Search Results (1,752)

The genus Alchornea Sw. belongs to the Euphorbiaceae family. Alchornea species are commonly used in traditional medicine to treat inflammation; infectious, gastrointestinal, respiratory, musculoskeletal, and dermatological disorders; as well as other diseases. This comprehensive review provides an overview of recent scientific findings on the taxonomy, ethnomedicinal uses, phytochemistry, pharmacological potential, and toxicology of the Alchornea species. The literature was searched using SciFinderⁿ, Google Scholar, and PubMed. The taxonomy of all reported plants was authenticated using “Plants of the World Online”. Studies were examined and categorized according to the genus’s taxonomic classification, traditional uses, phytochemistry, pharmacological potential, and toxicity. Phytochemical studies have identified 396 bioactive compounds, primarily triterpenoids, alkaloids, flavonoids, and phenolics. Pharmacological studies have reported significant antimicrobial, anti-inflammatory, antioxidant, anti-plasmodial, and cytotoxic effects. Nevertheless, toxicological statistics are limited and vary among species and extracts. The genus Alchornea exhibits significant pharmacological potential, as evidenced by its traditional uses. In comparison, the genus remains underexplored in terms of detailed mechanistic pharmacological evaluation. Studies of chemical constituents and biological activities have been conducted for only approximately 17 species. To translate the pharmacological potential of the genus Alchornea into clinical practice, a strategic focus on modern plant valorization is required. Future research should focus on the valorization of Alchornea species by developing standardized oral formulations and topical preparations that harness their validated anti-inflammatory and antimicrobial effects beyond traditional uses. However, these findings suggest that further research is needed to assess the efficacy and safety of the largely unexplored genus Alchornea. Full article

Background: Hypermobile Ehlers–Danlos syndrome (hEDS), the most common EDS subtype, is characterized by chronic pain and joint laxity, yet no definitive causative genes or imaging-based diagnostic criteria have been established. This study investigated the genetic basis of hEDS using whole-exome sequencing (WES) and objectively evaluated ankle instability. Methods: We conducted an observational cohort study with a case–control comparison, including 22 patients and a three-generation Korean family (six individuals, four affected) diagnosed with hEDS by the 2017 criteria. WES was performed; ankle laxity was assessed by the anterior drawer test (ADT), stress ultrasonography, and stress radiography. Healthy young adults (n = 24, Beighton score < 5) from our previous study served as controls. Results: The hEDS cohort had a mean Beighton score of 8.5, with all participants reporting a family history of hypermobility and musculoskeletal complications. Family-based WES identified variants in CD44 (c.1516 + 1G > A), ITIH2 (c.783C > G), and ADAM21 (c.397C > T) in all affected individuals. In 22 unrelated patients, 114 variants in 103 candidate genes were identified; 17 patients harbored variants in genes from the same pathways as the family-derived causative genes. Compared with controls, the hEDS group showed significantly greater manual ADT grade, anterior talofibular ligament (ATFL) length at rest and under stress, dynamic ATFL change, anterior talar translation, and talar tilt. Conclusions: These findings provide molecular evidence that hEDS is a multifactorial disorder involving interconnected biological pathways, and confirm ankle instability as a clinically meaningful diagnostic feature. These complementary approaches may improve diagnostic accuracy and provide insights into the prognosis and therapeutic strategies for hEDS. Full article

Medicinal plants play a crucial role in primary healthcare among indigenous communities; however, systematic ethnomedicinal documentation of the Yao people in Lingyun County, Guangxi, remains limited. This study aimed to document the diversity, traditional uses, and cultural significance of medicinal plants used by the Yao community. Ethnobotanical data were collected through semi-structured interviews with 104 informants. A total of 172 species belonging to 135 genera and 73 families were recorded, with Fabaceae, Lamiaceae, and Asteraceae being the most represented families. Herbs were the dominant growth form, and whole plants, roots, and shoots were the most frequently used parts, typically prepared in dried form and administered orally. Fidelity Level (FL) values ranged from 6.67 to 100, with several species showing high consensus in therapeutic use. Informant Consensus Factor (ICF) values (0.778–1.000) indicated strong agreement among informants, particularly for musculoskeletal, skin, gastrointestinal, and immune-related disorders. These findings highlight the richness and consistency of ethnomedicinal knowledge among the Yao people and provide a scientific basis for future pharmacological research, conservation planning, and the sustainable use of medicinal plant resources. Full article

