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Background: Parents play a pivotal role in influencing children’s oral health; thus, effective oral health education (OHE) is essential to equip them with the knowledge needed to support their children’s oral health care. In countries such as Pakistan, apart from limited access to dental care and socioeconomic barriers, the widespread lack of OHE is also an important factor contributing to the high prevalence of oral diseases. Conventional OHE approaches are often limited by passive delivery, lack of tailored content and poor accessibility. Social media platforms such as Facebook offer an accessible platform for health education; however, structured, validated, and tailored content is required. Aim: This study aims to develop and validate an online OHE module for Pakistani parents using the ADDIE instructional design model. Materials and Methods: The study was conducted in two phases using the ADDIE model. Parental OHE needs were identified through a questionnaire. An Urdu-language module was developed based on these needs and expert recommendations. Content validation was performed by six experts, followed by face validation with 15 parents. Results: Needs assessment guided the development of a culturally appropriate module covering six main topics. Item-level Content Validity Index ranged from 0.83 to 1.00, with a Scale-level Content Validity Index of 0.94 and a Scale-level Face Validity Index of 0.97. Conclusions: The developed Facebook-delivered OHE module demonstrated high content and face validity and may serve as an accessible and practical strategy for improving parental OHE. Further studies are required to evaluate its effectiveness in improving oral health-related behaviours and outcomes. Full article

(This article belongs to the Special Issue Current Advances in Oral Health Promotion)

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19 pages, 18341 KB

Open AccessArticle

Comparative Numerical Analysis of Thermal–FlowCharacteristics of Heat Exchanger Channels with Different Flow Turbulization Methods Using Performance Evaluation Criteria

by Piotr Bogusław Jasiński, Piotr Szymczak and Krzysztof Kantyka

Energies 2026, 19(12), 2788; https://doi.org/10.3390/en19122788 (registering DOI) - 10 Jun 2026

Abstract

This article presents the results of a numerical CFD study of heat exchanger channels with passive heat transfer enhancement methods. Two types of channel geometry were analyzed with different flow turbulization methods. In case I, internal micro-fins were applied to the tube wall, which disturbed the flow directly in the boundary layer; the investigated relative fin heights ranged from 0.01 h/D to 0.08 h/D, and the dimensionless longitudinal spacing varied from 0.92 L/D to 3.27 L/D. In case II, an insert with repeating drop-shaped elements was used, causing fluid turbulization in the tube core; the relative droplet diameter ranged from 0.38 d/D to 0.73 d/D, with the same longitudinal spacing as for the fins. The influence of the geometry and longitudinal spacing of the disturbance elements on the thermal–flow characteristics of such channels, namely, the friction factor, Nusselt number, and thermal efficiency evaluated using the PEC, was investigated over a Reynolds number range of 5000 to 400,000. The results show that the insert produces a larger increase in the Nusselt number, whereas the micro-finned tube generally achieves higher PEC values due to lower hydraulic losses. The results clearly indicate that, in most cases, the PEC is higher for the finned tube, particularly at low Reynolds numbers not exceeding 50,000. In turn, for the insert, the longitudinal distance between the elements, L, has a significant influence on the PEC; as L increases, the PEC also increase, reaching its maximum value for the largest L. Full article

(This article belongs to the Collection Advances in Heat Transfer Enhancement)

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23 pages, 28122 KB

Open AccessArticle

Urban–Rural Spatial Patterns, Landscape Configuration, and Carbon Emission Performance: A County-Level Analysis in Henan Province, China

by Shaowei Zhang, Xiaoyang Guo, Shennian Zhang, Chen Li and Chenming Zhang

Land 2026, 15(6), 1021; https://doi.org/10.3390/land15061021 (registering DOI) - 10 Jun 2026

