Bullous hemorrhagic dermatosis (BHD) is a rare cutaneous manifestation characterized by tense hemorrhagic bullae that appear at sites distant from low molecular weight heparin (LMWH) injections, typically within seven days of exposure. As of March 2022, only 94 cases have been reported. It most commonly affects elderly males with predisposing factors for thromboembolism, such as carcinoma, and usually involves the extremities.

This case highlights the importance of maintaining a high index of suspicion for bullous hemorrhagic dermatosis (BHD) in patients receiving low molecular weight heparin, even beyond the typical 7-day window and in demographics not commonly affected. Early recognition and prompt discontinuation of the offending agent, as demonstrated in this atypical presentation involving a Filipino elderly woman with multiple comorbidities and no malignancy, can lead to favorable outcomes. Clinicians should be aware of this rare but reversible complication to avoid misdiagnosis and ensure appropriate management.

Human ; Female ; Aged: 65-79 Yrs Old ; Affect ; Aged ; Blister ; Carcinoma ; Causality ; Demography ; Diagnostic Errors ; Enoxaparin ; Extremities ; Heparin ; Heparin, Low-molecular-weight ; Index ; Injections ; Lead ; Male ; Molecular Weight ; Neoplasms ; Patients ; Research Report ; Skin Diseases ; Thromboembolism ; Women

Objective Observational studies have shown an association between Parkinson disease （PD） and mental illness， but further studies are needed to explore the causal relationship between them. This study aims to investigate such causal relationship using the method of two-sample Mendelian randomization （MR）. Methods Related data were extracted from GWAS， and summary statistics associated with PD， depression， sleep disorders， and anxiety phenotype-variants were obtained. Single nucleotide polymorphisms （SNPs） for PD were selected as instrumental variables， and MR-PRESSO was used to exclude outliers. Inverse variance weighting was used as the main method to assess causal effect estimates， and MR Egger， weighted median， simple mode， and weighted mode were used to verify the robustness of the findings. A sensitivity analysis was used to validate the reliability of the results， including the Cochran Q test， the MR-Egger intercept test， funnel plots， and the leave-one-out method. Results A total of 21 SNPs associated with PD were identified. The MR analysis showed that PD had a causal relationship with depression （OR=0.974，95%CI 0.934‒1.015， P=0.210）， sleep disorders （OR=1.056， 95%CI 0.970-1.149， P=0.211）， and anxiety （OR=0.998， 95%CI 0.996‒1.001， P=0.118）， with no statistical significance. Different MR analyses and sensitivity analyses showed that PD did not directly contribute to the development of mental illness. Conclusion There is no direct causal relationship between PD and depression/sleep disorders/anxiety. In clinical practice， healthcare professionals should pay attention to the mental health of patients with PD. Randomized controlled studies should be conducted in the future to further validate the results of this study.
Depression ; Anxiety

Objective To investigate the association between sleep behaviors （including bedtime， sleep quality， and nap duration） and academic performance among college students， as well as the regulatory effect of test anxiety and exercise habit on the association between sleep and academic performance. Methods A questionnaire survey was conducted to collect data. The grade of compulsory courses （with higher grades indicating better academic performance） was used as an ordinal dependent variable. All independent variables were coded by levels： for bedtime during exam and non-exam periods， higher levels indicated later bedtimes； for anxiety during the exam period， higher levels indicated more severe anxiety； for sleep quality during both exam and non-exam periods， higher levels indicated better sleep quality； for nap duration， higher levels indicated longer naps. Exercise habit was treated as a binary variable （yes/no）. Ordinal logistic regression （proportional odds model） was used for multivariable analysis， and OR and 95%CIwere calculated. In addition， sex-stratified models were established to investigate sex differences in the associations between these factors and academic performance. Results A total of 1 221 college students were included， among whom male students accounted for 33.7%. After controlling for confounding factors， bedtime during the exam period was significantly positively associated with the grade of compulsory courses， indicating that later bedtime was associated with a greater likelihood of achieving a higher grade （OR=1.32，95%CI 1.08‒1.62， P=0.007）. Sex was also an independent predictive factor， and the OR of achieving a higher grade in female students was 2.4 times that in male students （OR=2.41， 95%CI 1.90‒3.06， P<0.001）. Sleep quality during the exam period （OR=1.18，95%CI 0.99‒1.42， P=0.070） and exercise habit （OR=1.24， 95%CI 0.99‒1.55， P=0.064） showed marginally significant associations with grade. In contrast， bedtime during the non-exam period， nap duration， anxiety during the exam period， and self-rated sleep quality during the non-exam period showed no statistical significance （all P>0.05）. Sex-stratified analysis showed that among the male students， later bedtime during the exam period was associated with a greater likelihood of achieving a higher grade （OR=1.48， 95%CI 1.05‒2.09， P=0.025）， whereas higher anxiety during the exam period was associated with a lower likelihood （OR=0.79，95%CI 0.63‒0.98， P=0.032）； among the female students， better sleep quality during the exam period was associated with a greater likelihood of achieving a higher grade （OR=1.27， 95%CI 1.02‒1.57， P=0.033）， and bedtime during the exam period showed a positive association with academic performance， but without statistical significance （OR=1.25，95%CI 0.96‒1.62，P=0.091）. Conclusion The association between sleep behaviors and academic performance among college students varies with academic period and sex. Later bedtime during the exam period is associated with better academic performance， but this effect is observed only among male students. In addition， the academic performance of male students is negatively affected by test anxiety， whereas the academic performance of female students is positively associated with subjective sleep quality. Future interventions aimed at improving academic health should consider sex-specific strategies.
Anxiety ; Exercise

