Search Results (644)

Thoracoabdominal aortic aneurysm (TAAA) is a complex vascular disorder involving both thoracic and abdominal segments of the aorta and remains associated with substantial morbidity and mortality. One of the most serious complications after thoracoabdominal aortic aneurysm (TAAA) repair is spinal cord ischemia (SCI), which may progress to spinal cord infarction and result in irreversible neurologic deficits including paraplegia, neurogenic bladder dysfunction, and bowel dysfunction. The incidence of SCI after TAAA repair varies with the extent of aneurysmal involvement, operative duration, and patient comorbidities. The primary pathophysiologic mechanism involves interruption of radiculomedullary arterial flow, compounded by systemic hypotension and limited collateral circulation. Because SCI profoundly affects functional recovery and long-term quality of life, prevention and early recognition are central to perioperative management. Established neuroprotective strategies emphasize maintenance of spinal cord perfusion through meticulous hemodynamic optimization, cerebrospinal fluid (CSF) drainage, and temperature modulation. Intraoperative neuromonitoring using motor and somatosensory-evoked potential facilitates early detection, while newer modalities such as near-infrared spectroscopy and CSF lactate monitoring may offer additional insight. When SCI occurs despite prophylaxis, rapid initiation of rescue measures including CSF drainage, hemodynamic augmentation, and other discussed treatments may improve neurologic outcomes. Long-term care focuses on rehabilitation, symptom management, and psychological support. Therefore, this review aims to consolidate medical evidence to improve the prevention, detection, and treatment of spinal cord infarction associated with thoracoabdominal aortic aneurysm repair. Full article

The transmission of trauma across generations has traditionally been explained through genetic, epigenetic, familial, and attachment-based mechanisms. While these approaches have generated valuable insights, they remain insufficient for explaining the persistence of psychological vulnerability in contexts where the original traumatic event has disappeared but maladaptive patterns continue to emerge across generations. This paper introduces the Contextual Resonance Theory of Psychopathology (CRTP), a novel cognitive–systemic framework proposing that transgenerational trauma is maintained through the recursive reproduction of trauma-shaped environments rather than exclusively through biological inheritance. According to this model, traumatic experiences generate adaptive cognitive, emotional, and behavioral responses that become embedded within family narratives, relational structures, institutional practices, and cultural expectations. Over time, these adaptations evolve into self-maintaining contextual systems that continuously communicate threat, unpredictability, and hypervigilance to subsequent generations. The theory introduces the concepts of contextual traumatic inertia, distributed psychopathology, and recursive contextual resonance to explain how vulnerability becomes socially reproduced even in the absence of direct trauma exposure. Drawing on predictive processing, ecological psychology, systems theory, and contemporary trauma research, the paper proposes that psychopathology emerges from persistent interactions between individuals and pathogenic environments rather than solely from intrapsychic dysfunction. Furthermore, a complementary mechanism termed corrective recontextualization is proposed as a pathway for reversing transgenerational vulnerability through repeated exposure to safe, predictable, and psychologically restorative contexts. The framework offers an integrative perspective capable of bridging cognitive neuroscience, developmental psychopathology, trauma studies, and mental health intervention research. Clinical, educational, organizational, and societal implications are discussed, alongside future directions for empirical validation and neurocognitive investigation. Full article

Postoperative cardiovascular complications remain a leading cause of morbidity and mortality after noncardiac surgery, yet current risk models do not incorporate psychosocial stress. With over 300 million noncardiac surgeries performed annually worldwide and a substantial burden of perioperative cardiovascular complications, preoperative chronic stress is increasingly recognized as a potentially modifiable risk factor. Chronic stress produces HPA axis dysregulation, glucocorticoid resistance, sympathetic activation, inflammation, endothelial dysfunction, and hypercoagulability. These pathways overlap with the mechanisms underlying perioperative myocardial injury, arrhythmogenesis, and venous thromboembolism. Prospective data demonstrated that preoperative psychological distress independently predicted 30-day cardiovascular complications and 1-year mortality after noncardiac surgery. Allostatic load studies in noncardiac surgery patients showed that high preoperative physiological burden was associated with up to twofold increases in postoperative mortality and elevated rates of myocardial infarction and venous thromboembolism. Epidemiological evidence further supports that anxiety and depression independently increase cardiovascular risk. Converging evidence suggests that preoperative psychological distress is a relevant perioperative cardiovascular risk factor. However, no randomized controlled trial has evaluated whether targeted preoperative stress reduction can decrease postoperative cardiovascular events, representing a critical gap warranting prospective investigation. Full article