Background: Neurological disorders are a leading cause of disability worldwide, placing increasing strain on healthcare systems. In Eastern Europe, and specifically Bulgaria, there is a significant lack of granular data regarding how ambulatory neurology services are utilized and how clinical workloads are distributed across different diagnostic groups. Objective: In this study, we aimed to analyze the clinical workload, demographic patterns, and diagnostic distribution within a single-center ambulatory neurology setting in Bulgaria, while identifying the primary determinants of patient age stratification. Methods: We conducted a retrospective observational study of 518 consecutive clinical encounters recorded over a one-year period in a specialized outpatient neurology clinic. Data on age, gender, visit type (ambulatory vs. dispensary), and ICD-10 diagnostic groups were analyzed. Inferential analyses included a one-way ANOVA for age differences and multivariable linear regression to identify independent predictors of age patterns, with age modeled as a continuous variable. Results: The clinical workload was highly concentrated, with spine-related disorders accounting for over 40% of all visits, and primary consultative examinations were the predominant service type (65.4%). Statistical analysis revealed significant age differences across diagnostic categories (p < 0.001), with neurodegenerative and cerebrovascular diseases associated with the highest mean age, while spine and headache syndromes involved significantly younger populations. Multivariable modeling confirmed that diagnostic category is the sole independent determinant of age distribution (p < 0.001), whereas gender and visit type showed no significant independent associations. Conclusions: Ambulatory neurology utilization in this setting is characterized by a high-turnover primary consultation model and a heavy concentration of musculoskeletal neurological conditions. These findings suggest that outpatient neurology functions as a critical diagnostic filter and pain management hub. The study underscores the need for diagnosis-specific clinical pathways and targeted resource allocation to optimize service efficiency and improve long-term management of chronic neurological morbidity in a public insurance-driven framework. Full article

Background/Objectives: Wrist cock-up orthoses are standard for work-related musculoskeletal disorders, yet consensus is lacking on whether commercial orthoses (COs) or custom-made thermoplastic orthoses (THs) better preserve function. While COs offer availability, THs provide a superior anatomical fit. This study evaluated dexterity and satisfaction in healthy female employees to establish a functional baseline for preventive strategies. Methods: Healthy female office workers with no prior musculoskeletal or neurological conditions participated in this randomized cross-over study. Manual dexterity was assessed at baseline and after each of two consecutive workdays, during which participants wore, in a randomized order, either a CO or a TH made by an expert physiotherapist. Outcome measures included the Functional Dexterity Test (FDT), recording time and errors, and the Client Satisfaction with Device (CSD-It) scale. Results: Twenty right-handed women (mean age 45.6 ± 11 years) participated. A significant difference in FDT completion times across conditions (χ² = 12.6, p = 0.002) was found. While both orthoses slowed performance compared to baseline (p < 0.01), the CO allowed for faster dexterity than the TH (p < 0.01). No differences were found in error rates. Regarding satisfaction, the CO achieved significantly better CSD-It scores than the TH (p = 0.0047), despite 60% of users reporting increased skin temperature with the CO. Final preferences were nearly evenly split (55% CO vs. 45% TH). Conclusions: Both orthoses impact manual dexterity without compromising precision. While the CO offered better execution speed and overall satisfaction, the TH version was preferred for prolonged skin tolerability. Selection should be individualized, balancing mechanical efficiency with the superior fit of custom-fabricated solutions in office environments. Full article

Polydeoxyribonucleotide (PDRN) activates the adenosine A2A receptor (A2AR), triggering anti-inflammatory signaling and providing essential nucleotides for the salvage pathway, thereby helping bypass metabolic bottlenecks and promoting tissue repair. Combining PDRN with biochemical agents and physical stimuli represents a significant shift in medical treatment, moving from monotherapy to an integrated, multi-target regenerative approach. These combinatorial strategies effectively address the limitations of PDRN, such as its rapid degradation and diffusion, by simultaneously meeting the structural, metabolic, and signaling needs of injured tissues. The mechanism of action for PDRN involves a synergistic effect with hyaluronic acid, amplification of growth factors (e.g., Platelet-Rich Plasma (PRP), Epidermal Growth Factor (EGF), Platelet-Derived Growth Factor (PDGF)), and enhancements from extracorporeal shockwave therapy (ESWT) and lasers. This results in a notable acceleration of the repair process for chronic wounds, musculoskeletal disorders, and neurological injuries. As intelligent delivery systems like responsive hydrogels and sustainable L-PDRN production continue to advance, these synergistic protocols are poised to redefine global standards of care in regenerative medicine and esthetic dermatology. Future clinical success will hinge on the standardization of sequence-specific protocols and large-scale validation to ensure long-term safety and efficacy. Full article

