Bruxism and temporomandibular disorders (TMD) are multifactorial conditions in which cognitive and behavioural traits may play an underrecognised role. Hyperfocus, defined as intense and sustained attentional engagement, has been proposed as a potential driver of heightened sensorimotor activity and pain vulnerability, yet its relevance to bruxism and painful TMD remains poorly understood. To examine whether hyperfocus is associated with probable bruxism and painful TMD (pTMD), and to determine whether probable bruxism mediates the relationship between hyperfocus and pTMD. This cross-sectional observational study included eighty-five adults attending a university dental clinic who underwent standardised assessments for probable bruxism, pTMD, anxiety, depression, hyperactivity, and hyperfocus. Logistic regression models were used to identify factors associated with probable bruxism and pTMD. Mediation analyses tested whether probable bruxism explained the association between hyperfocus and pTMD. Higher hyperfocus scores were significantly associated with both probable bruxism and pTMD. Each one-point increase in hyperfocus was linked to a 6.5% increase in the odds of PB and a 5.5% increase in the odds of pTMD. Hyperfocus was also associated with self-reported probable bruxism frequency in a dose-response pattern. Probable bruxism did not remain independently associated in the final multivariable model and therefore did not statistically explain the observed association between hyperfocus and pTMD, indicating that hyperfocus may act as an independent factor linked to both conditions. Hyperfocus emerged as a trait associated with probable bruxism and painful TMD in this exploratory cross-sectional study. Longitudinal and mechanistic studies are needed to determine whether these associations reflect causal relationships.
Next-generation air force operations increasingly depend on advanced flight systems, which raises questions about their impact on aircrew workload. Physiological measures enable continuous, objective, and unobtrusive assessments, overcoming some limitations of self-report measures. We investigated whether electroencephalogram, electrocardiogram, and electrodermal activity predicted subjective Rating Scale of Mental Effort (RSME) ratings of fighter pilots during an operationally relevant mission in an F-16 simulator. The mission included three flight segments expected to induce increasingly higher workload, with a mathematical task of two arithmetic difficulty levels added to each segment. This approach allowed us to explore whether physiology distinguished workload both across and within flight segments. Subjective ratings confirmed an increase in workload throughout the mission (ΔRSME = 22). However, our manipulation of arithmetic difficulty was less effective: neither subjective ratings nor arithmetic performance significantly differentiated simple and complex calculations (ΔRSME = 5; Δreaction time = 0.02 s, Δunsuccessful trials = 0.5). None of our physiological measures-frontal theta power (Δ0.08, Δ-0.07 mV), parietal alpha power (Δ-0.16, Δ0.14 mV), heart rate (Δ0.01, Δ-0.02 bpm), skin conductance response (Δ0.0, Δ0.0 mS), and skin conductance peaks (Δ0.3, Δ0.2)-systematically distinguished flight segments or arithmetic difficulty, respectively. Physiology also did not significantly predict subjective workload (R2 = 2.2%). Large interindividual variability, use of workload management strategies, and relatively small task demand differences may explain the null results. Our study underscores the complexity of workload assessment in an operational setting and offers methodological insights that may inform future ecologically valid research. Reuten AJC, Bruin J, Ledegang WD, Groen EL, Houben MMJ, Cornelisse E-J, Bottenheft C. Physiological and subjective assessment of fighter pilot mental workload. Aerosp Med Hum Perform. 2026; 97(8):592-600.
