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Stroke and late-onset Alzheimer’s disease (AD) are risk factors for each other; the comorbidity of these brain disorders in aging individuals represents a significant challenge in basic research and clinical practice. The similarities and differences between stroke and AD in terms of pathogenesis and pathophysiology, however, have rarely been comparably reviewed. Here, we discuss the research background and recent progresses that are important and informative for the comorbidity of stroke and late-onset AD and related dementia (ADRD). Glutamatergic NMDA receptor (NMDAR) activity and NMDAR-mediated Ca 2+ influx are essential for neuronal function and cell survival. An ischemic insult, however, can cause rapid increases in glutamate concentration and excessive activation of NMDARs, leading to swift Ca 2+ overload in neuronal cells and acute excitotoxicity within hours and days. On the other hand, mild upregulation of NMDAR activity, commonly seen in AD animal models and patients, is not immediately cytotoxic. Sustained NMDAR hyperactivity and Ca 2+ dysregulation lasting from months to years, nevertheless, can be pathogenic for slowly evolving events, i.e. degenerative excitotoxicity, in the development of AD/ADRD. Specifically, Ca 2+ influx mediated by extrasynaptic NMDARs (eNMDARs) and a downstream pathway mediated by transient receptor potential cation channel subfamily M member (TRPM) are primarily responsible for excitotoxicity. On the other hand, the NMDAR subunit GluN3A plays a “gatekeeper” role in NMDAR activity and a neuroprotective role against both acute and chronic excitotoxicity. Thus, ischemic stroke and AD share an NMDAR- and Ca 2+ -mediated pathogenic mechanism that provides a common receptor target for preventive and possibly disease-modifying therapies. Memantine (MEM) preferentially blocks eNMDARs and was approved by the Federal Drug Administration (FDA) for symptomatic treatment of moderate-to-severe AD with variable efficacy. According to the pathogenic role of eNMDARs, it is conceivable that MEM and other eNMDAR antagonists should be administered much earlier, preferably during the presymptomatic phases of AD/ADRD. This anti-AD treatment could simultaneously serve as a preconditioning strategy against stroke that attacks ≥ 50% of AD patients. Future research on the regulation of NMDARs, enduring control of eNMDARs, Ca 2+ homeostasis, and downstream events will provide a promising opportunity to understand and treat the comorbidity of AD/ADRD and stroke.

Medical students learning to use artificial intelligence for medical practices is likely to enhance medical services. However, studies in this area have been lacking. The present study investigated medical students’ perceptions of and behavioral intentions toward learning artificial intelligence (AI) in clinical practice based on the theory of planned behavior (TPB). A sum of 274 Year-5 undergraduates and master’s and doctoral postgraduates participated in the online survey. Six constructs were measured, including (1) personal relevance (PR) of medical AI, (2) subjective norm (SN) related to learning medical AI, (3) perceived self-efficacy (PSE) of learning medical AI, (4) basic knowledge (BKn) of medical AI, (5) behavioral intention (BI) toward learning medical AI and (6) actual learning (AL) of medical AI. Confirmatory factor analysis and structural equation modelling were employed to analyze the data. The results showed that the proposed model had a good model fit and the theoretical hypotheses in relation to the TPB were mostly confirmed. Specifically, (a) BI had a significantly strong and positive impact on AL; (b) BI was significantly predicted by PR, SN and PSE, whilst BKn did not have a direct effect on BI; (c) PR was significantly and positively predicted by SN and PSE, but BKn failed to predict PR; (d) both SN and BKn had significant and positive impact on PSE, and BKn had a significantly positive effect on SN. Discussion was conducted regarding the proposed model, and new insights were provided for researchers and practitioners in medical education.

