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Electrodermal activity (EDA) reflects sympathetic nervous system activity related to emotions and cognition. This mapping review aimed to systematically identify and map existing nursing research that utilized EDA and examine future research prospects. We searched PubMed, CINAHL, PsycArticles, Cochrane Collection Plus, Web of Science, IEEE Xplore, Ichushi-Web, CiNii Research, and Current Index to Japanese Nursing Literature without year limits. Inclusion criteria were EDA use, nursing research, human participants, and English or Japanese publications. Data were visualized to provide a comprehensive overview of EDA research in nursing and inform prospective research directions. Overall, 91 articles were included; most were primary research (n = 89) that mainly comprised intervention studies (n = 74). Studies involving healthy adults were common (n = 27), whereas those involving people with health impairments, infants and children, and older adults were limited. "Skin conductance" was the most frequently used term (n = 60), and the common measurement site was the finger or palm (n = 44). EDA was primarily used to measure psychological burden (n = 32) and physical responses (n = 27). Key phenomena included emotional arousal stimuli (n = 26) and complementary and alternative medicine (n = 22). Multiple demographic and physiological data and various scales were also examined. In nursing research, EDA is used in intervention studies with healthy adults across multiple countries. Future research should include people with health impairments, apply EDA in personalized care, and explore its application in nursing staff stress management.

Kynurenic acid (KYNA) is an endogenous molecule that acts as a nonselective antagonist of ionotropic glutamate receptors and has been shown to have neuroprotective properties. Although KYNA has shown considerable therapeutic potential in neurodegenerative disorders, its limited permeability across the blood-brain barrier restricts its direct clinical application. To overcome this limitation, various ester and amide derivatives have been developed as prodrugs to enhance brain delivery and subsequently release KYNA within the central nervous system. Beyond serving as prodrugs, KYNA derivatives have attracted substantial interest in medicinal chemistry due to their ability to interact with multiple molecular targets. Additionally, these compounds exhibit a wide range of biological activities, including potential treatments for Alzheimer's disease, Parkinson's disease, Huntington's disease, and psychiatric disorders. Therefore, kynurenic acid-based scaffolds have prompted further research into their derivatives, leading to a range of structurally distinct products. Here, we discuss the neuroprotective role of KYNA and its derivatives, which exhibit diverse bioactivities.

The androgen receptor (AR), beyond its classical roles in male sexual function and muscle maintenance, has emerged as a pivotal regulator of metabolic health. In men, age- or hypogonadism-related androgen decline is strongly associated with an increased risk of type 2 diabetes and impaired glucose tolerance, underscoring the protective role of AR signaling in glucose homeostasis. Conversely, its physiological significance in women remains largely unexplored, as clinical and basic research has predominantly focused on pathological hyperandrogenism, such as polycystic ovary syndrome (PCOS). This review delineates the genomic and non-genomic molecular mechanisms of AR action and synthesizes evidence from male genetically modified mouse models and cellular studies to clarify its role across key metabolic tissues, including skeletal muscle, liver, pancreatic β-cells, adipose tissue, and the central nervous system. Based on these insights, we hypothesize that physiological AR signaling exerts beneficial metabolic effects in women, whereas adverse metabolic outcomes are primarily associated with supraphysiological AR activation. Finally, we highlight key knowledge gaps and propose future directions to validate this hypothesis, with the goal of establishing a novel conceptual framework for understanding female metabolic homeostasis and informing sex-specific therapeutic strategies.

