Abstract

Background
Depression results from interactions between biological, social, and psychological factors. Literature shows that depression is associated with abnormal brain structure, and that socioeconomic status (SES) is associated with depression and brain structure. However, limited research considers the interaction between each of these factors.
Methods
Multivariate regression analysis was conducted using UK Biobank data on 39,995 participants to examine the relationship between depression and brain volume in 23 cortical regions for the whole sample and then separated by sex. It then examined whether SES affected this relationship.
Results
Eight out of 23 brain areas had significant negative associations with depression in the whole population. However, these relationships were abolished in seven areas when SES was included in the analysis. For females, three regions had significant negative associations with depression when SES was not included, but only one when it was. For males, lower volume in six regions was significantly associated with higher depression without SES, but this relationship was abolished in four regions when SES was included. The precentral gyrus was robustly associated with depression across all analyses.
Limitations
Participants with conditions that could affect the brain were not excluded. UK Biobank is not representative of the general population which may limit generalisability. SES was made up of education and income which were not considered separately.
Conclusions
SES affects the relationship between depression and cortical brain volume. Health practitioners and researchers should consider this when working with imaging data in these populations.

Introduction

Mental health problems are significant public health issues within the UK and worldwide, with depression being one of the most prevalent. Research shows that there is a relationship between depression and brain structure (Tang et al., 2007; Kronmüller et al., 2009; Bos et al., 2018; Maggioni et al., 2019), and that social factors, including socioeconomic status (SES), are associated with both depression (Delgadillo et al., 2016; Marmot, 2010; Freeman et al., 2016) and changes in brain structure (Kweon et al., 2022; Colich et al., 2020; Jednoróg et al., 2012; Noble et al., 2015). However, these three factors are rarely all considered together. Given the impact of depression on both the individual and society, as discussed below, understanding the mechanisms of this disorder, to improve prevention and treatment options, is of critical importance.

Around 1 in 6 adults in England met the criteria for a common mental health disorder in the week prior to being surveyed (McManus et al., 2016). Mental health problems are one of the leading contributors to overall worldwide disease burden and are reported to account for 16 % of Disability Adjusted Life Years (DALYs, Arias et al., 2022). They confer substantial societal and economic implications with an estimated annual cost in England of £77 billion (Kirkwood et al., 2010). Depression is one of the most prevalent mental health problems, affecting approximately 5 % of adults (World Health Organization, WHO, 2023) and 280 million people globally (Institute of Health Metrics and Evaluation, 2023). Depression can be long-lasting with a single chronic episode, or recurrent, with many episodes over a long time, and has a substantial impact on an individual’s ability to function and cope with daily life. The risk of suicide is reported to be about 15 times higher in those with depression than the general population (Cipriani et al., 2005). This is however likely to be an underestimate as many who die by suicide have undiagnosed depressive symptoms.

Conclusion

This study is, to our knowledge, the first study to examine the relationship between depression, cortical volume, and SES in a middle-aged to older sample of this size. Given that SES appears to impact the relationship between depression and brain structure, we posit that SES should be a consideration for clinicians and scientists working with imaging data in these populations. Future research involving large-scale longitudinal data is needed to elucidate the causal relationships between the factors examined in this study.

Abstract

Background
Platelets stored at 1–6 °C are hypothesized to be more hemostatically active than standard room temperature platelets (RTP) stored at 20–24 °C. Recent studies suggest converting RTP to cold-stored platelets (Delayed Cold-Stored Platelets, DCSP) may be an important way of extending platelet lifespan and increasing platelet supply while also activating and priming platelets for the treatment of acute bleeding. However, there is little clinical trial data supporting the efficacy and safety of DCSP compared to standard RTP.

Methods
This protocol details the design of a multicentre, two-arm, parallel-group, randomized, active-control, blinded, internal pilot trial to be conducted at two cardiac surgery centers in Canada. The study will randomize 50 adult (≥ 18 years old) patients undergoing at least moderately complex cardiac surgery with cardiopulmonary bypass and requiring platelet transfusion to receive either RTP as per standard of care (control group) or DCSP (intervention group). Patients randomized to the intervention group will receive ABO-identical, buffy-coat, pathogen-reduced, platelets in platelet additive solution maintained at 22 °C for up to 4 days then placed at 4 °C for a minimum of 24 h, with expiration at 14 days after collection. The duration of the intervention is from the termination of cardiopulmonary bypass to 24 h after, with a maximum of two doses of DCSP. Thereafter, all patients will receive RTP. The aim of this pilot is to assess the feasibility of a future RCT comparing the hemostatic effectiveness of DCSP to RTP (defined as the total number of allogeneic blood products transfused within 24 h after CPB) as well as safety. Specifically, the feasibility objectives of this pilot study are to determine (1) recruitment of ≥ 15% eligible patients per center per month); (2) appropriate platelet product available for ≥ 90% of patients randomized to the cold-stored platelet group; (3) Adherence to randomization assignment (> 90% of patients administered assigned product).

Discussion
DCSP represents a promising logistical solution to address platelet supply shortages and a potentially more efficacious option for the management of active bleeding. No prospective clinical studies on this topic have been conducted. This proposed internal pilot study will assess the feasibility of a larger definitive study.

Background

Platelets are one of the most commonly used blood products and as such are frequently in short supply. Currently, platelets are stored at room temperature (20–24 °C) to retain post-transfusion circulatory longevity but at the cost of reduced shelf-life, which is part of the reason for the supply challenges. Cold storage (at 1–6 °C) of platelets prolongs their shelf-life while maintaining hemostatic effectiveness in acutely bleeding patients. Thus, converting room temperature-stored platelets (RTSP) before their shelf-life expires to cold-stored platelets may be a good strategy for extending their shelf-life and addressing the platelet supply challenges, but the safety and comparative effectiveness of this strategy in bleeding patients has not been robustly assessed. This pilot study will assess the feasibility of conducting a definitive comparative study of standard room temperature-stored platelets (RTSP) and delayed cold-stored platelets (DCSP).