Grounded in the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), this study investigates the interplay between key UTAUT2 constructs and motivation modeled by Self-Determination Theory (SDT) in shaping English as a Foreign Language (EFL) learners’ behavioral intention and actual use of generative AI tools. Accordingly, three research questions were devised, including (1) What are the structural relationships between the UTAUT2 constructs for EFL learners to accept and use generative AI for English learning? (2) Does EFL learners’ SDT motivation influence their behavioral intention toward and actual use of generative AI? and (3) What are the moderating effects of EFL learners’ SDT motivation toward their acceptance and use of generative AI? A comprehensive survey involving 620 Chinese undergraduates assessed their technology acceptance and SDT motivation of generative AI tools in the EFL learning context. Confirmatory factor analysis and structural equation modeling were employed to analyze the data. Results indicate robust model fit indices, both with and without considering moderating effects. Performance expectancy, effort expectancy, social influence, hedonic motivation, habit, and SDT motivation serve as significant predictors of EFL learners’ behavioral intention towards generative AI tools, while price value does not demonstrate a significant impact on behavioral intention. Additionally, behavioral intention and SDT motivation jointly and significantly predict EFL learners’ actual use of the technology. Importantly, introducing SDT motivation as a moderator unveils additional insights. Facilitating conditions exerts a significant influence on both behavioral intention and actual use, indicating a significant moderating effect of SDT moderation on these two pathways. Moreover, SDT motivation also significantly moderates the relationships between facilitating conditions and behavioral intention as well as between facilitating conditions and actual use, adding depth to our understanding of the nuanced interplay between motivation and technology acceptance of generative AI tools. The study concludes with insightful discussions on the findings, acknowledging the robust contributions and highlighting areas for future research to further enrich our understanding of EFL learners’ adoption of generative AI tools in the context of UTAUT2 with SDT moderation.

Self-directed learning (SDL) is acknowledged as an effective language learning paradigm because learning a language is time-consuming. As language and literacy education is now embracing a more multimodal approach in writing instruction, teachers' multimodal technological, pedagogical, and content knowledge (TPACK) receives growing attention in language education. Based on a VR-supported L1 Chinese writing program, the present study collected and analyzed the VR courseware, lesson plans and student worksheets developed by a group of Chinese language teachers in Hong Kong. A coding scheme regarding multimodal TPACK for SDL was employed to assess the learning activities and to understand teachers' multimodal TPACK literacies in L1 Chinese writing instruction. The findings revealed that teachers were able to use VR to immerse students in an authentic environment to develop students' SDL ability and comprehension of nuanced socioemotional aspects of L1 Chinese writing. Nonetheless, there existed some limitations in the utilization of VR for teaching L1 Chinese writing which might be compensated for by pedagogical design. Moreover, teachers' pedagogical conception revealed their teaching was driven by syllabus requirements and focused on students' completion of writing, which might disregard the process of SDL in pedagogical implementation, and thus the process of collaborative knowledge building might be less developed. This study may contribute to the development of VR-based multimodal TPACK, which enhances multimodal lesson design for self-directed L1 writing.

Palpitations are a common symptom managed by general practitioners and cardiologists; atrial fibrillation (AF) is the most common arrhythmia in adults. The recent commercial availability of smartphone-based devices and wearable technologies with arrhythmia detection capabilities has revolutionized the diagnosis and management of these common medical issues, as it has placed the power of arrhythmia detection into the hands of the patient. Numerous mobile health (mHealth) devices that can detect, record, and automatically interpret irregularities in heart rhythm and abrupt changes in heart rate using photoplethysmography (PPG)- and electrocardiogram-based technologies are now commercially available. As opposed to prescription-based external rhythm monitoring approaches, these devices are more inexpensive and allow for longer-term monitoring, thus increasing sensitivity for arrhythmia detection, particularly for patients with infrequent symptoms possibly due to cardiac arrhythmias. These devices can be used to correlate symptoms with cardiac arrhythmias, assess efficacy and toxicities of arrhythmia therapies, and screen the population for serious rhythm disturbances such as AF. Although several devices have received clearance for AF detection from the United States Food & Drug Administration, limitations include the need for ECG confirmation for arrhythmias detected by PPG alone, false positives, false negatives, charging requirements for the battery, and financial cost. In summary, the growth of commercially available devices for remote, patient-facing rhythm monitoring represents an exciting new opportunity in the care of patients with palpitations and known or suspected dysrhythmias. Physicians should be familiar with the evidence that underlies their added value to patient care and, importantly, their current limitations.