Time-varying coefficient modeling (TVCM), which represents regression coefficients as smooth functions of continuous time, provides a flexible framework for uncovering complex patterns of change in levels and associations in intensive longitudinal data. However, conventional TVCM remains limited to investigating directional effects across individuals. By introducing a TVCM formulation of the multivariate normal distribution, the present study extends TVCM to explore change in undirected associations (couplings) and variability, thereby broadening its utility for psychological research. We discuss three versions of this approach: an aggregate-level model and two hierarchical versions capturing interindividual differences in unfolding change, either via person-specific intercepts accounting for onset differences or through fully person-specific coefficient functions smoothed via partial pooling. To illustrate the proposed developments, we apply them to six weeks of intensive longitudinal data from 16 anxiety patients undergoing therapy and examine unfolding changes in the level and volatility of nervousness and threat monitoring, their coupling, as well as between-person heterogeneity in each of these. We further show how inspecting first-order derivatives of the coefficient functions supports identifying periods of stability and change. Finally, we discuss extensions incorporating person-level characteristics to explain heterogeneity in patterns of change and predict outcomes.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating autoimmune disorder of the central nervous system that exhibits a broad spectrum of known clinical phenotypes, including optic neuritis, myelitis, acute disseminated encephalomyelitis, encephalitis, meningoencephalitis, and brainstem encephalitis. However, new evidence indicates that a small subset of patients may present with cortical cerebral encephalitis (CCE). When CCE manifests as acute unilateral limb weakness, it may closely mimic acute cerebral infarction (ACI), resulting in misdiagnosis and delayed initiation of immunotherapy. Here, we report a case initially diagnosed as ACI and highlight key diagnostic clues and therapeutic considerations that may help to facilitate earlier recognition and appropriate management. A young woman was admitted with left-sided limb weakness and was initially diagnosed with ACI. The final diagnosis was myelin oligodendrocyte glycoprotein (MOG) antibody-related autoimmune encephalitis, which was established by integrating the clinical presentation, contrast-enhanced brain magnetic resonance imaging (MRI) findings, cerebrospinal fluid (CSF) antibody testing, and systematic exclusion of alternative etiologies. After an initial misdiagnosis, the patient received neuroprotective agents without meaningful improvement. Subsequent lumbar puncture and CSF testing supported the diagnosis of MOG antibody-related autoimmune encephalitis. Treatment was then adjusted to include both high-dose intravenous corticosteroid pulse therapy and immunotherapy, which resulted in marked clinical improvement. The patient's condition remained stable at 2-month follow-up, with no disease progression. Contrast-enhanced MRI showed no abnormalities in the unilateral cerebral cortex. CCE associated with MOGAD may be misdiagnosed as ACI, particularly when focal motor deficits are the predominant presenting feature. Early recognition, prompt diagnostic evaluation, and timely initiation of immunotherapy are crucial for improving clinical outcomes. Greater clinician awareness and improved neuroimaging-based differentiation between ACI and CCE are therefore needed. In patients with stroke-mimicking presentations but atypical imaging findings, contrast-enhanced MRI and cerebrospinal fluid testing for MOG immunoglobulin G should be prioritized. High-dose steroid pulse therapy combined with immunotherapy remains the recommended first-line treatment for suspected MOG antibody-related autoimmune encephalitis.

Gamma-aminobutyric acid (GABA) is the principal inhibitory neurotransmitter in the central nervous system and exerts multiple health-promoting effects, including antidepressant, hypotensive, immunomodulatory, and antidiabetic actions. Previous studies have reported a positive correlation between the abundance of Bifidobacterium species in the gut and fecal GABA levels. However, the direct contribution of specific GABA-producing Bifidobacterium strains and the associated interaction with prebiotics remain insufficiently characterized. This study aimed to elucidate the direct effects of a GABA-producing strain, Bifidobacterium adolescentis 4-2, in combination with the prebiotic mannooligosaccharides (MOS), on fecal GABA concentrations using the Kobe University Human Intestinal Microbiota Model (KUHIMM), an in vitro simulation of the human colonic microbiota. GABA levels were quantified via high-performance liquid chromatography, and changes in microbial composition following oligosaccharide supplementation were assessed by next-generation sequencing of 16S rRNA genes. The presence and activity of the β-mannosidase producing genes, essential for MOS degradation and present in the B. adolescentis 4-2 genome, were evaluated using enzymatic assays. B. adolescentis 4-2 significantly increased fecal GABA levels within the KUHIMM. MOS supplementation elevated GABA levels, reduced fecal culture pH, and increased the relative abundance of Actinobacteria, particularly the Bifidobacterium species. Notably, the combined application of MOS and B. adolescentis 4-2 produced a synergistic increase in GABA production compared with the individual application of each component. β-mannosidase activity assays confirmed the effective utilization of MOS by B. adolescentis 4-2, supporting its role in enhancing GABA biosynthesis. These findings demonstrate a synergistic interaction between MOS and B. adolescentis 4-2 in promoting microbial GABA production in the KUHIMM in vitro. This synbiotic combination shows promise for modulating gut-derived GABA levels in vitro and warrants further investigation in animal models and human clinical studies.