Platelet transfusion is the primary therapy for platelet-related bleeding (i.e., excessive bleeding due to platelet deficiency or dysfunction). Platelets are one of the most commonly used blood products, particularly in major cardiothoracic surgery with cardiopulmonary bypass where platelet deficiency and dysfunction occur in all patients to varying degrees [1, 2]. As a result, approximately one in four cardiac surgical patients receive at least one platelet transfusion to treat active bleeding in the operating room or soon thereafter, with high levels of variability across institutions. Approximately 10% of the total platelet supply is directed to cardiac surgery alone [3,4,5]. Since the 1970s, standard international practice has been to store platelet units at room temperature (20–24 °C). This preserves the longevity of platelets post-transfusion but limits their storage shelf-life to 7 days for both pooled buffy-coat bacterially cultured and pooled buffy-coat pathogen-inactivated platelets [6]. The short shelf-life of room-temperature platelets (RTP) creates major supply challenges for blood suppliers and hospitals and leads to wastage of up to 30% of platelet units due to outdating [7]. Additionally, existing data suggests that storage at room temperature, while prolonging circulatory survival after transfusion, may in fact impair hemostatic function [8].

Discussion

Cold-stored platelets have been extensively studied in preclinical settings, and pilot trials in humans suggest at least comparable efficacy with no increased risk for adverse outcomes compared to room-temperature platelets [9, 18, 24, 39]. However, the safety and efficacy of cold-stored platelets have not been evaluated in large clinical trials and these products are not currently approved for use in Canada. Although they may have hemostatic superiority over conventional room-temperature platelets, there is a possibility that cold-stored platelets may increase the risk of thromboembolic events (as they are hemostatically more activated upon transfusion). However, this risk is largely theoretical and has not been demonstrated in prior studies [18, 40]. Nevertheless, we have taken several steps to minimize this risk and to identify it early should it occur. Additionally, while cohort studies have been published examining the impact on patient care of introducing delayed cold-stored platelets during times of shortages, large studies systematically measuring efficacy and safety are lacking [18].

The co-primary feasibility endpoints are adequate enrollment, adequate cold-stored platelet supply, and adequate clinician adherence to randomization assignment. We selected these outcomes because they will indicate what, if any, are the most important protocol modifications required before undertaking a large, definitive trial. Specifically, recruitment and protocol adherence are key common progression criteria for internal pilots of efficient RCTs [33], and confirming an adequate supply of cold-stored platelets at the time of transfusion is a critical metric for ensuring the feasibility of the definitive trial.

The planned primary outcome for the definitive study will be the mean number of ABCs transfused (including red cells, plasma, and platelets) within 24 h of CPB end. This outcome is an accepted measure of hemostatic efficacy that captures clinically relevant differences between study arms. It has been used as a primary outcome in a large randomized controlled trial comparing fibrinogen concentrate to cryoprecipitate in cardiac surgical patients in Canada [26, 28]. This outcome was used to support Canadian regulatory approval of fibrinogen concentrate in cardiac surgical patients, demonstrating its validity and importance for key regulatory stakeholders, and was a recommended outcome from the recent NHLBI Hemostasis Clinical Trial Outcomes Working Group [41].

Abstract

     Cancer screening is a source of much debate. At the interface between public health, specialist care, economics and public health policy, it creates tensions between professional groups, politicians, the media and the public. A screening test may be cheap but applying it to a population (with rigorous quality control and effective downstream processing of patients with abnormal results) creates a huge workload and cost. Screening can also have profound psychological effects. People with false-positive results require investigation yet are usually eventually found not to have cancer. Unless screening can be shown to reduce mortality from specific cancers, the resources used are better spent on improving care, and this has led to disparities in screening recommendations between countries. Advances in understanding the genetic basis of cancer are likely to provide new approaches to cancer risk assessment and new challenges for developing screening strategies, by risk-banding populations based on polymorphisms in low-penetrance cancer risk genes. The American Cancer Society guidelines for cancer screening, reviewed annually, represent a global gold standard that is difficult to emulate in most healthcare economies because of cost and under-capacity for downstream processing of abnormal findings. Tailoring cancer screening recommendations to a country’s health economy is an essential public health intervention.

Introduction

     Cancer screening seems so logical to all healthcare workers and patients alike. We all know that early cancer is curable in the majority of cases and later stage disease is not. So, picking up cancer before a patient has symptoms would seem ideal. The problem is that none of the tests available are perfect. And the resources spent on screening programmes may well be better spent on speeding up appropriate referral of symptomatic patients. Here, we will consider the advantages of screening along with the downside for the common cancers.

     The long-awaited publication of the independent review on national cancer screening programmes in England makes grim reading.1 Two disastrous information technology failures e one in breast cancer and the other in cervical cancer e were revealed in 2018. Thousands of patients were simply deleted from the computer database by accident. New technologies such as the faecal immunochemical test (FIT) and once-only colonoscopy programmes are still not fully rolled out even though plans were unveiled 8 years ago. And although much talked about, artificial intelligence currently plays little part in data interpretation except in research settings. Crucially, the consumer uptake of each of the three major programmes e breast, colon and cervix e is in decline, especially in deprived areas. The impact of coronavirus disease (COVID-19) has been severe and services are only just beginning to clear the huge backlog generated.2

The future

     New technology such as the microanalysis of circulating DNA e so-called liquid biopsy e could radically change the situation. Future changes in cancer screening will lead to profound ethical, educational, commercial and medical challenges. Completion of the Human Genome Project, the ability to handle large volumes of sequence data, and rapid and inexpensive assays for mutations using gene-chip technology will transform the assessment of cancer risk. Commercial pressures have caused the major pharmaceutical companies to invest heavily in genomics, and their interest will lead to the discovery of new drugs and more specific tailoring of therapies to individual patients. It is likely that groups of individuals with no family history of cancer will be identified as being at significantly increased risk of developing cancer. Devising optimal screening schedules for such groups will be a major challenge.

     The biggest problem of all is motivating the customers. The compliance rate varies enormously across the world, driven by education, socioeconomic factors and deprivation.5 The educated worried well are likely to go for every free test offered by the health system. The socially excluded residents of the neighbouring poorer districts on the wrong side of the tracks will not visit the doctor until they have advanced stage 4 cancer. And yet private clinics offer top of the range health screening for >£3000 of scans and tests to the gullible wealthy with no evidence of benefit. To save lives most effectively, we must target the poor.

Abstract

Excessive reassurance-seeking in OCD has been linked to the maintenance of OCD, functioning as a type of checking ritual. Current treatments recommend the imposition of the extinction of seeking and providing reassurance; however, this is not well tolerated. Although it has been suggested that the provision of support may provide a more helpful alternative, there is no empirical evidence for this. In the present study, 36 participants with OCD engaged with two personalised semi-idiographic scenarios in which they imagined seeking and receiving reassurance and seeking and receiving emotional support in counterbalanced order. The primary outcome measure was anticipated urge to seek reassurance, which was found to significantly decrease in the imagined support condition relative to the imagined reassurance condition regardless of order of presentation. Emotional support was perceived as significantly more acceptable when compared to imagining reassurance in terms of higher ratings of perceived helpfulness in managing emotions, feelings of calmness and closeness, and the sense that they were fighting OCD together. These findings provide preliminary evidence for the value of encouraging the seeking and giving of emotional support as an alternative to reassurance. Implications for clinical work and further research are discussed.

