Search Results (19,837)

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects up to 25% of children and impairs both skin barrier function and quality of life. This study examined the effectiveness of an emulgel containing hyaluronic acid, glycerol, grape seed oil, Calendula officinalis, aloe vera and sh-oligopeptide-1 (a synthetic Epidermal Growth Factor) for treating paediatric AD. In a randomised, self-controlled trial, 57 children (aged 2–14) applied the emulgel twice daily for 10 days to one forearm and left the other forearm as a control. Skin barrier parameters such as transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema and pH were measured. After applying the emulgel, lesional skin showed reduced erythema (p = 0.007), lower TEWL (p = 0.002) and higher SCH (p < 0.001). Non-lesional skin showed improved SCH (p < 0.001). SCORing Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI) scores indicated milder disease post-treatment (mild cases: 64.9% to 80.7% SCORAD; 82.5% to 93.0%EASI). The Dermatology Life Quality Index improved by ~3.5 points, and patients reported high satisfaction with no adverse effects. This emulgel is an effective and well-tolerated adjunctive therapy for paediatric AD, enhancing barrier function and clinical outcomes. Full article

Background: Past studies demonstrate that certain facial features systematically affect first impressions of psychological traits. However, no previous studies have examined how individual differences in facial health affect first impressions of psychological traits. Methods: In this study, we asked a large sample of fairgoers to give their first impressions of psychological traits in response to viewing videos of unilateral facial paralysis patients with varying degrees of facial functioning. Then, we used linear mixed-effects regression models to understand how individual differences in facial health predict first impressions. Results: Our results replicate previous findings regarding first impressions of faces, such as the attractiveness halo effect, as well as age (maturity) and gender (masculinity) effects. More importantly, our results reveal that facial health, as measured by a clinician-graded scale, is a significant predictor of first impressions. Specifically, we found that individuals with better dynamic facial health (as assessed by clinicians) were perceived to be more competent and more affiliative, but not more dominant, than individuals with lower levels of dynamic facial functioning. Conclusions: Our results have important implications for personalized medicine via the development and refinement of individually tailored therapies to improve facial reanimation surgery outcomes. Full article

Background: Male infertility is evaluated using standard semen parameters. However, these criteria offer limited insight into sperm functionality and poorly predict natural fertility or assisted reproductive technology (ART) outcomes. Methods: In this study, the expression levels of three genes (AURKA, HDAC4, and CARHSP1) involved in mitosis regulation, epigenetic modulation and early embryonic development, were measured by RT-qPCR in sperm samples (training dataset). For each gene, thresholds of normal and reduced expression were established by biostatistical modeling and combined with the number of motile spermatozoa to develop the Spermatozoa Function Index (SFI). Results: The ROC analysis was used to interpret the SFI values: SFI > 320 (normal), 290–320 (intermediate), and <290 (low). Then, this index was validated using 627 fresh semen samples from 25- to 60-year-old men at our ART center. Based on the World Health Organization criteria, 54.5% of the 627 sperm samples were normospermic, 8.8% showed oligo-astheno-teratospermia, and 36.6% had one or two abnormal parameters. According to the SFI values, 41% of sperm samples displayed normal expression, 55.9% low expression, and 4.1% intermediate expression. Only 57% of the 342 normospermic samples had normal SFI values and 37% had low SFI values. Among the 81 samples with stringent normal criteria (≥50 million/mL, ≥50% total motility, ≥14% normal morphology), 67.9% displayed normal SFI and 22.2% low SFI values. These findings suggest that even sperm with normal parameters may harbor dysfunctions. Conclusions: Our data highlight a gene signature with strong discriminatory power and promising diagnostic value for detecting subclinical sperm defects and improving male infertility assessment. Full article

Dietary sodium restriction is widely recommended in heart failure (HF) management; however, its benefits and risks remain a subject of ongoing debate. While moderate sodium reduction may improve symptoms and quality of life in selected patients, excessive restriction can trigger maladaptive neurohormonal activation, worsen renal function, and increase the risk of hyponatremia, malnutrition, and cachexia. Patient response is heterogeneous, influenced by clinical risk profile, salt sensitivity, comorbidities, and age, with some high-risk patients experiencing neutral or adverse outcomes. Additional challenges arise from hidden sodium in processed foods, medications, and meals, which complicate monitoring and adherence. Effective sodium management in HF therefore requires a nuanced, individualized approach that integrates risk stratification, dietary counseling, and public health measures targeting the food industry. Future research should refine patient selection criteria and establish optimal sodium targets to balance therapeutic efficacy with safety in real-world practice. Full article