Neurodegenerative disorders encompass a wide range of debilitating neurological conditions characterized by the progressive loss of specific neuronal populations in the central and/or peripheral nervous systems. This disease often leads to a gradual decline in cognitive, motor, and sensory abilities. This review explores the role of various lifestyle factors, such as age, sex, poor diet, depression, etc., which contribute to the onset and progression of NDDs. Various diseases are included in the neurodegenerative disorder, like Alzheimer's disease, Parkinson's disease, Huntington's disease, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, and Lewy body disease, which are chronic conditions that significantly impact cognitive and motor functions. A literature search was conducted in the scientific database using the keywords "neurodegenerative disorders, phytoconstituents, and herbals". This review includes a collection of reports from ScienceDirect, Scholar Google, and PubMed, all searched up to 2024. The results were assessed, gathered, and reported in this paper. A total of 241 articles were included, with exponential growth in publication numbers from 1985 to 2024. Effective management and control of NDDs require addressing these risk factors, alongside exploring therapeutic interventions. Some plants and herbs used to treat neurodegenerative diseases, such as curcumin, ashwagandha, ginkgo biloba, epigallocatechin-3-gallate, quercetin, ginseng, and resveratrol, have shown potential to improve neuronal health and mitigate disease progression. This review highlights the dual role of natural compounds in promoting improvements and upregulating brain function while potentially reducing degradation. The phytopharmaceuticals show the potential for treating neurological conditions with better efficacy and safer profiles. The review suggested that future research should focus on integrating lifestyle modifications and natural therapies to enhance the quality of life for individuals at risk or suffering from neurodegenerative diseases.

Despite effective antiretroviral therapy (ART), neurocognitive impairment (NCI) persists in 30-50% of virally suppressed people with HIV (VS PWH). The mechanisms underlying this persisting NCI remain incompletely understood. Soluble gp120 (sgp120) has been detected in the plasma of PWH on ART and may contribute to inflammation and CD4+ T-cell depletion in the presence of non-neutralizing anti-cluster A antibodies (Abs). gp120 can induce neurotoxicity, leading to neuronal damage both in vitro and in transgenic mice. To determine whether sgp120 and anti-cluster A Abs are detectable in the cerebrospinal fluid (CSF) of VS PWH and to evaluate whether their presence is associated with domain-specific neurocognitive performance. We analyzed paired plasma and CSF samples from 146 VS PWH and 37 unsuppressed PWH. Neurocognitive performance was assessed using a comprehensive neuropsychological testing battery across multiple domains, from which demographically adjusted T-scores for each test were derived. Levels of sgp120 and anti-cluster A Abs were measured to evaluate their association with neurocognitive performance in PWH. Sgp120 and anti-cluster A Abs were detected in the CSF of 11 and 26% of VS PWH, respectively. Detection of CSF sgp120 was associated with lower neurocognitive motor-domain T-scores (Mann-Whitney U, P = 0.039; Cliff's δ = -0.33). This association was confined to sgp120 in the CSF and was not observed for sgp120 in plasma or for anti-HIV antibodies in the CSF. These findings suggest that central nervous system (CNS) exposure to sgp120 may contribute to poorer motor neurocognitive performance in VS PWH. Strategies targeting CSF sgp120-related biomarkers warrant further investigation as potential approaches to mitigate NCI in VS PWH.

