Search Results (72,834)

Background and Objectives: Facial paralysis involves the complete or partial loss of facial movement due to damage to the facial nerve, leading to impaired voluntary muscle function and facial asymmetry. Given its significant physical and psychosocial impact, there is an urgent need to strengthen the evidence supporting non-pharmacological treatments. This umbrella review aims to compile the most reliable and current data to establish a consensus on the effectiveness of such interventions for patients with facial paralysis. Materials and Methods: This study is an umbrella review. A systematic search was conducted in PubMed, Embase, Scopus, and CINAHL (28 July 2024). The variables assessed included overall healing/recovery rate, facial disability, and facial function. Methodological quality was evaluated using the AMSTAR and ROBIS tools. Screening was performed independently by two reviewers, with a third reviewer resolving any discrepancies. Results: Five systematic reviews were included, all evaluating the impact of non-pharmacological interventions in facial paralysis. The findings suggest that acupuncture and electrical stimulation may improve recovery rates and facial function, although high heterogeneity and methodological limitations were noted in some studies. No definitive conclusions could be drawn regarding facial disability. Conclusions: The combination of electrotherapy with other complementary techniques, such as facial exercises or laser therapy, appears to be a safe and potentially effective approach for facial paralysis rehabilitation. Nonetheless, further research employing standardized protocols and higher methodological quality is necessary to establish more robust conclusions for physiotherapeutic practice. Full article

Background/Objectives: This study conducted a secondary and integrative analysis of qualitative data on adolescents and young adults (AYAs) with biliary atresia who survive with their native livers. These individuals struggle with independence and self-care due to prolonged parental involvement. Prior studies have insufficiently clarified how AYAs and parents jointly navigate daily responsibility transitions during this period. Therefore, we aimed to elucidate this process and develop a practical model to support nursing care. Methods: Semi-structured interview data from eight adolescent–parent dyads (one male and seven females, aged 17–25; one father and seven mothers, aged 40–60) were reanalyzed using the modified grounded theory approach. By reframing the analytical focus on dyadic interactions, four transition phases were identified, which were then integrated with the findings of two prior studies to construct an integrative process model. Results: The transition comprised four phases: (1) parent-led recuperation, (2) a vicious cycle of control and rebellion, (3) passing the axis of responsibility, and (4) aligning the parent–child rhythm to create a patient-centered life. The transition processes were shaped by changes in cognition and behavior. The model illustrates mutual adaptation through communication, negotiation, and reflection, identifying opportunities for nursing intervention. Conclusion: This process model offers a practical framework for nurses to assess readiness for care transitions, support transitional role shifts, and co-develop care strategies. The model provides insights into relationship-based communication and shared decision-making in transitional care by capturing the relational dynamics between AYAs and their parents. Full article

Background: The aim of this study was to evaluate the cervical regeneration process following monopolar electrosurgical conization (MESC), using a multimodal approach including ultrasonographic, cytologic, colposcopic, and histologic assessments, and to determine the relationship between the extent of excision and the capacity for cervical tissue regeneration. Methods: This prospective observational study included 28 patients who underwent MESC due to abnormal cervical cytology or biopsy-confirmed cervical intraepithelial neoplasia. Preoperative, postoperative one month and six month cervical measurements were obtained using two-dimensional transvaginal ultrasonography. Monthly colposcopic evaluations were conducted, cervical biopsies were taken at the third month, and a cytological assessment was performed at the sixth month. Cervical volume and length regeneration were calculated and analyzed in relation to the dimensions of the excised cone. Regeneration percentages and their correlations with excised tissue dimensions were evaluated using paired t-tests and Pearson correlation analysis. Results: Mean cervical volume and length regeneration rates at six months were 84.61% ± 5.64 and 86.36% ± 3.33, respectively. The transformation zone was histologically visible in 32.1% of patients at three months and cytologically in 75.9% at six months. An inverse correlation was observed between both cone volume and length and cervical regeneration (p < 0.005). Patients with larger preoperative cervical dimensions exhibited a higher regenerative capacity. Positive surgical margins were found in only one patient (3.4%), and no high-grade cytologic abnormalities were noted at follow-up. Conclusions: MESC may enable substantial cervical regeneration within six months. Larger excisions impair healing and delay transformation zone reformation, which may inform the optimal timing for initiating gynecological and colposcopic examinations, as well as for performing cervical interventions when indicated. Full article