This study examined the effects of using automatic speech recognition (ASR) technology on Chinese students' willingness to communicate (WTC) in oral English and the development trajectories of their interactional features in a flipped EFL context. One hundred sixty undergraduates from a Chinese university participated in the 14-week quasi-experiment. Both groups were taught in a flipped fashion. The treatment group was required to use the ASR technology for oral practice in their pre-class self-learning, while the control group conducted their self-learning without the ASR technology. The results found that the ASR-based oral practice led to a significant between-group difference in students' WTC with teacher and class and WTC with non-Chinese, showing that the ASR technology may contribute to improving the Chinese students' WTC in oral English. Conversely, except for the between-group effect on negotiation for meaning, there was no significant difference between the two groups on the other measures of interactional features. Moreover, none of the interactional features of the students in the treatment group changed significantly over time, indicating a limited role of the ASR technology on Chinese students' interactional features. Discussions were conducted regarding the contradictory effects of the ASR technology on WTC and peer interaction.

Although research into the educational benefits of Spherical Video-based Virtual Reality (SVVR) has gained popularity in traditional face-to-face English-as-a-Foreign-Language (EFL) class, little is known about whether this immersive, interactive, and imaginative teaching-assisted technology could facilitate learning in online EFL settings in the post-pandemic time. The current study explored how students engaged themselves in an online EFL class facilitated by SVVR. To achieve that, one focus group interview and two semi-structured interviews were conducted to collect in-depth data of students’ perceptions of their engagement under the SVVR-supported online learning. Based on the theoretical framework of engagement, the collected data were thematically coded into three categories, namely, behavioral, emotional, and cognitive engagement. The findings suggested that with SVVR affordances, students engaged behaviorally, emotionally, and cognitively in the online EFL writing class, both in an independent and interrelated way. The enhanced emotional engagement of students could then support their behavioral engagement while students’ cognitive engagement could also promote their emotional and behavioral engagement. The present study thereby could not only build our understanding of the dynamic, multifaceted, and interconnected nature of student engagement, but also provide one feasible solution to teachers towards the disengagement issue in online EFL learning in the post-pandemic time.

Background Calciphylaxis is a rare, often fatal disease resulting from calcification of dermal arterioles and capillaries. Usually diagnosed in patients with end-stage renal disease, this disorder typically presents as necrotic, nonhealing ulcers in acral or adipose areas. Here we report the case of an elderly man who was found to have calciphylaxis of the distal digits and penis, the latter of which is an uncommon site of disease that carries a particularly poor prognosis. Case presentation A 73-year-old African American man with multiple medical comorbidities including dialysis-dependent end-stage renal disease presented with worsening painful, necrotic lesions on his glans penis and several distal digits over the last 2 months. The wound on the glans was foul smelling with overlying purulence and had been unsuccessfully treated with amoxicillin–clavulanic acid. Discovery of diffuse intravascular calcification on computed tomography, in addition to a markedly elevated calcium–phosphate product immediately prior to the onset of his ulcers, led to the diagnosis of calciphylaxis. The patient was initiated on sodium thiosulfate without improvement in his lesions, and he died 3 months later after another prolonged hospitalization. Conclusions While calciphylaxis is a rare disease, involvement of the distal digits and especially the penis is even more uncommon and portends a particularly poor prognosis: 6-month mortality rates are reportedly as high as 70%. This suggests that prompt recognition and management of the disease is required; however, despite receiving standard therapy, our patient failed to experience improvement in his disease and instead developed several more fingertip ulcers at blood glucose sample points during his hospitalization. A corollary of the case presented here is the need for more effective management of calciphylaxis, especially for patients in whom uncommon sites, such as the penis, are involved.