Sympathetic and parasympathetic nervous system (SNS, PNS) control of cardiac rhythm during muscle metaboreflex activation (MMA) are important components of the physiological response to exercise but poorly understood. Therefore, SNS and PNS control of cardiac rhythm at the onset of MMA following exercise was examined in healthy young and old adults. Fourteen young (26 ± 2 years) and 10 old (62 ± 3 years) healthy adults performed 90-s, one-legged, isometric, calf exercise at 70% maximal voluntary contraction (MVC) and underwent a 0% MVC control trial, with unilateral circulatory occlusion beginning 5 s before exercise cessation and maintained for 30 s following exercise to isolate MMA. Absolute and normalized low-frequency (aLF, nLF) and high-frequency (aHF, nHF) bands and LF/HF were analyzed during a 30 s baseline period and the first 30 s of MMA following exercise (70% MVC) or continued rest (0% MVC). A time-trial interaction in LF/HF was observed in young adults (p = 0.043), with LF/HF elevated during 0-10 s of MMA compared to 10-30 s during the 70% MVC trial. This interaction was not observed in old adults (p = 0.490). These results indicate that healthy young adults exhibit restoration of PNS control of cardiac rhythm at the onset of MMA following exercise, whereas this restoration is absent in healthy old adults.

Heart rate variability (HRV) is a non-invasive measure of autonomic nervous system function and a sensitive marker of physiological stress. Health professions students are exposed to severe academic stress and multiple lifestyle-related factors that may influence autonomic regulation. This study aimed to evaluate HRV profiles in health professions students and examine associations with academic stress and lifestyle factors. A cross-sectional study was conducted among 237 students (81.4% females). HRV was assessed under standardized resting conditions using time-domain, frequency-domain, and Poincaré plot-derived geometrical indices. Autonomic status was classified as normal autonomic function (NAF), low HRV (LHRV), parasympathetic dominance (PD), or sympathetic dominance (SD). Associations with body mass index, smoking, physical activity, sleep quality, and perceived stress were analyzed using chi-square and correlation tests. Normal autonomic function was observed in 65.0% of students, while 35.0% exhibited autonomic imbalance (16.9% PD, 16.9% SD, and 1.3% LHRV). No significant associations were found with lifestyle factors (p > 0.05). Perceived academic stress was significantly associated with autonomic imbalance among females (p = 0.013). In conclusion, most students demonstrated preserved autonomic function, although approximately one-third showed autonomic imbalance. Academic stress was significantly associated with autonomic function, particularly among female students.

Atypical hemolytic uremic syndrome (aHUS) is a rare thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction, particularly affecting the kidneys and the central nervous system. It is caused by genetic variants or autoantibodies involved in dysregulation of the complement system. Pathogenic variants of the complement factor H (CFH) gene are associated with severe disease and may lead to life-threatening multiorgan failure during the acute phase. We report a case of CFH mutation-positive aHUS complicated by recurrent posterior reversible encephalopathy syndrome (PRES) during the course of treatment. A 32-year-old woman presented with progressive fatigue and acute dyspnea. Laboratory tests revealed hemolytic anemia, thrombocytopenia, and severe acute kidney injury. A peripheral blood smear revealed schistocytes, consistent with TMA. On hospital day 1, she developed generalized tonic-clonic seizures followed by respiratory arrest that required mechanical ventilation. Continuous hemodialysis was initiated for severe renal failure. After the exclusion of thrombotic thrombocytopenic purpura, typical hemolytic uremic syndrome, and secondary causes of TMA, a clinical diagnosis of aHUS was made. Genetic testing later revealed a pathogenic heterozygous CFH variant (c.3572C>T, p.Ser1191Leu), confirming the diagnosis of aHUS. Anti-C5 monoclonal antibody (eculizumab) was initiated based on the clinical diagnosis of aHUS. Intensive care management, including mechanical ventilation, renal replacement therapy, plasma exchange, and strict blood pressure control, was also provided. During the course of the disease, she developed severe cardiomyopathy and recurrent PRES. Early initiation of complement inhibition combined with intensive care management resulted in complete neurological recovery, and the patient was discharged home without any sequelae. This case highlights that CFH mutation-positive aHUS can be complicated by severe multiorgan dysfunction, including cardiomyopathy and recurrent PRES. Early clinical recognition and prompt initiation of complement inhibition were central to the favorable outcome, while intensive blood pressure control and comprehensive supportive care may have contributed to neurological recovery.