Introduction: The COVID-19 pandemic accelerated the adoption of alternative instructional approaches, including distance and online learning. This study aimed to determine factors associated with preference for online learning modality among medical students at a private medical school in the National Capital Region (NCR). Methods: An analytical cross-sectional study was conducted among 367 medical students using convenience sampling. Participants completed an online survey assessing preferred learning modality, general anxiety, self-efficacy, and satisfaction with online learning. Factors associated with preference for online learning were identified using logistic regression analysis. Results: Most respondents (79.3%) preferred traditional face-to-face learning, whereas 20.7% preferred online learning. Male students were more likely to prefer online learning than female students (OR = 2.19, p = 0.003). Married students were more likely to prefer online learning than unmarried students (OR = 9.71, p = 0.021). Students who reported greater satisfaction with their online learning experience were more likely to prefer online learning (OR = 2.28, p = 0.024). Self-efficacy demonstrated a borderline association with preference for online learning (OR = 0.42, p = 0.053). Conclusion Sex, civil status, and satisfaction with online learning were significantly associated with preference for online learning modality. Self-efficacy demonstrated a borderline association. Despite the increased use of online learning during the COVID-19 pandemic, most respondents continued to prefer traditional face-to-face instruction.
Education ; Anxiety ; Self-efficacy

BACKGROUND AND OBJECTIVES

This study examines how grieving Filipinos use Facebook to cope and find support. It investigates the combination of traditional mourning practices and the influence of social media. By exploring this intersection, the study fills an essential gap in the existing literature on digital mourning within Filipino culture. Understanding these digital bereavement practices can inform palliative care interventions, particularly in providing psychosocial support to grieving families.

METHODS

The study used a hermeneutic phenomenological approach, conducting in-depth interviews with ten bereaved Filipinos selected by specific criteria. Data were gathered through video calls and in-person interviews to explore their experiences, and the qualitative data was thematically analyzed for key insights.

RESULTS

The analysis revealed three key themes: (1) blending mourning traditions with Facebook for emotional support; (2) Facebook interactions that provide relief and validation in grief; and (3) digital mourning experiences that foster healing. Social media enhances grieving practices for Filipinos, allowing them to honor loved ones and strengthen community connections.

RECOMMENDATIONS

The study stresses the need for culturally sensitive digital spaces and grief support services that combine online and offline mourning practices. It calls on healthcare providers and grief counselors to incorporate digital mourning and highlights the need for further research on grief expressions on social media.