Glioblastoma Multiforme (GBM) is an aggressive brain tumor with a high mortality rate. Direct reprogramming of glial cells to different cell lineages, such as induced neural stem cells (iNSCs) and induced neurons (iNeurons), provides genetic tools to manipulate a cell’s fate as a potential therapy for neurological diseases. NeuroD1 (ND1) is a master transcriptional factor for neurogenesis and it promotes neuronal differentiation. In the present study, we tested the hypothesis that the expression of ND1 in GBM cells can force them to differentiate toward post-mitotic neurons and halt GBM tumor progression. In cultured human GBM cell lines, including LN229, U87, and U373 as temozolomide (TMZ)-sensitive and T98G as TMZ-resistant cells, the neuronal lineage conversion was induced by an adeno-associated virus (AAV) package carrying ND1. Twenty-one days after AAV-ND1 transduction, ND1-expressing cells displayed neuronal markers MAP2, TUJ1, and NeuN. The ND1-induced transdifferentiation was regulated by Wnt signaling and markedly enhanced under a hypoxic condition (2% O2 vs. 21% O2). ND1-expressing GBM cultures had fewer BrdU-positive proliferating cells compared to vector control cultures. Increased cell death was visualized by TUNEL staining, and reduced migrative activity was demonstrated in the wound-healing test after ND1 reprogramming in both TMZ-sensitive and -resistant GBM cells. In a striking contrast to cancer cells, converted cells expressed the anti-tumor gene p53. In an orthotopical GBM mouse model, AAV-ND1-reprogrammed U373 cells were transplanted into the fornix of the cyclosporine-immunocompromised C57BL/6 mouse brain. Compared to control GBM cell-formed tumors, cells from ND1-reprogrammed cultures formed smaller tumors and expressed neuronal markers such as TUJ1 in the brain. Thus, reprogramming using a single-factor ND1 overcame drug resistance, converting malignant cells of heterogeneous GBM cells to normal neuron-like cells in vitro and in vivo. These novel observations warrant further research using patient-derived GBM cells and patient-derived xenograft (PDX) models as a potentially effective treatment for a deadly brain cancer and likely other astrocytoma tumors.

Background Surgical approach is the most effective treatment for primary spontaneous pneumothorax. The two most widely adopted surgical methods are mechanical abrasion and apical pleurectomy, in addition to bullectomy. We performed a systematic review and meta-analysis to examine which technique is superior in treating primary spontaneous pneumothorax. Methods PubMed, MEDLINE and EMBASE databases were searched for studies published between January 2000 to September 2022 comparing mechanical abrasion and apical pleurectomy for treatment of primary spontaneous pneumothorax. The primary outcome was pneumothorax recurrence. Secondary outcomes included post-operative chest tube duration, hospital length of stay, operative time and intra-operative of blood loss. Results Eight studies were eligible for inclusion involving 1,613 patients. There was no difference in the rate of pneumothorax recurrence between pleural abrasion and pleurectomy (RR: 1.34; 95% CI: 0.94 to 1.92). However, pleural abrasion led to shorter hospital length of stay (MD: -0.25; 95% CI: -0.51 to 0.00), post-operative chest tube duration (MD: -0.30; 95% CI: -0.56 to -0.03), operative time (MD: -13.00; 95% CI -15.07 to 10.92) and less surgical blood loss (MD: -17.77; 95% CI: -24.36 to -11.18). Conclusion Pleural abrasion leads to less perioperative patient burden and shorter hospital length of stay without compromising the rate of pneumothorax recurrence when compared to pleurectomy. Thus, pleural abrasion is a reasonable first choice surgical procedure for management of primary spontaneous pneumothorax.