This study investigated the mechanism by which Xiaoyao San ameliorates "brain-gut" interaction disorders in chronic stress-induced mice by examining its effects on T helper 1 cell(Th1)/T helper 2 cell(Th2) immune balance. Forty male C57BL/6 mice(6-8 weeks old, SPF grade) were randomly assigned to four groups(n=10 per group): control group, model group, Xiaoyao San group(7.63 g·kg~(-1)), and fluoxetine hydrochloride group(4.11 mg·kg~(-1)). Except for the control group, all groups underwent 28 days of chronic unpredictable mild stress(CUMS) to establish the model. Behavioral tests were conducted on day 28. From day 29, the Xiaoyao San and fluoxetine hydrochloride groups received corresponding drug solutions via oral gavage for 28 days(once daily), while the control and model groups received equivalent volumes of saline. CUMS modeling continued uninterrupted during the administration period. Behavioral assessments were repeated on day 56, with body weight monitored throughout the experiment. Hematoxylin-eosin(HE) staining was used to observe pathological changes in intestinal tissues. The villus height and crypt depth were measured, and their ratio was calculated. Immunohistochemistry(IHC) was employed to detect the expression of tight junction proteins zonula occludens-1(ZO-1) and occludin in the intestinal mucosa. Serum levels of interferon-γ(IFN-γ), interleukin(IL)-2, IL-4, IL-10, corticosterone(CORT), gastrin(GAS), motilin(MTL), and somatostatin(SS) were measured using enzyme-linked immunosorbent assay(ELISA) and subjected to correlation analysis. Western blot was performed to assess T-box transcription factor T-bet and GATA-binding protein 3(GATA-3) protein expression in the hypothalamus and intestinal tissues. The results demonstrated that Xiaoyao San significantly alleviated CUMS-induced depressive-like behaviors, including weight loss, reduced sucrose preference, and decreased locomotor activity in the open field test. HE staining indicated that Xiaoyao San effectively restored intestinal villus structure and increased the villus height-to-crypt depth ratio. IHC results showed that Xiaoyao San enhanced the expression of occludin and ZO-1 related to intestinal mucosal barrier, suggesting improved intestinal barrier function. ELISA analysis revealed that Xiaoyao San significantly decreased serum levels of CORT, SS, IFN-γ, and IL-2, while increasing GAS, MTL, IL-4, and IL-10, indicating mitigation of stress-induced damage and inflammatory responses, as well as regulation of brain-gut peptide secretion. Western blot results showed that Xiaoyao San significantly reduced T-bet protein expression and the T-bet/GATA-3 ratio in both the hypothalamus and intestinal tissues, suggesting correction of Th1/Th2 immune imbalance induced by CUMS. Correlation analysis indicated significant associations between brain-gut peptides and Th1/Th2-related inflammatory factors, implying a link between Th1/Th2 inflammatory responses and brain-gut regulatory function. In conclusion, Xiaoyao San ameliorates brain-gut interaction disorders in chronic stress mice, potentially through restoring Th1/Th2 immune balance, attenuating inflammatory responses, and modulating "brain-gut" peptide secretion.
Neuro-oncology neurosurgeons (NONs) manage patients with progressive neurological decline, make high-stakes decisions, and face repeated exposure to death. While burnout has been recognized as a significant concern, grief and psychological strain remain underexplored as related, partly overlapping phenomena. To address this gap, we convened an exploratory international cohort of NONs to develop a dialogue-informed perspective on grief. Insights from semistructured roundtable discussions were used to explore how grief and psychological strain are experienced, their key triggers, coping approaches, cultural influences, and perceived institutional and evidence gaps. Informed by these discussions-recorded, transcribed, and analyzed with a rapid thematic analysis-findings were synthesized into six themes: 1) The perception of grief and impact. We collectively view grief and psychological strain among NONs as arising not only from patient death, but also from iatrogenic neurological deficits and complications, reexposure to the patient's decline during follow-up, and the long relational trajectories characteristic of lower-grade glioma care. 2) Patterns in experiences of grief in NONs. Such experiences are understood to contribute to rumination, emotional blunting, social withdrawal, and exhaustion associated with sustaining realism while preserving hope. 3) NONs' coping with grief. Coping is similarly viewed as encompassing exercise and other "reset" routines, restoration of mastery through reflection and case review, reframing and meaning-making, selective peer support, compartmentalization, and graduated reexposure to lower-risk cases following adverse events. Career stage is regarded as a double-edged aspect, including a "lonelier at the top" experience. 4) Cultural differences in grief experiences. Grief is universal, but its expression and management vary via spiritual frameworks, end-of-life expectations, resources, medicolegal climate, and team psychological safety. 5) Lack of formal training and the hidden curriculum of grief and coping. NONs navigated these challenges largely by "learning by doing," with minimal formal guidance. 6) Institutional support, evidence gaps, and unintended harms. Institutional support is perceived as limited, with morbidity and mortality conferences variably buffering or intensifying distress depending on the degree of psychological safety. In this context, the cohort represented here emphasized the need for implementation of routine check-ins, mentorship structures, and psychologically safe debriefing after adverse events. Together, these reflections frame grief as a shared and discussable reality of neuro-oncology surgery practice; explicitly distinguish grief-related strain from burnout, describing significant burden even without burnout; and point toward actionable recommendations to support psychological safety and professional sustainability.