The therapeutic management of extensive skin wounds in cats can be time-consuming and require multiple therapeutic interventions, which can have significant financial implications for pet owners. Reconstructive surgery is often necessary to close skin defects with tissue loss to provide a quicker patient recovery. Conventional therapies like systemic antibiotics, anti-inflammatories, and local dressings are not always successful due to antibiotic resistance or a poor response, such as no or delayed healing. For more than a century, ozone has been utilized as an excellent disinfectant, but caution should be taken due to its oxidizing properties. Only in the past decade have numerous studies established therapeutic dose ranges for a wider medical use of ozone. The objective of this study was to clinically evaluate ozone therapy as a complementary treatment supporting and completing plastic and reconstructive surgery in 4 cats with extensive skin defects. The results obtained, following the local application of ozone therapy before and after skin reconstruction in our patients, encourage the use of ozone as a complementary therapy in the management of extensive skin wounds treated surgically by different reconstructive techniques. Full article

Pancreatic Ductal Adenocarcinoma (PDAC) is one of the most lethal cancers, accounting for a significant proportion of cancer-related deaths globally. Despite advancements in medical science, treatment options for PDAC remain limited, and the prognosis is often poor. Early detection is a critical factor in improving patient outcomes, but current diagnostic methods often fail to detect PDAC until it has advanced to a late stage. In this context, the development of more effective diagnostic tools is of paramount importance. In this study, we explored the potential of non-coding RNAs (ncRNAs) as diagnostic markers for PDAC using cell-free nucleotides and liquid biopsies. Leveraging the power of Next Generation Sequencing (NGS), bioinformatics analysis, and machine learning (ML), we were able to identify unique RNA signatures associated with PDAC. Our findings revealed twenty key genes, including microRNAs (miRNAs), long-non-coding RNAs (lncRNAs), and miscellaneous RNAs that demonstrated high classification accuracy. Specifically, our model achieved a classification accuracy of 87% and an area under the receiver operating characteristic curve (AUC) of 91%. These ncRNAs could potentially serve as robust biomarkers for PDAC, offering a promising avenue for the development of a non-invasive diagnostic test. This could revolutionize PDAC diagnosis, enabling earlier detection and intervention, which is crucial for improving patient outcomes. This work lays the groundwork for future research, with the potential to significantly enhance PDAC diagnosis and therapy. Full article

Schizophrenia is a complex disorder that affects mental organization and cognitive functions, including concentration and memory. One notable manifestation of cognitive changes in schizophrenia is a diminished ability to scan and perform tasks related to visual inspection. From the three evaluable aspects of the ocular movements (saccadic, smooth pursuit, and fixation) in particular, smooth pursuit eye movement (SPEM) involves the tracking of slow moving objects and is closely related to attention, visual memory, and processing speed. However, evaluating smooth pursuit in clinical settings is challenging due to the technical complexities of detecting these movements, resulting in limited research and clinical application. This pilot study investigates whether the quantitative metrics derived from eye-tracking data can distinguish between patients with schizophrenia under treatment and healthy controls. The study included nine healthy participants and nine individuals receiving treatment for schizophrenia. Gaze trajectories were recorded using an eye tracker during a controlled visual tracking task performed during a clinical visit. Spatiotemporal analysis of gaze trajectories was performed by evaluating three different features: polygonal area, colocalities, and direction difference. Subsequently, a support vector machine (SVM) was used to assess the separability between healthy individuals and those with schizophrenia based on the identified gaze trajectory features. The results show statistically significant differences between the control and subjects with schizophrenia for all the computed indexes (p < 0.05) and a high separability achieving around 90% of accuracy, sensitivity, and specificity. The results suggest the potential development of a valuable clinical tool for the evaluation of SPEM, offering utility in clinics to assess the efficacy of therapeutic interventions in individuals with schizophrenia. Full article

