Autonomic Activity Research Articles

A Unified YOLOv8 Approach for Point-of-Care Diagnostics of Salivary α-Amylase

Salivary α-amylase (sAA) is a widely recognized biomarker for stress and autonomic nervous system activity. However, conventional enzymatic assays used to quantify sAA are limited by time-consuming, lab-based protocols. In this study, we present a portable, AI-driven point-of-care system for automated sAA classification via colorimetric image analysis. The system integrates SCHEDA, a custom-designed imaging device providing and ensuring standardized illumination, with a deep learning pipeline optimized for mobile deployment. Two classification strategies were compared: (1) a modular YOLOv4-CNN architecture and (2) a unified YOLOv8 segmentation-classification model. The models were trained on a dataset of 1024 images representing an eight-class classification problem corresponding to distinct sAA concentrations. The results show that red-channel input significantly enhances YOLOv4-CNN performance, achieving 93.5% accuracy compared to 88% with full RGB images. The YOLOv8 model further outperformed both approaches, reaching 96.5% accuracy while simplifying the pipeline and enabling real-time, on-device inference. The system was deployed and validated on a smartphone, demonstrating consistent results in live tests. This work highlights a robust, low-cost platform capable of delivering fast, reliable, and scalable salivary diagnostics for mobile health applications.

Association of negative affect with resting heart rate variability in medical students.

Association of negative affect with resting heart rate variability in medical students.

Heart Rate Variability (HRV) in Patients with Sleep Apnea and COPD: A Comprehensive Analysis

Background: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are prevalent conditions with overlapping clinical features and shared consequences on autonomic function. Heart rate variability (HRV), a non-invasive biomarker of autonomic nervous system activity, may offer diagnostic, prognostic, and therapeutic insights in this patient population. Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, and MEDLINE to identify peer-reviewed English-language studies published between January 2015 and December 2024. Studies were included if they evaluated HRV parameters in individuals with OSA, COPD, or overlap syndrome, explored HRV as a marker of disease severity or progression. A total of 239 studies were identified; after screening, 41 met the inclusion criteria. Results: The analysis revealed consistent evidence linking reduced HRV with both OSA and COPD severity. HRV alterations were more pronounced in overlap syndrome, reflecting synergistic autonomic dysfunction. HRV showed potential in differentiating disease stages, predicting cardiovascular risk, and evaluating treatment efficacy, particularly for CPAP therapy in OSA. Short-term HRV was particularly sensitive to autonomic changes, while long-term recordings helped track disease progression. Emerging evidence supports the use of HRV derived from wearable technologies as a viable screening tool for health and wellness. Conclusion: HRV is a valuable, non-invasive tool for assessing autonomic dysfunction in OSA, COPD, and their overlap. It offers significant potential for early diagnosis, disease monitoring, and treatment evaluation. Integrating HRV into clinical practice, could enhance diagnostic efficiency, reduce healthcare burden, and improve outcomes in high-risk respiratory populations. Furthermore, longitudinal studies are warranted to standardise HRV thresholds and validate their use in routine screening protocols.

Between a Curse and a Blessing: Germany’s Role in Shaping the EU-Turkish Relations with the Eastern Mediterranean as a Litmus Test

ABSTRACT Germany substantially influenced Türkiye’s relations with the European Union as a preponderant player in European politics. With accession negotiations de facto frozen, the EU refers to Türkiye as a key partner, but also as a challenger in the Eastern Mediterranean. The EU’s highly complex internal dynamics with member states’ diverging interests complicate Türkiye’s relations with the EU. The Eastern Mediterranean has become a hotspot for regional rivalry with ongoing power struggles between Türkiye, Greece, and Cyprus over sovereign rights. While the EU has sided with its member states in this conflict, entangling the multiple knots that involve these three Mediterranean countries – two of whom are EU members – and preserving peace in this region has become a top priority for Germany. This paper’s focus on the Eastern Mediterranean knot is based on the theoretical insights from liberal intergovernmentalism, with Germany’s relative power shaping European foreign policy towards Türkiye. The paper utilises legal, official documents from Germany and the EU to perform a co-occurrence network analysis, to combine empirical analysis with this theoretical background. The aim is to investigate the extent to which Germany, as an autonomous actor, influenced European foreign policy towards Türkiye and the Eastern Mediterranean.