Diabetes is associated with an increased risk of cognitive dysfunction. We are aimed at examining cognitive performance in people with Type 2 diabetes mellitus (T2DM) and their correlation with physical activity (PA)/fitness level and mood. A cross-sectional study involving 47 individuals with T2DM, 30 diabetes-free individuals (controls): ages of 40-65 years and without dementia. Subjects were evaluated using a neuropsychological test battery that included Stroop, VLMT, CORSI, TMT and neuropsychiatric scales. The Global Physical Activity Questionnaire (GPAQ) was assessed. Physical fitness was evaluated using a maximal cardiopulmonary exercise testing (CPX). Compared with controls, people with T2DM had lower cardiorespiratory fitness (CRF) and more frequent cognitive performance below 1 SD of the normative value. Those individuals with T2DM, who displayed low fitness, showed significantly poorer cognitive inhibition (Stroop, p < 0.001), processing speed (TMT-A, p < 0.001), cognitive flexibility (TMT-B, p < 0.001), visuospatial memory (CORSI, p < 0.001) and memory consolidation (VLMT, p < 0.001). Higher ventilatory and metabolic CRF markers and higher PA levels correlated significantly with higher cognitive performance. None of the neuropsychological or psychiatric background variables correlated significantly with any of the cognitive scales. Individual CRF markers and PA levels correlated positively with cognitive performance in people with T2DM and in nondiabetic individuals. However, individuals with T2DM showed at least two to three times more frequent cognitive performances more than 1 SD below norm as compared with controls. Among people with T2DM, those with low aerobic fitness/PA levels showed significantly lower cognitive performance, especially in the attention-concentration, executive functioning, episodic memory and visuospatial processing domains.
Thoracic surgery is commonly performed for the management of conditions involving the lungs, mediastinum, pleura, and chest wall. Despite advances in surgical techniques and perioperative care, postoperative pain remains a frequent complication. In some patients, pain may persist and progress into chronic post-thoracotomy pain syndrome (CPTPS), defined as pain lasting more than 2 months after surgery. The prevalence of chronic pain ranges from 21% to 91%, with lower rates observed in minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) (~35.5%) and robotic-assisted thoracic surgery (RATS) (11.2%-34.6%). This study presents a literature review evaluating the epidemiology, pathophysiology, and management of CPTPS, including pharmacological, interventional, and rehabilitation-based approaches, as well as emerging biological therapies. Chronic pain is multifactorial, involving tissue injury, inflammation, intercostal nerve damage, and central sensitization. It is associated with impaired respiratory function, reduced mobility, sleep disturbances, and decreased quality of life. Multimodal analgesia and regional anesthesia are key strategies, while rehabilitation supports functional recovery. Emerging biological therapies show promise but remain limited in evidence. A multidisciplinary approach is essential to reduce CPTPS and improve long-term outcomes and quality of life.
Accumulating studies have investigated the combined effects of 24-h movement behaviors on physical and mental health. The 24-hour Movement Behaviors Questionnaire (24HMBQ) was recently developed to measure the 24-hour movement behaviors in college students. However, its criterion validity remains to be elucidated. This study aimed to investigate the criterion validity of the 24HMBQ against accelerometer-derived data among Chinese college students. Eighty-eight college students (age = 20.2 ± 2.2 years) participated in this study. The Axivity AX3 accelerometers were used to objectively measure physical activity (PA), sedentary behavior (SB), and sleep levels over a consecutive seven-day period. At the last day, participants completed the 24HMBQ to self-report their PA, SB, and sleep levels. Paired-sample t-test, Spearman's rank correlation test, and Bland-Altman plot were used to examine the degree of agreement between 24HMBQ and accelerometer data. Spearman's correlation coefficients indicated strong agreement for sleep metrics (Rho = 0.77, p < 0.001 for weekdays; Rho = 0.68, p < 0.001 for weekends) and moderate agreement for SB (Rho = 0.55, p < 0.001 for weekdays; Rho = 0.33, p < 0.01 for weekends) between 24HMBQ and accelerometer measurements. However, lower correlations were observed for physical activities including light PA (Rho = 0.30, p < 0.01) and moderate-to-vigorous PA (MVPA; Rho = 0.15, p > 0.05). The 24HMBQ showed good criterion validity for sleep and moderate validity for sedentary behavior, but limited validity for physical activity (especially MVPA).