Background: Severe obesity is a chronic condition that adversely affects physical health and quality of life, including sexual function. However, its impact on multidimensional psychosexual outcomes remains unexplored. This study aimed to assess changes in erectile function, genital self-image, and psychological distress in men who underwent bariatric surgery. Methods: This prospective cohort study involved 50 male participants undergoing primary bariatric surgery who were evaluated within 30 days prior to the surgical procedure and at a minimum of 12 months postoperatively. Standardised questionnaires were used, including the International Index of Erectile Function-5 (IIEF-5), Male Genital Self-Image Scale (MGSIS-7), and Hospital Anxiety and Depression Scale–Modified (HADS-M). Secondary outcomes encompassed parameters of weight loss, sexual activity, and selected aspects of sexual behaviour, such as the utilisation of various sexual positions, their associated pleasure, and frequency. Results: Significant postoperative improvements were observed in BMI reduction from 42.8 kg/m² to 31.7 kg/m² (p < 0.001), erectile function (IIEF-5 improved from 16.3 to 19.6; p < 0.001), genital self-image (MGSIS-7 improved from 19.1 to 21.9; p < 0.001), and psychological distress (HADS-M reduction from 13.3 to 8.7; p < 0.001). Glycated haemoglobin decreased significantly (5.89% to 5.31%; p < 0.001), obstructive sleep apnoea severity improved (p < 0.001), and remission or clinically meaningful improvement of at least one major metabolic comorbidity was documented in 24 of 37 participants (64.9%). Sexual activity increased from 37/50 (74.0%) to 43/50 (86.0%), although this change was not statistically significant (p = 0.114). After FDR correction, frequency increased for 3 of the assessed positions, whereas pleasure increased only for one of them. Weight loss magnitude was not significantly correlated with changes in the IIEF-5 or MGSIS-7 scores. A greater reduction in the HADS-M score correlated with a greater improvement in the IIEF-5 score (ρ = −0.307, p = 0.030). Conclusions: Bariatric surgery was associated with improvements in erectile function, genital self-image, and psychological distress, alongside marked glycaemic and sleep-related recovery. Because the psychosexual changes were not statistically associated with the magnitude of weight loss and of metabolic and respiratory improvement, and because the design was uncontrolled, these exploratory findings indicate association rather than causation and support the incorporation of psychosexual and mental health assessment into postoperative bariatric care. Full article

Background and Objectives: Forgetting has been a passive process of memory failure; an active and controlled neurocognitive process is critical for cognitive efficiency, goal-directed behaviors, and emotional coping. This systematic review aims to provide a human-based summary of the scientific understanding of forgetting from neurobiological and psychological perspectives. Materials and Methods: A literature review from 2000 – 2025 was performed using PubMed/MEDLINE, PsycINFO, and Scopus. Original peer-reviewed human-based studies that used behavioral tasks, neuroimaging methods, electroencephalography, and physiological stress inductions were considered. Results: Active control processes have been identified in the forgetting paradigm, and intentional forgetting involved prefrontal–hippocampal downregulation, whereas unintentional forgetting occurred due to limited resources, interference, and competition at the stage of information retrieval. Stress-induced disruption of the ability to recall memories operated specifically via executive and inhibitory functions. Pathological forgetting in mild cognitive impairment was explained by encoding impairments and poor consolidation, but not by accelerated long-term decay. Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) featured pathological forgetting associated with decreased specificity, negative bias, and poor prefrontal–medial temporal lobe inhibition, resulting in asymmetrical memory retention. Forgetting has been recognized as a dynamic and multidetermined process, which involves executive control, hippocampal–cortical interactions, and emotional modulation. Different pathologies of forgetting occur depending on the disrupted domain, indicating that differential forgetting patterns specific to particular domains, such as encoding failures in Mild Cognitive Impairment (MCI) and inhibitory deficits in PTSD, may have implications for differential diagnoses and interventions. Conclusions: Executive and emotion-regulatory dysfunction leads to maladaptive forgetting and is characterized by less specificity, more interference, and weaker inhibition. Disrupted hippocampal amygdalar prefrontal networks, in disorders like PTSD and MDD, disrupt memory suppression, resulting in intrusive emotional memories with loss of context. Full article