Investigation of the Effect of Empagliflozin on Cardiac Sympathetic and Parasympathetic Nerve Activity Analyzed From Heart Rate Variability Frequency in Japanese Patients With Type 2 Diabetes - Results From the EMPYREAN Study.

The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

Effects of sleep habits and daily level of fatigue in parents on sleep habits and the autonomic nervous system activity of preschool-aged children

ABSTRACT The prevalence of lifestyle-related diseases in children has been increasing as a result of irregular lifestyles. The present study aimed to assess the effects of parents’ sleeping habits and daily fatigue levels on the autonomic nervous system of their children. The study participants were 95 preschool-aged children and their parents. The children’s autonomic nervous system (i.e. low-frequency component (LF)/high-frequency component (HF) ratio, HF, and total power) was measured. The parents completed a questionnaire survey on sleep habits and daily level of fatigue. The results indicated that children whose parents went to bed late compared with early had a higher LF/HF ratio and lower HF during the day. The parents’ sleep durations were negatively associated with the parents’ severity of daily fatigue, suggesting that good sleep habits in parents helped prevent their own fatigue, thereby contributing to good sleep habits and stable autonomic nervous system activity in their children.

Sphenopalatine Ganglion Blocks in Headache Management: A Review

Headache disorders are among the most prevalent and disabling neurological conditions worldwide, affecting more than three billion individuals and contributing to a substantial socioeconomic burden. Despite the availability of pharmacologic treatments such as triptans, NSAIDs, and CGRP monoclonal antibodies, a significant proportion of patients remain refractory or intolerant to these therapies. The sphenopalatine ganglion (SPG), a parasympathetic neural structure in the pterygopalatine fossa, is increasingly recognized as a critical node in the pathophysiology of primary headache disorders. SPG blocks—using local anesthetics, neurolytic agents, or electrical neuromodulation—offer a minimally invasive therapeutic approach by disrupting nociceptive transmission and autonomic activation. This narrative review synthesizes the anatomical and physiological rationale for SPG intervention, details various procedural techniques, evaluates clinical evidence across headache subtypes, and explores future research directions. Conditions covered include migraine, cluster headache, tension-type headache, trigeminal neuralgia, and persistent idiopathic facial pain. With expanding evidence and evolving technologies, SPG-targeted interventions have the potential to reshape the management of refractory headaches and facial pain syndromes.

Objective Measurement of Musculoskeletal Pain: A Comprehensive Review

Background: Musculoskeletal (MSK) pain is a leading contributor to global disability and healthcare burdens. While self-reported pain scales remain the clinical standard, they are limited by subjectivity and inter-individual variability. Therefore, objective assessment tools are increasingly sought to enhance diagnostic precision, guide treatment, and enable reproducible research outcomes. Methods: This comprehensive narrative review synthesizes evidence from physiological, behavioral, and neuroimaging approaches used to evaluate MSK pain objectively. Emphasis is placed on autonomic biomarkers (e.g., heart rate variability, skin conductance), facial expression analysis, electromyographic methods, and functional neuroimaging modalities such as fMRI and PET. Emerging applications of artificial intelligence and multimodal diagnostic strategies are also discussed. Results: Physiological signals provide quantifiable correlations of pain-related autonomic activity but are influenced by psychological and contextual factors. Behavioral analyses, including facial action coding systems and reflex testing, offer complementary, though complex, indicators. Neuroimaging techniques have identified pain-related brain patterns, yet clinical translation is limited by variability and standardization issues. Integrative approaches show promise for improving diagnostic validity. Conclusions: Objective assessment of MSK pain remains methodologically challenging but holds substantial potential for enhancing clinical diagnostics and personalized management. Future research should focus on multimodal integration, standardization, and translational feasibility to bridge the gap between experimental tools and clinical practice.