Sudden bereavement has a pronounced effect on the mental health of those left behind, yet less is known about intergenerational health effects if such a shock occurs during a pregnancy. We account for socioeconomic differences that influence both exposure to maternal loss and offspring birth outcomes, providing novel causal evidence on the effects of maternal loss during pregnancy. We employ data on all registered births (2001-2024) from the Dutch Perinatal Registry to obtain pregnancy trajectories and perinatal outcomes (pre-term birth and small-for-gestational age). We link this to data from Statistics Netherlands, including family and cause of death registers. With this linkage, we identify pregnancies that take place around the sudden loss of a mothers' family member. We exploit differences in the timing of maternal losses and compare perinatal outcomes of offspring exposed to a sudden maternal loss in utero (treatment group) and of their counterparts exposed shortly after birth (control group) to shed light on long-term mental health effects of exposure in utero. We are unable to present any results just yet, but will be able to do so at the time of the conference. However, because of various biological pathways that may transfer maternal stress to the fetus, we expect that the group exposed in utero will have worse perinatal outcomes than the group exposed shortly after birth. One of these pathways that causes this hypothesis is the through extensive exposure of cortisol, which may inhibit fetal growth and may active childbirth processes earlier than usual.
This study aimed to evaluate the antidepressant activity of Piper laetispicum extract and preliminarily explore its underlying mechanism using a zebrafish model of depression combined with quantitative proteomics. A chronic unpredictable mild stress(CUMS) paradigm was employed to establish the depression model. AB strain zebrafish were randomly assigned into four groups: control, model, P. laetispicum, and fluoxetine, with 15 fish in each group. Except the control group, all groups were subjected to CUMS for 2 weeks. Intervention of P. laetispicum extract or fluoxetine lasted for 3 consecutive weeks. Upon completion of the experiment, the pathological morphology of zebrafish brain tissue was observed, and the expression levels of tumor necrosis factor-alpha(TNF-α), interleukin-1 beta(IL-1β), brain-derived neurotrophic factor(BDNF), and 5-hydroxytryptamine receptor 2A(5-HT2A) were measured in each group. Brain tissue proteins were extracted and subjected to quantitative proteomic analysis to identify differentially expressed proteins(DEPs), which was followed by bioinformatics analysis. Key DEPs were validated using Western blot and RT-qPCR. The results demonstrated that P. laetispicum extract significantly ameliorated CUMS-induced brain histopathological damage, reduced the levels of the inflammatory cytokines TNF-α and IL-1β, and reversed the aberrant expression of BDNF and 5-HT2A. Proteomic profiling identified a total of 11 633 proteins, among which the expression levels of 81 proteins were markedly reversed following P. laetispicum extract treatment. Subsequent validation by Western blot and RT-qPCR confirmed that P. laetispicum significantly modulated the expression of annexin A1(Anxa1) and transcription factor JunB(JunB). Collectively, these findings suggest that P. laetispicum exerts antidepressant effects potentially through the regulation of Anxa1 and JunB expression.