Abstract

Against the backdrop of global climate change and increasing pressure to mitigate carbon emissions, counties serve as critical units for urban–rural spatial development and carbon governance. However, their carbon emission performance (CEP) and underlying spatial mechanisms remain insufficiently understood. This study focuses on 157 counties in Henan Province, selecting three time points: 2013, 2018, and 2023. The study measures the CEP and analyzes its spatiotemporal differentiation characteristics. First, considering that carbon emissions are undesirable outputs generated during the economic production process, this study employs the undesirable output slack-based measure (UN_SBM) model and the super-efficiency slack-based measure model with undesirable outputs (Un_Super_SBM) to evaluate county-level carbon emission performance. Second, landscape pattern indicators, including expansion, complexity, and compactness, are selected, and regression models are constructed to explore the influence of different factors on carbon emission performance. The results show the following: (1) The overall CEP of counties in Henan Province improved from 2013 to 2023, but there were significant spatial differences. (2) Both “Total landscape area” (TA) and “Area-weighted mean shape index” (AWMSI) had significant positive impacts on CEP, whereas the “Splitting index” (SPLIT) inhibited CEP. (3) The effects of vegetation cover and transportation conditions varied, reflecting the heterogeneity of development stages and spatial functional positioning across different counties. This study reveals the relationship between urban–rural spatial form and carbon emission performance at the county level, providing empirical evidence for optimizing construction land spatial structure, enhancing CEP, and promoting regional low-carbon development. Full article

(This article belongs to the Special Issue Land Use Sustainability from the Viewpoint of Carbon Emission: 3rd Edition)

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10 pages, 549 KB

Open AccessArticle

Caregiver-Mediated Adherence and Perceived Health System Factors Associated with Viral Suppression Among Children Receiving Antiretroviral Therapy in Rural South Africa

by Sinentlahla Mamane, Monwabisi Faleni, Guillermo Alfredo Pulido Estrada, Ziphelele Ncane and Laston Gonah

Int. J. Environ. Res. Public Health 2026, 23(6), 780; https://doi.org/10.3390/ijerph23060780 (registering DOI) - 10 Jun 2026

Abstract

Background: While caregiver and health system factors are known to influence paediatric ART outcomes, their roles within routine rural South African settings remain insufficiently characterised. Aim: The aim of this study is to assess the association between caregiver-mediated ART adherence, perceived healthcare access and service quality with viral suppression among children receiving ART in a rural South African province. Methods: A cross-sectional study was conducted among 86 children aged <15 years receiving ART in routine paediatric HIV care. Viral load suppression was defined as <1000 copies/mL. Predictor variables included caregiver-reported adherence (30-day recall; adherent vs. non-adherent), perceived healthcare access and perceived service quality. Associations were assessed using Chi-square or Fisher’s exact tests, where appropriate. Effect sizes were estimated using risk differences. Results: Overall, 77.9% of the child participants were virally suppressed. Caregiver-reported adherence was significantly associated with VLS (p = 0.034). The probability of viral suppression was 100% among adherent children compared to 73.2% among non-adherent children (risk difference: 26.8 percentage points). Caregiver-reported adherence demonstrated high specificity (100%) and positive predictive value (100%) but low sensitivity (22.4%) and negative predictive value (26.8%), indicating that while reported adherence reliably identified children who were suppressed, non-adherence did not consistently predict virological failure. Perceived healthcare access (p = 0.372) and service quality (p = 0.267) were not significantly associated with viral suppression. Conclusions: Caregiver-mediated adherence was strongly associated with viral suppression, whereas perceived health system factors were not independently associated with treatment outcomes in this cohort. These findings should be interpreted cautiously given the cross-sectional design and reliance on short-term adherence measures. Strengthening household-level adherence support is critical for improving paediatric HIV outcomes in rural settings. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

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31 pages, 473 KB

Open AccessArticle

Strategic Enablers of SMEs Sustainability: Examining Green Innovation, Internal Learning and External Pressure Mechanisms in Saudi SMEs

by Mohammed Abdullah Alanazi

Sustainability 2026, 18(12), 5931; https://doi.org/10.3390/su18125931 (registering DOI) - 10 Jun 2026

Abstract

Aligned with Saudi Arabia’s Vision 2030, which emphasizes sustainability, innovation, and economic diversification, this study investigates how green innovation (GI), organizational learning (OL), and regulatory pressure (RP) influence sustainability performance (SP) among small and medium-sized enterprises (SMEs). Additionally, addressing a key theoretical gap, this study examines OL as a mediating mechanism and RP as a moderating factor in the GI–SP relationship, an area rarely explored in emerging economies. Grounded in the Resource-Based View and Dynamic Capabilities Theory. Methodology: This study adopts a quantitative, cross-sectional design and gathers data from 386 SME employees across Saudi Arabia using validated survey instruments. SPSS analysis revealed that GI significantly improved SP both directly and indirectly via OL, highlighting the critical role of internal learning capabilities. Furthermore, RP positively moderates the effect of GI on SP, indicating that supportive regulatory environments can amplify the benefits of innovation for sustainability outcomes. This study contributes to the literature by integrating internal capabilities and external pressures into a cohesive framework for understanding sustainability. Empirically, it offers fresh insights into the under-researched SME sector in Saudi Arabia. Practically, the findings provide valuable guidance for managers and policymakers to promote sustainability through enhanced learning culture and well-structured regulatory frameworks. Full article