Introduction

Obsessive-compulsive disorder (OCD) is a common and pervasive mental health disorder characterised by the presence of severe and disabling obsessions and compulsions, (American Psychological Association, 2023). Thought to have a lifetime prevalence of around 2% (Cervin, 2023). OCD is associated with increased autoimmune disorders (de la Cruz et al., 2022), long-term socioeconomic difficulties (Pérez-Vigil et al., 2018), significantly impaired quality of life (Eisen et al., 2006; Macy et al., 2013), and significant strains on peer and family relationships (Grover & Dutt, 2011; Walseth et al., 2017).

Cognitive theories of OCD focus on the threat of harm to self and/or others, and an inflated sense of responsibility for such harm, as the precipitating factors and motivators of the responses that maintain OCD (Rachman, 2002; Salkovskis, 1985; Salkovskis & Warwick, 1985; Smith et al., 2022). Compulsive behaviours motivated by responsibility beliefs are considered key maintaining responses, functioning as safety-seeking behaviours (SSB) intended to achieve certainty that harm or responsibility for it is eliminated (Salkovskis, 1991). Like most SSBs, however, checking has the effect of preventing disconfirmation and maintaining pre-occupation (Osborne & Williams, 2013). For example, with each instance of checking the memory of previous checks is tarnished (Radomsky et al., 2006). As such, the level of certainty of safety tends to decrease, and checking is perpetuated (Rachman, 2002; Tolin et al., 2002). Recent work thus suggests that excessive reassurance-seeking (ERS) is a special type of checking. Defined as the “verbal and/or non-verbal interaction with someone who you perceive has access to potentially threat relieving information, with the intention of increasing your perceived sense of certainty from harm” (Halldorsson & Salkovskis, 2023), in practice, this often looks like requests or comments (verbal or non-verbal) that search for certainty that their feared outcome is untrue (e.g., “did I do that properly?“, “am I a bad person?” etc.) with responses provided that attempt to provide this certainty (e.g., “Yes you did”, “No you aren’t a bad person”. Unlike most other forms of checking, this interaction has the additional function of transferring responsibility onto others (Rachman, 2002; Salkovskis, 1999).

Conclusion

The present study highlights the anticipated advantages of seeking and receiving emotional support as opposed to reassurance. People with OCD imagined support as not only more effective in the long-term, but also as more acceptable when compared to reassurance. Future research may benefit from assessing these outcomes in caregivers of those with OCD also, in addition to in-vivo experiments that can investigate the effectiveness and acceptability of reassurance in practice.

Abstract

Background. Perioperative sleep disorders exert a severe adverse impact on postoperative recovery. Recently, some observational studies reported that acupuncture-point stimulation (APS) provided benefits for promoting perioperative sleep quality. However, the effects of APS on perioperative sleep disorders following general anesthesia have not been thoroughly assessed by any systematic study and meta-analysis. Therefore, we conducted this systematic review and meta-analysis to reveal the effects of APS on perioperative sleep disorders. Methods. Eight databases (Chinese: CNKI, VIP, CBM, and Wanfang; English: PubMed, Embase, Web of Science, and Cochrane Library) were thoroughly searched to find randomized controlled trials (RCTs) that indicated a link between APS and the occurrence of perioperative sleep disorders. We applied RevMan 5.4 (Cochrane Collaboration) and Stata 16.0 (Stata Corp) to conduct our meta-analysis. In addition, the trial sequential analysis (TSA) tool was utilized to estimate the validity and reliability of the data. Results. In this study, nine RCTs with 719 patients were conducted. Compared to the control group, APS significantly improved perioperative subjective sleep quality (SMD: −1.36; 95% CI: −1.71 to −1.01; ). Besides, it increased perioperative TST (preoperative period MD = 24.29, 95% CI: 6.4 to 42.18, ; postoperative period MD = 45.86, 95% CI: 30.00 to 61.71, ) and SE (preoperative MD = 3.62, 95% CI: 2.84 to 4.39, ; postoperative MD = 6.43, 95% CI: 0.95 to 11.73, ). The consequence of trial sequential analysis further confirmed the reliability of our meta-analysis results. Conclusion. According to the currently available evidence, APS could effectively improve perioperative sleep quality and play an essential role in decreasing the incidence of perioperative sleep disorders.

Introduction

Sleep is vital for overall health as it influences the quality of life and physical functioning [1]. Good sleep quality is a sign of wellbeing, whereas poor sleep quality raises comorbidity, mortality, and medical expenses [2]. Despite advances in operative and anesthetic procedures, sleep disorders continue to be a concern in the perioperative period. Perioperative sleep problems, as compared to household sleep disorders, have gained more attention recently, such as reduced nighttime sleep, fragmentation of sleep, and circadian rhythm disruptions at night after admission [3,C4]. The proportion of sleep disorders in hospitalized patients (64%–73.1%) is much higher than that in people at home (30.6%–41.2%) due to the surgical stress response, ward environment, and patients’ underlying diseases [5–7]. Perioperative sleep problems were noted in several observational studies to be important risk factors for poor recovery [8] and were associated with anxiety, altered pain perception, and postoperative cognitive dysfunction (such as delirium), further deteriorating the patient’s physical state [1, 6, 7, 9]. Moreover, it was suggested that perioperative sleep disorders might lead to postoperative fatigue, episodic hypoxemia, cardiovascular disorders, metabolic impairment, and immune disorders [10, 11]. Enhancing perioperative sleep quality is probably related to improved health, surgery effect, and patient safety [9]. Unfortunately, there are no specific therapeutic strategies for perioperative sleep disorders. Even though it was reported that pharmaceutical therapies, such as benzodiazepines and other sedating agents, might improve perioperative sleep quality, the potentially addictive nature and risk of tolerance restricted their clinical application [9].

