie-talkies. To validate the dataset, we benchmark state-of-the-art detection models, including YOLOv10, Faster R-CNN, DETR, and GroundingDINO, establishing baseline results across multiple security-screening tasks. By reflecting real-world threat concealment, clutter, and variability, IEDXray provides the research community with a high-fidelity benchmark to advance automated explosive detection and improve x-ray security screening.
Acquired immunodeficiency syndrome (AIDS) is one of the most dangerous diseases threatening global public health. Antiretroviral therapy (ART) is currently the primary treatment for people living with HIV (PLWH). However, some patients are classified as immunological non-responders (INRs), defined by the failure to achieve adequate CD4+ T cells reconstitution despite continuous viral suppression, and are associated with inferior clinical outcomes. This behavior may be linked to the ongoing dysfunction of the intestinal microenvironment. Although PLWH exhibit similar clinical changes such as intestinal mucosal injury, barrier failure, and microbial community problems, intestinal microenvironment abnormalities in INRs are more severe. The specific manifestations include persistently low levels of intestinal CD4+ T cells with limited reconstitution, along with a significant reduction in the proportion of Th17 cells, leading to severe impairment of mucosal anti-infective capacity and immune regulatory function. Additionally, elevated levels of pro-inflammatory mediators drive chronic inflammation, thereby exacerbating tissue damage. Furthermore, microbial dysbiosis is more pronounced, characterized by a marked decrease in beneficial symbiotic bacteria and an expansion of opportunistic pathogens. In contrast, immunological responders showed some degree of recovery in these indicators. These pathological features are not only associated with a higher risk of disease progression and complications in INRs but also provide a theoretical basis for developing adjuvant treatment strategies targeting intestinal immune reconstitution. In addition, we summarize the current mainstream definitions of INRs and propose a more robust definition. This review systematically elaborates the pathogenic mechanisms and potential intervention strategies underlying intestinal microenvironment abnormalities in INRs and holds important clinical value for improving the long-term prognosis of patients and advancing individualized treatment.