The rising global burden of cerebrovascular disease, propelled by an aging population, highlights the inherent limitations of conventional, labor-intensive diagnostic paradigms. In the context of time-sensitive stroke management, variability in image interpretation and the high rate of misclassification, particularly during the assessment of transient ischemic attack (TIA), underscore the urgent need for more consistent and efficient diagnostic solutions. Artificial intelligence (AI), particularly deep learning (DL), offers a transformative pathway by automating the analysis of complex neurovascular imaging. Here, we conduct a comprehensive examination of how DL is revolutionizing stroke-related image analysis, moving beyond general assertions of potential to discuss specific technical implementations. We systematically detail the evolution from traditional segmentation algorithms to advanced deep learning architectures—such as U-Net, DeepMedic, and their variants—in performing critical tasks. These tasks encompass the automated segmentation of intracranial and extracranial (carotid) arteries, the quantification of stenosis and plaque burden, and the hemodynamic assessment of vascular lesions across modalities including MRA, CTA, and DSA. By synthesizing landmark studies, our analysis delineates three core aspects: the technological trajectory of DL models in achieving expert-level accuracy in vascular feature extraction in controlled studies; the clinical translation of these tools into diagnostic, prognostic, or therapeutic procedural planning workflows; and the persistent challenges and future directions, including data standardization, model generalizability, and multimodal integration. This review posits that DL represents not merely an assistive technology but a foundational cornerstone for the next generation of precision cerebrovascular medicine. It holds the potential to bridge critical gaps in diagnostic speed, objectivity, and accessibility, provided its development and validation are guided by rigorous, interdisciplinary collaboration.
The vagus nerve as a neurovisceral interface: a comprehensive review
The vagus nerve is the longest cranial nerve and a key component of the autonomic nervous system, functioning as a neurovisceral interface between the brain and peripheral organs. Despite well-defined anatomy, the mechanisms underlying its integrative roles in cardiovascular, metabolic, and neuropsychiatric regulation remain incompletely understood. This narrative review synthesizes current evidence on the anatomical organization, physiological functions, and clinical relevance of the vagus nerve, focusing on cardiac autonomic control, gastrointestinal and metabolic regulation, the gut–brain axis, and vagus nerve stimulation. In the cardiovascular system, it interacts with sympathetic pathways within the cardiac plexus and intrinsic cardiac nervous system to regulate heart rate and conduction. In the gastrointestinal system, it coordinates motility, secretion, and metabolic homeostasis through nutrient- and hormone-sensitive pathways. Within the gut–brain axis, emerging evidence highlights rapid neuroepithelial signaling and microbiota-dependent modulation mediated by vagal circuits. The vagus nerve stimulation represents a promising therapeutic strategy for restoring autonomic balance, although challenges remain in fiber selectivity and clinical variability. Advances in multi-omics approaches are beginning to reveal the molecular heterogeneity of vagal neurons, but significant gaps persist due to limited human anatomical data. In conclusion, the vagus nerve functions as a multidimensional integrative system, and a deeper understanding of its structure and molecular organization is essential for developing precise neuromodulatory therapies.
A study on the relationship between research stress, research anxiety, research performance, and job satisfaction among Chinese healthcare professionals and its influencing mechanisms: a national multi-center survey
BackgroundChinese healthcare professionals face dual pressures from clinical duties and research activities, which may increase research-related anxiety and reduce job satisfaction. While occupational stress has been well studied, the mechanisms linking research stress to job satisfaction are unclear. Research performance may also play a key role, but its impact remains uncertain. This study explores the relationships between research stress, research anxiety, research performance, and job satisfaction, and identifies the pathways connecting these variables.MethodsA cross-sectional survey was conducted among healthcare professionals (nurses, physicians, and pharmacists) from eastern, central, and western regions of China to assess research-related conditions and job satisfaction (JS). Job satisfaction was measured using a modified validated scale. Research stress (RS), research anxiety (RA), and research performance (RP) were assessed using self-developed instruments. Structural equation modeling (SEM) was employed to perform path analysis and mediation analysis.ResultsA total of 924 healthcare professionals were included in the study. Over 85% reported working more than 40 hours per week, and 66.5% rated their health status as fair or poor. Regarding the types of research conducted by healthcare professionals, clinical research accounted for the highest proportion (63.2%), followed by basic science research (9.8%), while health services research and community-based research were relatively less common. The mean scores of JS, RS, RA, and RP were 3.40 ± 0.88, 2.56 ± 0.70, 2.34 ± 0.87, and 3.55 ± 0.82, respectively. Path analysis revealed that research stress was positively associated with research anxiety and negatively associated with both research performance and job satisfaction. Research anxiety was also negatively associated with research performance and job satisfaction, whereas research performance was positively associated with job satisfaction. Mediation analysis indicated that research stress was associated with job satisfaction both directly and indirectly through research anxiety and research performance.ConclusionsResearch stress is negatively associated with job satisfaction among healthcare professionals through increased research anxiety, whereas higher research performance is positively associated with job satisfaction. Hospitals and healthcare institutions should optimize the research environment, strengthen psychological support, and enhance research resource allocation to reduce research stress, improve research performance, and ultimately increase job satisfaction.
