Public health and safety professionals, including firefighters, police officers, and emergency medical personnel, serve as critical pillars of public safety and societal well-being. These professions require navigating environments characterized by ‘brittleness’, ‘anxiety’, ‘nonlinearity’, and ‘incomprehensibility’—conditions that lead to chronic physical and psychological stress. This stress significantly elevates the risk of mental health disorders such as post-traumatic stress disorder, anxiety disorders, mood disorders, and sleep disturbances, while also increasing the likelihood of human errors driven by cognitive lapses. Such challenges extend beyond individual health, undermining organizational efficiency and ultimately jeopardizing public safety and societal welfare. Existing mental health management systems predominantly depend on reactive interventions, which are insufficient to meet the dynamic and unpredictable demands of high-risk occupational environments. As a proactive alternative, this paper introduces the concept of ‘Mind Vital Signs,’ an innovative framework that expands the traditional concept of vital signs into the mental health domain. Mind Vital Signs integrates physiological indicators—including heart rate variability, physical activity, respiratory rates, and sleep patterns—with psychological and behavioral data such as ecological momentary assessments and life logs. By employing real-time monitoring and advanced analytics, this multidimensional system facilitates early detection of mental health risks and supports targeted and timely preventive interventions. The implementation of Mind Vital Signs not only bolsters individual resilience and organizational stability but also enhances operational efficiency and strengthens public safety and societal well-being. Future research should prioritize clinical validation and policy development to ensure the effective integration and scalability of Mind Vital Signs in high-risk occupational settings.

Public health and safety professionals, including firefighters, police officers, and emergency medical personnel, serve as critical pillars of public safety and societal well-being. These professions require navigating environments characterized by ‘brittleness’, ‘anxiety’, ‘nonlinearity’, and ‘incomprehensibility’—conditions that lead to chronic physical and psychological stress. This stress significantly elevates the risk of mental health disorders such as post-traumatic stress disorder, anxiety disorders, mood disorders, and sleep disturbances, while also increasing the likelihood of human errors driven by cognitive lapses. Such challenges extend beyond individual health, undermining organizational efficiency and ultimately jeopardizing public safety and societal welfare. Existing mental health management systems predominantly depend on reactive interventions, which are insufficient to meet the dynamic and unpredictable demands of high-risk occupational environments. As a proactive alternative, this paper introduces the concept of ‘Mind Vital Signs,’ an innovative framework that expands the traditional concept of vital signs into the mental health domain. Mind Vital Signs integrates physiological indicators—including heart rate variability, physical activity, respiratory rates, and sleep patterns—with psychological and behavioral data such as ecological momentary assessments and life logs. By employing real-time monitoring and advanced analytics, this multidimensional system facilitates early detection of mental health risks and supports targeted and timely preventive interventions. The implementation of Mind Vital Signs not only bolsters individual resilience and organizational stability but also enhances operational efficiency and strengthens public safety and societal well-being. Future research should prioritize clinical validation and policy development to ensure the effective integration and scalability of Mind Vital Signs in high-risk occupational settings.

Public health and safety professionals, including firefighters, police officers, and emergency medical personnel, serve as critical pillars of public safety and societal well-being. These professions require navigating environments characterized by ‘brittleness’, ‘anxiety’, ‘nonlinearity’, and ‘incomprehensibility’—conditions that lead to chronic physical and psychological stress. This stress significantly elevates the risk of mental health disorders such as post-traumatic stress disorder, anxiety disorders, mood disorders, and sleep disturbances, while also increasing the likelihood of human errors driven by cognitive lapses. Such challenges extend beyond individual health, undermining organizational efficiency and ultimately jeopardizing public safety and societal welfare. Existing mental health management systems predominantly depend on reactive interventions, which are insufficient to meet the dynamic and unpredictable demands of high-risk occupational environments. As a proactive alternative, this paper introduces the concept of ‘Mind Vital Signs,’ an innovative framework that expands the traditional concept of vital signs into the mental health domain. Mind Vital Signs integrates physiological indicators—including heart rate variability, physical activity, respiratory rates, and sleep patterns—with psychological and behavioral data such as ecological momentary assessments and life logs. By employing real-time monitoring and advanced analytics, this multidimensional system facilitates early detection of mental health risks and supports targeted and timely preventive interventions. The implementation of Mind Vital Signs not only bolsters individual resilience and organizational stability but also enhances operational efficiency and strengthens public safety and societal well-being. Future research should prioritize clinical validation and policy development to ensure the effective integration and scalability of Mind Vital Signs in high-risk occupational settings.