Pediatric obesity is a complex, multifactorial pandemic with serious early-onset comorbidities, including prediabetes, type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), and cardiovascular disorders. While lifestyle modifications and the Mediterranean diet remain primary interventions, artificial intelligence (AI) is emerging as a critical tool for early diagnosis and personalized management. This review evaluates the current role of AI in predicting and treating childhood obesity and its complications. A literature search was conducted on PubMed and Google Scholar for English-language articles published from 2015 onward. Search terms included combinations of keywords related to “obesity”, “pediatric”, “comorbidities” (e.g., MASLD, diabetes), and “artificial intelligence” (e.g., machine learning, deep learning, multi-omics). Eligible study types ranged from original articles to systematic reviews and clinical guidelines. By integrating multi-omic data (genome, epigenome, transcriptome, metabolome, microbiota) with socio-psychological metrics, AI can predict obesity risk and early complications. Machine learning (ML) and deep learning have successfully identified specific metabolites, gut flora alterations, neurological pathways, and metabolic SNPs linked to obesity susceptibility. Furthermore, ML-driven prognostic models enable risk assessment for MASLD or diabetes progression, while specialized software supports remote lifestyle monitoring and tailored dietary interventions. AI has the potential to revolutionize pediatric obesity management through precision medicine. However, challenges regarding data privacy, digital literacy, and equitable access persist. Because current evidence relies heavily on limited and heterogeneous pediatric datasets, large-scale, well-characterized, and externally validated cohorts are essential to establish the clinical applicability of AI models before routine implementation. Full article

The enteric nervous system (ENS) can function semi-autonomously from the central nervous system (CNS) in regulating complex gastrointestinal processes and exhibits substantial developmental, epigenetic, neuroimmune, and adaptive plasticity. We propose the concept of Stress-Induced Long-term Epigenetic Implicit Memory (SLEIM) as a hypothesis-generating theoretical framework suggesting that prenatal maternal stress may contribute to persistent biological alterations within ENS-related pathways through interacting epigenetic, neuroimmune, neuronal, glial, and microbiota-associated mechanisms. The precise biological substrates and mechanisms underlying this proposed framework remain unknown. Through the microbiota–gut–brain axis (MGBA), such stress-related biological alterations may influence physiological communication between the ENS and CNS and in turn affect stress-response systems, including HPA axis activity, immune signalling, cortisol regulation, mast-cell activation, and cytokine balance. The frequent comorbidity of fibromyalgia (FM) and irritable bowel syndrome (IBS) suggests the existence of shared pathogenic mechanisms involving central sensitisation, neuroimmune processes, and MGBA dysfunction. In this study, we therefore also address dependency-related characteristics and autonomy vulnerabilities reported in some patients with FM and consider how developmental, psychological, neurobiological, and illness-related factors may contribute to these patterns. Within the proposed SLEIM framework, prenatal stress-related biological influences may represent a potential developmental pathway that contributes to vulnerability to IBS, FM, and related functional disorders later in life. However, these relationships remain hypothetical and require future empirical investigation. Full article