ADHD as a disorder of operational capacity: a buffered-state framework for sustained engagement instability
Attention-deficit/hyperactivity disorder (ADHD) is commonly conceptualized as a disorder of executive dysfunction or impaired motivation. In clinical practice, however, many individuals with ADHD describe a different core difficulty: they can initiate tasks appropriately, understand goals, and exert effort, yet struggle to remain engaged as time-on-task and internal strain accumulate. These failures are often abrupt, ego-dystonic, and strongly context-dependent, posing challenges for models based solely on static deficits or gradual depletion. Building on this phenomenology, we propose a constraint-level framework that conceptualizes ADHD as a disorder of operational capacity—the finite tolerance for sustaining stable mental engagement under cumulative cognitive and emotional demand. Within this framework, sustained engagement is modeled as a buffered state that remains stable while cumulative load is within tolerance but becomes increasingly fragile near saturation and may undergo nonlinear collapse into disengagement. We formalize this governing constraint as Operational Economy (OE)—a regulatory, not energetic, constraint principle—and describe a pre-volitional Global Switching Framework (GSF) that mediates rapid state transitions once engagement stability is exceeded. This formulation integrates and extends cognitive-energetic and state-regulation accounts while explicitly differentiating the OE/GSF framework from these predecessors by its emphasis on threshold-dependent dynamics, bounded tolerance, and asymmetric re-engagement. This framework offers a coherent account of clinical features such as intact initial performance with late-stage disengagement, pronounced time-on-task effects, and context-dependent hyperfocus. The framework generates falsifiable predictions regarding sensitivity to cumulative demand, stress-related acceleration of disengagement, pharmacological effects that preferentially extend engagement endurance rather than normalize peak executive performance, and individual differences across ADHD subtypes and comorbid presentations. These predictions are consistent with existing empirical findings on time-dependent variability in ADHD and provide a basis for future experimental validation.
Altered EEG microstate dynamics in adolescents with non-suicidal self-injury at rest and following acute social exclusion
BackgroundNon-suicidal self-injury (NSSI) is highly prevalent in adolescence, yet the fast dynamics of large-scale brain networks remain poorly understood. We aimed to characterize resting-state EEG microstate dynamics in a clinically recruited adolescent NSSI sample and to examine state-dependent changes following acute social exclusion.MethodsResting-state EEG was recorded in hospitalized, medicated adolescents with NSSI and in healthy controls (HCs). An NSSI subgroup then completed EEG assessments before and after either Cyberball-induced social exclusion or a non-stress control condition. Microstate parameters and transition probabilities were analyzed.ResultsAfter multiple-comparison correction, the core baseline finding was robustly reduced microstate A duration in the NSSI group relative to HCs. In uncorrected exploratory analyses, additional differences included shorter durations of microstates B and F, higher occurrence of microstate D, and increased F→D transition probability. A multivariate pattern analysis suggested group-related information but must be interpreted cautiously given the modest sample size. Within the NSSI group, the exclusion group showed reduced microstate A expression and increased microstate D expression relative to the non-stress subgroup, with a broader transition shift toward microstate D. Several interaction effects survived correction.ConclusionsIn this medicated inpatient sample, resting-state microstate dynamics differed from HCs, most robustly in reduced microstate A duration, and reorganized after social exclusion. Specificity to NSSI remains uncertain given the absence of an MDD-only clinical-control group and healthy Cyberball comparison. These preliminary findings require replication in larger studies including medication-naive MDD-only, MDD+NSSI, and HC groups.