In complementary and alternative medicine, acupuncture-point stimulation (APS) was employed to improve perioperative sleep quality [12]. According to the theory of traditional Chinese medicine (TCM), APS refers to stimulating the body’s acupoints with various methods, including acupressure (manual stimulation), acupuncture (sterile needle stimulation), laser acupuncture, electrical stimulation (transcutaneous electrical acupoint stimulation and electrical acupuncture), magnetic acupuncture (stimulation with special equipment), moxibustion therapy, and auricular point pressing, with the goal of achieving therapeutic effects such as sleep improvement and pain management [13–18]. APS has been an integral part of traditional Chinese medicine treatment. Based on the traditional Chinese medicine meridian theory, the body’s qi circulation is restored when target acupoints along meridians are stimulated [14]. It was reported that APS might lower the risk of poor sleep quality due to its considerable analgesic and sedative effects [19, 20]. Recently, a significant number of RCTs were carried out on the effects of APS on perioperative sleep disorders [8, 15]. Besides, a previous review concluded that EA might work to alter neurotransmitter concentrations and reduce the levels of norepinephrine and dopamine so as to enhance the quality of postoperative sleep quality after general anesthesia [12]. However, this study not only did not conduct a statistical assessment of the efficiency of EA on inpatients’ sleep quality during the postoperative period but also did not examine preoperative sleep quality thoroughly [12].

Conclusion

Taken together, our systematic review and meta-analysis suggested that APS could effectively improve perioperative sleep disorders, indicating that it was worthwhile to offer such therapies in perioperative healthcare institutions. Although our results had certain clinical implications of APS for the treatment of perioperative sleep disorders, more studies are needed to offer stronger evidence to further verify our conclusions in the future.

Abstract

Background. Rasagiline or pramipexole monotherapy has been suggested for the management of early Parkinson’s disease (PD). The aim of this research was to systematically review the clinical efficacy and safety of rasagiline or pramipexole in early PD (defined as disease duration ≤5 years and Hoehn and Yahr stage of ≤3). Methods. Randomized controlled trials (RCTs) of rasagiline or pramipexole for early PD published up to September 2021 were retrieved. Outcomes of interest included changes in the Unified Parkinson’s Disease Rating Scale (UPDRS) Parts II and III and the incidence of adverse events. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated, and heterogeneity was measured with the I2 test. Results. Nine rasagiline and eleven pramipexole RCTs were included. One post hoc analysis of one rasagiline study was included. Five studies for each drug were included in meta-analyses of the UPDRS scores. The rasagiline meta-analysis focused on patients receiving 1 mg/day. Rasagiline and pramipexole significantly improved UPDRS Part II and III scores when compared to placebo. Significant heterogeneity among the studies was present (I2 > 70%). Neither rasagiline nor pramipexole increased the relative risk for any adverse events, serious adverse events, or adverse events leading to withdrawal when compared with placebo. Conclusion. Applying a Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to summarize the evidence, we found moderate confidence in the body of evidence for the efficacy of rasagiline or pramipexole in early PD, suggesting further well-designed, multicenter comparative RCTs remain needed.

Introduction

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized clinically by bradykinesia, tremor, rigidity, and postural instability and histologically by neuronal inclusions composed of α-synuclein. Nonmotor symptoms including olfactory dysfunction, rapid eye movement, sleep behavior disorder, mood disorders, and autonomic dysfunction often precede the appearance of motor symptoms by several months or years [1, 2]. These motor and nonmotor symptoms can adversely affect a patient’s quality of life [3]. The incidence of PD is rising and increases with age [4, 5].

Early management of PD could prolong the ability of a patient to stay in working life and improve their overall quality of life [6, 7]. Levodopa is widely considered one of the most effective treatments for PD, but its use is often delayed because of drug-induced dyskinesias and wearing-off and on-off fluctuations [8, 9]. Alternatives to levodopa in early pharmacologic treatment of PD are dopamine agonists and monoamine oxidase B (MAO-B) inhibitors [10, 11]. A meta-analysis by Chang and coworkers (2017) [12] showed the irreversible inhibitor of MAO-B inhibitor rasagiline to have benefits both as a monotherapy and in combination with another intervention. The safety profile of rasagiline was similar to that of placebo in a systematic review of its use in PD patients [13]. Pramipexole, a nonergoline, D3-preferring dopamine agonist, is another treatment option for the management of motor symptoms associated with PD [14]. A recent systematic review showed that combined pramipexole and levodopa therapy was superior to levodopa monotherapy for the improvement of clinical symptoms in PD patients [15].

Prior systematic reviews evaluating the efficacy and safety of either rasagiline or pramipexole have evaluated patient populations at all stages of the disease. The goal of this study was to focus on the safety and efficacy of these drugs in early PD. Defining early PD in our review was based on the duration of PD in affected patients (five years or less) as well as the presence of mild to moderate symptoms based on the Hoehn and Yahr scale. The Hoehn and Yahr scale is commonly used in clinical studies to stage the level of functional disability and impairment seen in PD patients [16].

Results
4.1. Description of the Included Rasagiline Studies
The key characteristics of the nine rasagiline studies are reported in Table 1. One study [21] compared pramipexole and rasagiline as interventions and is included in this portion of the analysis. One post hoc analysis of a randomized controlled trial [22] met the inclusion criteria and was included in the systematic review. There were a total of 2121 patients in the studies, and 1059 patients were on rasagiline: 738 patients had a dose of 1 mg/day, 307 had a dose of 2 mg/day, and 14 had a dose of 4 mg/day. The mean age of study populations ranged from 59.3 to 70.2 years. The mean duration of PD ranged from 2.5 months to 4.8 years. The proportion of the study population who were males in the intervention groups ranged from 42.9 to 76.9%. There were four studies where other PD medications were either discontinued before the study or patients were PD-drug naïve [21, 23–25]. The rest of the studies allowed other PD medications with stable dosage for more than 4 weeks before the start of the study [26–29]. Rescue LD was accepted in one rasagiline study if PD symptoms worsened, and the current therapy did not relieve the symptoms [28]. Hoehn and Yahr stage was ≤3 in every study. The overall discontinuation rates were 7.3% and 10.7% in the rasagiline and placebo groups, respectively. One study reported seven discontinued patients without indicating which intervention the patients were using [27].