Acceptance- and mindfulness-based interventions are effective for improving pain-related outcomes, yet their effects on psychological flexibility have not been meta-analyzed. This systematic review and meta-analysis addressed this gap by comparing these interventions with control conditions on psychological flexibility and its core dimensions in adults with chronic pain. Searches were conducted in PsycINFO, MEDLINE, Cochrane CENTRAL, Scopus and Web of Science from inception to May 2025. Sixty randomized controlled trials comprising 6692 participants were included. Meta-analyses were conducted for global psychological flexibility (k = 17), acceptance (k = 38), committed action (k = 4) and values (k = 4). Heterogeneity, risk of bias and certainty of evidence were assessed. Interventions significantly improved psychological flexibility at post-treatment, short-term (≤ 6 months) and long-term (> 6 months) follow-up (g = 0.35-0.69), and acceptance across all time points (g = 0.41-0.77). Effects for committed action and values were non-significant. Heterogeneity was substantial, most trials had a high risk of bias, and the certainty of evidence was low to very low. Moderator analyses indicated larger effects when interventions were compared with inactive controls, delivered by psychologists or implemented as stand-alone programs. Evidence suggests that acceptance- and mindfulness-based interventions may improve global psychological flexibility and acceptance. However, the certainty of evidence was low to very low, and most included trials were at high risk of bias. More rigorous trials are needed to clarify effects across specific dimensions of psychological flexibility. This systematic review and meta-analysis provide the first comprehensive synthesis of the effects of acceptance- and mindfulness-based interventions on psychological flexibility in chronic pain. These findings show that these interventions improve psychological flexibility, particularly pain acceptance, supporting it as a clinically relevant treatment target. PROSPERO: CRD420251018441.
OBJECTIVE: To determine the trajectory of (1) change in pain-related fear and catastrophizing factors, (2) changes in pain-related fear and catastrophizing by treatment satisfaction groups, and (3) the relationship between pain-related fear trajectories, and catastrophizing factors and shoulder disability during an 8-week resistance exercise program. DESIGN: Prospective longitudinal observational study. METHODS: Sixty-four people with rotator cuff tendinopathy completed the exercise protocol. Outcomes of Penn Shoulder Score (Penn) shoulder disability and pain-related fear and catastrophizing via the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) were assessed at baseline and at 2, 4, and 8 weeks. Patient Acceptable Symptom State (PASS) defined satisfaction with treatment at 8 weeks. RESULTS: All pain-related fear and catastrophizing measures changed over time during resistance exercise (P < .01) but differed by PASS-defined responder and nonresponder groups. For the Fear-Avoidance Beliefs Questionnaire-Work subscale (FABQ-W), nonresponders had an increase (0.63 pt) while responders had a decrease (-3.5 pt) (mean difference, 4.2 pt; 95% confidence interval [CI]: -7.6, -0.7; P = .02). For TSK-11, nonresponders had less of a decrease (-0.1) than responders (-3.2 pt) (mean difference, 3.1 pt; 95% CI: -5.9, -0.3; P = .03). Reduced shoulder disability was related to less pain-related fear and catastrophizing (P < .01), and differed by responder group. Nonresponders had no relationship between change in pain-related fear and catastrophizing and disability (P>.05); responders had an overall negative relationship (P < .04). CONCLUSION: Pain-related fear and catastrophizing changed over time for individuals with rotator cuff tendinopathy, and changes varied by participant. Those who were not satisfied at 8 weeks had higher levels of pain-related fear and catastrophizing, while those who were satisfied had reduced pain-related fear and catastrophizing. Less pain-related fear and catastrophizing was related to decreased disability. J Orthop Sports Phys Ther 2026;56(8):546-554. Epub 9 Jun 2026. doi:10.2519/jospt.2026.13563.
Acute postsurgical pain (APSP) and chronic postsurgical pain (CPSP) remain prevalent and insufficiently resolved challenges in perioperative medicine. This narrative review summarizes the current state of knowledge regarding personalized pain prediction, examines existing prognostic models and their limitations, and identifies the conceptual and methodological developments most likely to advance the field toward genuine individual prediction. Individual predictors, whether clinical, psychological, psychophysical, or surgical in nature, are, on their own, insufficiently informative to enable individual risk stratification. Existing multivariate prognostic models demonstrate at best moderate discriminatory power and are consistently rated as having a high risk of bias. To date, no externally validated predictive model exists for either outcome. Transitional Pain Services (TPS) and Shared Decision Making (SDM) represent promising organizational and communicative frameworks for translating risk stratification into clinical practice, although controlled trial evidence remains limited. Emerging approaches, including multidomain biosignatures, machine learning-based integration, and standardized outcome definitions, offer a particularly promising path toward genuinely personalized perioperative pain management. Personalizing perioperative pain prediction will require moving beyond individual risk factors toward the multidomain integration of biological, psychophysical, and psychosocial variables. Artificial intelligence could prove to be a catalyst for this integration, but the crucial step is conceptual in nature: recognizing postsurgical pain as a network phenomenon and establishing and implementing the clinical infrastructure needed to act on this insight.