Barriers and facilitators impacting access to sexual and reproductive health services for women with intellectual disability
BackgroundIn most parts of the world, people with disabilities are deprived of education, employment, health, and social and political rights. Moreover, women with disabilities can be subjected to double discrimination because of their gender and are more likely to experience physical, mental, and sexual abuse. Because of the nature of their disability, women with intellectual disability in particular face stigma and discrimination in accessing sexual and reproductive healthcare, which in turn affects their decision-making abilities regarding sexuality. In Ethiopia, due to a lack of resources and limited awareness, women with intellectual disabilities have difficulties accessing sexual and reproductive healthcare to meet their needs. We, therefore, aimed to explore the barriers and facilitators impacting access to sexual and reproductive health services in Gondar, Ethiopia.MethodsThe study employed a qualitative descriptive approach to explore the existing barriers and facilitators impacting access to sexual and reproductive health services, aiming to inform how to improve service provision for women with intellectual disabilities in Gondar, Ethiopia. Using a semi-structured interview guide, we conducted interviews in Amharic with 17 purposively selected women with intellectual disability, aged 15-49, in Gondar, Ethiopia. After the interviews were transcribed, we conducted a thematic analysis using both inductive and deductive approaches in NVivo 14.ResultsThe analysis of the study resulted in six themes reflecting on different barriers and facilitators impacting Sexual and reproductive healthcare access: sexual and reproductive health education, contraception, prevention of sexual abuse, prevention of sexually transmitted infections, pregnancy and parenthood, and the roles of community-based rehabilitation impacting access to Sexual and reproductive health services.ConclusionsStudy findings showed the barriers and facilitators impacting access to sexual and reproductive health services for women with intellectual disability, based on firsthand information and experiences of these women embedded in structural and sociocultural factors. The study’s findings could guide future researchers, healthcare policymakers and healthcare practitioners to design culturally appropriate and disability inclusive interventions promoting sexual and reproductive healthcare access and improved outcomes among women and girls with intellectual disability.
Fragile self, mechanical world: mechanistic delusions and ego fragility in schizotypal–affective spectrum disorder—a CARE case report
Categorical nosological systems frequently fall short when confronted with patients whose presentations cross established diagnostic boundaries. We report M.S., a 44-year-old Brazilian man involuntarily admitted to a psychiatric inpatient unit who presented with systematized persecutory ideation of mechanistic–technological content (chip implantation, satellite-based surveillance), structural ego fragility, absent insight, and progressive social and occupational deterioration. While prior diagnoses of bipolar disorder and provisional schizophrenia had been considered, neither fully captured the clinical complexity. Psychopathological-dimensional analysis, grounded in phenomenological observation and contemporary psychopathological theory, suggests three potentially interacting axes: (1) structural ego fragility (Ich-Schwäche), potentially arising from impaired early attachment and deficient relational learning; (2) a relational causality deficit replaced by concrete–mechanistic reasoning; and (3) limbic hyperactivation that appears to sustain an anxiety–perplexity–paranoia feedback loop. These converge on a schizotypal–affective spectrum formulation. Laboratory investigations identified severe dyslipidemia and marked hyperandrogenism (total testosterone 1,367 ng/dL), the latter potentially associated with limbic hyperactivation, though causality cannot be established from a single cross-sectional measurement. Psychometric assessment (BPRS-18) at admission yielded a total score of 43, with suspiciousness (5) and unusual thought content (5) as dominant items. During a seven-day inpatient course, a multimodal thymic strategy—risperidone, lithium carbonate, and structured psychotherapy—produced attenuation of paranoid reactivity, improved family engagement, and the spontaneous resumption of guitar playing from day 3, as a functional correlate of behavioral stabilization. The patient was discharged with a referral for a three-monthly paliperidone palmitate long-acting injectable. The pharmacological response retrospectively supports the dimensional formulation and illustrates the heuristic value of psychopathological analysis grounded in ego structure, causal reasoning, and affective dysregulation as a complementary approach to categorical nosology in complex psychotic–affective presentations.
Editor’s pick: Stylus Medicine
Nature Biotechnology, Published online: 16 July 2026; doi:10.1038/s41587-026-03225-x
Each year, Nature Biotechnology highlights companies that received sizeable early-stage funding in the previous year. Stylus Medicine is engineering novel recombinases for in vivo CAR T cell cancer therapy.
J. Craig Venter 1946–2026
Nature Biotechnology, Published online: 16 July 2026; doi:10.1038/s41587-026-03248-4
J. Craig Venter 1946–2026
Englumafusp alfa plus glofitamab in B cell non-Hodgkin lymphoma: a phase 1 trial
Nature Medicine, Published online: 16 July 2026; doi:10.1038/s41591-026-04533-0
Combining the CD19–4-1BBL co-stimulatory molecule englumafusp alfa with the bispecific antibody glofitamab in patients with relapsed or refractory aggressive B cell non-Hodgkin lymphoma showed acceptable safety signals and encouraging preliminary clinical responses, with mechanistic data supporting the rational choice of therapy.