Abstract

Osteoporosis (OP) is a metabolic bone disease with a high incidence rate worldwide. Its main features are decreased bone mass, increased bone fragility and deterioration of bone microstructure. It is caused by an imbalance between bone formation and bone resorption. Ginsenoside is a safe and effective traditional Chinese medicine (TCM) usually extracted from ginseng plants, having various therapeutic effects, of which the effect against osteoporosis has been extensively studied. We searched a total of 44 relevant articles with using keywords including osteoporosis, ginsenosides, bone mesenchymal cells, osteoblasts, osteoclasts and bone remodeling, all of which investigated the cellular mechanisms of different types of ginsenosides affecting the activity of bone remodeling by mesenchymal stem cells, osteoblasts and osteoclasts to counteract osteoporosis. This review describes the different types of ginsenosides used to treat osteoporosis from different perspectives, providing a solid theoretical basis for future clinical applications.

Introduction

Osteoporosis (OP) is a metabolic bone disease characterized by decreased bone mass and destruction of bone tissue microstructure, leading to increased bone fragility and susceptibility to fractures ( Gopinath, 2023 ). A global epidemiological survey on osteoporotic vertebral fractures showed that one in three women and one in five men over the age of 50 will be directly affected by osteoporosis for the rest of their lives ( Laird et al., 2023 ). A study on the prediction of hip fractures in Asia estimated that by 2050, the direct cost of osteoporotic fractures in Asia alone may reach at least $15 billion per year ( Cheung et al., 2018 ). Therefore, early detection and treatment of osteoporosis is crucial for preventing fractures and reducing the burden on the global health care system.

Normal bone homeostasis in the human body is mainly maintained by osteoblasts differentiated from bone marrow mesenchymal stem cells (BMSCs) and osteoclasts produced by the fusion of monocytes and macrophages ( Guo et al., 2023 ; Kular et al., 2012 ), which participate in bone reconstruction and exert the sequential function of absorbing old bone and forming new bone ( Harris et al., 2023 ; Iantomasi et al., 2023 ) ( Fig. 1 ). The main cause of OP is aging, while secondary causes include genetic diseases, endocrine diseases, gastrointestinal diseases, blood diseases, neurological diseases, rheumatism and autoimmune diseases ( Patel and Wairkar, 2023 ). In addition, lifestyle changes, such as vitamin D and calcium deficiency, high salt intake, alcohol consumption, and smoking, also significantly increase the risk of osteoporosis. These factors can lead to an imbalance in bone cell activity and disrupt the dynamic cycle of bone formation and absorption, thereby affecting bone homeostasis and exacerbating OP ( Beekman et al., 2023 ).

Conclusion

In recent years, there has been increasing research on the treatment of osteoporosis with ginsenosides. Therefore, this review describes the possible mechanisms of different types of treatment for osteoporosis from three aspects, BMSCs, osteoblasts, and osteoclasts, and summarizes their specific signaling pathways or key factor mechanisms. However, this treatment method is still in the initial stage of clinical transformation, and there are still many obstacles between its experimental results and clinical application, such as in terms of combination therapy, drug delivery pathways, bioavailability, and combination with biochemical materials. With increasing attention given to the role of ginsenosides in bone reconstruction, ginsenosides may become a new drug for treating osteoporosis and promoting fracture healing and a powerful candidate for cytokines in tissue engineering bone.

Abstract

Osteoporosis is a systemic bone disease characterized by reduced bone mass and deterioration of the microstructure of bone tissue, leading to an increased risk of fragility fractures and affecting human health worldwide. Food-derived peptides are widely used in functional foods due to their low toxicity, ease of digestion and absorption, and potential to improve osteoporosis. This review summarized and discussed methods of diagnosing osteoporosis, treatment approaches, specific peptides as alternatives to conventional drugs, and the laboratory preparation and identification methods of peptides. It was found that peptides interacting with RGD (arginine-glycine-aspartic acid)-binding active sites in integrin could alleviate osteoporosis, analyzed the interaction sites between these osteogenic peptides and integrin, and further discussed their effects on improving osteoporosis. These may provide new insights for rapid screening of osteogenic peptides, and provide a theoretical basis for their application in bone materials and functional foods.

Osteoporosis

As the global population ages, the prevalence of diseases associated with aging, such as diabetes, arthritis, and dementia, also increases ( Li et al., 2021 , Lopes et al., 2022 ). Among these, the increasing incidence of chronic diseases such as osteoporosis have caused a significant societal burden ( Su et al., 2020 ). Osteoporosis affects more than 200 million people worldwide ( Shen et al., 2022 ). By 2030, the number of hip fractures among males are estimated to increase by 51.8% globally, and females are at even higher risk ( Gasparik et al., 2023 ). The increasing incidence of osteoporosis may contribute to a higher risk of fractures and reduced life expectancy, necessitating investigations on the prevention and treatment of this condition.

In the human body, normal bone metabolism involves persistent bone tissue remodeling through osteoblast-dependent bone formation and osteoclast-dependent bone resorption. Enhanced bone resorption leads to reduced bone density, a primary factor in the development of osteoporosis ( Malluche, Davenport, Lima, & Monier-Faugere, 2022 ). Osteoporosis is characterized by reduced bone density, deteriorating bone microstructure, and aggravated bone fragility, which increase the risk of fracture. These changes in bone structure are closely linked to the activities of osteoblasts and osteoclasts: osteoblasts secrete non-collagen proteins to regulate the mineralization of bone matrix, while osteoclasts are responsible for bone resorption ( Kittivanichkul, Watanabe, Nagaoka, & Malaivijitnond, 2016 ). Osteocytes, the most abundant cells in mature bone ( Fig. 1 ), interact with osteoblasts and osteoclasts to influence bone formation and resorption and are closely related to osteoporosis.

Perspectives

The value of food protein digests and bioactive peptides as functional foods in the future cannot be estimated. A healthy diet should contain osteogenic peptides that have been investigated through preclinical research and clinical trials. Prediction of osteogenic peptides directly from enzymatic hydrolysis products has significantly reduced the cost of osteogenic peptides compared to multi-step purification, isolation, screening and identification. Moreover, advanced and powerful technologies, such as mass spectrometry, protein purification, bioinformatics, crystallography, micro-computed tomography, and biofilm interference, are widely utilized to study molecular structure and provide a theoretical basis for understanding the relationship between structure and activity at the molecular level. In this review, the evaluation methods and treatment methods of osteoporosis are reviewed, and it is found that osteopoietic peptides from food sources are a potential source to replace drugs with side effects for osteoporosis treatment. Peptides can improve osteoporosis by interacting with RGD binding sites within integrins, which may be used in future computer simulations to rapidly predict and screen new methods of osteogenic peptides. Taken together, these not only improve the safety of osteoporosis treatment but also reduce the cost of screening osteogenic peptides. This review aims to encourage studies on the structure-activity relationships between osteogenic peptides and integrins that regulate cell adhesion, promoting osteoblast and inhibiting osteoclast proliferation and differentiation. Osteogenic peptides also have the potential for application in the development of bioadhesives for bone materials. Therefore, research ideas for predicting and screening bone-forming active peptides have been summarized, these ideas may lead to the development of bone materials, active drugs that promote bone formation and functional foods.