Objectives: We aimed to determine temporal patterns of blood–brain barrier (BBB) dysfunction, edema formation and functional recovery in acute stroke. Materials and Methods: Patients of two observational studies on ischemic and hemorrhagic stroke between 2006 and 2019 were analyzed. Blood–brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio. Edema formation was measured on all available imaging scans during hospital stay. Relative edema was defined as the ratio of edema volume to stroke volume. Multivariable regression models were applied to analyze associations and calculate predicted probabilities. Results: Overall, 138 stroke patients, 103 (74.6%) with ischemic stroke and 35 (25.4%) with hemorrhagic stroke, were analyzed. The predicted probability of substantial BBB dysfunction was approximately 46 (37–55) % among patients analyzed on 1 day after symptom onset and declined with increasing time, thereafter reaching 10 (3–29) % on day 30. The maximal extent of edema was lower in ischemic versus hemorrhagic stroke (relative edema: 1.5 [1.2–1.8] vs. 2.6 [1.9–4.5], p = 0.003) and occurred earlier after stroke onset (5.9 [4.6–8.5] days vs. 12.3 [9.7–16.4] days, p = 0.009). BBB dysfunction was associated with increased edema formation (adjusted relative edema: 4.0 [2.8–4.5] vs. 2.3 [1.8–3.0], p = 0.037) and lower chances of functional recovery (20/48 [41.7%] vs. 51/90 [56.7%], adjusted Odds Ratio: 0.37 [0.16–0.88], p = 0.025) in both ischemic and hemorrhagic stroke patients. Conclusions: BBB dysfunction frequently occurred in acute ischemic and hemorrhagic stroke and was associated with secondary injury and worse clinical outcomes. Future studies should evaluate BBB dysfunction as a potential therapeutic target using advanced imaging techniques early after stroke onset. Edema formation was aggravated and prolonged in hemorrhagic versus ischemic stroke. Full article

The fractional thermoelasticity theory is presented for the thermal response of a circular cylinder. The basic equations of the cylinder are derived from a fractional theory in the context of the generalized Lord and Shulman theory. It is taken into consideration the variable thermal conductivity of the circular cylinder. A temperature-mapping function is used for this purpose. The cylinder is subjected to an exponential decay of temperature mapping over time at its outer surface. The governing equations are solved by using the Laplace transform technique, and its inversion is carried out numerically. Numerical outcomes are computed and represented graphically for the field variables along the radial direction of the cylinder. The effects of many parameters on all thermoelastic fields are investigated. The analysis highlights the relationship between the field quantities and the radial direction of the circular cylinder, the impact of the exponential decay time, the impact of the thermal conductivity parameter, the inclusion of the fractional parameter, and the difference between the refined thermoelasticity theories. Full article

Background and Objectives: NR5A1-related 46,XY differences of sex development (DSD) represent a heterogeneous group of conditions characterized by variable degrees of undervirilization, gonadal dysgenesis, and endocrine dysfunction. Mutations in the NR5A1 gene affect critical pathways of gonadal development and steroidogenesis, leading to complex diagnostic and management challenges. This narrative review aims to summarize the clinical spectrum, diagnostic algorithms, surgical management, and outcome data of pediatric NR5A1-related 46,XY DSD. Materials and Methods: A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted, using terms related to NR5A1 mutations, ambiguous genitalia, gonadal dysgenesis, tumor risk, and surgical management. A total of 26 studies were initially identified, of which 16 met the inclusion criteria for pediatric patients (≤18 years) with confirmed 46,XY karyotype, NR5A1 mutation, and available clinical or surgical data. Results: NR5A1 mutations are associated with phenotypes ranging from complete female external genitalia to apparently normal males with later infertility. While Sertoli cell function during fetal life is often preserved, Leydig cell dysfunction leads to incomplete masculinization. Spontaneous virilization during puberty has been reported. Management of gonadal dysgenesis remains controversial: while streak-like intra-abdominal gonads carry high germ cell tumor risk, warranting early gonadectomy, well-formed testes may be preserved under strict surveillance. Conclusions: NR5A1-related 46,XY DSD requires individualized, multidisciplinary management integrating genetic, endocrine, surgical, and psychosocial expertise. Gonadectomy decisions should be risk-stratified and, when possible, delayed to allow patients to participate in decision-making. Early psychological support and lifelong follow-up are essential to optimize physical and psychosocial outcomes. Full article