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), represents a chronic immune-mediated disorder frequently associated with extraintestinal manifestations. While musculoskeletal, dermatologic, and ocular complications are well recognized, ear, nose, and throat (ENT) involvement remains underrecognized despite its potential morbidity. Objective: To systematically evaluate the spectrum of ENT manifestations in IBD, focusing on clinical presentation, diagnostic approaches, and outcomes. Methods: A systematic literature search was conducted in PubMed and Scopus in accordance with PRISMA 2020 guidelines. Eligible studies included English-language human studies (2015–2026) reporting ENT manifestations in UC or CD. Following screening, 23 studies were included in the qualitative synthesis. Extracted data comprised study design, IBD subtype, patient demographics, ENT manifestations, diagnostic methods, and clinical outcomes. Results: The majority of studies consisted of case reports and small observational series. Sensorineural hearing loss (SNHL) was the most frequently reported manifestation in both adult and pediatric populations, with evidence suggesting immune-mediated mechanisms and variable responsiveness to corticosteroids. Nasal involvement included pyoderma gangrenosum, pyoderma vegetans, and aseptic nasal septal abscess, occasionally resulting in severe structural complications such as saddle-nose deformity. Laryngeal and airway involvement included dysphonia, tracheitis, and rare but potentially life-threatening inflammatory airway disease. Additional findings included associations with chronic rhinosinusitis. Diagnosis relied on audiometry, imaging, endoscopy, and histopathology. Systemic corticosteroids were frequently effective; however, delayed recognition may lead to irreversible sequelae. Conclusions: ENT manifestations in IBD constitute a clinically heterogeneous but important group of extraintestinal complications. Increased awareness of ENT manifestations may support earlier diagnosis and multidisciplinary management of IBD, potentially reducing irreversible complications. Full article

Glycosylation is a critical determinant of extracellular vesicle (EV) biology, shaping vesicle biogenesis, stability, biodistribution, cellular recognition, and uptake. Because EV glycans mirror disease-associated remodeling of parental cells, EV glycosylation is emerging as both a rich source of biomarkers and a functional regulator of regenerative signaling. This review highlights how altered EV glycosylation generates disease-specific signatures across major cancers, including lung, hepatocellular, colorectal, bladder, ovarian, pancreatic, and prostate cancer, and also discusses evidence in neurological, neuropsychiatric, metabolic, autoimmune, urinary, and musculoskeletal disorders. Beyond diagnostics, we examine the growing role of EV glycosylation in regenerative medicine, where glycan-dependent targeting and tissue interactions contribute to neural, cardiac, renal, skeletal, joint, and skin repair. We further provide an integrated overview of analytical strategies for EV glycosylation research, spanning mass spectrometry-based glycomics and glycoproteomics, affinity-based profiling, lectin microarrays, imaging, spectroscopic methods, advanced biosensing and nanotechnology-based approaches, and emerging artificial intelligence and bioinformatics tools. Current methodological challenges, biosafety issues, translational barriers, and future technologies are also critically discussed. Altogether, this review positions EV glycosylation as a promising interface between EV biology, precision diagnostics, and next-generation regenerative therapeutics. Full article

Background/Objectives: Age-related musculoskeletal (MSK) disorders lead to pain, reduced function, and diminished quality of life. This study aimed to evaluate the impact of a virtually delivered MSK care program on pain and function in older adults. Methods: A single-arm pre–post study was conducted analyzing self-reported outcomes of 902 patients aged ≥ 65 years who completed an initial evaluation with both an MSK specialty physician/nurse practitioner and a physical therapist, followed by two or more clinical visits. Outcome measures included pain (NPRS), function (SANE and PROMIS-10 GPH), and mental health (GAD-2, PHQ-2, and PROMIS-10 GMH). Results: Across 891 patients, mean pain intensity decreased from 4.56 ± 0.07 to 2.30 ± 0.07 (49.6%, p < 0.001) with 693 patients (77.8%) experiencing pain relief (63.2%, p < 0.001). In 172 patients with severe baseline pain (NPRS ≥ 7), 91.3% reported decreased pain (60.9%, p < 0.001). Functional gains were clinically meaningful, with SANE scores increasing from 53.85 ± 0.90 to 76.62 ± 0.75 (n = 795, 42.3%, p < 0.001). Pain reduction correlated with functional improvement (ρ = −0.29, p < 0.001) with modest correlations between engagement and improved pain (ρ = −0.09) and function (ρ = 0.23). Mental health outcomes remained stable, with marked improvement among patients with baseline symptoms of anxiety or depression, 44.2% and 57.1%, respectively. Conclusions: The virtual MSK care program produced meaningful improvements in pain and function while maintaining overall health. This highlights the potential for virtual MSK-focused integrated practice units (IPUs) to support holistic well-being and healthy aging in older adults. Full article