This study aims to investigate the molecular mechanisms underlying germ cell tumors (GCTs), focusing specifically on seminomas and teratomas. By analyzing gene expression profiles and miRNA interactions, the goal is to identify key regulatory miRNAs and signaling pathways that differentiate these tumor types and could serve as important regulators for therapy development. Raw data for seminomas and teratomas were extracted from the GEO database, and gene hubs were identified using STRING and Gephi. Signaling pathways and functional annotations were analyzed using miRPathDB, while miRNA–gene interactions were explored via miRWalk. Hub miRNAs were filtered and confirmed using miRDB. This study highlights significant changes in gene expression diversity between tumor and normal gonadal tissues, providing insights into the molecular dynamics of seminomas and teratomas. Distinctions between seminomas and teratomas were identified, shifting the focus toward miRNAs to discover more precise and novel therapeutic approaches. The hub genes of seminomas and teratomas were identified separately. MiRNAs targeting these hub genes were also determined and confirmed. These miRNAs collectively influence essential oncogenic pathways—confirming hsa-miR-138-5p as a regulator of pathways such as Hippo signaling, transcriptional misregulation in cancer, and microRNA cancer signaling in seminomas, and hsa-miR-200b-3p as a regulator of p53 signaling, T cell receptor signaling, and pathways including PI3K/AKT, MAPK/ERK, and Wnt/β-catenin in teratomas—confirming their potential as promising candidates for subtype-specific therapeutic intervention. MiRNAs identified through bioinformatics analyses, and their predicted regulatory roles in key oncogenic pathways, represent potential therapeutic targets or regulators of biological processes. However, further experimental validation is needed to confirm these findings. Full article

Background: Parapneumonic effusion is a common complication of community-acquired pneumonia and can range from a simple inflammatory transudate to an organized purulent collection, known as empyema. Progression to empyema significantly worsens the prognosis, leading to increased morbidity, longer hospital stays, and a greater need for invasive interventions. Several risk factors for pleural effusion and progression to empyema have been identified, but the absence of standardized criteria underline the need for better risk stratification. We analyzed clinical and laboratory data from a cohort of children hospitalized with pneumonia associated with pleural effusion or empyema, to identify predictive risk factors associated with these complications. Methods: We retrospectively analyzed clinical and laboratory data from patients admitted to our Pediatric Emergency Department with pneumonia complicated by pleural effusion and compared patients with simple effusion to those with empyema. Results: Seventeen children with simple pleural effusion and eighteen with empyema were enrolled. Patients with empyema had higher absolute neutrophil count, higher levels of C-reactive protein, procalcitonin, and ferritin, and lower serum albumin levels. Furthermore, they took a longer time for normalization of inflammatory markers when compared with those with pleural effusion. Invasive interventions, such as pleural drainage, and the need for intensive care were more frequent in the empyema group. Conclusions: Pleural effusion and empyema are two common complications of pediatric community-acquired pneumonia. Children developing pleural empyema have higher inflammatory markers and lower levels of serum albumin compared to patients with simple pleural effusion. Morbidity is significantly worse in children with empyema as they are more prone to require invasive interventions and intensive care. Full article

Asbestos-related diseases (ARDs), including malignant mesothelioma, asbestos-related lung cancer, and asbestosis, are known for their long latency periods and poor prognoses. Although the physical effects of ARDs have been widely studied, limited research has examined the psychological burden faced by affected individuals. This study investigated depressive and anxiety symptoms among 275 patients officially recognized as asbestos victims in Korea. Mental health was assessed using the Korean version of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Hospital Anxiety and Depression Scale (HADS). The analysis revealed that the mean ± standard deviation of depression and anxiety levels among patients with asbestos-related diseases were 8.06 ± 6.27 for PHQ-9, 6.02 ± 5.64 for GAD-7, 7.09 ± 5.44 for HADS-A, and 8.41 ± 5.47 for HADS-D. Patients with asbestosis had higher levels of depressive and anxiety symptoms than those with malignant mesothelioma or lung cancer, with symptom severity increasing alongside asbestosis grade. When compared with national data from the 2020–2021 Korea National Health and Nutrition Examination Survey (KNHANES), PHQ-9 and GAD-7 scores among ARD patients, particularly those with Grade 1 asbestosis, were higher than the scores reported for all major cancer types. These findings highlight the substantial psychological distress experienced by individuals with ARDs and emphasize the urgent need for targeted mental health interventions in this population. Full article