Parkinson's disease (PD) is characterized by dopaminergic neuron loss and α-synuclein aggregation in the substantia nigra pars compacta (SNpc). It is a multifactorial disorder with motor and non-motor manifestations and growing evidence suggests that gastrointestinal dysfunction may precede motor onset. Sex differences influence PD risk, onset and clinical features, with men exhibiting higher prevalence and earlier onset, driven by hormonal, genetic, and metabolic factors. The gut microbiota communicates bidirectionally with the central nervous system (CNS) via the gut-brain axis, modulating neural, immune and metabolic processes. Gut dysbiosis and altered microbial metabolites contribute to PD pathogenesis, with distinct sex-specific differences in the microbial composition and functional dynamics of gut microbiota. Despite growing evidence linking the gut-brain axis to PD, sex-specific regulation of microbiota-metabolite interactions remains poorly understood, representing a critical knowledge gap. Further most studies are male-biased, neglecting sex-specific variations in microbial profiles, hormone dynamics, metabolic responses and treatment outcomes. This review addresses current evidence on sex-specific interactions between gut microbiota, metabolites, microbial metabolites and PD mechanisms, highlighting their role in oxidative stress, neuroinflammation, glial dysfunction and genetic predisposition. It further emphasizes the need for sex-tailored, precision therapeutic strategies integrating hormonal, genetic and microbial determinants to improve clinical PD outcomes.

Fluoroquinolones may have negative effects on the central nervous system; isolated dysarthria has not been thoroughly described. Piperacillin/tazobactam and high-dose levofloxacin were used to treat a severe case of Legionella pneumophila pneumonia in a 55-year-old man with diabetes and temporary renal failure who was admitted to the hospital. On the eighth day of treatment, he experienced sudden dysarthria without any additional neurological impairment. Magnetic resonance angiography and brain magnetic resonance imaging results were negative. After levofloxacin was stopped two days later and replaced with azithromycin, the patient's dysarthria completely disappeared, and he was discharged on azithromycin (500 mg for 11 days). The Naranjo score (likely adverse reaction) was 6. This case report highlights the importance of quickly identifying even mild neurological problems in fluoroquinolone-treated patients, especially when risk factors are present. In a broader sense, it upholds the concepts of patient safety and therapeutic appropriateness, which state that drugs should only be used when necessary and should be stopped immediately if they have negative side effects. In this regard, strict adherence to the current regulatory cautions about fluoroquinolones is necessary.

Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by autonomic dysfunction, parkinsonism, and cerebellar ataxia. Repetitive transcranial magnetic stimulation (rTMS) may provide therapeutic benefits; however, evidence remains limited. We aimed to evaluate the effects of rTMS on ataxia, motor, and psychological outcomes in MSA. Two investigators independently searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to February 2025. Randomized controlled trials (RCTs) evaluating the effects of rTMS in MSA were included. Primary outcome was Scale for the Assessment and Rating of Ataxia. Six RCTs involving 140 patients were included. rTMS significantly improved ataxia (mean difference [MD]: -6.26, 95% confidence interval [CI]: -8.52 to -4, P<0.001), motor function (MD: -1.95, 95% CI: -3.91 to 0, P=0.05), anxiety (MD: -6.43, 95% CI: -10.08 to -2.77, P<0.001), depression (standardized MD: -0.99, 95% CI: -1.6 to -0.38, P=0.001), and fatigue (MD: -13.03, 95% CI: -19.18 to -6.87, P<0.001). rTMS may improve ataxia, motor function, anxiety, depression, and fatigue in patients with MSA. Given the limited treatment options, rTMS may represent a promising noninvasive adjunctive treatment option; however, further RCTs are needed.

