Changes In System Research Articles

Forgiveness as morally serious response to errors in healthcare: A narrative review

Retribution is often seen as a morally serious response to errors and undesirable behaviors, typically expressed through blame, punishment, and exclusion. These actions are meant to uphold professional standards, deter future wrongdoing, and restore moral balance. However, I argue that while retribution addresses certain ethical concerns, it is incomplete and can be counterproductive, particularly for patient safety and organizational learning. Systems that focus primarily on individual blame risk fostering underreporting, entrenching learning disabilities, and exacerbating harm. In this paper I propose that forgiveness — the foregoing of vindictive resentment toward a wrongdoer — offers a morally serious alternative. It facilitates accountability, restoration, and healing without trivializing the ethical weight of the harm done. By encouraging forward-looking accountability, forgiveness allows the wrongdoer to acknowledge their mistakes, make amends, and help improve practice. This not only respects the humanity of everyone involved, and addresses emotional and relational consequences, but also recognizes the systemic factors that contribute to errors. I outline concrete steps for integrating forgiveness into healthcare’s post-incident processes, balancing accountability with the need for healing and systemic change.

Exploring Online Education for Circular Economy: Content Analysis and Didactical Approaches in Plastic Waste Management Courses

Purpose: The increasing emphasis on sustainable practices in managing plastic waste underscores the importance of education and training in fostering a circular economy. This article aims to elucidate the critical role of awareness-raising and capacity-building initiatives, which have become pivotal as societies transition towards more sustainable economic models, particularly concerning plastic management. Study design/methodology/approach: This article investigates online courses' availability, content, and methodological frameworks dedicated to the circular economy and plastic-related issues. The primary objective is to develop a comprehensive theoretical framework that elucidates how these courses are designed to enhance awareness of plastic-related challenges, disseminate relevant knowledge, and educate the public about potential solutions. Findings: The analysis focuses on these courses' structure, content, and pedagogical methodologies to evaluate their effectiveness in informing and engaging learners. It assesses how effectively these courses enhance learners' capacities to tackle plastic-related challenges and equip them with the skills necessary for fostering innovation within the plastic value chain. Originality/value: While awareness-raising and capacity-building are essential for advancing a circular economy, systemic changes in production and consumption patterns are equally critical. The integration of advanced recycling methods, renewable energy solutions, and carbon capture technologies can significantly mitigate the plastic industry's carbon footprint. A holistic approach that comprehensively addresses the lifecycle of plastics—from design to disposal—is essential for achieving a genuinely circular and climate-neutral economy.

Allocating quotas for industrial carbon emissions fairly and efficiently to achieve “peak carbon”: A case of the yellow river basin in China

The “peak carbon” target has triggered wide-ranging and profound systemic changes and transformations that have left the provinces along the basin facing the dual dilemma of implementing carbon reduction actions and socioeconomic development. The allocation of carbon emission quotas is a fundamental task that reflects the division of labour and collaboration within a river basin to achieve the “peak carbon” target. Therefore, the fair and efficient allocation of industrial carbon emission quotas is the key to the implementation of carbon emissions trading and the establishment of carbon offset mechanisms. In the study, based on the description of the spatial and temporal evolution of the industrial carbon footprint and its carrying capacity, the industrial carbon offset area and industrial carbon reimbursement area are divided. Moreover, the allocation method of industrial carbon emission quotas is proposed by accounting for the principles of fairness, efficiency, and sustainability, and is verified using the provinces along the Yellow River Basin in China as a case. The results show that the industrial carbon carrying capacity is “unbalanced”. The provinces with strong carrying capacity are in the middle and upper reaches, and provinces with weak carrying capacity are in the middle and lower reaches. Moreover, the industrial carbon offset in the basin as a whole is higher than the industrial carbon compensation, which is potentially conducive to the implementation of cross-basin carbon offset. The weights of the equity, efficiency and sustainability indicators are 0.46, 0.23 and 0.31, respectively. The two industrial carbon compensated provinces can transfer the surplus industrial carbon emission quotas to the two industrial carbon offset provinces after obtaining the corresponding financial compensation. The Gini coefficient is 0.26, which is relatively fair. The study not only reveals the mechanism of the relationship among industrial carbon carrying capacity, carbon emission quota and carbon offset, but also provides a scientific basis for the establishment of a carbon emission quota trading market and the strengthening of the inter-provincial coordinated emission reduction incentives in the basin.