(This article belongs to the Special Issue Advancing Innovation and Sustainability in SMEs and Entrepreneurship)

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18 pages, 1506 KB

Open AccessArticle

Solvent-Driven Variation in the Determination of Antioxidant Capacity and Oxidative Stress Indicators of Extra Virgin Olive Oils from the Aegean Region

by Aslıhan İlayda İlhan, Suzan Yalçın and Sıddika Songül Yalçın

Foods 2026, 15(12), 2092; https://doi.org/10.3390/foods15122092 (registering DOI) - 10 Jun 2026

Abstract

This study investigated the influence of different extraction solvents (ethanol and methanol) on antioxidant and oxidative stress parameters in 55 extra virgin olive oil samples obtained from various producers in the Aegean region of Türkiye. In this context, DPPH radical scavenging activity, total phenolic content (TPC), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were determined in both extracts. Ethanol extracts showed higher TPC and DPPH radical scavenging activity, with mean DPPH values of 24.48% and 15.42% for ethanol and methanol extracts, respectively. Similarly, TOS and OSI values were higher in ethanol extracts, whereas TAS values were higher in methanol extracts. Correlation analysis revealed significant negative relationships between antioxidant parameters (TPC and TAS) and OSI, indicating an inverse association between antioxidant capacity and oxidative stress. Principal component analysis (PCA) demonstrated a distinct separation between antioxidant and oxidant variables. Bland–Altman analysis further confirmed systematic differences between extraction methods. Overall, the findings indicate that the extraction solvent is a critical factor in the determination of antioxidant and oxidative stress parameters in olive oil. Ethanol provides a higher phenolic content and radical scavenging activity, whereas methanol appears more effective in assessing total antioxidant capacity. The variability among samples reflects differences in production, processing, and storage conditions. Full article

(This article belongs to the Section Food Physics and (Bio)Chemistry)

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17 pages, 11772 KB

Open AccessArticle

Study on Compressive Strength Prediction of Steel Fiber Recycled Aggregate Concrete Based on GA–PSO–BP Neural Network

by Shuo Zhang, Chunfeng Yang and Dianwen Zhao

Buildings 2026, 16(12), 2316; https://doi.org/10.3390/buildings16122316 (registering DOI) - 10 Jun 2026

Abstract

With the advancement of China’s carbon peaking and carbon neutrality targets and the low-carbon upgrading of the construction industry, steel fiber recycled aggregate concrete (SFRAC) has attracted increasing attention as a sustainable construction material due to its advantages in resource recycling and enhanced mechanical performance. However, its compressive strength is influenced by multiple interacting factors, making accurate prediction challenging when using conventional empirical or regression-based methods. To enhance predictive performance, a compressive strength database was established based on published experimental data. The input layer included seven mixture parameters: water content, cement content, fine aggregate content, natural coarse aggregate content, recycled coarse aggregate content, steel fiber content, and superplasticizer dosage, with the 28-day compressive strength serving as the output variable. Using this database, four prediction models were developed, including a back-propagation (BP) neural network and three optimized variants—GA–BP, PSO–BP, and GA–PSO–BP, optimized by genetic algorithm (GA) and particle swarm optimization (PSO)—were developed. Their performance was evaluated using the coefficient of determination (R²), root mean square error (RMSE), and mean absolute error (MAE). Among the four models, GA–PSO–BP produced the best predictive performance, with a best-run R² of 0.9308 on the validation set, exceeding the BP, GA–BP, and PSO–BP neural networks by 0.0642, 0.0326, and 0.0512, respectively. Over 10 independent runs, it attained an average R² of 0.8822 and consistently delivered the lowest RMSE and MAE with small standard deviations, confirming its superior predictive accuracy and stability. These findings suggest that integrating GA and PSO can effectively enhance the predictive accuracy and stability of the BP neural network, thereby providing a dependable reference for compressive strength prediction and mix proportion optimization of steel fiber recycled aggregate concrete. Full article