Kidney transplantation greatly improves survival and quality of life for children and adolescents with kidney failure. However, it also brings psychological and social challenges, including anxiety, depression, and difficulties with adaptation. Families often face ongoing stress even after successful transplantation. Although qualitative studies have explored these issues, no systematic review has synthesized their findings. This study aims to fill that gap by reviewing qualitative research on the post-transplant experiences of children and adolescents, providing insights to support their psychosocial well-being. This was a systematic review of qualitative studies. Literature searches were conducted in PubMed, Web of Science, CINAHL, Embase, Scopus, ProQuest, China National Knowledge Infrastructure (CNKI), and Wanfang database. The search period was from the inception of the databases up to January 2025. This review was conducted in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis for qualitative research. Two reviewers independently carried out the screening process and data extraction. Studies meeting the inclusion criteria were evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative studies. Thematic synthesis was performed following the approach outlined by Thomas and Harden. A total of ten descriptive themes were extracted from the included qualitative studies. Through a process of thematic synthesis, these were consolidated into three overarching analytical themes: (1) Rebirth and Transformation - capturing the personal growth, psychological adaptation, and evolving identity experienced by children and adolescents following kidney transplantation; (2) Facing Challenges - reflecting the physical, emotional, and social difficulties encountered during recovery and reintegration into daily life; and (3) Future Uncertainty and Lack of Support - highlighting ongoing concerns related to long-term health outcomes, fear of graft failure, and the perceived inadequacy of informational, and systemic support. Kidney transplantation offers children and adolescents a renewed chance at life, boosting their self-esteem and overall well-being. However, they often face considerable psychological stress, including anxiety about the future and limited support. To address these challenges, healthcare providers and social organizations must focus on their unique needs through comprehensive psychological assessments, identification of unmet needs, and strengthened collaboration among medical teams, families, and communities. PROSPERO: (CRD420250654624).

Sleep-wake disturbances are frequently reported by patients with chronic pain. Physical activity, recommended as a first-line treatment for chronic pain, can be difficult to implement due to pain severity. This study aimed to assess the prevalence of insomnia and other sleep-wake disturbances in a cohort of patients with chronic pain and to explore the influence of physical activity, opioid use, reported pain, and symptoms of depression and anxiety. This clinical cross-sectional study included 100 patients with chronic pain attending a specialist-level pain clinic. Participants were consecutively enrolled, and sleep and physical activity were evaluated using accelerometers. Additional assessments included the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), symptoms of restless legs syndrome (RLS), STOP-Bang score, pain intensity assessed by Numeric Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and self-reported level of physical activity. Overall, nearly all participants experienced sleep-wake disturbances. Average sleep duration (hh:mm) was 5:30 (range, 1:46-9:52), and sleep efficiency was 64% (range, 28-81). Based on PSQI scores, 95% were classified as having poor sleep quality. Clinical insomnia (ISI &#x2265;&#x2009;15p) was reported by 67%. A statistically significant correlation (rs&#x2009;=&#x2009;0.31, 95% CI, 0.10-0.50) was found between sleep efficiency and level of physical activity and between ISI and HADS depression (rs&#x2009;=&#x2009;0.41, 95% CI, 0.22-0.57). A wide range of sleep-wake disturbances were present in the examined cohort, highlighting the possible benefit of assessing sleep to optimise pain rehabilitation. In this cohort, nearly all patients with chronic pain experienced sleep-wake disturbances, and none reached 85% sleep efficiency indicating stable sleep. These findings emphasise the need for a comprehensive assessment of sleep problems to improve the understanding and management of severe pain. ClinicalTrials.gov: NCT04649281.

The transition from hospital to home is a critical period for patients with coronary heart disease (CHD), and inadequate post-discharge care can adversely affect recovery. Continuing care models have been proposed to address these challenges, but their relative effectiveness compared with standard care still requires further evaluation. Therefore, this study evaluated the impact of continuing care on quality of life and recovery of cardiac function in patients with CHD. This single-center, retrospective cohort study included 135 discharged CHD patients. Based on nursing plans, patients were allocated into two groups: a Continuing Care Group (n = 61) and a Routine Care Group (n = 74). The Continuing Care Group received a structured, nurse-led 3-month program, while the Routine Care Group received standard post-discharge instructions. Various parameters, including cardiac function, quality of life, psychological well-being, self-care capacity, medication adherence, overall comfort, and nursing satisfaction, were compared between groups at 3-month follow-up. At 3 months, the Continuing Care Group showed significantly greater improvement in left ventricular ejection fraction (LVEF, 58.31% vs. 54.88%), six-minute walk distance (6MWD, 399.34 m vs. 382.25 m), 36-Item Short-Form Health Survey Physical Component Summary (SF-36 PCS, 67.94 vs. 63.92), and 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS, 71.46 vs. 66.87). Patients in the Continuing Care Group also reported lower Depression Anxiety Stress Scales-21 (DASS-21, 17.24 vs. 18.31) and Perceived Stress Scale-10 (PSS-10) scores (22.01 vs. 23.14), higher Psychological General Well-Being Index (PGWBI, 85.95 vs. 83.47), Exercise of Self-Care Agency Scale (ESCA, 116.03 vs. 113.72), and Post-Traumatic Growth Inventory (PTGI) scores (74.81 vs. 72.31), along with superior medication adherence (84.16 vs. 82.35), comfort (87.06 vs. 84.91) and nursing satisfaction (86.94 vs. 84.89). At 3-month follow-up, Seattle Angina Questionnaire (SAQ) scores improved significantly from baseline in both groups, but no significant between-group difference was observed. Continuing care is associated with potential improvements in cardiac function, quality of life, psychological well-being, self-management, medication adherence, and patient-reported experiences compared with routine care in patients with CHD.