Young children’s problematic media use (PMU) is a growing concern, and parents are critical in shaping early digital habits. However, research often overlooks the dyadic interplay between mothers’ and fathers’ attitudes and parenting practices. This study examined how parents’ favorable attitudes toward child screen media (PASU) predict their own (actor) and their partner’s (partner) mediation behaviors, and how these behaviors subsequently mediate the path to children’s PMU. Drawing on survey data from 1802 matched urban Chinese mother–father pairs, we employed an Actor–Partner Interdependence Mediation Model (APIMeM) within a structural equation modeling (SEM) framework. This dyadic model simultaneously tested actor, partner, and indirect mediation paths connecting parental attitudes to PMU via eight specific parenting practices. Results showed that more positive PASUs predicted each parent’s own supportive behaviors (e.g., high-quality dialogue, autonomy support) but not restrictive limits. Partner effects were modest and asymmetric: mothers’ positive attitudes predicted greater knowledge in fathers, whereas fathers’ positive attitudes were linked to lower communication quality from mothers. Of all parenting dimensions, only higher communication quality (both parents) and mothers’ hands-on monitoring directly predicted lower PMU. Mediation analyses confirmed communication quality as the sole reliable pathway: each parent’s favorable attitudes indirectly lowered PMU by enhancing their own dialogue, but fathers’ attitudes simultaneously increased PMU by eroding mothers’ dialogue. These findings spotlight constructive conversation and coordinated dyadic strategies—especially safeguarding maternal dialogue—as critical targets for interventions aimed at curbing early PMU. Full article

Multisystemic Therapy (MST) is an intensive family and community-based treatment targeting antisocial behaviours in adolescents. Treatment fidelity has proved crucial for successful implementation of the MST intervention, with prior research demonstrating a strong association with positive and enduring treatment outcomes. The Therapist Adherence Measure (TAM) is a standardised measure reported by caregivers and comprised of 28 items based on the nine treatment principles of MST. Several randomised control trials have confirmed that therapist adherence to the MST model is a valid predictor for a reduction of antisocial behaviours in adolescents. However, there is limited understanding of mechanisms by which therapist model adherence is related to positive changes in family relations and association with decreased adolescent behavioural problems. In this retrospective study, we evaluated effects of therapist adherence on changes in parental factors (e.g., parental mental well-being, monitoring and discipline approach) which in turn were associated with decreased behavioural problems in adolescents. We extracted data collected from 186 families engaged with the MST research program operating within the Western Australian Child and Adolescent Mental Health Service (CAMHS) during 2018–2024. Data for TAMs were collected monthly during treatment, and family outcome measures were collected at pre-treatment and post-treatment. The finding highlights the importance of therapists maintaining treatment fidelity and addressing treatment barriers throughout MST intervention to ensure the desired therapeutic outcomes. Full article

Retrieval-Augmented Generation (RAG) offers a promising strategy to harness large language models (LLMs) for delivering up-to-date, accurate clinical guidance while reducing physicians’ cognitive burden, yet its effectiveness hinges on query clarity and structure. We propose an adaptive Self-Query Retrieval (SQR) framework that integrates three refinement modules—PICOT (Population, Intervention, Comparison, Outcome, Time), SPICE (Setting, Population, Intervention, Comparison, Evaluation), and Iterative Query Refinement (IQR)—to automatically restructure and iteratively enhance clinical questions until they meet predefined retrieval-quality thresholds. Implemented on Gemini-1.0 Pro, we benchmarked SQR using thirty postoperative rhinoplasty queries, evaluating responses for accuracy and relevance on a three-point Likert scale and for retrieval quality via precision, recall, and F1 score; statistical significance was assessed by one-way ANOVA with Tukey post-hoc testing. The full SQR pipeline achieved 87% accuracy (Likert 2.4 ± 0.7) and 100% relevance (Likert 3.0 ± 0.0), significantly outperforming a non-refined RAG baseline (50% accuracy, 80% relevance; p < 0.01 and p = 0.03). Precision, recall, and F1 rose from 0.17, 0.39 and 0.24 to 0.53, 1.00, and 0.70, respectively, while PICOT-only and SPICE-only variants yielded intermediate improvements. These findings demonstrate that automated structuring and iterative enhancement of queries via SQR substantially elevate LLM-based clinical decision support, and its model-agnostic architecture enables rapid adaptation across specialties, data sources, and LLM platforms. Full article