Background/Objectives: Enucleation, evisceration, and exenteration remain essential in ophthalmic practice, despite advances in medical and surgical care. Optimal outcomes rely on meticulous technique, implant selection, and long-term socket rehabilitation. This study reports a single surgeon’s 15-year experience managing anophthalmic sockets at a tertiary referral hospital in Southeast Asia. Methods: A retrospective review was conducted. Clinical records were examined for demographics, indications, type of surgery, implant characteristics, wrapping material, complications, and secondary interventions. Results: A total of 175 anophthalmic sockets were managed (82 primary, 88 secondary). Mean age was 34.1 ± 30.0 years, 54.9% males. The most common indications were ocular/orbital tumors and trauma. Among primary cases, 70 underwent enucleation, 7 evisceration, and 5 exenteration. The most common implant placed was porous polyethylene (Medpor). Donor sclera was the most frequently used wrapping material. Fifteen (18.3%) primary sockets developed postoperative complications, implant exposure being the most common. Among secondarily managed sockets, more than half had severe complications, particularly severe socket contraction and post-enucleation socket syndrome. Conclusions: Anophthalmic sockets remain a complex and challenging condition in ophthalmic practice. Tumors and trauma were the leading indications for globe removal in this cohort. Despite refinements in surgical technique, complications persist, emphasizing the need for multidisciplinary, long-term care to optimize functional and aesthetic outcomes. Full article

Background/Objectives: We compared the efficacy of audiovisual sexual stimulation (AVSS) using 3D virtual glasses with a desktop monitor. Methods: In this randomized crossover study, 60 patients with ED underwent two penile duplex Doppler ultrasound sessions 1 week apart, each after intracavernosal prostaglandin E1 injection. Patients were randomly assigned to receive AVSS via 3D virtual glasses or a desktop monitor in the first session, with crossover in the second. We measured the resistive index (RI), erectile hardness score (EHS), peak systolic velocity (PSV), anxiety (State-Trait Anxiety Inventory), and satisfaction (visual analog scale). Results: 3D virtual glasses were associated with superior outcomes. The linear mixed models analysis showed higher adjusted mean RI (p < 0.001), PSV (p < 0.001), and satisfaction (p < 0.001) for 3D glasses. Generalized estimating equations analysis showed patients were 6.68 times more likely to achieve functional erection (EHS ≥ 3) with 3D glasses (odds ratio 6.68, 95% confidence interval [2.54, 17.55], p < 0.001). Anticipatory anxiety before subsequent examinations was lower with virtual glasses (p < 0.001). Conclusions: AVSS with 3D virtual glasses is associated with superior hemodynamic parameters and clinical responses consistent with reduced false-positive diagnoses. It also lowers anticipatory anxiety for subsequent procedures, enhancing patient experience. Full article