The escalating psychosocial burden is critically amplified in conflict zones such as Syria, with cancer patients already in need of critical psychological care to distinguish between somatic and psychiatric dimensions of their state, overwhelmed by the extreme environmental pressures of the war. This creates a challenge for both patients and physicians, severely hindering effective diagnosis, treatment, and care. This study aimed to evaluate the prevalence of anxiety and depression among Syrian cancer patients and validate the compatibility between Hospital Anxiety and Depression Scale (HADS) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5)- the gold standard of clinical diagnosis. A cross-sectional study was conducted with 101 patients with cancer at specialised centres in Damascus. Participants were assessed using the self-reported HADS, where the researcher was blinded to the participants' scores to eliminate bias. Then followed by independent clinical interviews conducted by another specialist based on the DSM-5 criteria. The HADS-D identified a high prevalence of depression (54.5%), significantly exceeding the clinical diagnosis of Major Depressive Disorder (22.8%) via the DSM-5. While the anxiety subscale (HADS-A) demonstrated moderate and acceptable agreement with clinical findings (Cramer's V&#x2009;=&#x2009;.329, P&#x2009;=&#x2009;.001), the depression subscale (HADS-D) revealed a striking systematic discrepancy, indicated by a negative Cohen's Kappa value of -0.085 (P&#x2009;=&#x2009;.031). High depression scores were significantly associated with older age (>&#x2009;55&#xa0;years), whereas no demographic or clinical variables showed significant correlations with independent clinical diagnoses. The findings highlight a "methodological failure" of the HADS-D in differentiating between somatic cancer symptoms and true psychological distress within the Syrian cultural and crisis context. This study cautions against the exclusive reliance on traditional self-report screening tools in such settings and underscores the vital necessity of expert clinical interviews (DSM-5) to ensure diagnostic accuracy in psycho-oncology.

Breast biopsies often cause anxiety and pain that influence patients' experience and procedure outcomes. Music interventions offer a practical alternative to pharmacological methods for reducing these effects. We conducted a PRISMA-compliant systematic review and meta-analysis to evaluate the efficacy of music during breast biopsies. We searched PubMed, Cochrane CENTRAL Library, EMBASE, and ClinicalTrials.gov up to May 2025. We included randomized controlled trials (RCTs) comparing music interventions with routine care without music intervention. The primary outcomes were anxiety and pain scores; secondary outcomes assessed changes in these scores before and after the procedure. We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) using a random-effects model. Seven RCTs with 606 participants met the inclusion criteria. The mean age of participants was 50.8 years. Anxiety scores were significantly lower in the music group compared with controls (SMD = -0.22, 95% CI: -0.38 to -0.06, p < 0.05, I2 = 0%). Anxiety reduction from pre- to postprocedure was also greater with music (SMD = 0.25, 95% CI: 0.07-0.44, p < 0.05, I2 = 0%). However, pain scores did not differ significantly (SMD = -0.33, 95% CI: -0.83 to 0.17, p > 0.05, I2 = 82%). Music interventions were associated with a small but statistically significant reduction in anxiety during breast biopsy procedures, but no significant reduction in pain. These findings support music as a safe, nonpharmacological option to improve patient experience, particularly with respect to procedural anxiety.