Parkinson’s disease (PD) is traditionally defined by dopaminergic loss in the substantia nigra, yet its heterogeneous phenotypes and prodromal trajectories challenge a linear, dopamine-centered model. The α-synuclein origin and connectome (SOC) model proposes two major trajectories: a brain-first pathway, with the pathology initiating in limbic and brainstem structures and spreading ipsilaterally to the nigrostriatal system, and a body-first pathway, with the pathology originating in enteric and peripheral autonomic nerves before ascending to the brain. In this review, we integrate the SOC model into a broader framework, reconceptualizing PD as a progressive disorder of spatial–temporal symmetry. Spatial symmetry encompasses left–right and cranio-caudal balance of neural and musculoskeletal systems, whereas temporal symmetry denotes the coherence of biological rhythms from circadian and autonomic cycles, coupled with metabolic health and mitochondrial function, to sub-second timing governed by dopaminergic and basal ganglia–cortical network dynamics. We outline how systemic insulin resistance and mitochondrial stress erode temporal symmetry, while cranio-cervical malalignment and temporomandibular disorders perturb spatial symmetry. We discuss the neurobiological implementation of these symmetry axes via large-scale networks and dopaminergic modulation of spatial–temporal sensorimotor dynamics, framing PD as a multiscale symmetry-breaking process, and explore the implications for symmetry-oriented biomarkers, subtyping, and future interventions. Full article

Background: Musculoskeletal pain remains a major cause of disability worldwide, encompassing disorders such as rheumatoid arthritis (RA), osteoarthritis (OA) and chronic back pain. Acupuncture and dry needling are increasingly used for symptom management, yet their effects on inflammatory modulation remain unclear. This systematic review and meta-analysis evaluated the influence of acupuncture on inflammatory biomarker regulation in musculoskeletal pain. Methods: Following PRISMA and Cochrane methodological guidelines, comprehensive searches were conducted across MEDLINE (via PubMed), Web of Science, Cochrane Library, Scopus, Google Scholar, and OpenEvidence from inception to August 2025. Eligible studies were randomized controlled trials (RCTs) involving acupuncture or dry needling interventions with inflammatory biomarker outcomes. Screening, data extraction, and risk of bias assessment using ROB2 were performed by two reviewers independently. The certainty of evidence was appraised using GRADE criteria. The protocol was registered on PROSPERO (CRD420251011831). Results: Nineteen RCTs and one randomized cross-over study (n = 1492) met inclusion criteria. Some studies demonstrated reductions in CRP, ESR, IL-1β, IL-6 and TNF-α following acupuncture. Random-effects meta-analysis indicated that modified acupuncture (electroacupuncture or needle-knife therapy) significantly reduced TNF-α in knee OA compared with traditional acupuncture (SMD = −1.63, 95% CI −2.47 to −0.80, p < 0.01) but not IL-1β. However, no significant effects were observed from acupuncture versus sham acupuncture for CRP or ESR in patients with arthritis. However, the findings are limited by high heterogeneity and the small number of studies included in each meta-analysis. Conclusions: A moderate level of GRADE evidence suggests that modified acupuncture may be more effective than standard acupuncture in reducing TNF-α levels in patients with OA. Further high-quality biomarker-based RCTs are warranted to confirm these findings. This study received no external funding. Full article

Thoracic outlet syndrome (TOS) is a rare neurovascular compression disorder involving the brachial plexus and/or subclavian vessels at the cervicothoracobrachial junction. Clinical presentation is often nonspecific and may overlap with peripheral neuropathies, cervical spine disorders, and musculoskeletal conditions, making diagnosis challenging. Although clinical evaluation remains central to diagnosis, imaging plays a complementary role in supporting the diagnosis of TOS by identifying the affected neurovascular structures, localizing the site of compression, and elucidating the underlying anatomical or pathological causes. Moreover, imaging is essential for excluding alternative diagnoses, including thoracic malignancies and inflammatory or degenerative vascular diseases that may mimic TOS. This review provides a comprehensive overview of the radiological anatomy of the thoracic outlet, the etiological factors contributing to neurovascular compression, and the strengths and limitations of current imaging modalities used in the evaluation of TOS. Full article

