Extracellular vesicles (EVs) are membrane-bound vesicles released by various cell types and contain biologically active molecules that participate in key physiological and pathological processes. EVs play crucial roles in intercellular communication, immune regulation, tissue repair, and disease progression, particularly in cancer, neurodegenerative disorders, and cardiovascular conditions. Because of their structural stability and ability to evade immune detection, EVs are potential noninvasive biomarkers and therapeutic delivery vehicles. Advances in isolation and purification techniques have further supported their application in precision medicine, with research indicating EVs provide insight into disease mechanisms and therapeutic responses. EVs also facilitate the transfer of nucleic acids, proteins, and lipids between cells, thereby modulating gene expression and cellular activities. Their emerging role as biomarkers for diagnosis and outcome prediction, especially in cancer and neurodegenerative diseases, are areas of active investigation. Despite these promising applications, several challenges hinder clinical translation, including difficulties in distinguishing disease-derived EVs from normal EVs, the absence of standardized therapeutic protocols, the possibility of oncogenic cargo, high production costs, and variability in immune responses. Addressing these challenges by developing improved isolation techniques, standardized evaluation protocols, and cost-effective production strategies and continuing to conduct research is essential to fully realizing the diagnostic and therapeutic potential of EVs in precision medicine.

Poststroke cognitive impairment (PSCI) is a common functional disorder that occurs following stroke, but there are few effective therapies. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulatory technique that has been used to improve cognitive function in stroke patients. Despite its widespread use in clinical research, the underlying mechanisms of rTMS are largely unknown. This study hypothesized that rTMS ameliorates PSCI by regulating white matter injury, which is of vital importance in cerebral ischemia.

An ischemic stroke rat model was created using transient middle cerebral artery occlusion. The extents of brain damage and white matter injury, including diffusion tensor imaging and diffusion tensor tractography, were evaluated using MRI. Behavioral tests, including the modified neurological severity score test and Morris water maze test, were also used. In addition, we preliminarily explored the potential role of SDF-1α/CXCR4 by Western blot analysis and real-time reverse transcription PCR.

The results showed that 10 Hz rTMS promoted neurological recovery and cognitive deficits in ischemic rats. Additionally, 10 Hz rTMS alleviated cerebral infarct severity and attenuated white matter lesions. Furthermore, the expression levels of components of the SDF-1α/CXCR4 axis influenced the effect of rTMS on ischemic stroke.

This research provides further evidence that 10 Hz rTMS can alleviate white matter injury in affected brain regions and improve PSCI after ischemic stroke, potentially through the activation of the SDF-1α/CXCR4 axis.

BACKGROUND Left ventricular thrombus (LVT) is a well-defined complication of myocardial infarction and congestive heart failure that has an increased risk of morbidity, mortality, and development of systemic embolism. Vitamin K antagonists, such as warfarin, remain the criterion standard therapy. Although direct oral anticoagulants have been shown to be more effective than warfarin in preventing stroke or systemic embolism in patients with atrial fibrillation, there is insufficient and debatable evidence on their efficacy for the treatment of LVT. CASE REPORT A 62-year-old man with multiple comorbidities and a high risk of thrombosis and bleeding risk had a recurrence of stroke secondary to an increase in LVT size while on apixaban 2.5 mg twice daily for 6 months. It was concluded that the patient experienced treatment failure and therefore was switched to warfarin 5 mg. Upon follow-up, a complete resolution was achieved after 5 months. CONCLUSIONS We report a case of recurrence of ischemic stroke and an increase in the size of LVT during apixaban administration in a patient with severe ischemic cardiomyopathy and advanced chronic kidney disease who successfully achieved a complete resolution when shifted to warfarin. This case report questions the hypothesis on the efficacy of apixaban for patients with high risk of thrombosis and bleeding risk and advanced chronic kidney disease.