Numerous infants have been conceived by in vitro fertilization (IVF) and other assisted reproductive technologies (ART). Increasing evidence indicates that these approaches induce minor alterations in molecules during the initial phases of embryogenesis. This narrative review examines the molecular pathophysiology of embryonic cardiogenesis in the context of assisted reproductive technology, emphasizing transcriptional and epigenetic regulation. Essential transcription factors for cardiac development, including NKX2-5, GATA4, TBX5, ISL1, MEF2C, and HAND1/2, play a crucial role in mesodermal specification, heart tube formation, and chamber morphogenesis. Animal models and human preimplantation embryos have demonstrated that ART-related procedures, including gamete micromanipulation, supraphysiological hormone exposure, and extended in vitro culture, can alter the expression or epigenetic programming of these genes. Subsequent to ART, researchers have identified anomalous patterns of DNA methylation, alterations in histones, and modifications in chromatin accessibility in cardiogenic loci. These alterations indicate that errors occurred during the initial reprogramming process, potentially resulting in structural congenital heart abnormalities (CHDs) or modifications in cardiac function later in life. Analysis of the placental epigenome in babies conceived using assisted reproductive technology reveals that imprinted and developmental genes critical for cardiac development remain dysfunctional. This review proposes a mechanistic theory about the potential subtle alterations in the cardiogenic gene network induced by ART, synthesizing findings from molecular embryology, transcriptomics, and epigenomics. Understanding these molecular issues is crucial not only for enhancing ART protocols but also for evaluating the cardiovascular risk of children conceived by ART postnatally and for early intervention. Full article

Multiple sclerosis (MS) is a chronic, immune-mediated neurological disorder with increasing global prevalence. Emerging evidence underscores the role of lifestyle interventions (particularly diet and physical activity) in modulating disease progression and improving quality of life. This narrative review synthesizes current scientific literature on the effects of dietary interventions, including the Mediterranean, ketogenic, Swank, Wahls, gluten-free, and fasting-based diets, alongside various physical activity regimens. The Mediterranean and ketogenic diets show promise in reducing inflammation, enhancing neuroprotection, and improving metabolic health. Similarly, structured physical activity (including aerobic, resistance, sensorimotor, and mind–body exercises) demonstrates benefits in mobility, fatigue, and mental well-being. The review highlights the need for personalized, sustainable approaches that integrate nutritional and exercise-based strategies for optimal MS management in the long term. Full article

Probiotics containing Lactobacillus spp. have demonstrated immunological and gastrointestinal benefits and may aid in recovery from mood disorders. However, evidence of their mood-modulating efficacy remains inconsistent. Aim: To analyze the efficacy of probiotic interventions with Lactobacillus spp. in modulating mood in humans. A scoping review was conducted following the PRISMA guidelines. A systematic search of the PubMed and Scopus databases was performed using nine Boolean combinations of the terms “mental”, “mental diseases”, “mental disorders”, “gastrointestinal microbiome”, “gut microbiome”, “gut microbiota”, and “lactobacillus”. The search was limited to clinical trials published in English and limited to ten years of publication. Eligible studies met the following criteria: (a) probiotic interventions in adults, with or without mood disturbances; (b) the use of Lactobacillus spp., either alone or in combination; (c) mood assessment instruments applied pre- and post-intervention; and (d) reporting of probiotic concentrations. Trials involving populations with other psychiatric or neurological diagnoses or those combining probiotics with additional mood-modulating nutrients were excluded. From 3291 records, 17 clinical trials met the inclusion criteria. Data extracted included the author, year, population, country of origin, probiotic strain(s), dosage, intervention mode and duration, and outcomes related to the microbial composition, biomarkers, and microbial metabolites. Trials were categorized by probiotic type (single vs. multi-species) and participant profile (healthy individuals and those with depressive symptoms or specific physiological conditions). Preliminary evidence from single-strain interventions, particularly high-dose L. plantarum administered for ≥8 weeks, suggests potential improvements in anxiety, sleep quality, and inflammatory biomarkers. Multi-species formulations yielded reductions in depressive symptoms and changes in neurobiological markers. Nonetheless, substantial heterogeneity in strains, dosages, durations, and outcome measures limited cross-study comparisons. Lactobacillus spp. interventions show promising mood-modulating potential, especially with specific strains and prolonged administration. Standardized protocols, rigorous controls, and clearly defined clinical cohorts are needed to establish robust, evidence-based recommendations. Full article