Human ; Bereavement ; Social Media

Objective To investigate the potential genetic mechanisms of insomnia and anxiety and the bidirectional causal relationship between them using Linkage Disequilibrium Score Regression （LDSC） and Mendelian Randomization （MR）. Methods Based on the data from genome-wide association studies， LDSC was used to analyze the genetic correlation of insomnia with anxiety and its subtypes. The inverse variance weighted （IVW） method was used as the main analytical method， supplemented by MR-Egger regression， weighted median， the simple model method， and weighted model. The Cochran’s Q test was used for heterogeneity testing， MR-Egger was used for pleiotropy testing， and the leave-one-out method was used for sensitivity analysis. Results The LDSC analysis revealed the genetic correlation of insomnia with anxiety and its subtypes. The results of IVW analysis showed that insomnia had a causal relationship with the increased risk of anxiety （OR=1.448，95%CI 1.025‒2.045，P=0.036，PFDR=0.178） and generalized anxiety disorder （OR=2.098，95% CI 1.105‒3.986， P=0.024， PFDR=0.314）. Conversely， the reverse MR analysis showed a causal relationship between generalized anxiety disorder and the increased risk of insomnia （OR=1.010， 95% CI 1.003‒1.017， P=0.008， PFDR=0.329）. No significant horizontal pleiotropy was detected for the instrumental variables （P>0.05）， and the sensitivity analysis showed that the results of MR analysis were stable. Conclusion Insomnia may be used as a risk factor for anxiety， and there is a genetic correlation between the two diseases.
Insomnia ; Anxiety

A single-center, randomized, double-blind, dose-controlled trial of modified Sini Powder in treating mild to moderate generalized anxiety disorder(GAD) in the patients with syndrome of liver depression transforming into fire was conducted at Xiyuan Hospital, China Academy of Chinese Medical Sciences. A total of 80 patients with mild to moderate GAD and the syndrome of liver depression transforming into fire were included. Patients were assigned by the central randomization system at a ratio of 3∶1 into an observation group(n=60, receiving a conventional-dose of granules of modified Sini Powder) and a control group(n=20, receiving low-dose granules with the active ingredients being 50% of that in observation group). Assessments were conducted before treatment(baseline), after 2 weeks of introduction, after 2/4/8 weeks of treatment, and after 4 weeks of follow-up. The results were summarized as follows. In terms of primary outcome indicators, the observation group(62.2%) showed higher total response rate than the control group(26.6%)(P<0.05), and greater Hamilton anxiety scale(HAMA) score reduction after 8 weeks of treatment(P<0.05). In terms of secondary outcome indicators, the HAMA score(somatic anxiety score), traditional Chinese medicine(TCM) syndrome scores, Pittsburgh sleep quality index(PSQI) scale, and clinical global impression(CGI) scale score in the observation group showed a significant compared to the control group at each visit points(P<0.05). Adverse events occurred in 10 cases, including 9(16.9%) cases in the observation group and 1(6.6%) case in the control group. No adverse reaction was observed. In conclusion, conventional-dose modified Sini Powder demonstrated superior efficacy and favorable safety for mild and moderate GAD in the patients with the syndrome of liver depression transforming into fire over low-dose treatment.
Humans ; Male ; Female ; Adult ; Middle Aged ; Double-Blind Method ; Drugs, Chinese Herbal/administration & dosage* ; Anxiety Disorders/drug therapy* ; Treatment Outcome ; Young Adult ; Powders ; Aged ; Liver/drug effects* ; Generalized Anxiety Disorder