Phosphoric acid etching before internal bleaching may enhance peroxide penetration. The objective of this ex vivo study was to compare the whitening efficacy of four treatment protocols: 35% hydrogen peroxide with (HP + E) and without (HP) etching, and 35% carbamide peroxide with (CP + E) or without (CP) etching. Twenty-four extracted teeth were allocated to one of these treatment protocols. Treatments were applied for 21 days with renewal at 7 and 14 days. Samples were stored in a humidity chamber at 37°C. Tooth shade was measured weekly using an electronic spectrophotometer, after agent rinsing. Overall shade change (∆E00) and Whiteness Index for Dentistry (WID) were calculated. Two-way ANOVA and Tukey's HSD test were used to analyze differences between groups. After 21 days, HP + E was found as the most effective bleaching agent (∆E00 = 4.98 ± 1.09), statistically superior to CP and showing a strong tendency towards superiority over HP and CP + E. ∆WID scores were consistently higher for HP + E than for CP groups. Only HP + E reached clinical significance in both ∆E00 (>2) and ∆WID (>3) for all samples after 21 days, thus showing strong reliability. These data support recommendation for clinicians to use phosphoric acid etching prior to internal bleaching, especially for treating most discolored teeth.

Liver transplantation is the standard therapy for end-stage liver disease, but the long-standing shortage of donor livers has constrained its advancement. The use of standard donor criteria expansion partially alleviates the supply-demand imbalance but increases postoperative complication risks. Extracorporeal mechanical perfusion mitigates ischemia-reperfusion injury, extends preservation time, and enables functional assessment and partial repair of the liver under ex vivo settings. Current clinical evidence confirms that short-term mechanical perfusion positively improves outcomes, but it still has limitations in terms of functional evaluation and deep repair. Therefore, the exploration of prolonged mechanical perfusion has possibilities for the restoration of organ function. The concept of "organ medicine" has enabled the breakthrough application of mechanical perfusion technology, originating from organ transplantation, to multiple disciplines, such as organ research, education, and therapy. Additionally, advancements in transforming research results and industrial upgrading are anticipated to develop into a strategic technology for a new round of medical revolution and industrial transformation.

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, with conventional therapies mainly providing symptomatic relief without targeting underlying molecular and cellular mechanisms. Additionally, limitations of systemic drug administration, including poor tissue targeting and low accumulation, highlight the need for innovative approaches.

Nanomedicine offers promising strategies for CVDs. Among nanocarriers, calcium phosphate nanoparticles (CaP NPs) are particularly attractive due to their biocompatibility, biodegradability, pH-responsive behavior, and versatility for drug incorporation. This report summarizes recent advances, identified through a literature search using Web of Science, PubMed and Scopus, on the application of CaP NPs for CVD therapy. Although still in its infancy, emerging evidence, including studies in large animal models, suggests the CaP NPs can selectively target cardiac tissues and efficiently deliver diverse bioactive molecules.

CaP NPs represent a highly promising platform for cardiovascular therapy. Their safety and potential for noninvasive inhalation administration could enable precise, effective, and patient-friendly treatments. Future research, including comparative studies with other nanocarriers, will help to validate their therapeutic potential. Continued development of CaP NP-based strategies may transform CVD management by enabling molecular-level interventions that improve clinical outcomes, reduce systemic side effects, and allow rapid and convenient dosing.

Large language models (LLMs) are increasingly applied in health care. However, concerns remain that their nursing care recommendations may reflect patients' sociodemographic attributes rather than clinical needs. While this risk is acknowledged, there is a lack of empirical evidence evaluating sociodemographic bias in LLM-generated nursing care plans.

To investigate potential biases in nursing care plans generated by LLMs, we focused on whether outputs differ systematically based on patients' sociodemographic characteristics and assessed the implications for equitable nursing care.

