Sleep disturbance is a prevalent issue among those who have experienced a stroke. The impact of gender on the prevalence of sleep disturbance within Asian stroke populations remains ambiguous. This research seeks to examine the prevalence of sleep disturbance among stroke survivors in Indonesia.

This quantitative prevalence analysis was based on the 2018 Indonesian Basic Health Research. A total of 7,147 stroke survivors who answered the sleep disturbance questions were included. The estimated prevalence and regression models were examined utilizing SPSS software.

The total prevalence of sleep disturbance among stroke survivors in Indonesia was 28.4% (95% CI: 27.4%-29.4%). Females exhibited a greater frequency of sleep disturbance than males (34.4% versus 26.1%, respectively). When categorized by age group, both females and males exhibited a trend of rising sleep disturbance prevalence with time. Moreover, daily smoking, low educational attainment, rural residency, and insufficient physical activity were correlated with sleep disturbance symptoms in the male cohort. In females, the presence of comorbidities such as cardiovascular disease and asthma was associated with sleep disturbance.

This study's findings revealed a significant prevalence of sleep disturbance among stroke survivors in Indonesia. Our findings indicate a gender influence on sleep disturbance prevalence, with females exhibiting a higher prevalence than males. These findings underscore the significance of sleep assessment and treatment in clinical or community environments.

Functional neurological recovery after ischemic stroke remains a formidable challenge in neuroscience. Exosomes serve as pivotal mediators of intercellular communication, and the microRNAs (miRNAs) they carry, in particular, offer a promising "cell-free therapy" strategy for promoting neurological repair. This review systematically summarizes the multi-target mechanisms by which exosomal miRNAs regulate the neurovascular unit (NVU) and outlines technical strategies to enhance exosomal therapeutic efficacy through targeted modification and engineered cargo loading, with the aim of constructing a smart drug delivery system capable of precise navigation. Following the trajectory of "natural exosomes-engineered exosomes-clinical translation", this review addresses the core scientific question of how to transform exosomal miRNAs from natural messenger molecules with basic reparative activity into an intelligent therapeutic system for precise targeted delivery. It further explores precision exosome treatment models based on the pathological staging of stroke progression, and integrates single-cell, spatial transcriptomic, and multi-omics technologies to decode the "miRNA-cell source-target cell-signaling pathway" regulatory axis, thereby identifying candidate miRNA combinations with translational potential. Finally, this review provides an in-depth analysis of the core challenges in translating such nanotherapeutic strategies from the bench to the bedside, including manufacturing standardization, quality control, and potency assessment, with the aim of providing a theoretical basis for advancing exosomal miRNA therapies from mechanistic studies to precision stroke treatment.

Quality control (QC) and quality assurance (QA) are critical for validating laboratory data in longitudinal studies. The Tehran Lipid and Glucose Study (TLGS), the first large cohort study in Iran, was designed to investigate the incidence of and risk factors for cardiovascular diseases. This article reviews the methodological quality control system used for biochemical testing in the TLGS, with an emphasis on its design, implementation, evaluation, and data stability across study phases.

In this methodological review, internal and external quality-control protocols used in phases 2 to 7 of the TLGS were analyzed and compared with international standards, including those of the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study. Analytical precision data (coefficient of variation [CV%]) for glucose, creatinine, total cholesterol, triglycerides, HDL-C, ALP, ALT, and AST were extracted from a central database, and temporal trends were evaluated. Internal quality control was performed daily using two levels of control sera (normal and abnormal), and interlaboratory accuracy was assessed through participation in an external evaluation program.

The mean CV for all tests across the study phases was less than 5% (glucose, 1.95%; creatinine, 3.10%; cholesterol, 2.05%; triglycerides, 2.16%; HDL-C, 3.33%; ALP, 2.10%; ALT, 3.00%; and AST, 3.35%). External quality-control results received an "Excellent" rating for all parameters. The temporal trend in CVs demonstrated stability and a gradual improvement in precision across phases. Levey-Jennings charts, Westgard rules, and weighted regression methods were effective in detecting systematic deviations and enabling prompt corrective action.