(This article belongs to the Special Issue High-Performance Concrete: Modification Methods, Sustainability, and Multifunctional Applications—2nd Edition)

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15 pages, 304 KB

Open AccessArticle

Occupational and Lifestyle Factors of Male and Female Infertility Patients: Do They Impact ART Success?

by Jelena Micić, Mladen Andjić, Jelena Dotlić, Katarina Ivanović, Aleksandar Trklja, Jovana Plešinac, Maja Maslovarić, Bojana Mihajlović, Lela Šurlan, Isidora Protić, Lidija Tulić, Jovan Bila and Jelena Stojnić

Medicina 2026, 62(6), 1132; https://doi.org/10.3390/medicina62061132 (registering DOI) - 10 Jun 2026

Abstract

Background and Objectives: Numerous risk factors for both female and male fertility have been established including age, ovarian reserve, infertility cause, occupational and lifestyle factors. The objective of our study was to determine the influence of occupational and lifestyle factors on assisted reproduction (ART) outcomes at a Serbian referral tertiary center. Materials and Methods: The study included all consecutive infertile couples undergoing ART at the Clinic for Ob/Gyn University Clinical Center Belgrade, from January 2019 to January 2022. Inclusion criteria comprised primary and unexplained infertility, age ≤ 45 years, body mass index ≤ 30 kg/m² and undergoing fresh autologous ART cycles. All patients filled in the socio-epidemiological questionnaire that analyzed their lifestyle and habits. Medical history data and data regarding the current ART cycle were taken from patient records. The primary outcome was clinical pregnancy. Results: Our study included 501 couples (women and men) with infertility undergoing ART. Clinical pregnancy was achieved in 22.2% of examined patients. Achieving clinical pregnancy in the ART cycle for women was associated with younger age and use of vitamins, minerals, and trace elements, whereas younger age and absence of chronic illnesses were the most important factors for male partners. When women and men were assessed together as couples, achieving clinical pregnancy correlated only with the use of vitamins, minerals and trace-elements by both partners. Conclusions: This study confirmed that some occupational and lifestyle factors were associated with clinical pregnancy after ART in patients with unexplained primary infertility and normal BMI. Full article

(This article belongs to the Special Issue Management and Diagnosis of Infertility and Recurrent Abortions in Obstetrics and Gynecology)

18 pages, 2399 KB

Open AccessArticle

Intent to Accept a Valley Fever Vaccine for Humans and Dogs and Factors Influencing Intended Uptake: A Cross-Sectional Survey in Two Endemic Regions

by Julia N. Hermann, Sophia E. Kruger, Natalie Wodniak, Jammie Holland, Veronica Janosick, Asley Sanchez, Julio C. Zuniga-Moya, Dana Brucker, Bianca Torres, Keny Mendoza Melo, Emilse Oliveros, Rasha Kuran, Carlos D’Assumpcao, Royce H. Johnson, R. Scott Van Pelt, Abinash Bhattachan, Abram L. Wagner and Jennifer R. Head

J. Fungi 2026, 12(6), 420; https://doi.org/10.3390/jof12060420 (registering DOI) - 10 Jun 2026

Abstract

As Valley fever (coccidioidomycosis) vaccine candidates progress towards human trials, a challenge to their eventual introduction is understanding vaccine demand and addressing vaccine hesitancy. We assessed intent to accept a Valley fever vaccine for humans and dogs in two populations living in highly endemic regions: employees at Kern Medical (KM) in Bakersfield, California (N = 103) and members of the public in West Texas (N = 230). We compared the weighted proportions of each population willing to vaccinate themselves and their dogs by demographic and coccidioidomycosis risk factors and assessed the importance of vaccine-related factors on vaccine uptake in each population. We found that 42% (95% confidence interval (CI): 34–49%) of West Texas residents and 76% (95% CI: 63–85%) of KM employees were willing to accept a coccidioidal vaccine, while 49% (95% CI: 41–58%) of West Texas residents and 74% (95% CI: 58–86%) of KM employees were willing to vaccinate their dogs. Among West Texas residents, vaccination willingness was significantly higher among those with prior awareness of Valley fever (adjusted odds ratio (aOR): 3.83, 95% CI: 1.73, 8.49). Across both study populations, absence of side effects was the most important condition that would increase vaccination willingness. Our results indicate substantial interest in a Valley fever vaccine while suggesting that increased Valley fever awareness and minimal vaccine side effects may be important for increased uptake. Full article