Autonomous nervous system responses to environmental-level exposure to 5G's first deployed band (3.5GHz) in healthy human volunteers.

Following the global progressive deployment of 5G networks, considerable attention has focused on assessing their potential impact on human health. This study aims to investigate autonomous nervous system changes by exploring skin temperature and electrodermal activity (EDA) among 44 healthy young individuals of both sexes during and after exposure to 3.5GHz antenna-emitted signals, with an electrical field intensity ranging from 1 to 2V/m. The study employed a randomized, cross-over design with triple-blinding, encompassing both 'real' and 'sham' exposure sessions, separated by a maximum interval of 1week. Each session comprised baseline, exposure and postexposure phases, resulting in the acquisition of seven runs. Each run initiated with a 150s segment of EDA recordings stimulated by 10 repeated beeps. Subsequently, the collected data underwent continuous decomposition analysis, generating specific indicators assessed alongside standard metrics such as trough-to-peak measurements, global skin conductance and maximum positive peak deflection. Additionally, non-invasive, real-time skin temperature measurements were conducted to evaluate specific anatomical points (hand, head and neck). The study suggests that exposure to 3.5GHz signals may potentially affect head and neck temperature, indicating a slight increase in this parameter. Furthermore, there was a minimal modulation of certain electrodermal metrics after the exposure, suggesting a potentially faster physiological response to auditory stimulation. However, while the results are significant, they remain within the normal physiological range and could be a consequence of an uncontrolled variable. Given the preliminary nature of this pilot study, further research is needed to confirm the effects of 5G exposure.

Systemic Immunological Changes After Yttrium-90 Radioembolization: A Pilot Prospective Observational Study-Clinical Insights.

To prospectively investigate levels of circulating cytokines, changes in frequencies of various immune cell subsets and expression of proliferation and checkpoint molecules on T cells in the peripheral blood after yttrium-90 radioembolization (TARE) of colorectal cancer liver metastases (CLM). We prospectively collected, isolated, and froze peripheral blood mononuclear cells (PBMC) and plasma samples from 15 patients immediately before, immediately after, 3 and 6 weeks post-TARE of CLM. Plasma samples were assessed for various cytokines using a multiplex immunoassay platform. PBMC samples were analyzed in a monocyte/dendritic cell (DC)/B cell flow panel and a T cell activation/exhaustion flow phenotyping panel. We compared the levels at the respective time points using Wilcoxon signed rank test. IFN-g significantly decreased immediately after (mean 1.62 vs. 3.02 at baseline, p = 0.04) and increased at 6weeks compared to the immediately post-TARE nadir (mean 9.42 vs. 1.62, p = 0.04). IL-10 decreased at 3weeks (mean 0.36 vs. 1.75, p = 0.025) post-TARE compared to baseline. Increased CD3+T cells (mean 78.24 vs. 60.8, p = 0.002) and decreased CTLA-4+CD4+T cells (mean 2.58 vs. 4.41, p = 0.033) were observed at 3weeks compared to baseline. Increased Ki-67+ proliferating CD8+T cells at 3 and 6weeks (mean 7.28 and 9.06, respectively, vs. 3.93 at baseline, p = 0.02 and 0.03) were recorded. A shift toward a favorable antitumoral cytokinic and immune cells response was observed after TARE. Significant changes were in specialized immune cells subsets playing important roles in the activation of the immune system. These results support trials combining TARE with immunotherapy for patients with CLM.

Some personal reflections on prison medical care.

This is a personal account of medical practices and healthcare behind bars, which draws on direct experiences and narrations from fellow prisoners, accumulated during eleven years in custody. It touches on issues of the relationship of medical professionals with the torture of detenus, the anarchy of everyday prison medication, frailty and death among older inmates and the proposals and prospects for prison healthcare reform. It sees a need for systemic change, but the prognosis is not optimistic.

The long arc of learning: Perspectives and innovations from 20 years of U.S. National Professional Development Program projects

AbstractU.S. National Professional Development (NPD) grants can afford a longitudinal understanding of how teachers learn to support English learners. When NPD projects are completed successively and successfully, they can provide an even greater longitudinal arc of understanding. This article chronicles the designs and lessons learned across five NPD grants between 2002 and 2023. Each grant represents a snapshot in time, presenting a set of assumptions from the field, programmatic innovations, and insights from research outcomes. From highlighting the difference between incremental and radical pedagogical change and what it takes to move beyond individual teacher change to systemic change benefiting multilingual learners, the article outlines the succession of aspirations (capacity building, sustainability, and scalability), experiences, changing conditions, and data points framing lessons learned and new cycles of praxis. This article offers implications for theory, practice, and research. It stands as an argument for adapting, innovating, and moving beyond the status quo to inspire more innovation in teacher preparation for multilingual learners.