Abstract

• Delayed-onset seizures after deep brain stimulation (DBS) surgery were seldom reported in previous studies. We studied 341 PD patients who underwent STN-DBS surgery from 2006 to 2021 in our department retrospectively.

• Five patients experienced seizures after DBS surgery with an incidence of 1.47 %. All 5 seizures cases were characterized as delayed-onset with an average time of 12 days postoperatively, which was different from the previous studies. In the further risk factors analysis of seizures, we found that the average diameter of peri-electrode edema of patients with seizures was larger than the average diameter of patients without seizures, which indicated that peri-electrode edema was risk factor for delayed-onset seizures after DBS surgery.

• Further multivariate analysis confirmed the result. Our study is the first report focusing on clinical characteristics and risk factors of delayed-onset seizures after DBS surgery based on a case series.

• Although DBS related seizure is uncommon complication, patients who experienced seizures are still exposed in risks of trauma and damage to the implanted simulator. We believe that these findings were useful for prevention and management of seizures associated with DBS surgery.

Introduction

Deep brain stimulation (DBS) is a well-established surgical therapy for some movement and psychiatric disorders. Patients are exposed in risks of trauma and implanted simulator damage when seizures occur, though seizures are not common postoperative adverse event of deep brain stimulation surgery. Previous studies indicated that the risk factors for seizures related to DBS included hemorrhage, peri-electrode edema, and increased age [1, 2, 3]. Most of the seizures occurred during electrode implantation procedures or within 48 h after DBS surgery [1, 2, 3], and delayed-onset seizures were seldom reported. However, this seizures incidence time-point presents quite different from those reports when retrospectively screening those PD patients who underwent subthalamic nucleus (STN) DBS in our center. We found that the seizures after DBS surgery were mainly delayed-onset (1–2 weeks after surgery). Therefore, this study summarized the clinical characteristics of delayed-onset seizures after DBS surgery and analyzed related risk factors.

Conclusions

Delayed-onset seizure after STN-DBS treating PD patients was uncommon with an incidence of 1.47 %. The seizures were transient and self-limiting, not easily developing into chronic epilepsy. Peri-electrode edema was a risk factor for delayed-onset seizures after DBS surgery. Patients with an average peri-electrode edema diameter > 2.70 cm had a higher risk to develop seizures.

Abstract

Nowadays, it is an established concept that the capability to reach a specialised cell identity via differentiation, as in the case of multi- and pluripotent stem cells, is not only determined by biochemical factors, but that also physical aspects of the microenvironment play a key role; interpreted by the cell through a force-based signalling pathway called mechanotransduction. However, the intricate ties between the elements involved in mechanotransduction, such as the extracellular matrix, the glycocalyx, the cell membrane, Integrin adhesion complexes, Cadherin-mediated cell/cell adhesion, the cytoskeleton, and the nucleus, are still far from being understood in detail. Here we report what is currently known about these elements in general and their specific interplay in the context of multi- and pluripotent stem cells. We furthermore merge this overview to a more comprehensive picture, that aims to cover the whole mechanotransductive pathway from the cell/microenvironment interface to the regulation of the chromatin structure in the nucleus. Ultimately, with this review we outline the current picture of the interplay between mechanotransductive cues and epigenetic regulation and how these processes might contribute to stem cell dynamics and fate.

Introduction

One of the basic principles enabling multicellular life is the differentiation of stem cells (SCs), into specialised cells with a defined identity, shape, and function ( McBeath et al., 2004 ) ( Tewary et al., 2018 ). SCs are defined as cells that are clonogenic, which defines their capability of both, self-renewing and retaining multilineage differentiation potency. In vertebrates, the Zygote represents the earliest stem cell (totipotent) in ontogeny, from which originate the pluripotent stem cells (PSCs) of the inner cell mass of the blastocyst ( Dean et al., 2003 , Smith, 2017 ). Soon thereafter, PSCs continue to expand during embryo development becoming progressively committed in their cell fate and acquiring a more restricted potency ( Dean et al., 2003 , Osorno et al., 2012 , Smith, 2017 ). Even at the end of embryogenesis, when the organism is fully formed, and its organs are composed of functionally mature cells, some SCs are still present. These cells, which possess a more limited differentiating potential (multipotent), in turn, give rise to a progeny of precursor cells and, finally, to functionally mature cells. Some examples are represented by the hematopoietic SCs in the bone marrow, the intestinal SCs in the gut’s crypts, the epithelial SCs in the epidermis or the mesenchymal stem cells (MSCs) which play an important role in the maintenance and regeneration of bones and cartilage ( Barker, 2014 , Evans et al., 2013 , Guan et al., 2012 , Tewary et al., 2018 , Watt, 2002 , Weissman, 2000 ).

The inherent high level of plasticity characterising SCs is at the base of their capability to respond precisely to appropriate stimuli with differentiative behaviour. Understanding this essential principle of multicellular life; i.e., the regulation of cell identity and fate, is one of the most important fields of research in modern cell biology, primarily due to its impact on the development of new therapeutic approaches in regenerative medicine. Such knowledge can directly benefit stem cell bioengineering by leveraging the SC plasticity and control over SC behaviour for the application in tissue engineering, patient-specific disease modelling and cell therapies ( Tewary et al., 2018 ).

Conclusions

In recent years there has been a fascinating expansion of our knowledge about the interplay between mechanotransductive signalling and chromatin regulation, and how this impacts on multi- and pluripotent stem cell dynamics, which we try to highlight in this review.

However, what shapes the life of a cell and its identity, from the outside (biophysical and structural cues of the cellular microenvironment) and from the inside (nuclear and chromatin organisation) and how it is connected (mechanotransduction and epigenetics) are highly relevant biological issues that are yet far from being understood in detail. Starting from the stem cell/microenvironment interface, a much more detailed understanding of the nanoscale events in this interface is necessary to unravel 1) what the SC perceives of the biophysical nature and the 3D adhesion site configuration and 2) how the immanent nanoscale information is interpreted and converted, through force-based actions, into a remodelling at the level of the IACs, cell/cell adhesions, cytoskeleton and nucleus.