(This article belongs to the Special Issue Basic Science and Clinical Research of Coccidioides and Coccidioidomycosis)

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28 pages, 617 KB

Open AccessArticle

Measurement and Analysis of Influencing Factors of Green Total Factor Productivity in Mariculture: Empirical Evidence from China

by Lewei Peng, Ying Ma, Linhua Peng, Zhoufu Yan and Lixia Zhang

Fishes 2026, 11(6), 346; https://doi.org/10.3390/fishes11060346 (registering DOI) - 10 Jun 2026

Abstract

Enhancing mariculture’s green total factor productivity (GTFP) is essential to balance industrial growth with ecology, safeguard global food security, and meet UN Sustainable Development Goal 14 amid mounting marine stress. As a global leading mariculture producer, China provides a typical research sample. This study constructs a mariculture GTFP measurement index system, estimates GTFP in China’s coastal provinces via the global Super-SBM model, identifies root causes of efficiency loss, and explores influencing factors and spatial spillover effects using a spatial econometric model. The results show that the overall mariculture GTFP of China’s coastal provinces exhibits a fluctuating upward trend with significant regional heterogeneity, specifically presenting a distribution pattern of “the highest in the South China Sea Region, followed by the East China Sea Region, and the lowest in the Yellow Sea and Bohai Sea Region”. Meanwhile, mariculture GTFP shows significant positive spatial autocorrelation, with distinct High-High and Low-Low agglomeration characteristics. Excessive resource consumption and undesirable output discharge are the core drivers of efficiency loss. For direct effects, industrial scale, industrial structure, fishermen’s income, transportation accessibility, internet development, technology adoption, and environmental regulation significantly boost local GTFP, while fishery disasters exert a significant negative impact. For spatial spillovers, industrial scale, industrial structure, and internet development show significant positive effects, while fishermen’s income and urbanization present negative effects. Based on these findings, this study proposes targeted multi-stakeholder optimization paths, providing decision support for China’s mariculture green development and replicable experience for global coastal countries. Full article

(This article belongs to the Section Fishery Economics, Policy, and Management)

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11 pages, 226 KB

Open AccessReview

Factors and Mechanisms Underlying Individual Differences in Intestinal Susceptibility to Dietary Emulsifiers: A Review

by Gabriela Riebeek and Anje A. te Velde

Dietetics 2026, 5(2), 35; https://doi.org/10.3390/dietetics5020035 (registering DOI) - 10 Jun 2026

Abstract

Dietary emulsifiers, common in processed and ultra-processed foods, improve food texture and shelf life but may affect gut health by interacting with the microbiota and intestinal barrier. While emulsifiers have long been considered safe, growing evidence links their presence in ultra-processed foods to chronic disease risk. This review aims to evaluate the current understanding of the factors and mechanisms underlying individual differences in intestinal mucosal susceptibility to dietary emulsifiers. A search of PubMed and Embase through February 2026 identified eight relevant studies. Overall, the available evidence indicates a heterogeneous and highly individualized host response to dietary emulsifiers. These differences appear to be strongly influenced by the gut microbiota and its functional properties, while animal studies further suggest that host factors such as sex-related differences in microbial composition may also contribute to variability in response. Importantly, not all emulsifiers have the same effects, underscoring compound-specific impacts on gut physiology. The findings demonstrate that sensitivity to dietary emulsifiers varies substantially between individuals, challenging the long-standing assumption that these additives are universally safe. Given the multifactorial nature of this susceptibility, particularly the role of the gut microbiota, future research should adopt an integrative approach that combines microbial profiling with host genetics, immune responses, and early-life exposures. Such efforts will be essential to identify at-risk individuals and to inform more personalized dietary recommendations aimed at preserving intestinal health and reducing disease risk. Importantly, there is a clear need for larger, well-powered studies that can validate and expand upon these initial observations. Full article

(This article belongs to the Special Issue Personalized Nutrition and Dietary Interventions in Inflammatory Bowel Disease (IBD))