Efficiency of Sustainability Cues in Consumer Choices of Seafood—Consumer Segments and Willingness to Pay in Southern China

Achieving sustainability goals in the food system should be informed by consumer demand that signals the market trend and drives systemic changes. This study examines the efficiency of sustainability cues in influencing consumer choices of seafood among consumers in Southern China. The preference and willingness to pay for each seafood attribute are estimated using the Latent Class Logit model. The results show that respondents strongly believed in governmental certifications and were more willing to pay for domestic seafood certified to public standards over imported seafood with third-party sustainability certifications. By integrating individual characteristics into the membership function, this study finds that the preference for sustainability cues and other authenticity cues is related to seafood consumption habits and education. The study highlights the efficiency heterogeneity of sustainability cues, providing valuable insights for formulating public policy and developing marketing strategies that promote sustainable consumption.

Rethinking Loss of Available Work and Gouy-Stodola Theorem

Abstract Exergy represents the maximum useful work possible when a system at a specific state reaches equilibrium with the environmental dead state at temperature To. Correspondingly, the exergy difference between two states is the maximum work output when the system changes from one state to the other, assuming that during the processes, the system exchanges heat reversibly with the environment. If the process involves irreversibility, the Guoy-Stodola theorem states that the exergy destruction equals the entropy generated during the process multiplied by To. The exergy concept and the Gouy-Stodola theorem are often used to optimize processes or systems, even when they are not directly connected to the environment. In the past, questions have been raised on if To is the proper temperature to use in calculating the exergy destruction. Here, we start from the first and the second laws of thermodynamics to unambiguously show that the useful energy loss (UEL) of a system or process should equal to the entropy generation multiplied by an equivalent temperature associated with the entropy rejected out of the entire system. For many engineering systems and processes, this entropy rejection temperature can be easily calculated as the ratio of the changes of the enthalpy and entropy of the fluid stream carrying the entropy out, which we call the state-change temperature. The UEL is unambiguous and independent of the environmental dead state, and it should be used for system optimization rather than the exergy destruction.

Systemic Effects and Absorption of Subepithelial Dexamethasone Vocal Fold Injections.

To compare the systemic changes following two office-based procedures-subepithelial vocal fold steroid injections (VFSI) and vocal fold augmentation (VFA), and to characterize the magnitude and chronicity of the effects observed. Prospective, controlled before-after comparative study. Patients prospectively underwent VFSI with 0.8-2 mg of dexamethasone or VFA. Serum cortisol, white cell count (WCC), and C-reactive protein (CRP) were measured at day 0 (pre-procedure), 1 and 7. Salivary cortisol was measured at baseline and daily for 7 days post-procedure. Fourteen patients underwent VFSI and 36 VFA. At baseline serum cortisol measured 304.6 ± 116.6 nmol/L and fell significantly to 48.1 ± 41.8 nmol/L 1 day following dexamethasone injection (p = 0.001) and recovered by day 7 to 303.7 ± 78.7 nmol/L. Salivary cortisol demonstrated a similar pattern with significant recovery demonstrated by day 3 (p = 0.001). White cell counts were affected by the systemic absorption of exogenous steroid and normalized by day 7. Patients who underwent VFA demonstrated no significant change in their serum or salivary cortisol and no significant change in their WCC. No significant changes in CRP or patient's physiological parameters were observed in either procedure. Our findings demonstrate systemic absorption of dexamethasone following VFSI, with acute hypothalamic-pituitary-adrenal (HPA) axis suppression which normalizes day 3 post-procedurally. 3 Laryngoscope, 2024.