Introduction: Halitosis is a common oral condition that may negatively affect social interactions, psychological well-being, and quality of life. However, evidence regarding its association with mental health and sleep quality remains inconsistent, particularly among university students. Aim: This cross-sectional study investigated the prevalence of objectively measured halitosis and its association with tongue coating, sleep quality, and symptoms of anxiety, depression, and stress among university students from the metropolitan region of Santos, Brazil. Methods: Sixty-two Brazilian university students enrolled in health-related undergraduate programs participated in the study; most were in the first academic year (61.3%) and resided in the municipality of Santos (59.7%). Halitosis was assessed using a portable breath detector, tongue coating was evaluated using the Coated Tongue Index, sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and symptoms of depression, anxiety, and stress were measured using the Depression, Anxiety and Stress Scale (DASS-21). Results: Objectively measured halitosis was identified in 25 participants (40.3%; 95% CI: 29.0–52.7%). The analyses did not provide statistically significant evidence of associations between objectively measured halitosis and tongue coating, sleep quality, or symptoms of anxiety, depression, and stress. Significant positive correlations were identified between stress and sleep disturbance, anxiety and sleep disturbance, and depression and sleep latency, daytime dysfunction, and overall sleep quality. Tongue-cleaning habits were significantly associated with the presence of halitosis, whereas oral mucosal desquamation was less frequent among participants with halitosis. Conclusion: The study did not provide statistically significant evidence of associations between objectively measured halitosis and tongue coating, sleep quality, or psychological symptoms in this population. Significant positive correlations were identified between stress and sleep disturbance, anxiety and sleep disturbance, and depression and sleep latency, daytime dysfunction, and overall sleep quality. These findings highlight the importance of objectively assessing oral malodor in epidemiological studies. Full article

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract that arises from a complex interplay of genetic susceptibility, immune dysregulation, environmental exposures, and altered host–microbiome interactions. Increasing evidence identifies the gut microbiota as a central component of IBD pathogenesis. In healthy individuals, the intestinal microbiota supports epithelial integrity, metabolic homeostasis, immune education, colonization resistance, and bidirectional gut–brain communication. In IBD, this ecosystem is disrupted by reduced microbial diversity, expansion of pathobionts, and broader functional alterations affecting community stability and metabolic output. Importantly, these changes are increasingly viewed not merely as consequences of inflammation, but as active contributors to disease development and persistence. Dysbiosis may also influence neuroimmune signaling through the gut–brain axis, linking microbial metabolites, intestinal barrier dysfunction, enteric nervous system activity, and psychological comorbidities frequently observed in patients with IBD. This review provides a comprehensive overview of the role of the gut microbiota in IBD, beginning with its physiological functions in intestinal homeostasis and the evidence linking dysbiosis to disease pathogenesis, followed by a critical evaluation of current microbiome-based therapeutic strategies, their translational challenges, and prospects for personalized microbiota-directed interventions. Approaches such as fecal microbiota transplantation (FMT), probiotics, live biotherapeutic products, and genetically engineered bacteria aim to restore microbial balance and modulate intestinal inflammation. Among these, FMT has provided the strongest proof-of-concept for microbiome restoration, whereas probiotic efficacy remains variable and strain-dependent. Emerging defined microbial consortia and engineered bacterial platforms offer improved standardization and mechanistic precision, but their clinical application remains limited by challenges related to engraftment, durability of response, safety, and treatment optimization. Collectively, current evidence supports gut microbiota as both a key determinant of IBD pathogenesis and a promising therapeutic target, underscoring the need for more precise and personalized microbiota-directed approaches in IBD management. Full article

Psychological stress arises when individuals perceive demands as exceeding their capacity to cope. Social stress can be acute, such as giving a presentation, producing transient increases in heart rate, blood pressure, and neuroendocrine activation, or chronic, in which stressors persist over extended periods. Chronic psychosocial stress disrupts immune homeostasis and contributes to anxiety, depression, and post-traumatic stress, while also increasing risk for infections, inflammatory and autoimmune diseases, cardiovascular disease, metabolic dysfunction, and cancer. Persistent stress engages interconnected neuroendocrine–immune networks, including the hypothalamic–pituitary–adrenal axis, the sympathetic–adrenomedullary system, and the gut microbiota–brain–immune axis, leading to sustained glucocorticoid and catecholamine signaling, gut dysbiosis, impaired barrier integrity, and altered microbial metabolite profiles. In this review, we summarize the molecular and cellular mechanisms by which these axes remodel innate and adaptive immunity and shape disease susceptibility. Using social defeat and social isolation in mice as model systems, we highlight how chronic social stress reprograms immune responses in key tissues, including the lung, brain, and gut. Full article