Establishing a multilevel QC/QA system in the TLGS ensured the stability and accuracy of biochemical data in a large national cohort. The findings indicate that the accuracy of biochemical testing was consistent with international standards and that the resulting data are highly reliable for epidemiological and clinical analyses. This experience may serve as a local model for other longitudinal studies in developing countries.

Atherosclerosis (AS) remains a leading cause of cardiovascular morbidity and mortality worldwide, with current treatments focused primarily on reducing low-density lipoprotein levels while failing to repair damaged endothelial cells, thus highlighting the urgent need for novel therapeutic drugs. To address this challenge, we analyzed human AS patient single-cell RNA sequencing datasets to identify disease-driving genes and then employed connectivity map analysis to screen for potential therapeutic compounds. Using network pharmacology and machine learning to predict core drug targets, the study validated drug-target interactions through molecular docking, molecular dynamics simulations, and surface plasmon resonance analysis, with experimental validation conducted using endothelial cell damage models and ApoE ^-/- atherosclerotic mice. The integrative approach successfully identified narciclasine as a promising therapeutic compound that targets vascular cell adhesion molecule 1 and intercellular adhesion molecule-1 (VCAM-1/ICAM-1) for AS treatment, with molecular studies confirming strong binding affinity and experimental validation demonstrating significant alleviation of endothelial dysfunction through downregulation of VCAM-1/ICAM-1 expression and reduction of aortic plaque burden in mouse models. This multiplatform methodology combining single-cell sequencing, network pharmacology, machine learning, computational simulation, and experimental validation provides a robust framework for drug discovery while positioning narciclasine as a promising therapeutic candidate warranting clinical investigation for AS treatment.

Lifestyle medicine (LM) provides a high-value framework for treating and potentially reversing chronic diseases, such as type 2 diabetes (T2D), obesity, cardiovascular diseases, and some cancers. Yet, the field of LM is still growing, and few examples exist of how to successfully implement LM into clinical care. This paper describes the implementation of 1:1 lifestyle medicine (LM) coaching visits for 45 patients with uncontrolled type 2 diabetes (T2D), (mean HbA1c 10.5%) and on multiple diabetes medications, at Cone Health's Reidsville Endocrinology practice in North Carolina, USA. In brief, during routine endocrinology visits, the lead physician of the LM program at Cone Health, who is trained in LM, identified patients with uncontrolled T2D where scheduling allowed him to fit in some additional time for coaching. Forty-five interested patients selected over a period of several weeks from Spring of 2022 to Fall of 2022 made the first cohort. During a typical LM encounter, immediately after addressing their referral concerns with a routine endocrinology consult, verbally consenting patients were personally invited to learn more about LM. They were provided with a packet of materials focused predominately on prescribing nutrition and exercise as treatment for chronic disease. The physician spent an additional 10-15 minutes with each verbally consenting patient to go through selected materials in the packet, focusing largely on nutrition and physical activity, and successfully billed for the additional time. The patients were encouraged to take the packet home for further learning and return to their next routine visits with questions and to engage in further coaching. Following this brief but intensely focused coaching session which was done in addition to the routine endocrinology visit, lifestyle medicine coaching was able to be incorporated into subsequent, routine endocrinology visits in many of the initially identified patients. The majority of these patients also accepted a referral to a dietitian in the same practice. This experience highlights a model for potentially integrating LM coaching into routine practice and, consistent with previous research, highlights the importance of a site champion for successful LM implementation. Future research is needed to formally assess the success of coaching visits, particularly in terms of assessing health outcomes in patients who engaged in the 1:1 coaching.