Magnitude of cardiac abnormality and its associated factors among hyperthyroidism patients on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BackgroundThyroid hormones have an effect on every organ system, in particular, the heart responds to minimal changes in serum thyroid hormone level. Thyroid hormone causes a lot of changes in the cardiovascular system, such as increased heart rate, contractility, systolic hypertension, changes in peripheral vascular resistance, atrial fibrillation (AF), and hypercoagulability from the direct effect of thyroid hormone on cardiac myocyte and /or due to increased metabolic state. However, the magnitude of such heart abnormalities and its associated factors were not well studied in Ethiopia.ObjectiveTo determine the magnitude of cardiac abnormality and its associated factors among hyperthyroidism patients on follow-up at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, 2022.MethodsAn institution-based cross-sectional study was carried out among 318 hyperthyroid patients who were on follow-up at the endocrine clinic of TASH, Addis Ababa, Ethiopia from June to October 2022. The data were collected using a pretested structured interviewer administered questionnaire. The data were entered into the computer using EpiData version 3.1 and analyzed using SPSS version 25 software. Bivariable and multivariable logistic regression models were fitted to determine the association between the independent and dependent variables. Adjusted odds ratio with its 95% confidence interval and p-value < 0.05 were used to declare the presence and strength of statistically significant associations.ResultIn this study a total of 318 hyperthyroid patients were participated, most (90.9%) of them were females. The overall prevalence of heart failure among hyperthyroid patients was 17.0% (95% CI = 13.0, 21.6). More than half (52.7%) and one third (33.2%) of the participants showed abnormal electrocardiographic and echocardiographic findings respectively. Marital status (not married) [AOR = 2.37, 95% CI (1.03, 5.44)], pattern of hyperthyroidism [AOR = 13.09, 95% CI (4.70, 36.41)], being Asthmatic [AOR = 7.63, 95% CI (1.55, 37.52)], type of medication [AOR = 3.49, 95% CI (1.11, 11.02)] and duration of treatment [AOR = 4.95, 95% CI (2.05,11.99)] were significantly associated with cardiac abnormality.ConclusionA significant portion of hyperthyroid patients overburdened by cardiac abnormalities. Being unmarried, overt hyperthyroid, Asthmatic, long stay on treatment and type of treatment were significantly associated with cardiac abnormality. Hence, attention should be given for cardiac abnormalities while treating hyperthyroid patients.

Intraperitoneal Injection of the Porphyromonas gingivalis Outer Membrane Vesicle (OMV) Stimulated Expressions of Neuroinflammatory Markers and Histopathological Changes in the Brains of Adult Zebrafish.

Porphyromonas gingivalis is the major pathogenic bacteria found in the subgingival plaque of patients with periodontitis, which leads to neuroinflammation. The bacteria destroy periodontal tissue through virulence factors, which are retained in the bacteria's outer membrane vesicles (OMV). This study aimed to determine the real-time effect of an intraperitoneal injection of P. gingivalis OMV on the production and expression of inflammatory markers and histopathological changes in adult zebrafishes' central nervous systems (CNS). Following the LD50 (21 µg of OMV), the zebrafish were injected intraperitoneally with 18 µg of OMVs, and the control group were injected with normal saline at seven different time points. Brains of experimental zebrafish were dissected at desired time points for colorimetric assays, ELISA, and histology. This study discovered that nitric oxide and PGE2 were significantly increased at 45 min, while IL-1β and IL-6 were expressed at subsequent 12 h and 24 h time points, respectively. Histopathological changes such as blood coagulation, astrocytosis, edema, spongiosis, and necrosis were observed between the 6hour and 24 h time points. The two apoptotic enzymes, caspases 3 and 9, were not expressed at any point. In summary, the OMV-induced neuroinflammatory responses and histopathological changes in adult zebrafish were time-point dependent. This study will enrich our understanding of the mechanism of P. gingivalis OMVs in neuroinflammation in a zebrafish model, most especially the timing of the expression of inflammatory mediators in relation to observable changes in brain tissues.

Functional activity and connectivity signatures of ketamine and lamotrigine during negative emotional processing: a double-blind randomized controlled fMRI study

Ketamine is a highly effective antidepressant (AD) that targets the glutamatergic system and exerts profound effects on brain circuits during negative emotional processing. Interestingly, the effects of ketamine on brain measures are sensitive to modulation by pretreatment with lamotrigine, which inhibits glutamate release. Examining the antagonistic effects of ketamine and lamotrigine on glutamate transmission holds promise to identify effects of ketamine that are mediated through changes in the glutamatergic system. Investigating this modulation in relation to both the acute and sustained effects of ketamine on functional activity and connectivity during negative emotional processing should therefore provide novel insights. 75 healthy subjects were investigated in a double-blind, single-dose, randomized, placebo-controlled, parallel-group study with three treatment conditions (ketamine, lamotrigine pre-treatment, placebo). Participants completed an emotional face viewing task during ketamine infusion and 24 h later. Acute ketamine administration decreased hippocampal and Default Mode Network (DMN) activity and increased fronto-limbic coupling during negative emotional processing. Furthermore, while lamotrigine abolished the ketamine-induced increase in functional connectivity, it had no acute effect on activity. Sustained (24 h later) effects of ketamine were only found for functional activity, with a significant reduction in the posterior DMN. This effect was blocked by pretreatment with lamotrigine. Our results suggest that both the acute increases in fronto-limbic coupling and the delayed decrease in posterior DMN activity, but not the attenuated limbic and DMN recruitment after ketamine, are mediated by altered glutamatergic transmission.