We used a mixed methods simulation study. A standardized clinical vignette experiment was used to prompt GPT-4 to generate 9600 nursing care plans for 96 patient profiles with varying sociodemographic characteristics (eg, sex, age, income, education, and residence). We first conducted a quantitative analysis of all plans, assessing variations in thematic content. Subsequently, a panel of senior nursing experts evaluated the clinical quality (eg, safety, applicability, and completeness) of a stratified subsample of 500 plans.

We analyzed 9600 LLM-generated nursing care plans and identified 8 consistent themes. Communication and Education (99.98%) and Emotional Support (99.97%) were nearly universal, while Nurse Training and Event Analysis were least frequent (39.3%). Multivariable analyses revealed systematic sociodemographic disparities. Care plans generated for low-income patient profiles were less likely to include the theme Environmental Adjustment (adjusted relative risk [aRR] 0.90). Profiles with lower education were associated with an increased likelihood of including Family Support (aRR 1.10). Similarly, plans generated for older patient profiles were more likely to contain recommendations for Pain Management (aRR 1.33) and Family Support (aRR 1.62) but were less likely to mention Nurse Training (aRR 0.78). Sex and regional differences were also significant. Expert review of 500 plans showed high overall quality (mean 4.47), with strong interrater reliability (κ=0.76-0.81). However, urban profiles had higher completeness (β=.22) and applicability (β=.14) but lower safety scores (β=-0.09). These findings demonstrate that LLM-generated care plans exhibit systematic sociodemographic bias, raising important implications for fairness and safe deployment in nursing practice.

This study identified that LLMs systematically reproduce sociodemographic biases in the generation of nursing care plans. These biases appear in two forms: they shape the thematic content and influence expert-rated clinical quality. These findings reveal a substantial risk that such models may reinforce existing health inequities. To our knowledge, this is the first empirical evidence documenting these nuanced biases in nursing. The study also contributes a replicable framework for evaluating LLM-generated care plans. Finally, it underscores the critical need for robust human oversight to ensure that artificial intelligence serves as a tool for advancing equity rather than perpetuating disparities.

Evidence provides support for the therapeutic benefits of targeting avoidance in prolonged grief. However, it is not clear whether avoidance interferes with mourning through altered resilience to stress, as measured by heart rate variability (HRV).

Thirty-five adults (30 female; mean age: 39.2 years), who had been bereaved for more than one year, participated in this prospective, observational study. At each of the initial assessments and up to six-month follow-ups, grief symptoms were assessed using the Complicated Grief Questionnaire, and a resting electrocardiogram was recorded to extract the high-frequency component of HRV (HF-HRV). To differentiate avoidance from grief itself, principal component analysis was used.

A nonlinear cross-sectional relationship was observed between avoidance and HF-HRV (coefficient = 0.29, p = .003); the lower the avoidance, the lower the HF-HRV in the low avoidance group. Grief improved only in the low avoidance group longitudinally. The observed relationship between increased HF-HRV and decreased grief was modified by the avoidance group, such that the low-avoidance group drove this association (estimate -0.53, 95% CI -0.86, -0.21, p = .001), while the high-avoidance group did not (estimate 0.44, 95% CI -0.32, 1.20, p = .26).

Despite its palliative gain, avoidance relates to the maintenance of grief longitudinally through attenuated autonomic resilience to stress.

Universal health care aims to provide effective and affordable health services to everyone. However, immigrant women often experience worse maternal and child health outcomes than their indigenous counterparts, including higher risks of mental health issues, premature child births, and maternal mortality. This study examined the barriers and facilitators to maternal health service use among immigrants in the Tamale Metropolis in Ghana. Using a qualitative approach, 30 immigrant women, including pregnant women and new mothers, were recruited through snowball sampling. Key informant interviews were conducted at six health facilities. The findings identified barriers to accessing care, such as language difficulties, concerns about privacy, and perceived discrimination. On the other hand, supportive factors included social support, perceived quality of care, accessibility of National Health Insurance, and outreach programs. To improve maternal and child health services for immigrant women, it is essential to address these barriers and strengthen the supportive factors.