Objective: This short-term prospective observational study aimed to evaluate the efficacy of vestibular rehabilitation therapy (VRT) in Patients Diagnosed with Persistent Postural-Perceptual Dizziness (PPPD). Methods: Given the exploratory design, the small sample (n = 25) and absence of a formal power calculation limit precision, findings should be interpreted as preliminary, and confirmatory trials are warranted. Patients were assessed before (T1), immediately after a five-week vestibular rehabilitation program (T2), and again three months later without continued therapy (T3). Clinical symptoms were assessed using the Dizziness Handicap Inventory (DHI). A Generalized Estimating Equations (GEE) model was used to analyze changes in dizziness-related physical, emotional, and functional impacts over time, accounting for sex and its interaction with time. Statistical significance was tested using the Wald test, with results reported as estimated means and standard errors (SEs), and a significance level set at p ≤ 0.05. Results: The mean age of participants was 44.48 ± 14.43 years, and the majority were women (84%). In the functional domain, the mean score difference was 6.69 points between T1 and T2 (p = 0.018), 7.11 points between T1 and T3 (p = 0.013), and 0.42 points between T2 and T3 (p > 0.05). In the emotional domain, the mean difference was 4.12 points between T1 and T2 (p = 0.008), 4.40 points between T1 and T3 (p = 0.005), and 0.29 points between T2 and T3 (p > 0.05). In the physical domain, the mean difference was 3.77 points between T1 and T2 (p = 0.024), 4.32 points between T1 and T3 (p = 0.009), and 0.55 points between T2 and T3 (p > 0.05). For the total score, the mean difference was 14.58 points between T1 and T2 (p = 0.005), 15.83 points between T1 and T3 (p = 0.003), and 1.25 points between T2 and T3 (p > 0.05). The moment variable had a statistically significant effect across all domains. Sex had a significant effect only in the emotional domain, with women consistently reporting higher scores than men. Conclusions: This study demonstrates that a five-week vestibular rehabilitation program significantly improves the physical, emotional, and functional impacts of dizziness in patients with PPPD, with these benefits largely sustained three months after the intervention. Emotional improvements were particularly notable among women, highlighting potential sex-related differences in response to treatment. These findings underscore the importance of addressing emotional health in PPPD management and support the long-term effectiveness of vestibular rehabilitation in improving patient outcomes. Full article

Background/Objectives: Compartmentalized glucose metabolism in the brain contributes to neuro-metabolic stability and shapes hypothalamic control of glucose homeostasis. Glucose transporter-2 (GLUT2) is a plasma membrane glucose sensor that exerts sex-specific control of hypothalamic astrocyte glucose and glycogen metabolism. Aging causes counterregulatory dysfunction. Methods: The current research used Western blot and HPLC–electrospray ionization–mass spectrometry to investigate whether aging affects the GLUT2-dependent hypothalamic astrocyte metabolic sensor, glycogen enzyme protein expression, and glycogen mass according to sex. Results: The data document GLUT2-dependent upregulated glucokinase (GCK) protein in glucose-deprived old male and female astrocyte cultures, unlike GLUT2 inhibition of this protein in young astrocytes. Glucoprivation of old male and female astrocytes caused GLUT2-independent downregulation of 5′-AMP-activated protein kinase (AMPK) protein, indicating loss of GLUT2 stimulation of this protein with age. This metabolic stress also caused GLUT2-dependent suppression of phospho-AMPK profiles in each sex, differing from GLUT2-mediated glucoprivic enhancement of activated AMPK in young male astrocytes and phospho-AMPK insensitivity to glucoprivation in young female cultures. GS and GP isoform proteins were refractory to glucoprivation of old male cultures, contrary to downregulation of these proteins in young glucose-deprived male astrocytes. Aging elicited a shift from GLUT2 inhibition to stimulation of male astrocyte glycogen accumulation and caused gain of GLUT2 control of female astrocyte glycogen. Conclusions: The outcomes document sex-specific, aging-related alterations in GLUT2 control of hypothalamic astrocyte glucose and ATP monitoring and glycogen mass and metabolism. These results warrant future initiatives to assess how these adjustments in hypothalamic astrocyte function may affect neural operations that are shaped by astrocyte–neuron metabolic partnership. Full article

Prehabilitation programs for abdominal pre-operative patients are increasingly recognized for improving surgical outcomes, reducing post-operative complications, and enhancing recovery. Internet of Things (IoT)-enabled human movement monitoring systems offer promising support in mixed-mode settings that combine clinical supervision with home-based independence. These systems enhance accessibility, reduce pressure on healthcare infrastructure, and address geographical isolation. However, current implementations often lack personalized movement analysis, adaptive intervention mechanisms, and real-time clinical integration, frequently requiring manual oversight and limiting functional outcomes. This review-based paper proposes a conceptual framework informed by the existing literature, integrating Digital Twin (DT) technology, and machine learning/Artificial Intelligence (ML/AI) to enhance IoT-based mixed-mode prehabilitation programs. The framework employs inertial sensors embedded in wearable devices and smartphones to continuously collect movement data during prehabilitation exercises for pre-operative patients. These data are processed at the edge or in the cloud. Advanced ML/AI algorithms classify activity types and intensities with high precision, overcoming limitations of traditional Fast Fourier Transform (FFT)-based recognition methods, such as frequency overlap and amplitude distortion. The Digital Twin continuously monitors IoT behavior and provides timely interventions to fine-tune personalized patient monitoring. It simulates patient-specific movement profiles and supports dynamic, automated adjustments based on real-time analysis. This facilitates adaptive interventions and fosters bidirectional communication between patients and clinicians, enabling dynamic and remote supervision. By combining IoT, Digital Twin, and ML/AI technologies, the proposed framework offers a novel, scalable approach to personalized pre-operative care, addressing current limitations and enhancing outcomes. Full article