Actionable human–water system modelling under uncertainty

Abstract. This paper develops an actionable interdisciplinary model that quantifies and assesses uncertainties in water resource allocation under climate change. To achieve this objective, we develop an innovative socio-ecological grand ensemble that combines climate, hydrological, and microeconomic ensemble experiments with a widely used decision support system for water resource planning and management. Each system is populated with multiple models (multi-model), which we use to evaluate the impacts of multiple climate scenarios and policies (multi-scenario, multi-forcing) across systems so as to identify plausible futures where water management policies meet or miss their objectives and to explore potential tipping points. The application of the methods is exemplified by a study conducted in the Douro River basin (DRB), an agricultural basin located in central Spain. Our results show how marginal climate changes can trigger non-linear water allocation changes in the decision support systems (DSSs) and/or non-linear adaptive responses of irrigators to water shortages. For example, while some irrigators barely experience economic losses (average profit and employment fall by &lt; 0.5 %) under mild water allocation reductions of 5 % or lower, profit and employment fall by up to 12 % (∼ 24 ×) when water allocation is reduced by 10 % or less (∼ 2×). This substantiates the relevance of informing the potential natural and socio-economic impacts of adaptation strategies and related uncertainties for identifying robust decisions.

Neoliberalism and the Complexities of Conceptualizing Community School Policy for Racial Equity

Full-service community schools are increasingly adopted as educational policy nationwide to transform educational institutions into community hubs, addressing racial and social disparities and countering deficit narratives related to marginalized youth and families. As the movement toward community schooling as an educational policy gains momentum, more research is needed to understand the complex process of conceptualizing such an initiative for racial equity. Spanning from the early planning stages to 3 years into the implementation of community schooling, this paper uncovers the tensions that emerge as school and district leaderships’ interpretation of the purpose of community schooling and root cause of racial inequity unveil conflicting conceptualizations of the community school initiative: community schooling rooted in neoliberal ideals of efficiency, coordination, and service choice, on one hand, and those rooted in more transformative approach with systemic reflection and change in classrooms, schools, and other institutions on the other.

Research trends in innovation ecosystem and circular economy

Understanding innovation ecosystems and the circular economy is crucial for systemic change in business and industry, fostering eco-innovation and advancing sustainable development. This study uses bibliometric analysis to uncover the research trends, patterns, and collaborations, revealing a significant gap in understanding the interactions between innovation ecosystems and the circular economy and offering potential avenues for future research that align with sustainable development. The analysis was carried out with the help of Biblioshiny and VOSviewer on the final selected documents of 2981 from the Scopus database through a search query and the SPAR-4-SLR stages of filtration. The key findings of the study are as follows: collaboration among countries involves accessing countries’ resources, knowledge, markets, and location. The study explores research trends in the innovation ecosystem and circular economy, focusing on five key clusters: the circular economy for eco-innovation and resource recovery, circular business models for fostering sustainable innovation in the bioeconomy, sustainability through renewable energy and sdgs, the sustainable business model for enhancing green innovation through entrepreneurship, and Artificial Intelligence (AI) and the circular business model in Industry 4.0. The bibliometric analysis identifies trends, research gaps, and collaboration patterns, revealing potential avenues for future exploration in industrial symbiosis, energy transition, and the system of innovation. The study analyzed only the documents available in Scopus. The exclusion of papers based on the search period, language, document type, and incomplete details are the limitations of this research and open the scope of potential future research. The findings will help existing researchers in this field as well as new researchers interested in this field by clearly understanding trends and further research scopes. The study also offers actional recommendations and practices to policymakers. Practices, and entrepreneurs for the attainment of global sustainability goals. The novelty and originality of this study rely on a thorough literature review that describes the state of the art in the innovation ecosystem and circular economy.