Background and Objectives: Temporomandibular disorders (TMDs) are prevalent conditions affecting the temporomandibular joint and associated musculature, arising from a complex interplay of biomechanical, neuromuscular, and psychosocial factors. Increasing evidence supports functional interconnections among the TMJ, cervical spine, and shoulder girdle, suggesting that dysfunction in one region may influence others; however, these relationships remain incompletely understood. This study aimed to evaluate the association between scapulohumeral trauma, postural abnormalities, and TMDs, and to assess their evolution following interdisciplinary rehabilitation. Materials and Methods: A retrospective observational study with prospective follow-up was conducted in patients with scapulohumeral fractures associated with TMD and postural abnormalities. Postural parameters and the clinical features of temporomandibular disorders (TMDs) were evaluated at baseline and follow-up using a structured clinical assessment informed by the DC/TMD framework, together with clinical examination, electromyographic analysis, and mandibular mobility measurements. Postural evaluation was performed using digital baropodometric analysis (Free Med™ platform with FreeStep™ software, standard Medica sensor, Rome, Italy. Patients received individualized multidisciplinary treatment, including orthopaedic rehabilitation, occlusal splint therapy, physiotherapy (twice weekly), pharmacological management, and odonto-periodontal care. Statistical analyses were performed using non-parametric tests (p < 0.05). Results: Significant postural improvement was observed (p < 0.01), with the proportion of patients with normal posture increasing from 0% to 22.2% and the proportion with moderate forward lean decreasing from 53.3% to 15.6%. TMD severity decreased progressively across evaluations (Friedman χ² = 72.35, p < 0.01). No statistically significant differences were found between treatment groups with respect to postural outcomes, although descriptive differences in TMD improvement were observed at later evaluation points. Conclusions: Interdisciplinary rehabilitation was associated with significant improvements in both postural alignment and TMD severity. Scapulohumeral trauma may be associated with alterations in TMJ function and overall posture, while multimodal therapy supports functional recovery. Further randomized controlled studies are needed to confirm these findings. Full article

Background: Prolonged standing can lead to musculoskeletal disorders, especially in the lower extremities, when appropriate footwear is not used. The aim of this study is to investigate the relationship between footwear styles, foot problems, and pain characteristics related to lower extremities in individuals with prolonged standing. Methods: A descriptive, cross-sectional study design was employed, using a random sample of individuals with prolonged standing (n = 159). Participants were asked questions about their footwear choices. They were asked to mark the lower extremity pain localization on the McGill Pain Map. In addition, foot deformities were evaluated by physical examination. Results: The findings revealed that most females (n = 88) and males (n = 71) preferred flat/sports footwear styles in both summer and winter. There was no significant difference between footwear styles and foot pain duration, intensity, and localization in both genders (p > 0.05). However, a statistically significant difference was observed among males between their summer footwear styles and pain related to lower extremities (low back pain and knee pain), and among females between their summer footwear styles and foot problems (bone deformities, skin pathologies and soft tissue issues) (p < 0.05). Conclusions: The results of this study show that the preferred footwear style was associated with lower extremity pain and foot problems, which emphasized the importance of footwear selection and footwear evaluation in the musculoskeletal evaluation of the lower extremities. Full article

Patient manual handling during positioning is widely recognised to have a sparse evidence base, exposing healthcare practitioners (HCPs) to a high risk of work-related musculoskeletal disorders (WRMSDs). This study aimed to provide in-depth insight into the challenges of manual patient bed positioning in long-term care settings to identify best practices for optimising care. Semi-structured interviews were conducted with purposively recruited subject experts in the UK (n = 9; aged 30–62 years). Interviews focused on challenges, best practices, and solutions to patient manual handling positioning. Data were explored using thematic and framework analysis. Major gaps were evident in HCP training and in key aspects of positioning, including patient bed mobility, postural management, and turning patients into the side-lying position. Experts identified a need for realistic, comprehensive training for HCPs on the integrated, optimised use of low-tech equipment (e.g., wedges, breathable pillows, sliding systems, and sleep systems) for safe, single-handed patient positioning. This study provided novel recommendations for optimising practices in patient bed mobility, posture care, repositioning, and turning into side-lying, aimed at improving patient outcomes and mitigating occupational risks. Full article