Russia’s Right and the Putin regime

ABSTRACT Can there be a political current to the right of a regime often described as fascist and as eliminating or crowding out all dissent? We argue that differences in Russia’s political landscape are still discernible and important: distinguishing between the regime and currents to its right allows understanding the ideologization of the Putin regime as the outcome of a dynamic interaction between the regime and factions acting simultaneously as loyalists and critics. The right is an autonomous actor with a historically constituted agenda and ideological coherence that the regime only recently matched. It has provided the Putin regime with many of the concepts and narratives that justify Russia’s current aggressive international posture – while at the same time constituting the country’s most important source of pro-war regime criticism. We explain how the right was able to achieve such influence by discussing how the “geopolitical” current gradually subordinated ethnonationalist positions in the 2010s while joining forces with Russia’s Christian Right.

Students’ Perceptions of Using WhatsApp to Foster Autonomous Listening Skills in English Language Learning

The optimization of WhatsApp as an alternative medium aimed to support learner autonomy and address time constraints in conventional learning, particularly in listening classes. Limited face-to-face meetings reduced students’ opportunities to practice their listening skills. Therefore, WhatsApp was utilized to foster autonomous learning, enabling students to practice listening beyond the classroom. This study aimed to explore the use of WhatsApp as a teaching medium to promote learner autonomy and to investigate students’ perceptions of conducting autonomous listening activities. A qualitative research design was employed, involving 10 students from the Basic Training Class at Happy English Course selected through purposive sampling. Data were collected through observations and semi-structured interviews, then analyzed using data reduction, data display, and conclusion. The findings revealed that students exercised two forms of autonomy control: cognitive process control and learning management control. Students expressed positive perceptions of using WhatsApp for autonomous listening, including ease of access to materials and tasks, increased opportunities for practice, and enhanced motivation through interactive learning. In conclusion, WhatsApp serves as an effective tool to promote learner autonomy and improve students’ listening proficiency.

Associations between SNAP-25 gene polymorphism, autonomic nervous system activity and recovery of consciousness from propofol anesthesia.

The release of synaptic neurotransmitters and function of pre-synaptic proteins are essential for maintaining nervous system excitation. General anesthesia is a reversible state characterized by the loss of consciousness and reduced responsiveness. This study hypothesized that polymorphisms in one or more genes encoding the three pre-synaptic proteins comprising the SNARE complex affect consciousness and autonomic nerve function during propofol anesthesia. One hundred thirty preoperative patients volunteered to undergo a simulated anesthesia procedure. The participants were genotyped for candidate single-nucleotide polymorphisms using the Sanger method. Changes in verbal commands, eyelash reflexes, and the ability to hold a weighted object during anesthesia induction and recovery were recorded. Further, other anesthesia endpoints such as effector compartment concentrations (Ce), bispectral index BIS, heart rate variability (HRV), and peripheral perfusion index (PPI) were explored, based on the polymorphic site of significant differences in consciousness. The results show that the recovery time of verbal commands of the synaptosome-associated protein 25 (SNAP-25) rs6039822 G/G genotype (G/G vs. A/A, 319 (259-378) vs. 379 (318-466) s, P=0.048) were shorter. Logistic regression analysis showed that SNAP-25 rs6039822 and sex were independent factors influencing the recovery of verbal commands (χ2 = 11.916, P=0.008). Other consciousness indices, Ce, HRV and PPI, support the resistance of the SNAP-25 rs6039822 variant to anesthetic during recovery. Genetic variation in SNAP-25 gene is associated with the recovery of consciousness and autonomic nervous system activity during propofol anesthesia. This finding supports that the pre-synaptic proteins may be related to the mechanism of action of propofol.