Incarcerated people are often excluded from health research, limiting the evidence available to address the specific needs of this population. US federal regulations provide a foundation for research involving incarcerated people, but many prison and jail systems have developed institution-specific policies that further govern research. Carceral research policies may represent an underexamined mechanism for regulating research access in prisons and jails. We analyzed US carceral research policies and found substantial variation across systems, including approaches to ethical oversight and institutional discretion over research activities and dissemination of research findings. The wide variation in policies, power facilities have over research access, and potential censoring of findings highlights the need for more standardized practices. We propose policy changes that would better align carceral research policies with best practices in research governance, facilitating ethical research access and strengthening the evidence needed to address the health needs of this marginalized population.

Subclinical metabolic disturbances have been associated with functional brain changes; however, the neural pathways mediating their cognitive effects remain unclear.

This study investigated whether large-scale brain network connectivity mediates associations between metabolic risk factors and cognition in healthy young adults.

Data were obtained from 676 participants (22 - 37 years) in the Human Connectome Project. Metabolic indices (body mass index (BMI), glycated hemoglobin, thyroid-stimulating hormone (TSH), systolic/diastolic blood pressure, and hematocrit) were assessed alongside the National Institutes of Health (NIH) Toolbox Cognition Battery scores, the Mini-Mental State Examination, and fluid intelligence measures. Resting-state fMRI data underwent group independent component analysis to identify 14 intrinsic connectivity networks. Partial correlations were computed between network time series, and multiple regression models were adjusted for age, sex, race, and education. Mediation analyses with bootstrapped confidence intervals were conducted to test whether network connectivity explained the metabolic-cognition relationships.

We found that large-scale resting-state networks significantly mediated the associations between specific metabolic risk factors and cognitive performance. Specifically, BMI, hematocrit, and TSH showed significant associations with both cognition and network connectivity (all P < 0.05). BMI-related reductions in vocabulary performance were fully mediated by altered connectivity in the frontoparietal-language, sensorimotor-frontoparietal, primary visual-auditory, and default mode-executive attention networks and partially mediated (compensatory effect) by salience-sensorimotor connectivity (indirect effects: -0.0238, -0.0115, -0.0110, -0.0096, and 0.0068, respectively; 95% CIs: [-0.0421, -0.0085], [-0.0239, -0.0030], [-0.0237, -0.00016], [-0.0206, -0.0014], and [0.0001, 0.0165], respectively). Hematocrit's positive association with vocabulary performance was partially mediated by the primary visual-auditory, salience-auditory, and language-dorsal attention networks, with primary visual-ventral attention connectivity exerting a suppressive effect (indirect effects: 0.0094, 0.0149, 0.0074, and -0.0113, respectively; 95% CIs: [0.0007, 0.0215], [0.0032, 0.0319], [0.0001, 0.0197], and [-0.0249, -0.0012], respectively). TSH was positively associated with fluid intelligence via a direct pathway (P = 0.010), without mediation by resting-state connectivity.

These findings highlight large-scale brain networks as potential intermediate phenotypes that link metabolic health to cognition, suggesting that targeted neuromodulation of vulnerable circuits, combined with metabolic interventions, may offer novel strategies for preserving cognition in at-risk populations.

This study explored the feasibility and perceived clinical utility of a novel psychotherapy intervention consisting of two components (1) assessment of patients' social context using the experience sampling methodology (ESM) and personal social network data collection (PSN) and (2) a feedback report summarizing the collected data. Four qualitatively driven concurrent embedded mixed-methods case studies were conducted in a large mental health care facility in the Netherlands and included nine young adults receiving either individual or group psychotherapy: six in part-time treatment and three transitioning from inpatient to outpatient care. Feasibility and utility were evaluated using codebook thematic analysis of semi-structured patient and therapist interviews, patient compliance with the intervention components and researchers' reflexive field notes. Overall, the intervention appeared most feasible in individual therapy, in which patient and therapist engaged with it collaboratively. Engagement was more difficult among avoidant patients and when the intervention was experienced as too confronting by patients, highlighting the importance of establishing rapport before its use. The intervention yielded varying degrees of insight for patients, depending on their ability to engage with the assessments and feedback-based therapeutic dialogue. The feedback report specifically improved therapists' understanding of patients' social context. Future implementation will require automation, integration into digital clinical infrastructure, and therapist training to support appropriate interpretation of feedback and follow-up action.