Public health and safety professionals, including firefighters, police officers, and emergency medical personnel, serve as critical pillars of public safety and societal well-being. These professions require navigating environments characterized by ‘brittleness’, ‘anxiety’, ‘nonlinearity’, and ‘incomprehensibility’—conditions that lead to chronic physical and psychological stress. This stress significantly elevates the risk of mental health disorders such as post-traumatic stress disorder, anxiety disorders, mood disorders, and sleep disturbances, while also increasing the likelihood of human errors driven by cognitive lapses. Such challenges extend beyond individual health, undermining organizational efficiency and ultimately jeopardizing public safety and societal welfare. Existing mental health management systems predominantly depend on reactive interventions, which are insufficient to meet the dynamic and unpredictable demands of high-risk occupational environments. As a proactive alternative, this paper introduces the concept of ‘Mind Vital Signs,’ an innovative framework that expands the traditional concept of vital signs into the mental health domain. Mind Vital Signs integrates physiological indicators—including heart rate variability, physical activity, respiratory rates, and sleep patterns—with psychological and behavioral data such as ecological momentary assessments and life logs. By employing real-time monitoring and advanced analytics, this multidimensional system facilitates early detection of mental health risks and supports targeted and timely preventive interventions. The implementation of Mind Vital Signs not only bolsters individual resilience and organizational stability but also enhances operational efficiency and strengthens public safety and societal well-being. Future research should prioritize clinical validation and policy development to ensure the effective integration and scalability of Mind Vital Signs in high-risk occupational settings.

Public health and safety professionals, including firefighters, police officers, and emergency medical personnel, serve as critical pillars of public safety and societal well-being. These professions require navigating environments characterized by ‘brittleness’, ‘anxiety’, ‘nonlinearity’, and ‘incomprehensibility’—conditions that lead to chronic physical and psychological stress. This stress significantly elevates the risk of mental health disorders such as post-traumatic stress disorder, anxiety disorders, mood disorders, and sleep disturbances, while also increasing the likelihood of human errors driven by cognitive lapses. Such challenges extend beyond individual health, undermining organizational efficiency and ultimately jeopardizing public safety and societal welfare. Existing mental health management systems predominantly depend on reactive interventions, which are insufficient to meet the dynamic and unpredictable demands of high-risk occupational environments. As a proactive alternative, this paper introduces the concept of ‘Mind Vital Signs,’ an innovative framework that expands the traditional concept of vital signs into the mental health domain. Mind Vital Signs integrates physiological indicators—including heart rate variability, physical activity, respiratory rates, and sleep patterns—with psychological and behavioral data such as ecological momentary assessments and life logs. By employing real-time monitoring and advanced analytics, this multidimensional system facilitates early detection of mental health risks and supports targeted and timely preventive interventions. The implementation of Mind Vital Signs not only bolsters individual resilience and organizational stability but also enhances operational efficiency and strengthens public safety and societal well-being. Future research should prioritize clinical validation and policy development to ensure the effective integration and scalability of Mind Vital Signs in high-risk occupational settings.

Purpose: Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes. Methods: In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment. Results: In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure. Conclusion We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder. Pain catastrophizing, characterized by magnification, rumination, and helplessness, increases perceived pain intensity and mental distress in CRPS patients. As functional connectivity patterns in CRPS remain largely unknown, we aimed to investigate functional connectivity alterations in CRPS patients and their association with pain catastrophizing using a whole-brain analysis approach. Twenty-one patients with CRPS and 49 healthy controls were included in the study for clinical assessment and resting-state functional magnetic resonance imaging. Between-group differences in whole-brain functional connectivity were examined through a Network-based Statistics analysis. Associations between altered functional connectivity and the extent of pain catastrophizing were also assessed in CRPS patients. Relative to healthy controls, CRPS patients showed higher levels of functional connectivity in the bilateral somatosensory subnetworks (components 1~2), but lower functional connectivity within the prefronto-posterior cingulate (component 3), prefrontal (component 4), prefronto-parietal (component 5), and thalamo-anterior cingulate (component 6) subnetworks (p<0.05, family-wise error corrected). Higher levels of functional connectivity in components 1~2 (β=0.45, p=0.04) and lower levels of functional connectivity in components 3~6 (β=-0.49, p=0.047) were significantly correlated with higher levels of pain catastrophizing in CRPS patients. Higher functional connectivity in the somatosensory subnetworks implicating exaggerated pain perception and lower functional connectivity in the prefronto-parieto-cingulo-thalamic subnetworks indicating impaired cognitive-affective pain processing may underlie pain catastrophizing in CRPS.

Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disease characterized by persistent dizziness, unsteadiness, and/or non-spinning vertigo, and is the most common vestibular syndrome in young adults. A stiffened postural control strategy, shift to reliance on visual over vestibular information, and hypervigilance to the environment have been suggested as possible pathophysiological mechanisms of PPPD. However, the exact mechanisms remain unclear. Recently, neuroimaging studies using magnetic resonance imaging and single photon emission computed tomography have provided pivotal insights into the pathophysiology of PPPD. The aim of this review was to evaluate and summarize the existing data on neuroimaging studies in PPPD. In summary, these studies fairly consistently reported decreased brain structure, function, and connectivity among the areas involved in multisensory vestibular processing and spatial cognition, and increased function and connectivity in the visual processing areas in patients with PPPD. The detected brain changes might reflect maladaptive and compensatory mechanisms including dysfunctional integration of multisensory vestibular information and visual dependence. Notably, various factors including personality traits (i.e., neuroticism), psychiatric comorbidities (i.e., anxiety and depression), and triggering factors (i.e., peripheral vestibular lesions) seem to modulate brain functional activity and connectivity patterns, possibly accounting for some differences across the results. Future studies should carefully control for these confounding effects in order to draw firm conclusions.

The incidence of neurosyphilis has declined since effective penicillin therapy against Treponema pallidum was introduced. However, the diagnosis of neurosyphilis early in the disease course is very important in order to select appropriate antibiotic therapy. We report brain MRI, SPECT with Tc-99m ECD, and PET with F-18 FDG findings before antibiotic therapy in a neurosyphilis patient with neurological symptoms. The cerebral cortices showed hypoperfusion with a patchy distribution on SPECT and foci with high signal intensity on MRI, suggesting ischemia. Brain PET showed areas with hypometabolism in the temporoparietal lobes bilaterally.

Purpose: Increasing attention has been paid to low-intensity transcranial focused ultrasound (tFUS) for its potential therapeutic effects in Alzheimer's disease (AD). While preclinical studies have shown promising therapeutic effects of low-intensity tFUS in AD models, its efficacy and safety remain unclear in humans. In this pilot study, we investigated the effects of low-intensity tFUS on blood-brain barrier opening, the regional cerebral metabolic rate of glucose (rCMRglu), and cognition in patients with AD. Methods: After receiving institutional review board approval, four patients with AD received tFUS to the hippocampus immediately after an intravenous injection of a microbubble ultrasound contrast agent. Sonication was delivered at low-intensity, at a pressure level below the threshold for blood-brain barrier opening. Patients underwent brain magnetic resonance imaging, 18F-fluoro-2-deoxyglucose positron emission tomography, and neuropsychological assessments before and after the tFUS procedure. A whole-brain voxel-wise paired t test was conducted to compare rCMRglu before and after tFUS. Results: The sonication, as anticipated, did not show evidence of active blood-brain barrier opening on T1 dynamic contrast-enhanced magnetic resonance imaging. rCMRglu in the superior frontal gyrus (P<0.001), middle cingulate gyrus (P<0.001), and fusiform gyrus increased after tFUS (P=0.001). Patients demonstrated mild improvement in measures of memory, executive, and global cognitive function following tFUS. No adverse events were reported. Conclusion These results suggest that hippocampal sonication with low-intensity tFUS may have beneficial effects on cerebral glucose metabolism and cognitive function in patients with AD. Further larger studies are needed to confirm the therapeutic efficacy of tFUS in AD.