The Role of Personal Autonomy in the Development of Transformative Competencies in Students

Transformative skills (such as critical thinking or adaptability) are relevant themes in contemporary education, and personal autonomy is often associated with them. Personal autonomy in students is a topic explored in psychology, pedagogy, and educational sciences, focusing primarily on their ability to make decisions, manage their own resources, and act independently in various contexts. Through this research, we aim to investigate the role of personal autonomy in the development of transformative skills in adolescents, reflecting on how freedom of choice, self-regulation and individual responsibility contribute to the development of critical thinking and adaptability to change in modern society. The scientific approach will use a mixed format (qualitative and quantitative) and a range of methods, such as: questionnaires for students (to measure autonomy, motivation, and developed competencies); case studies (interviews with teachers and students from schools with democratic practices); natural experiments (comparison of two classes of students from a high school in Chisinau with a contingent of 268 people - one using traditional methods, and the other with autonomous activities). The questionnaire was divided into three dimensions in order to monitor the cognitive, social and emotional, and methodological autonomy of students. It is important to note that the 268 students come from urban areas, from high school and from the humanities profile. The questionnaire was divided into three dimensions in order to monitor students' cognitive, social and emotional, and methodological autonomy. The data collected allowed us to identify significant differences between students with high versus low autonomy (those with higher autonomy developed more creativity or resilience).

The relationship between sleep quality and cardiac autonomic modulation according to physical activity levels in adults: a cross-sectional study.

Poor sleep quality has been related to various health issues, particularly cardiovascular diseases. This association is partly due to the negative influence that sleep problems have on cardiac autonomic activity, which is often evaluated heart rate variability (HRV). Regular physical activity (PA) has been suggested as an effective strategy to improve HRV and mitigate the adverse effects of sleep disorders. Although some studies have been conducted in this field, further research is warranted to comprehensively understand how PA influences this dynamic. To analyse the association between cardiac autonomic modulation (CAM) and sleep quality, stratified by physical activity levels. The sample consisted of 230 participants. CAM was assessed under resting conditions using time- and frequency-domain indices of HRV: RMSSD, SDNN, LF n.u, HF n.u and nonlinear metrics such as SD1 and SD2. Sleep quality was measured using the Pittsburgh Sleep Quality Index, and PA was objectively quantified with an ActiGraph GT3X accelerometer. Among participants classified as insufficiently active, poor sleep quality was significantly associated with lower parasympathetic activity, reflected in reduced RMSSD (β = -12.10; 95% CI: -21.02 to -3.06) and SD1 (β = -8.39; 95% CI: -14.81 to -1.97) values. No significant associations were found in the physically active group. Lower parasympathetic modulation was observed in insufficiently active individuals reporting poor sleep quality, suggesting that PA may mitigate the unfavorable effects of sleep impairment on cardiac autonomic function.

Emotional Reactivity and Internalizing Symptoms in Middle Childhood: Integrating Autonomic and Behavioral Markers of Social Fear and Positive Affect

ABSTRACTEmotional reactivity is a well‐validated corollary of children's risk for internalizing psychopathology and can be indexed by autonomic and behavioral measures. Yet, it is unclear whether and how autonomic and behavioral markers of emotional reactivity interact to characterize internalizing symptoms and whether these associations differ based on emotional context. As such, the current study aimed to (1) clarify associations between autonomic (RSA, PEP) and behavioral measures of emotional reactivity across two tasks designed to elicit fear and positive affect in social contexts and (2) examine the unique and combined associations between autonomic and behavioral reactivity during these tasks and internalizing symptoms. Participants were 328 children aged 6–10 (M = 7.91, SD = 0.97; 50% female; 94% White). Behavioral displays of positive affect during a parent task were associated with RSA withdrawal, but there were no significant associations between autonomic reactivity and behavioral displays of stranger fear. RSA augmentation during the parent task was associated with lower internalizing symptoms at average or high levels of positive affect. Finally, higher stranger fear was associated with higher internalizing symptoms only when coupled with reciprocal parasympathetic activation. These findings suggest context‐specific patterns of autonomic activation that are differentially associated with internalizing symptoms.

