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14 pages, 777 KiB  
Article
Effectiveness of a Flossing Protocol and Manual Therapy in Improving the Clinical and Functional Status of Subjects with Recurrent Ankle Sprains; A Double-Blind Randomized Clinical Trial
by Mario Bermúdez-Egidos, Raúl Pérez-Llanes and Rubén Cuesta-Barriuso
Med. Sci. 2025, 13(3), 149; https://doi.org/10.3390/medsci13030149 - 20 Aug 2025
Abstract
Introduction: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. [...] Read more.
Introduction: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. Methods: Randomized, double-blind clinical study with a follow-up period. Twenty-six subjects were assigned to two study groups: experimental (flossing technique and passive manual therapy techniques) and placebo control group (flossing technique without compression and manual therapy techniques without sliding). The intervention lasted three weeks, with two sessions per week. The study variables were dorsiflexion under load (Leg Motion®), ankle mobility under unloaded conditions (goniometer), pressure pain threshold (algometer), and stability (Rs Scan® pressure platform). Three measurements were taken: pre-treatment (T0), post-treatment (T1), and after 3 weeks of follow-up (T2). Results: There were significant intergroup differences in dorsiflexion under load (F = 4.90; p = 0.02). Range of motion in plantar flexion without load (F = 3.78; p = 0.04), in the ellipse area (F = 4.72; p = 0.01), left stability (F = 3.74; p = 0.03), and right stability (F = 3.73; p = 0.03) without visual support. Conclusions: A physiotherapy protocol using flossing and manual sliding therapy can increase loaded dorsal flexion in young adults with previous ankle sprains. This intervention can also improve ankle plantar flexion under unloaded conditions. The area of the ellipse without visual support can improve in young adults with a history of ankle sprains following a program of flossing and manual therapy. Full article
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12 pages, 960 KiB  
Article
Association Between Survival After Living Donor Liver Transplantation and Recipient Systemic Inflammation and Body Composition
by Jae Hwan Kim, Yeon Ju Kim, Hye-Mee Kwon, Kyung-Won Kim, Jin YanZhen, Sa-Jin Kang, In-Gu Jun, Jun-Gol Song and Gyu-Sam Hwang
J. Clin. Med. 2025, 14(16), 5889; https://doi.org/10.3390/jcm14165889 - 20 Aug 2025
Abstract
Background/Objectives: Preoperative sarcopenia in liver transplantation (LT) recipients is an important prognostic factor of LT outcomes. Systemic inflammatory status (SIS) has been proposed as a unifying mechanism for skeletal muscle loss; thus, considering SIS and sarcopenia together may enhance prognosis assessment in patients [...] Read more.
Background/Objectives: Preoperative sarcopenia in liver transplantation (LT) recipients is an important prognostic factor of LT outcomes. Systemic inflammatory status (SIS) has been proposed as a unifying mechanism for skeletal muscle loss; thus, considering SIS and sarcopenia together may enhance prognosis assessment in patients undergoing LT. Herein, we aimed to describe the relationship between the SIS and skeletal muscle index (SMI) with short-term and long-term mortality post-living donor LT (LDLT). Methods: In total, 3387 consecutive adult LDLT recipients were retrospectively evaluated. The neutrophil-to-lymphocyte ratio (NLR, using a cut-off of 3) was utilized as an SIS. SMI was calculated using computed tomography scans, measured at the third lumbar vertebra; sex-specific cut-offs were determined from contemporary donors. Univariate and multivariable Cox proportional hazard analyses were performed. Results: Decreasing SMI was associated with increasing NLR. Increasing NLR and decreasing SMI both showed dose-dependent relationships with a risk of 90-day mortality. Within sarcopenic patients, NLR > 3 (vs. NLR ≤ 3) was associated with higher 90-day (9.3% vs. 3.5%, p = 0.049) and overall mortality (28.4% vs. 19.1%, p = 0.045). Sarcopenia and NLR > 3 (vs. neither) were independent predictors of 90-day mortality (hazard ratio [HR] 2.48 [1.40–4.40], p = 0.002) and overall mortality (HR, 1.81 [1.37–2.38], p < 0.001) after multivariable adjustment. When stratified by age, sex, and MELD score, the association between sarcopenia and overall mortality persisted in all subgroups, with the highest risk observed in women (HR 3.43, 95% CI 1.83–6.43). Conclusions: Sarcopenia, with the systemic inflammatory response, nearly doubled the risk of 90-day and overall mortality post-LT, proposing that these readily available biomarkers are a practical index for predicting survival post-LT. Considering that these are potentially modifiable factors, our result may provide a new therapeutic target to improve survival post-LT. Full article
(This article belongs to the Section Anesthesiology)
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13 pages, 1225 KiB  
Article
Peritoneal Fluid Modulates Redox Balance and RNA Integrity in Mouse Oocytes: Insights into Endometriosis-Related Oxidative Stress
by Joanne Horton, Simon Lane and Ying Cheong
Antioxidants 2025, 14(8), 1018; https://doi.org/10.3390/antiox14081018 - 20 Aug 2025
Abstract
Reactive oxygen species (ROS) are vital for oocyte development, yet the redox state of peritoneal fluid may differ between health and disease. This study investigates the effects of peritoneal fluid from women with and without endometriosis on mouse oocytes’ redox status and RNA [...] Read more.