Physician burnout represents a major occupational health concern associated with impaired wellbeing, reduced job satisfaction, and decreased quality of patient care. Although burnout is frequently examined using variable-centered approaches, less is known about distinct burnout profiles among physicians and their associations with professional identification and intellectual humility. The present study investigated relationships between burnout, job satisfaction, professional social identification, and intellectual humility among physicians using both variable-centered and person-centered approaches. A sample of 100 physicians completed measures assessing burnout dimensions, job satisfaction, professional identification, and intellectual humility. Cluster analysis identified four distinct burnout profiles characterized by different combinations of exhaustion, distancing, cognitive dysfunction, and emotional dysfunction. Significant differences between profiles emerged regarding job satisfaction and professional identification, with higher burnout generally associated with lower occupational wellbeing and weaker professional identification. Correlational analyses also indicated negative associations between burnout, job satisfaction, and professional identification. Although global intellectual humility was not significantly associated with burnout severity, exploratory analyses revealed that openness to correction and engagement in debate were negatively associated with cognitive and emotional dysfunction. These findings support the heterogeneous nature of physician burnout and suggest that professional identification and humility-related cognitive openness represent relevant psychological resources in demanding healthcare environments. Full article

The research investigates the psychopathological mechanisms through which perceived leader favoritism (PLF) can affect counterproductive work behavior (CWB) through the mediating effects of employee jealousy toward their coworkers and the specialized form of envy known as malicious envy. Integrating Social Comparison Theory with Affective Events Theory, the study proposes that perceived favoritism triggers unfavorable social comparisons, which in turn evoke negative emotional states that manifest in dysfunctional workplace behaviors. The research used a quantitative study design to gather information from 436 employees working in hotels. The researchers used structural equation modeling (SEM) to analyze the research data while they also conducted reliability and validity assessments. The study shows that perceived leader favoritism leads to higher organizational counterproductive work behavior (CWB-O) and higher interpersonal counterproductive work behavior (CWB-I) among employees. The study found that PLF leads to higher employee jealousy levels which result in higher malicious envy levels that drive CWB behavior. The research found that jealousy and malicious envy function as central psychological pathways which connect favoritism to workplace deviance. This study offers a new contribution to the existing body of knowledge about leadership by extending its scope to investigate how subtle favoritism practices lead to harmful results while explaining the emotional mechanisms which cause counterproductive behavior. The research develops an integrated framework which helps people comprehend how perceived leader favoritism affects emotional responses and behavioral patterns within modern workplaces. Full article