The Effects of Virtual Reality on Hope and Travel Expectations in Healthy and Hospitalized Children: Quasi-Experimental Design Approach

BackgroundVirtual reality (VR) has become a powerful tool for enhancing the experiences of patients with critical illnesses, particularly hospitalized children with leukemia. Since traveling is nearly impossible for them, St Jude has teamed up with the travel company Expedia to launch “Dream Adventures,” a pilot program that offers immersive VR experiences, allowing children to explore new destinations from the comfort of the hospital.ObjectiveThe aim of this study was to evaluate the pleasurable experience of VR and its impact on healthy and hospitalized children’s travel expectations and hope by using electrocardiography (ECG) and questionnaires to enhance research objectivity.MethodsParticipants were children aged 7-18 years, divided into 2 distinct groups: 30 healthy children and 18 hospitalized children with leukemia. Both groups received the same VR intervention and were assessed using a 1-group pretest-posttest design. The questionnaires were designed to assess differences in the children’s sense of hope and travel expectations, and their physiological data were collected through ECG.ResultsThe results indicated a statistically significant increase in hope levels from pre-VR to post-VR intervention in both healthy children (preintervention: mean 5.83, SD 0.87; postintervention: mean 6.36, SD 0.76; P=.002) and hospitalized children (preintervention: mean 5.51, SD 1.17; postintervention: mean 5.73, SD 1.15; P=.03), as determined by paired samples 2-tailed t tests. Furthermore, an independent samples 2-tailed t test revealed a significant difference in postintervention hope levels between the hospitalized children (mean 5.73, SD 1.15) and healthy children (mean 6.36, SD 0.76; P=.05). Then, we further compared the mean differences in hope scores from preintervention to postintervention. Healthy children demonstrated a greater increase (an increase of 0.53, from 5.83 to 6.36) than the hospitalized children (an increase of 0.22, from 5.51 to 5.73). In terms of physiological responses, ECG indicators such as SD of all normal-to-normal intervals and low-frequency power revealed significant differences in autonomic nervous system activity between the 2 groups. Healthy children exhibited higher sympathetic activation, suggesting greater emotional engagement during the VR experience, whereas hospitalized children demonstrated more attenuated responses. The consistency between physiological data and self-reported measures strengthens the construct validity of the instruments used and enhances the overall reliability of the study findings.ConclusionsThe VR intervention significantly increased hope levels in both healthy children and hospitalized children with leukemia, with a greater improvement observed among healthy participants. Therefore, this study suggests that when designing interventions for hospitalized children, more targeted emotional support strategies should be considered. Future studies are recommended to explore different types of VR content and the medical conditions of hospitalized children.

An exploratory study on maternal-fetal heart rate variability during normal and operative vaginal delivery: physiopathological, behavioral and clinical perspectives

Objective. Operative vaginal delivery (OVD) is a major obstetrical issue in developed countries. In this study, we analyzed simultaneous maternal (MHR) and fetal heart rate (FHR) variabilities, as markers of maternal and fetal autonomous nervous systems activity, in relation with OVD.Approach. A set of 44 simultaneous MHR and FHR recordings were obtained from distinct singleton term pregnancies in normal (n= 27) and OVD (n= 17) in the last two hours of labor (H1and H2), and were analyzed using linear and nonlinear indices of heart rate variability analysis. Interaction between MHR and FHR was assessed through their differences and cross-sample entropy analysis.Main results. With progression of labor, there was an increase in most MHR and FHR linear indices, a decrease of entropy indices and an increase of MHR and FHR synchrony/regularity, whereas the sympatho-vagal balance (LF/HF) increased in the mother but decreased in the fetus. Mean MHR, predominance of low frequencies (LFnorm) and LF/HF were significantly higher in the OVD group, while the opposite occurred with the high frequencies (HF) and entropy. The synchronization/regularity between MHR and FHR was significantly higher in OVD. A sensitivity and specificity of 94.1% and 70.4%, respectively, were achieved in the classification of OVD cases using an univariate linear discriminant.Significance. Maternal-FHR variability analysis adds information regarding intrapartum physiology and maternal-fetal behavior and might be considered in prediction models.

AI and Criminal Liability: Theoretical Dilemmas in Applying Criminal Law to Artificial Intelligence

The rapid growth of artificial intelligence (AI) shows undetermined challenges for criminal law, particularly in determining liability for autonomous or semi-autonomous AI actions as traditional legal doctrines based on human intent (Mens Rea) and action (Actus Reus) are not sufficient when applied to Artificial intelligence which lacks consciousness or moral agency, this paper conducts analysis of these pre-existing elements and discusses international and domestic legal frameworks—focusing on Pakistan, the European Union, the United States, and others—to explore how AI-related criminal liability is perceived globally. The study show key gaps in legal areas, liability and enforcement mechanisms, it demonstrate that current legal systems must be reformed or expanded to address the complex legal status of AI for future regulatory development and legal areas.