27 pages, 9262 KB

Open AccessArticle

Spatial-Temporal Evolution and Driving Factors of Cropland Multifunctionality in Henan Province Under the Production-Living-Ecological-Cultural Framework

by Mengfei Song, Honghui Zhu, Qiuyi Wu and Shuo Qing

Land 2026, 15(6), 1020; https://doi.org/10.3390/land15061020 (registering DOI) - 10 Jun 2026

Abstract

This study aims to reveal the spatial-temporal evolution rule and driving mechanism of cropland multifunctionality in major grain-producing areas. Taking Henan Province as the research case, we establish a comprehensive evaluation index system covering production, living, ecological and cultural functions based on multi-source datasets spanning 2013–2022. It adopts the entropy weight method, spatial analysis and geographical detector (GeoDetector) model to analyze the spatial-temporal differentiation characteristics and influencing mechanism of cropland multifunctionality systematically. The results show that the overall level of cropland multifunctionality in Henan Province rose from 2013 to 2022. Its spatial pattern presents a feature of high in the south and low in the north, with obvious agglomeration in southern Henan. The production function is high in the east and low in the west with a stable pattern. The living, ecological and cultural functions all show a distribution of high in the south and low in the north, with prominent regional differences. Factor detection results indicate that average slope, population density and average annual temperature are the core driving factors. The overall influence of natural factors is stronger than that of socio-economic factors. Interaction detection shows that all factors produce a strengthening effect, mainly in the form of nonlinear enhancement effects. Based on this, the research has proposed targeted and differentiated strategies for the management of cultivated land. Specifically, southern Henan should consolidate its inherent multifunctional advantages and strengthen the coordinated development of production, ecological and cultural functions. Northern and western Henan needs to mitigate terrain and climatic constraints, optimize agricultural infrastructure, and improve overall cropland service capacity. Eastern plain areas should further stabilize grain production function while balancing ecological protection. Central urban agglomerations should coordinate urban expansion and cropland protection to restrain multifunctional degradation. Full article

(This article belongs to the Special Issue Land Use Optimization for Sustainable Agricultural and Food Systems)

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14 pages, 244 KB

Open AccessArticle

Predicting Momentary Mood in Daily Life from Accelerometer Data: Evaluating Single vs. Multiple Sensor Locations Using Machine Learning

by Simon Woll, Julius Müther, Dennis Birkenmaier, Gergely Biri, Ulrich W. Ebner-Priemer and Marco Giurgiu

Sensors 2026, 26(12), 3688; https://doi.org/10.3390/s26123688 (registering DOI) - 10 Jun 2026

Abstract

Physical activity is a key lifestyle factor for mental health prevention, yet the influence of accelerometer placement on mood prediction remains unclear. We merged high-resolution acceleration data and Ecological Momentary Assessment (EMA) mood reports from 259 healthy participants across three ambulatory studies (SedMood, 24 hrCog, HO). Additionally, 15 min pre-assessment movement windows consisting of raw triaxial acceleration (64 Hz) from hip, thigh, chest, and wrist sensors were paired with six-item mood EMA queries. Features (e.g., mean, entropy, spectral power) were extracted and fed into gradient-boosted decision tree models (XGBoost), trained separately for energetic arousal, valence, and calmness. Performance was measured using the metrics MAE, RMSE and R². Within individual studies, chest and hip sensors achieved the highest performance, followed by wrist and thigh. In the combined dataset, hip sensors again outperformed thigh (R² 0.38 vs. 0.20). Multi-sensor models rarely surpassed the best single-sensor configuration and sometimes reduced accuracy. These results suggest that sensor location modestly impacts mood-prediction performance, with hip and chest offering the most reliable signals, while adding sensors does not reliably enhance predictive power. Future work should explore larger, homogenous datasets and location-specific feature engineering to refine wearable-based mental health monitoring. Full article

(This article belongs to the Special Issue Wearable Sensors for Continuous Health Monitoring and Analysis: 2nd Edition)

16 pages, 841 KB

Open AccessArticle

Circulating Brain-Derived Neurotrophic Factor (BDNF) and Multimodal Opioid-Based Analgesia in Chronic Pain: Plasma BDNF as an Indicator of Pain Intensity and Neuropathic Pain

by Urszula Kosciuczuk, Piotr Jakubow and Damian Misiuk

Biomedicines 2026, 14(6), 1313; https://doi.org/10.3390/biomedicines14061313 (registering DOI) - 10 Jun 2026