Bilateral vestibulopathy (BVP) is characterized by bilateral vestibular hypofunction and classically manifests with oscillopsia and postural instability. However, clinical severity is highly heterogeneous and poorly explained by the magnitude of peripheral vestibular loss alone. To investigate the relationship between peripheral vestibular dysfunction, integrated postural-control measures, and clinical disability in BVP, and to identify functional determinants of oscillopsia, falls, and disability phenotypes. In this retrospective multicenter study, 126 patients with definite BVP were included. Audiovestibular assessment comprised pure-tone audiometry, video Head Impulse Testing (vHIT), vestibular-evoked myogenic potentials, dynamic posturography (Sensory Organization Test [SOT], Limits of Stability [LOS]), and dynamic visual acuity (DVA). Patients were stratified into mild, moderate, and severe disability phenotypes based on oscillopsia and falls. Oscillopsia was associated with reduced semicircular canal function, particularly lateral canal gain (LSC AUC = 0.637, p = 0.004), while DVA showed no consistent discrimination. In contrast, falls were primarily related to impaired postural control, with significant differences in SOT (AUC = 0.676, p = 0.031) and LOS (AUC = 0.699, p = 0.021), but not vHIT or VEMP parameters. Disability phenotypes differed significantly in etiological distribution (p < 0.001), with CANVAS and vestibulotoxicity overrepresented in severe cases, while no major differences were observed in vestibular test profiles across clusters. In BVP, disability is only partially explained by peripheral vestibular loss. Oscillopsia is more related with canal dysfunction, whereas falls are associated with postural and multisensory impairment. These findings highlight the need for integrated frameworks combining vestibular physiology, compensation, and functional outcomes.
Interpersonal touch is a fundamentally multidimensional and multisensory experience and as such is highly subjective. By whom, where and how we are touched determines how we react to and feel about it. Previous research using topographical body tasks has mainly examined where people feel comfortable being touched by others. Using the BodyMap Tool, we mapped distinct somatoperceptions associated with positive and negative social touch videos, comparing physical sensations and emotional responses. We quantified these patterns with a BodyMap Score (BMS) reflecting valence and spatial coverage. Positive videos elicited higher physical than emotional BMS, whereas negative videos showed the opposite pattern, with broader emotional than physical somatoperceptions. Individual differences further modulated these effects: touch-avoidant participants showed reduced BMS for positive touch, and participants reporting pain exhibited overall lower BMS, though this reduction was attenuated for positive stimuli. These findings highlight the complex and context-dependent bodily representation of social touch.