Abstract

Although knowledge drives organizational growth, limited teamwork skills have hindered effective knowledge sharing and utilization across departments and individuals in higher education institutions (HEIs). Thus, this paper develops a pertinent knowledge-intensive teamworking model for HEIs. Educational background, leadership, and social media adoption were independent variables, while knowledge acquisition, development, application, revision, and knowledge-intensive teamwork were dependent variables. Using an online questionnaire, a quantitative investigation of 918 people across different HEIs tested hypotheses based on PLS-SEM findings. Results showed that educational background, leadership, and social media adoption are integral enablers in smoothing knowledge management operations, while the synergistic combination of process phases drives teamwork. Consequently, outcomes establish foundations for fostering a continuous learning culture, accountability, and cooperation in HEIs.

Introduction

Most management and technology research has focused on the technical efficiency of social media [1]. Information technology revolutionized education over three decades ago, and more recent research has examined various impacts on the workplace, such as training and communication [2,3]. Social media adoption in higher education institutions (HEIs) depends on strategic aims, resources, and cultural factors [4]. Furthermore, the adoption of technology by HEIs is contingent on organizational strategy and differs among HEIs in the same education system [5]. The use of social media in education has drawn interdisciplinary interest [6,7] as HEIs shift communication from one-way to interactive to regularly engage stakeholders [8]. Continual society-wide communication needs frequent updates across media, especially social platforms. Different methods can shape how HEIs utilize social media as key channels, enabling stakeholder conversations. Communication frequently starts on blogging platforms and spreads across media as users access multiple integrated channels, facilitating tailored, multi-way exchanges without time barriers.

The COVID-19 pandemic necessitated remote work and learning, disrupting traditional HEI teamwork models and requiring new virtual collaboration approaches [9]. This research extends knowledge management theory by examining how social media enables leadership, knowledge sharing, and co-development in virtual teams. Specifically, it provides empirical support for the knowledge management cycle model of Kang and Hau [10] by demonstrating how social media can facilitate key stages of knowledge acquisition, sharing, and revision in virtual settings. The findings reveal how social media-enabled leadership, through modeling knowledge-sharing practices and incentivizing participation, is critical for overcoming motivational barriers to collaborative knowledge activities online [11]. This paper advances the theoretical understanding of the interconnected relationships between social media adoption, leadership influence, and iterative knowledge improvement critical for virtual team effectiveness in higher education institutions. Moreover, a key contribution is providing empirical evidence on the affordances of different social media platforms for enabling specific collaborative activities in virtual HEI teams. The findings provide actionable guidance to HEI leaders on effective social media policies and professional development to optimize virtual teamwork. This research also contributes a new conceptual model of social media-enabled knowledge-intensive teamwork tailored to the HEI context.

Conclusion

The COVID-19 pandemic has significantly impacted higher education institutions, catalyzing a shift towards remote and online learning. In this context, social media has become an integral platform enabling knowledge-intensive teamwork, allowing seamless communication and collaboration regardless of location. Specifically, social media can promote the development of such teams in several key ways. Online discussions and forums can be leveraged to share information and resources, discuss ideas, brainstorm solutions, and provide feedback among team members. Video conferencing tools facilitate virtual meetings and presentations, helping members stay connected and engaged. Additionally, knowledge management systems allow the centralized sharing and accessing of documents while tracking progress – optimizing coordination. Consequently, social media facilitates effective knowledge-intensive teamwork in higher education after COVID-19 by providing ubiquitous channels for cooperation.

In conclusion, high-performing knowledge-based teams in higher education are predicated on an innovation-centric framework requiring integrated organizational and procedural alignment. Positive relationships among knowledge skill-building, leadership support, and cultural enablement underscore the need to embed holistically developmental, technological, and structural conditions that foster learning and innovative capacity at individual and team levels. Internally, sustained idea flows via cooperation enable continuous adaptation and improvement as contexts shift.

Abstract

Background
Heart failure has an estimated global prevalence of 64.3 million cases, with an average age of a person living with heart failure at 75.2 years. Approximately 20% of residents living in nursing homes (a long-term residential care environment for some individuals) report living with heart failure. Residents living with heart failure in nursing home environments are often frail, have reduced quality of life, higher rates of rehospitalisation and mortality, and greater complications in heart failure management. Further, nursing home staff often lack the knowledge and skills required to provide the necessary care for those living with heart failure. Interventions for improving heart failure management in nursing homes have proven effective, yet there is a lack of understanding regarding interventions for optimising care provision. The aim of this review was to synthesise the current evidence on educational interventions to optimise care provided to people with heart failure in nursing homes.

Methods
A scoping review with four databases searched: Medline, CINAHL, Web of Science, and EMBASE. Relevant reference lists were searched manually for additional records. Studies of nursing home staff or resident outcomes associated with changes in care provision (i.e., resident quality of life, staff knowledge of heart failure) were included. Results from the charting data process were collated into themes: intervention outcomes, changes to practice, and implementation and process evaluation.

Results
Seven papers were deemed eligible for inclusion. Most studies (n=6) were comprised of nursing home staff only, with one comprised only of residents. Study aims were to improve heart failure knowledge, interprofessional communication, heart failure assessment and management. Positive changes in staff outcomes were observed, with improvements in knowledge, self-efficacy, and confidence in providing care reported. No difference was reported concerning nursing home resident outcomes. Interprofessional communication and staff ability to conduct heart failure assessments improved post-intervention. Changes to practice were mixed, with issues around sustainability reported. Nursing home staff highlighted their appreciation towards receiving education, recommending that videos, images, and humour could improve the intervention content.

Conclusions
There is a paucity of evidence around educational interventions to support residents living with heart failure in nursing homes. However, available evidence suggests that educational interventions in nursing homes may improve care through improving staff self-efficacy and confidence in providing care, heart failure knowledge and interprofessional communication. The complexity of implementing educational interventions in the nursing home setting must be considered during the development process to improve implementation, effectiveness, and sustainability.

Background

Heart failure, defined as a clinical syndrome characterised by structural and/or functional changes to the heart (Bozkurt et al., 2021), has an estimated prevalence of 64.3 million cases worldwide (Savarese et al., 2022). People living with heart failure often present with three or more comorbidities, such as hypertension, diabetes mellitus and chronic kidney disease, which increases the severity of heart failure symptoms and negatively impacts quality of life and prognosis (Groenewegen et al., 2020). The presence of multi-comorbidities increases the complexity to effectively manage patients with heart failure (Conrad et al., 2018). Consequently, difficulties in management have resulted in higher rates of rehospitalisation (Groenewegen et al., 2020, Komajda, 2015, Wachter and Rommel, 2022), placing a significant demand on hospital facilities and personnel, and incurring substantial healthcare costs (Cleland et al., 2019, Conrad et al., 2018, Lesyuk et al., 2018, Urbich et al., 2020).