Introduction: Post-traumatic and post-surgical ulnar nerve neuropathies at the elbow and wrist remain challenging conditions often associated with significant sensory and motor impairment. Traditional approaches such as neurolysis alone may be insufficient, especially in complex or recurrent cases. Adipofascial flaps have shown promising outcomes in peripheral nerve surgery. The aim of this study was to evaluate the outcomes of 13 patients with severe ulnar neuropathies who were treated with a size- and shape-personalized adipofascial flap for nerve coverage. Materials and Methods: We retrospectively analyzed 13 patients treated between May 2020 and May 2024 for severe post-traumatic or post-surgical ulnar neuropathies. All underwent surgical decompression, external neurolysis, and adipofascial flap coverage. Pre- and postoperative outcomes were assessed with clinical and neurological evaluations and using the QuickDASH and NRS pain scores. Discussion: All patients showed improvement in pain and sensory-motor function, including those with complications, supporting the role of flap coverage in neuroprotection. This is the first study to describe the use of adipofascial flaps for pseudo-palsy and painful neuroma-in-continuity of the ulnar nerve at the elbow and wrist level. Conclusions: Adipofascial flaps represent a safe, technically feasible, and effective option in complex ulnar nerve injuries, providing both mechanical and biological support. Despite the small cohort, the results suggest strong clinical potential across varied injury patterns. Full article

Total knee arthroplasty (TKA) remains a cornerstone of orthopedic surgery, with optimal coronal alignment playing a pivotal role in determining both clinical outcomes and implant longevity. Traditionally, mechanical alignment has been regarded as the gold standard. However, the emergence of alternative philosophies—such as kinematic alignment and hybrid techniques—has shifted the focus toward individualized approaches. Recent advancements in robotic and computer-assisted systems have significantly enhanced the precision of implant positioning, allowing surgeons to better replicate native knee biomechanics and improve patient satisfaction. This narrative review examines current alignment philosophies in TKA, including mechanical, kinematic, and hybrid methods. It analyzes each technique’s principles, functionalities, benefits, and limitations while highlighting ongoing debates regarding their clinical application. Special attention is given to the role of technology in enabling more accurate, patient-specific surgical execution. Despite promising developments, challenges remain in standardizing these techniques and validating their long-term efficacy. To ensure a comprehensive evaluation relevant literature was reviewed, focusing on studies that explore alignment strategies, biomechanical outcomes, and the integration of technology in TKA. This review aims to synthesize current evidence, identify gaps in knowledge, and outline directions for future research needed to optimize alignment strategies in modern knee arthroplasty. Full article

The Dung Beetle Optimizer (DBO) has shown promise in solving complex optimization problems, yet it often suffers from premature convergence and limited accuracy. To overcome these limitations, this paper proposes the Enhanced Reproductive Dung Beetle Optimizer (ERDBO). The ERDBO introduces a three-stage mechanism: (1) a larval growth phase using experiential learning to enrich population diversity and improve global exploration; (2) a reproduction and nurturing phase that employs parent–offspring verification and a teaching strategy to strengthen local exploitation; and (3) a predator avoidance phase integrating Lévy flight and sinusoidal perturbations to enhance adaptability and accelerate convergence. The effectiveness of the proposed algorithm is assessed using the CEC2017 benchmark functions, where it is contrasted with several advanced metaheuristic approaches. The experimental findings highlight its advantages in terms of convergence rate, stability, and solution precision. Furthermore, the ERDBO is applied to three well-known engineering design tasks—namely the tension/compression spring, the three-bar truss, and the pressure vessel problem. The outcomes verify both its efficiency and applicability, indicating that the ERDBO provides a robust and competitive optimization framework for tackling challenging real-world engineering scenarios. Full article