Plasmodium vivax malaria has long been considered less severe than P. falciparum infection. However, there is growing evidence that P. vivax can lead to severe and life-threatening disease, although its burden is likely to be underestimated, particularly in low-transmission settings.This study aimed to contextualize the application of World Health Organization (WHO) severe malaria criteria in a low-transmission setting by describing the clinical and parasitological profile of hospitalized malaria patients in the Peruvian Amazon.

We conducted a retrospective hospital-based study at Hospital Regional de Loreto, Iquitos, Peru, from January 1, 2023, to October 30, 2025. The total hospital malaria caseload was determined from records assigned a laboratory-confirmed ICD-10 malaria diagnosis. The analytic cohort comprised hospitalized patients with microscopy-confirmed malaria who received intravenous artesunate because of severe malaria according to the WHO 2022 criteria, or inability to tolerate oral antimalarial treatment.

During the study period, 519 laboratory-confirmed malaria diagnoses were recorded in the hospital; of these, 127 patients (24.5%) were hospitalized. Of these, 97 had P. vivax infection (76.4%), 27 had P. falciparum infection (21.3%), 2 had mixed P. vivax/P. falciparum infection (1.6%), and 1 had P. malariae infection (0.8%). Overall, 67 patients (52.8%) met criteria for severe malaria, which was observed in 51/97 patients with P. vivax (52.6%) and 14/27 patients with P. falciparum (51.9%), with no significant difference between species. Notably, patients with P. vivax malaria presented with severe manifestations including impaired consciousness, pulmonary oedema or acute respiratory distress syndrome, and shock. Laboratory differences between species were modest, although P. falciparum infections were associated with lower haemoglobin and glucose levels, while P. vivax was associated with more marked thrombocytopenia. Clinical outcomes were generally favourable, with one death to which malaria-related complications may have contributed.

P. vivax contributed substantially to severe malaria in this low-transmission Amazonian setting and showed a severity profile similar to that of P. falciparum. The overlap observed between severe and non-severe presentations supports the contextual application of international severity criteria and continued recognition of the clinically important burden of P. vivax malaria.

This preliminary study examined the efficacy of cathodal transcranial direct current stimulation (tDCS) targeting the medial prefrontal cortex (mPFC) in reducing symptom severity, enhancing cognitive flexibility, and modulating brain-derived neurotrophic factor (BDNF) levels in individuals with obsessive-compulsive disorder (OCD).

A double-blind, randomized, sham-controlled trial was conducted with 20 patients meeting DSM-V criteria for OCD, of whom 15 completed the intervention and were included in the final analysis. Participants received cathodal mPFC-tDCS (2 mA, 20 min, 10 sessions) or sham stimulation. Symptom severity (Y-BOCS), cognitive flexibility (task-switching), salivary BDNF, and frontal alpha activity (qEEG at Fz) were measured at baseline, post-treatment, and follow-up.

The tDCS group exhibited greater reductions in Y-BOCS scores over time (F(2, 26) = 12.562, p < 0.001, partial η² = 0.425). Task-switching performance improved in the experimental group compared with controls (F(2, 26) = 20.351, p < 0.001, partial η² = 0.531). Salivary BDNF levels increased significantly in the tDCS group at follow-up (F(2, 16) = 6.086, p = 0.01, partial η² = 0.432). Trends toward normalization of frontal alpha activity were observed, but did not reach statistical significance.

Cathodal mPFC-tDCS was associated with reduced OCD symptom severity, improved cognitive flexibility, and increased salivary BDNF. These preliminary findings warrant replication in larger controlled samples.

This study extends previous tDCS research in OCD by integrating clinical outcomes with cognitive performance and a peripheral marker of neuroplasticity. It provides preliminary support for mPFC-targeted tDCS as a potential intervention for OCD.