Abstract

Background: Brain-derived neurotrophic factor (BDNF) is crucial in the nociception and mechanisms underlying chronic and neuropathic pain. The evaluation of circulating BDNF in patients with multimodal analgesia has not been reported previously. We hypothesized that opioid-based multi-analgesia induces changes in BDNF values and that BDNF correlates with pain intensity in neuropathic pain. Methods: Adult patients who met low back pain (LBP) criteria and received multimodal opioid-based therapy were included. The control group included patients with LBP who did not receive any pharmacotherapy. Plasma measurements obtained with the ELISA test were analyzed. The study was registered at Clinical Trials.gov (NCT 04227223). Results: Patients with multimodal opioid-based analgesia had significantly higher BDNF values compared to the monotherapy: 3.6 ng/mL vs. 2.7 ng/mL, p = 0.01. No statistical differences were observed compared to the non-pharmacologically treated group: 3.6 ng/mL vs. 5.0 ng/mL, p = 0.75. The median BDNF values were lowest in the mild-pain group, and significant differences were observed between the severe and moderate-pain groups (p = 0.006) and the mild-pain group (p = 0.0001). BDNF was significantly higher in the neuropathic-pain group compared to the group of patients without neuropathic pain (p = 0.0005). A significant correlation was demonstrated between the BDNF and numerical rating pain score (NRS) in the neuropathic-pain component (rho = 0.6, p = 0.001). Conclusions: Multimodal opioid-based analgesia decreases plasma BDNF concentrations less than opioid monotherapy, which offers an opportunity to limit opioid-induced adverse effects. BDNF influences pain intensity and predicts neuropathic pain in multimodal opioid-based analgesia. Full article

(This article belongs to the Special Issue Biomarkers in Pain: 2nd Edition)

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13 pages, 2194 KB

Open AccessArticle

CT-Quantified Sarcopenic Visceral Obesity Is Negatively Associated with Recompensation in Patients with Decompensated Cirrhosis: A Retrospective Single-Center Study

by Hongxia Zhang, Zhenzhen Wen, Fengjuan Tian and Yanfei Fang

J. Clin. Med. 2026, 15(12), 4482; https://doi.org/10.3390/jcm15124482 (registering DOI) - 10 Jun 2026

Abstract

Background/Objectives: Recompensation in patients with decompensated cirrhosis has significant prognostic implications. In this study, we aimed to evaluate the incidence and predictors of recompensation in cirrhotic patients, specifically focusing on elucidating the influence of sarcopenia and visceral obesity on achieving recompensation in a cohort of decompensated individuals. Methods: We conducted a retrospective analysis of 195 patients with decompensated cirrhosis from 2021 to 2024. Body composition abnormalities were determined by the skeletal muscle index (SMI) and visceral-to-subcutaneous adipose tissue ratio (VSR) on computed tomography (CT), respectively. Factors related to recompensation, defined using the modified Baveno VII criteria, were identified using multivariate regression. Results: Patients who achieved recompensation exhibited a lower age (62 vs. 67, p < 0.05), a higher body mass index (22.8 vs. 21, p < 0.01), a lower aspartate aminotransferase level (32 vs. 39, p < 0.01), a higher albumin level (35.2 vs. 32.3, p < 0.01), a lower ascites prevalence (60% vs. 74.07%, p < 0.05), a lower Child–Pugh score (6 vs. 7, p < 0.01), and a lower End-Stage Liver Disease score (9 vs. 10, p < 0.05) compared to those with non-recompensated cirrhosis. Body composition abnormalities were significantly more prevalent in non-recompensated patients than in recompensated patients (77.04% vs. 63.33%, p < 0.05), mainly because of a significantly higher prevalence of combined sarcopenia and visceral obesity in non-recompensated individuals (28.29% vs. 6.67%, p < 0.01). Multivariate analysis indicated that combined sarcopenia and visceral obesity was the sole independent risk factor for non-recompensation in this population. Furthermore, in the subgroup of patients aged < 70 years, with normal weight and preserved liver function, differences in recompensation rates among various states of body composition abnormalities were more pronounced. Conclusions: Sarcopenic visceral obesity is an independent risk factor for non-recompensation in patients with decompensated cirrhosis, highlighting the need for targeted interventions to mitigate body composition abnormalities in this vulnerable population. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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