To investigate the prevalence of negative emotions and mobile phone addiction among adolescents and explore the longitudinal association between the two. A random cluster sampling method was employed to administer the Depression, Anxiety and Stress Scale (DASS-21) and Mobile Phone Addiction Index (MPAI) to 2115 secondary school pupils (junior and senior high) across three mainstream secondary schools in Xinxiang City during December 2022 (T1) and December 2023 (T2). Depression-Stress Simplified Chinese Version (DASS-21) and Mobile Phone Addiction Index (MPAI) to conduct a two-stage longitudinal study among 2115 secondary school students (junior and senior high) from three general secondary schools in Xinxiang City. Data were analysed using a cross-lagged panel model. (1) The study encompassed 2115 adolescents, predominantly junior secondary school pupils (58.8%), with an average age of (14.89±2.31) years. Among them, 1091 were male (51.6%) and 1024 female (48.4%), the vast majority being non-only children (92.4%). Their current residence was predominantly rural (54.0%), and their parents' educational attainment was chiefly at junior secondary level. and 1024 females (48.4%). The vast majority were non-only children (92.4%), with 54.0% residing in rural areas. The educational attainment of participants' parents was predominantly at junior secondary level. (2) At Time Point 1 (T1), adolescents' scores for depression, anxiety, stress, and mobile phone addiction were (5.52±3.47), (6.88±5.72), (7.43±4.49), and (34.49±12.31) points respectively. At T2, these scores significantly increased to (8.43±3.26), (9.62±3.88), (11.14±3.45), and (40.51±13.55) points respectively (P<0.01). (3) Cross-lagged analysis revealed that depression at T1 significantly and positively predicted mobile phone addiction at T2 (β=0.34, P<0.01), while mobile phone addiction at T1 also significantly and positively predicted depression at T2 (β=0.24, P<0.05). (4) Anxiety at T1 significantly and positively predicted mobile phone addiction at T2 (β=0.22, P<0.01), whereas the predictive effect of T1 mobile phone addiction on T2 anxiety was non-significant (β=0.07, P> 0.05). (5) T1 stress significantly and positively predicted T2 mobile phone addiction (β=0.37, P<0.01), whilst T1 mobile phone addiction also significantly and positively predicted T2 stress (β=0.41, P<0.01). A stable reciprocal predictive relationship exists among adolescent depression, stress, and mobile phone addiction, whereas adolescent anxiety only unidirectionally predicts mobile phone addiction.
Robotic right hemicolectomy has been widely adopted, but the impact of extraction-site location on postoperative pain in single-port (SP) surgery remains unclear. We aimed to compare short-term outcomes between SP and multiport robotic surgery and to evaluate postoperative wound pain according to extraction-site location. This retrospective single-center study included 49 consecutive patients who underwent robotic right hemicolectomy (January 2024-December 2025): 25 in the SP group and 24 in the Xi group. Postoperative pain was assessed using the cumulative pain score (sum of daily maximum NRS values, POD1-POD7). Pain outcomes were compared among SP_P (Pfannenstiel, n = 13), SP_Umb (umbilical, n = 12), and Xi_P (Pfannenstiel, n = 22). Perioperative and oncological outcomes were comparable between the groups. The SP group had significantly shorter operative time (244 vs. 309 min, p = 0.0013) and console time (167 vs. 239 min, p = 0.0014). Postoperative pain differed significantly among the three subgroups (p = 0.0049). Pairwise comparisons showed significantly lower pain in SP_P than in SP_Umb (p = 0.0062), with no significant difference for the other two comparisons. The difference between SP_P and SP_Umb remained significant after adjusting for anastomotic technique and surgical procedure in multiple regression analysis. SP-assisted right hemicolectomy was safe, with short-term outcomes comparable to the Xi platform. These findings suggest that postoperative pain following robotic right hemicolectomy may be influenced not only by the number of abdominal ports but also by the location of the extraction incision.
The aim of this study was to develop a conceptual framework for understanding surgeon grief in pediatric neurosurgery, examine its intersection with moral distress and professional burnout, and review evidence for institutional interventions supporting physician well-being after patient death. The author conducted a narrative review of English-language literature on physician grief, moral distress, and burnout in surgical specialties, with attention to pediatric practice. PubMed, PsycINFO, and CINAHL were searched for publications from January 2000 to December 2024. The initial search yielded 847 articles; after screening, 67 met inclusion criteria for narrative synthesis. An illustrative case of a neonate with an unresectable brain tumor contextualizes the framework. Five dimensions of surgeon grief specific to therapeutic futility were identified: grief of unexpressed mastery (inability to deploy technical expertise), grief of identity disruption (challenge to action-oriented surgical identity), grief of anticipatory knowledge (burden of prognostic awareness), grief of perceived failure (internalization of patient death as personal defeat), and disenfranchised grief (grief not socially recognized within surgical culture). These dimensions interact bidirectionally with moral distress to produce cumulative emotional burden contributing to burnout and career attrition. Evidence supports institutional interventions that include structured debriefing, peer support programs, Schwartz Rounds, and early palliative care integration. Surgeon grief represents a significant but understudied occupational hazard in pediatric neurosurgery. The proposed 5-dimension framework provides a conceptual foundation for research, instrument development, and targeted interventions. Recognizing that providing a good death is a form of surgical success and that surgeon grief reflects preserved humanity is essential for workforce sustainability.