Background: Sexual function in postmenopausal women is influenced by both hormonal and psychological factors. This study investigates the associations between sex hormones, sexual function, and sexual beliefs in this population. Objective: This research seeks to assess the relationship between sex hormones, sexual function, and dysfunctional sexual beliefs in postmenopausal women. Methods: A cross-sectional study was conducted with 42 postmenopausal women aged 45–65 years. Instruments included the FSFI and SDBQ. Hormones assessed were testosterone, estradiol, progesterone, prolactin, DHEA, SHBG, and LH. Blood samples were collected in the morning and analyzed using chemiluminescence or radioimmunoassay. Pearson correlation tests were used, with Bonferroni adjustment applied to control for multiple comparisons. Results: Free testosterone was positively correlated with sexual desire and negatively associated with dysfunctional beliefs regarding sexual desire. Estradiol also showed a positive correlation with desire, while prolactin was negatively associated. No other FSFI domains showed significant hormonal associations. Conclusions: Findings suggest that testosterone may influence both sexual desire and the internalization of dysfunctional sexual beliefs in postmenopausal women, highlighting the interplay between biological and psychological dimensions of sexuality, which may be relevant for a more comprehensive clinical assessment of sexual function in this population. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents the hepatic manifestation of systemic metabolic dysfunction and has become one of the leading causes of chronic liver disease worldwide. Although obesity is a major determinant of MASLD, the metabolic and lifestyle context in which the disease develops may vary across different geographical and dietary environments. The present study aimed to evaluate the prevalence of MASLD among adults with metabolic dysfunction from two European cohorts, to compare the clinical, metabolic, lifestyle, and psychological characteristics of participants with MASLD from Romania and Italy, and to explore differences according to MASLD status within each cohort. In addition, intestinal permeability was exploratorily assessed in a subgroup of the Italian cohort. Methods: This prospective multicentre observational study included 132 adults undergoing metabolic and hepatic evaluation in Romania (n = 52) and Italy (n = 80). Hepatic steatosis was assessed using SteatoTest in the Romanian cohort and ultrasonography in the Italian cohort. Anthropometric and metabolic parameters were recorded in all participants. Dietary quality was evaluated using the MEDI-LITE questionnaire, physical activity using the International Physical Activity Questionnaire (IPAQ), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and health-related quality of life using the 36-Item Short Form Health Survey (SF-36). Intestinal permeability was evaluated in the Italian cohort using the lactulose/mannitol absorption test. Results: MASLD was identified in 80.8% of participants from the Romanian cohort and in 66.3% of participants from the Italian cohort. Among patients with MASLD, Italian participants exhibited significantly higher body mass index, waist circumference, fasting insulin, total cholesterol, LDL cholesterol, and diastolic blood pressure compared with Romanian participants, whereas HDL cholesterol levels were significantly higher in the Romanian cohort. Sex-stratified analyses revealed significant sex-related differences in anthropometric and metabolic parameters within both cohorts. In both geographical populations, participants with MASLD demonstrated lower adherence to the Mediterranean diet, lower physical activity levels, higher depressive symptom burden, and less favorable quality-of-life indicators compared with participants without MASLD. Exploratory analyses of intestinal permeability in the Italian cohort did not reveal significant differences according to MASLD or obesity status. Conclusions: MASLD was highly prevalent in both Romanian and Italian adults with metabolic dysfunction. Patients with MASLD exhibited distinct metabolic and lifestyle profiles across the two geographical cohorts, supporting the potential contribution of environmental and lifestyle-related factors to MASLD heterogeneity. Lower adherence to the Mediterranean diet, reduced physical activity, and increased psychological burden were consistently associated with MASLD in both populations. Exploratory intestinal permeability analyses did not demonstrate significant differences according to MASLD or obesity status in the Italian cohort. Full article

Background: Adolescent substance abuse is a growing public health concern associated with poor mental health, unsafe sexual behaviour, violence, school dropout, and psychosocial dysfunction. In rural South Africa, peer influence, cultural practices, poverty, and inadequate psychosocial support may increase learners’ vulnerability to substance use. However, limited qualitative evidence exists on how these factors influence substance abuse among school learners in rural communities. Aim: This study explored peer-group and cultural influences on substance abuse among school learners in a rural community in Limpopo Province, South Africa. Methods: A qualitative, exploratory, descriptive, and contextual design was adopted. Purposive sampling was used to recruit 30 learners from selected secondary schools in the DIMAMO area of the Capricorn District, Limpopo Province. Data were collected through semi-structured one-on-one interviews until data saturation was reached. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis guided by Social Learning Theory. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability. Ethical approval and informed consent were obtained prior to data collection. Results: Two major themes emerged: causes of substance abuse and factors maintaining substance use. Peer pressure and social influence contributed to the initiation of alcohol, cannabis, cigarette, and snuff use. Cultural practices and ancestral beliefs further normalised substance use behaviours. Psychological distress associated with poverty, family conflict, and inadequate parental support increased learners’ vulnerability. Continued substance use was reinforced by addiction, perceived emotional relief, social tolerance, and easy access to substances. Conclusions: Adolescent substance abuse in rural communities is influenced by interconnected social, cultural, psychological, and environmental factors. Integrated school- and community-based psychosocial interventions are needed to strengthen adolescent mental health and substance abuse prevention strategies. Full article