This study aims to investigate the mechanism through which Xiangshao Granules treat anxiety and depression using metabolomics and gut microbiota techniques, combined with animal experiments. Sixty female ICR mice were selected for the experiment and randomly divided into six groups: a control group, a model group, a low-dose Xiangshao Granules group, a medium-dose Xiangshao Granules group, a high-dose Xiangshao Granules group, and an estradiol(positive drug) group. Except for the control group, rats in other groups were induced for anxiety and depression model by ovariectomy(OVX) combined with chronic unpredictable mild stress(CUMS). After successful modeling, the mice received oral administration of Xiangshao Granules or estradiol for three weeks. Anxiety and depression behaviors in mice were evaluated using light-dark box tests, open field tests, and elevated plus-maze tests. The levels of substances closely related to anxiety and depression, such as serotonin(5-HT) and estrogen(E_2), were quantified in plasma and hippocampal tissue using enzyme-linked immunosorbent assay(ELISA). Metabolomics and 16S rDNA amplicon sequencing techniques were employed to analyze the regulatory effects of Xiangshao Granules on plasma metabolites and metabolic pathways in anxiety and depression mice, as well as their impact on the distribution of gut microbiota. Finally, the correlation between plasma metabolites and differential gut microbiota was constructed using the Spearman correlation coefficient method. Behavioral experimental results indicated that, compared to the control group, the model group exhibited significantly decreased dwell time in the light box, reduced total distance in the open field, and diminished dwell time in the open arm. In contrast, high dose of Xiangshao Granules were found to increase the dwell time in the light box and total distance in the open field. ELISA results indicated that the levels of 5-HT, gamma-aminobutyric acid(GABA), E_2 were significantly decreased, luteinizing hormone(LH), adrenocorticotropic hormone(ACTH), and corticosterone(CORT) were significantly elevated in the anxiety and depression mice, and treatment with middle, high dose of Xiangshao Granules reversed the levels of these substances. Additionally, in the anxiety and depression mouse model, the levels of follicle-stimulating hormone(FSH) were significantly increased, whereas middle, high dose of Xiangshao Granules decreased FSH levels. Metabolomics analysis revealed that Xiangshao Granules significantly changed the metabolic profile of the anxiety and depression mice, affecting central carbon metabolism, amino acid biosynthesis, and ABC transporter pathways. The results from 16S rDNA amplicon sequencing showed that Xiangshao Granules improved the relative abundance of genera such as Bacteroidia, Bacilli, Lactobacillales, and Lactobacillus. Spearman correlation analysis indicated a close association between specific differential gut microbiota and plasma differential metabolites. This study suggests that Xiangshao Granules significantly ameliorate anxiety and depression symptoms in mice by altering the levels of substances associated with these conditions, including 5-HT, GABA, E_2, LH, and ACTH. The metabolomics and gut microbiota data suggest that the therapeutic mechanism may be closely related to the regulation of amino acid biosynthesis, central carbon metabolism, and the alteration of key microbial community compositions.
Animals ; Drugs, Chinese Herbal/administration & dosage* ; Anxiety/microbiology* ; Depression/microbiology* ; Gastrointestinal Microbiome/drug effects* ; Mice ; Female ; Mice, Inbred ICR ; Metabolomics ; Serotonin/metabolism* ; Humans ; Disease Models, Animal ; Rats ; Behavior, Animal/drug effects*

Emotion classification and recognition is a crucial area in emotional computing. Physiological signals, such as electroencephalogram (EEG), provide an accurate reflection of emotions and are difficult to disguise. However, emotion recognition still faces challenges in single-modal signal feature extraction and multi-modal signal integration. This study collected EEG, electromyogram (EMG), and electrodermal activity (EDA) signals from participants under three emotional states: happiness, sadness, and fear. A feature-weighted fusion method was applied for integrating the signals, and both support vector machine (SVM) and extreme learning machine (ELM) were used for classification. The results showed that the classification accuracy was highest when the fusion weights were set to EEG 0.7, EMG 0.15, and EDA 0.15, achieving accuracy rates of 80.19% and 82.48% for SVM and ELM, respectively. These rates represented an improvement of 5.81% and 2.95% compared to using EEG alone. This study offers methodological support for emotion classification and recognition using multi-modal physiological signals.
Humans ; Emotions/physiology* ; Electroencephalography ; Support Vector Machine ; Electromyography ; Signal Processing, Computer-Assisted ; Galvanic Skin Response/physiology* ; Machine Learning ; Male

In audiovisual emotion recognition, representational learning is a research direction receiving considerable attention, and the key lies in constructing effective affective representations with both consistency and variability. However, there are still many challenges to accurately realize affective representations. For this reason, in this paper we proposed a cross-modal audiovisual recognition model based on a multi-head cross-attention mechanism. The model achieved fused feature and modality alignment through a multi-head cross-attention architecture, and adopted a segmented training strategy to cope with the modality missing problem. In addition, a unimodal auxiliary loss task was designed and shared parameters were used in order to preserve the independent information of each modality. Ultimately, the model achieved macro and micro F1 scores of 84.5% and 88.2%, respectively, on the crowdsourced annotated multimodal emotion dataset of actor performances (CREMA-D). The model in this paper can effectively capture intra- and inter-modal feature representations of audio and video modalities, and successfully solves the unity problem of the unimodal and multimodal emotion recognition frameworks, which provides a brand-new solution to the audiovisual emotion recognition.
Emotions ; Humans ; Attention ; Algorithms