Role of Central Inflammatory and Oxidative Pathways in the Morphine Exacerbation of Cardiovascular Effects of Sepsis in Rats

Background/Objectives: Sepsis remains one of the most serious and possibly fatal complications encountered in intensive care units. Considering the frequent use of narcotic analgesics in this setting, we investigated whether the cardiovascular and peripheral and central inflammatory features of sepsis could be modified by morphine. Methods: Rats were instrumented with femoral and intracisternal (i.c.) indwelling catheters and sepsis was induced by cecal ligation and puncture (CLP). Results: The i.v. administration of morphine (3 and 10 mg/kg) significantly and dose-dependently aggravated septic manifestations of hypotension and impaired cardiac autonomic activity, as reflected by the reductions in indices of heart rate variability (HRV). Cardiac contractility (dP/dtmax) was also reduced by morphine in septic rats. The morphine effects were mostly eliminated following (i) blockade of μ-opioid receptors by i.v. naloxone and (ii) inhibition of central PI3K, MAPK-ERK, MAPK-JNK, NADPH oxidase (NADPHox), or Rho-kinase (ROCK) by i.c. wortmannin, PD98059, SP600125, diphenyleneiodonium, and fasudil, respectively. Further, these pharmacologic interventions significantly reduced the heightened protein expression of toll-like receptor 4 (TLR4) and monocyte chemoattractant protein-1 (MCP1) in brainstem rostral ventrolateral medullary (RVLM), but not cardiac, tissues of CLP/morphine-treated rats. Conclusions: Morphine worsens cardiovascular and autonomic disturbances caused by sepsis through a mechanism mediated via μ-opioid receptors and upregulated central inflammatory, chemotactic, and oxidative signals. Clinical studies are warranted to re-affirm the adverse cardiovascular interaction between opioids and the septic challenge.

Self-care and self-management in diabetes: concepts, theories and practices.

Diabetes mellitus is a progressive disorder that requires the active participation of individuals with diabetes to improve management and delay the onset of acute and chronic complications. Effective diabetes care necessitates a multifaceted approach involving insulin therapy, non-insulin anti-diabetic drugs and lifestyle adjustments. Self-management and self-care are integral, yet distinct, components of diabetes care. While both play a pivotal role in optimising diabetes care, their distinctions and similarities are often misunderstood. These terms are frequently used interchangeably. Although some activities are unique to each concept, inconsistencies exist in the published literature. Self-management refers to patient behaviours guided by healthcare professionals, whereas self-care encompasses autonomous actions patients take to maintain health and prevent complications. Both concepts involve activities that foster long-term collaboration between patients and healthcare professionals.

Illustrating the contribution of Confucian philosophy through a reinterpretation of Beauchamp and Childress' principle of respect for autonomy.

This article illustrates the contribution of Chinese philosophy to the field of medical humanities by focussing on the ideas and conduct of Confucius. Drawing on a Chinese philosophical classic, the Analects (Lunyu), this study proposes a Confucian reinterpretation of Beauchamp and Childress' principle of respect for autonomy in medical ethics. The paper begins by critiquing Beauchamp and Childress' three conditions of autonomous action, namely intentionality, understanding, and the absence of controlling influences that determine one's action. It is contended that the three conditions over-emphasise rationality and overlook the role of emotions and morality in autonomy. The second part of the article proposes a Confucian reformulation of the three conditions that is derived from the concepts of xin (heart-mind) and li (normative behaviour). The modified conditions are moral intentionality, the integration of understanding and emotions, and the absence of controlling influences that determine one's action and underlying values, beliefs, attitudes, feelings and predispositions. From a Confucian perspective, Beauchamp and Childress' positive obligation for the principle of respect for autonomy requires medical professionals to render empathetic treatment towards patients. By challenging and reconstructing major theories and assumptions in medical ethics, this paper demonstrates the saliency of non-Western philosophical traditions in medical humanities.