Due to an ageing population, improvements in diagnostic testing, and greater survival rates following a cardiovascular event, the incidence of heart failure is expected to continue to rise (Lippi and Sanchis-Gomar, 2020, Savarese et al., 2022). The prevalence of heart failure increases with age, from 1% for those <55 years to 10% for those aged >70 years (McDonagh et al., 2021). In the USA between 2001 and 2014, of the 14.6 million individuals hospitalised due to heart failure, 75.3% were classified as older people (>65 years) (Akintoye et al., 2017). The mean age of this population is 75.2 years (Norhammar et al., 2023).

Conclusions

The findings from this review highlight the potential of interventions implemented in nursing homes for improving care provision to residents with heart failure. However, outcomes reported across the included studies were mostly focused on nursing home staff. Thus, future research is needed to determine whether such interventions are effective in improving outcomes associated with nursing home residents. Also, future research should aim to determine whether such interventions can produce long-term effects and sustainability. Education was a common intervention component employed across the studies, provided face-to-face to nursing home staff. Participant feedback, although limited, indicated that education was well-received and beneficial, improving heart failure knowledge of staff. However, this study reported poor participant attendance at the sessions, with the intervention facilitator indicating that this approach was burdensome. The delivery of a digital intervention may provide greater success, reducing the burden on staff and the need for an intervention facilitator. A digital approach also provides participants with the ability to access the intervention at a time that suits them, potentially improving intervention acceptability, user engagement, and likelihood of success.

Abstract

Developmental prosopagnosia (DP) is a condition that indicates the inability to recognize individuals by their faces from birth, without any history of brain damage. The assessment of face recognition ability and diagnosis of DP involve the use of face tests such as the Cambridge Face Memory Test (CFMT) and the Cambridge Face Perception Test, along with self-reported measures like the 20-Item Prosopagnosia Index (PI20). Face recognition accuracy is affected by anxiety. However, previous studies on the relationship between face recognition ability and anxiety have not used the PI20 measure. This study aimed to investigate the relationship between self-reported measures of face recognition ability and anxiety tendencies among healthy young individuals for DP diagnosis and its implications. We used a face recognition test, involving the PI20, CFMT, Visual Perception Test for Agnosia–Famous Face Test (VPTA–FFT), and State-Trait Anxiety Inventory (STAI). We assessed the performance of 116 Japanese young adults (75 females, median age of 20.7 years, with a standard deviation of 1.2). Subsequently, we conducted a statistical analysis to examine the relationship between the outcomes of the face recognition tests and STAI scores using Pearson correlation analysis and single correlation coefficients. The results showed a positive correlation between state anxiety and PI20 (r = 0.308, p = 0.007), and a weak positive correlation was also observed between trait anxiety and PI20 (r = 0.268, p = 0.04). In contrast, there was no correlation between CFMT and VPTA–FFT with respect to STAI. The results of the hierarchical multiple regression analysis also suggested that the correlation between the performance on the PI20 (self-report) and objective measures of face recognition performance (the CFMT and the VPTA–FFT) are driven by differences in anxiety. This study is the first to explore the relationship between face recognition abilities and anxiety using the PI20 self-report measure. There are implications for future research on the diagnosis of DP and the relationship between anxiety and face recognition.

Introduction

Face recognition ability enables individuals to differentiate and identify faces, playing a crucial role in interpersonal recognition and everyday communication. Clinical and functional imaging studies have highlighted that brain lesions, particularly in regions such as the fusiform gyrus, can lead to face recognition impairment. In recent years, there has been a growing interest in the field of face recognition research regarding developmental prosopagnosia (DP). DP refers to a condition in which individuals experience lifelong impairments in face recognition despite possessing normal visual and intellectual capabilities since birth. Clinically, there is no indication of overt central nervous system disorders, and neuroimaging studies also reveal the absence of organic brain lesions (Bate & Tree, 2017; Behrmann & Avidan, 2005; Cook & Biotti, 2016; Duchaine & Nakayama, 2006a). Epidemiological studies in Europe and Asia have reported a prevalence rate of approximately 1.9 %–2.9 % of the population (Bowles et al., 2009; Kennerknecht et al., 2006; Kennerknecht et al., 2008). People with DP encounter challenges and psychosocial difficulties in their interpersonal interactions due to impaired face recognition (Yardley et al., 2008). Early diagnosis and support are crucial, especially before adulthood and entering the workforce.

Currently, diagnosing DP presents challenges due to the absence of established strict objective criteria or biological markers (Barton & Corrow, 2016; Susilo & Duchaine, 2013). Previous studies have revealed ambiguous criteria for diagnosing DP and differentiating it from conditions other than DP in face recognition tests (Bate & Tree, 2017; Dalrymple & Palermo, 2016). Dalrymple and Palermo (2016) provided guidelines that define DP as objectively poor performance on face memory tests and a subjective feeling of repeated face recognition failures in daily life. The authors emphasized the importance of using questionnaires and interviews to assess face recognition difficulties in daily life and highlighted the limitations of relying solely on questionnaires for DP diagnosis, as individuals with DP may lack accurate insight into their own face recognition abilities.

Conclusions

The present study is the first to investigate the relationship between self-reported face recognition abilities and anxiety in young, healthy Japanese individuals using the self-perception face recognition test PI20. The findings indicated that unlike the objective face recognition tests CFMT and VPTA–FFT that showed no association with anxiety, the self-perception test scores may be influenced by state anxiety. Self-reporting, at least in its current form, provides limited insights into predicting face recognition performance in young individuals and diagnosing DP. Therefore, self-reporting is insufficient to evaluate face recognition abilities in young individuals, and DP cannot be diagnosed solely based on self-perception tests. It is necessary to combine self-perceived indicators of face recognition impairment with other perception-based face recognition function tests and consider the presence and extent of anxiety tendencies. Our findings have significant psychological implications for understanding face recognition impairments, DP diagnosis, and clinical practices. In the future, expanding research to investigate the interaction between facial and expression recognition abilities and anxiety is expected to enhance the accurate diagnosis and support for young individuals with facial recognition impairments.