Unveiling Lipidomic Alterations in Metabolic Syndrome: A Study of Plasma, Liver, and Adipose Tissues in a Dietary-Induced Rat Model

Metabolic syndrome (MetS) is a complex condition characterized by fat accumulation, dyslipidemia, impaired glucose control and hypertension. In this study, rats were fed a high-fat high-fructose (HFF) diet in order to develop MetS. After ten weeks, the dietary-induced MetS was confirmed by higher body fat percentage, lower HDL-cholesterol and increased blood pressure in the HFF-fed rats compared to the normal-fed control animals. However, the effect of MetS development on the lipidomic signature of the dietary-challenged rats remains to be investigated. To reveal the contribution of specific lipids to the development of MetS, the lipid profiling of rat tissues particularly susceptible to MetS was performed using untargeted UHPLC-QTOF-MS/MS lipidomic analysis. A total of 37 lipid species (mainly phospholipids, triglycerides, sphingolipids, cholesterol esters, and diglycerides) in plasma, 43 lipid species in liver, and 11 lipid species in adipose tissue were identified as dysregulated between the control and MetS groups. Changes in the lipid signature of selected tissues additionally revealed systemic changes in the dietary-induced rat model of MetS.

Beyond Lau: Envisioning humanizing and culturally sustaining workspaces for teachers in dual-language bilingual education schools

ABSTRACT Fifty years after the Lau decision, dual-language programs face critical challenges, particularly a national teacher shortage, especially in bilingual programs representing less commonly taught languages like Mandarin Chinese. This study explores the workplace environments of 13 Mandarin Dual Language Bilingual Education (MDLBE) teachers in a diverse urban school district. Drawing on Freire’s concept of humanization, Paris’s cultural sustainment framework, and Bronfenbrenner’s ecological systems theory, qualitative interviews reveal themes of outsiderness, coupled with a need for humanizing relationships with colleagues and leadership. Findings highlight the importance of culturally sustaining practices and systemic changes to foster inclusive, supportive environments, advocating for a transformation “Beyond Lau” to sustain dual-language programs.

Pupils’ beliefs about Norwegian Nynorsk: ‘I don’t believe we need to learn a second Norwegian language’

According to the national curriculum, Norwegian pupils are supposed to learn both official written Norwegian languages, Bokmål and Nynorsk, in school (1-13); one of the written languages as their so-called main written language and the other one as the alternative written language. At the end of lower secondary school (10th grade) and the end of upper secondary school (13th grade), most pupils get three individual grades in Norwegian as a school subject: written Bokmål, written Nynorsk and oral skills. The majority of pupils (more than 85%) have Bokmål as their main written language and Nynorsk as their alternative written language, and many pupils struggle with motivational issues when it comes to learning Nynorsk. In the present study, lower secondary pupils (10th graders) have been asked about their thoughts and beliefs before and after an intervention in the form of a language-history lecture by an external Nynorsk teacher and user (a researcher). The pupils wrote down their opinions and thoughts in class under the supervision of their teacher. These (anonymous) reflection notes were handed to the researcher who categorized and analysed them by trying to extract the overall ‘beliefs’ about Nynorsk from each text. Even though most pupils admit having learned a little from the intervention, the result is clear: a one-time intervention – even with a clear purpose and good arguments – is not enough to change the pupils’ opinion, attitudes or beliefs when it comes to Nynorsk as a second Norwegian language in school, and more fundamental changes in the educational system are needed. /Keywords: attitudes, beliefs, emotions, language learning, language policy, language teaching

Phosphatidylserine: A Novel Target for Ischemic Stroke Treatment.

Over the past 40 years, research has heavily emphasized stroke treatments that directly target ischemic cascades after stroke onset. Much attention has focused on studying neuroprotective drugs targeting one aspect of the ischemic cascade. However, the single-target therapeutic approach resulted in minimal clinical benefit and poor outcomes in patients. Considering the ischemic cascade is a multifaceted and complex pathophysiological process with many interrelated pathways, the spotlight is now shifting towards the development of neuroprotective drugs that affect multiple aspects of the ischemic cascade. Phosphatidylserine (PS), known as the "eat-me" signal, is a promising candidate. PS is involved in many pathophysiological changes in the central nervous system after stroke onset, including apoptosis, inflammation, coagulation, and neuronal regeneration. Moreover, PS might also exert various roles in different phases after stroke onset. In this review, we describe the synthesis, regulation, and function of PS under physiological conditions. Furthermore, we also summarize the different roles of PS after stroke onset. More importantly, we also discuss several treatment strategies that target PS. We aim to advocate a novel stroke care strategy by targeting PS through a translational perspective.