Familiarity judgments are thought to involve evidence accumulation, a decision-making process in which information is gathered over time until a threshold is reached. Previous work has identified a scalp-recorded signature of evidence accumulation called the central-parietal positivity (CPP). We built on this previous work and recorded electroencephalography while participants listened to several melodies, instructing participants to respond as soon as the song felt familiar. A prominent CPP was noted, time-locked to decisions. We then used linear regression to unmix overlapping neural responses and observed a stimulus-locked indicator of evidence accumulation that increased in amplitude just prior to a familiarity decision. This result suggests that song familiarity relies on evidence accumulation, with individual notes in a familiar song acting as "evidence".
This study aims to investigate the improving effects and potential molecular mechanisms of total flavonoids from Hemerocallis citrina(HCFs) on depression-like behaviors induced by chronic unpredictable mild stress(CUMS) in mice. The mice were randomly divided into a control group, model group, low-dose HCFs group, middle-dose HCFs group, high-dose HCFs group, and fluoxetine group. After four consecutive weeks of gastric gavage administration, the sucrose preference test, forced swimming test, tail suspension test, and open-field test were conducted to evaluate depression-like behaviors. The levels of corticosterone(CORT), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), hippocampal 5-hydroxytryptamine(5-HT), and brain-derived neurotrophic factor(BDNF) in the serum were determined by enzyme-linked immunosorbent assay; hematoxylin-eosin staining was used to observe hippocampal pathological changes; transcriptome sequencing was performed to analyze differentially expressed genes and Western blot was performed to detect the expression levels of key proteins related to the neuronal function and inflammatory response. The results demonstrate that compared with the model group, HCFs groups with low, medium, and high doses can significantly increase sucrose preference, decrease immobility time, enhance central zone activity, reduce CORT, IL-6, and TNF-α levels, elevate BDNF and 5-HT contents, and alleviate hippocampal tissue injury. Transcriptomics and Western blot analyses reveal that HCFs can significantly up-regulate the pathways related to neurotransmitter synthesis, myelin formation, synaptic plasticity, and energy metabolism regulation, while down-regulating the pathways related to inflammatory response and excessive metabolism and regulating the expressions of proteins related to hippocampal neuronal function and inflammatory response. In conclusion, HCFs exert a significant antidepressant effect on CUMS-induced mice, and their mechanism may be related to the multi-target synergistic regulation involving monoamine neurotransmitter balance and neuroinflammation inhibition.
We aimed to explore the experiences, challenges, and coping strategies of nurses working in pediatric organ transplant clinics in Türkiye. We investigated emotional stressors, ethical dilemmas, communication challenges, and the effectiveness of institutional support to address these challenges. A qualitative descriptive study design was employed. Data were collected through semi -structured face -to -face interviews with 20 organ transplant nurses from various hospitals in Türkiye. We used a purposive sampling method to select the participants. We used qualitative data analysis software (NVivo; version 12 ) to identify recurring themes related to emotional distress, ethical concerns, communication issues, and coping strategies. Ethical approval was obtained from the relevant institutional review board, and informed consent was secured from all participants. Thematic analysis revealed 4 main categories: emotional challenges, ethical dilemmas, communication challenges, and coping strategies. Nurses reported experiencing high levels of stress and burnout due to prolonged exposure to critically ill children. Ethical dilemmas related to organ allocation decisions created additional moral distress. Communication challenges were primarily linked to breaking bad news to patients' families and managing unrealistic expectations from families. Coping mechanisms included reliance on peer support, use of previously established personal resilience strategies, and access to institutional psychological support. Pediatric organ transplant nurses encounter important emotional, ethical, and communication challenges. Enhancing institutional support structures, providing targeted psychological counseling, and improving communication training programs could alleviate these concerns and thereby improve both nurse well -being and patient care outcomes. Future multicenter studies would expand the generalizability of these findings and identify best practices for institutional support of transplant nurses.