Reactive oxygen species (ROS) are vital for oocyte development, yet the redox state of peritoneal fluid may differ between health and disease. This study investigates the effects of peritoneal fluid from women with and without endometriosis on mouse oocytes’ redox status and RNA oxidation. Peritoneal fluid samples were collected during laparoscopy from women enrolled in an ethically approved case–control study. Stimulated C57BL6 mouse germinal vesicle oocytes were microinjected with RNA transcribed from a Grx1-roGFP2 construct and imaged to assess redox changes. Further oocytes were incubated in standard media, H2O2, or 20% peritoneal fluid, fixed, and immunostained for 8-OHG to evaluate RNA oxidative damage. Oocytes exposed to endometriosis-affected peritoneal fluid showed significantly less redox reduction (mean change 0.07, p < 0.001) compared to fluid from unaffected women (mean change 0.17, p < 0.001), suggesting impaired antioxidant capacity. Those treated with fluid from women without endometriosis showed a more significant reduction (mean ratio change 0.17, p < 0.001). RNA damage was higher in oocytes incubated in fluid from women with infertility compared to pelvic pain (p < 0.001). These findings suggest an altered oxidative environment of peritoneal fluid in endometriosis may contribute to impaired oocyte quality, highlighting a potential mechanism of infertility in affected women. Full article
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17 pages, 814 KiB  
Review
Optimization of Photodynamic Therapy in Dermatology: The Role of Light Fractionation
by Luis Alonso-Mtz de Salinas, Emilio Garcia-Mouronte, Jorge Naharro-Rodriguez, Luis Alfonso Perez-Gonzalez and Montserrat Fernández-Guarino
Int. J. Mol. Sci. 2025, 26(16), 8054; https://doi.org/10.3390/ijms26168054 (registering DOI) - 20 Aug 2025
Abstract
Photodynamic therapy (PDT) has become a widely used modality for treating actinic keratosis (AK) and non-melanoma skin cancers (NMSC), as well as other inflammatory or infectious diseases. Despite its efficacy, limitations such as incomplete responses and pain have motivated the exploration of protocol [...] Read more.
Photodynamic therapy (PDT) has become a widely used modality for treating actinic keratosis (AK) and non-melanoma skin cancers (NMSC), as well as other inflammatory or infectious diseases. Despite its efficacy, limitations such as incomplete responses and pain have motivated the exploration of protocol enhancements. This review examines the clinical and biological rationale for light fractionation—dividing the total light dose into two separate exposures with a dark interval—as a strategy to improve PDT outcomes. We reviewed preclinical and clinical studies evaluating fractionated illumination using 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL). The findings consistently demonstrate superior efficacy of fractionated schemes, particularly with ALA, showing higher complete response rates in AK, superficial basal cell carcinoma (sBCC), and Bowen’s disease (BD), and improved long-term tumor control compared to single illumination. The better outcomes are attributed to increased reactive oxygen species (ROS) generation following tissue reoxygenation during the dark interval and greater susceptibility of partially damaged cells to subsequent illumination. Fractionated PDT also shows a favorable safety and cosmetic profile. These results support considering light fractionation protocols as a standard approach for optimizing PDT efficacy in dermatologic oncology, particularly in lesions with limited depth and high recurrence risk. Full article
(This article belongs to the Special Issue Dermatology: Advances in Pathophysiology and Therapies (2nd Edition))
25 pages, 824 KiB  
Study Protocol
Effects of a Multidimensional Exercise and Mindfulness Approach Targeting Physical, Psychological, and Functional Outcomes: Protocol for the BACKFIT Randomized Controlled Trial with an Active Control Group
by Belén Donoso, Gavriella Tsiarleston, Yolanda Castellote-Caballero, Alba Villegas-Fuentes, Yolanda María Gil-Gutiérrez, José Enrique Fernández-Álvarez, Santiago Montes, Manuel Delgado-Fernández, Antonio Manuel Mesa-Ruíz, Pablo Molina-García, Rocío Pozuelo-Calvo, Miguel David Membrilla-Mesa and Víctor Segura-Jiménez
Healthcare 2025, 13(16), 2065; https://doi.org/10.3390/healthcare13162065 - 20 Aug 2025
Abstract
Introduction: Chronic primary low back pain (CPLBP) is a prevalent condition in primary care and a leading cause of disability and absenteeism worldwide. Multidimensional approaches may be necessary to achieve physical and mental health benefits in individuals with CPLBP. Objective: The BACKFIT [...] Read more.
Introduction: Chronic primary low back pain (CPLBP) is a prevalent condition in primary care and a leading cause of disability and absenteeism worldwide. Multidimensional approaches may be necessary to achieve physical and mental health benefits in individuals with CPLBP. Objective: The BACKFIT randomized controlled trial aims to evaluate the effectiveness of a multidimensional intervention—combining supervised exercise and mindfulness—on pain, physical fitness, mental health, and functional outcomes in individuals with CPLBP. Hypothesis: Both the supervised exercise program focused on motor control and trunk muscle strength (IG1) and the multidimensional intervention combining supervised exercise with mindfulness training (IG2) are expected to produce significant health improvements in individuals with CPLBP. It is further hypothesized that IG2 will yield greater improvements compared to IG1, both immediately post-intervention and at the two-month follow-up. Design. Randomized controlled trial. Setting: Virgen de las Nieves University Hospital, Granada (Spain). Participants: 105 individuals. Inclusion criteria: Previously diagnosed with CPLBP, aged ≥18 and ≤65 years, able to read and understand the informed consent, and able to walk, move, and communicate without external assistance. Exclusion criteria: serious lumbar structural disorders, acute or terminal illness, physical injury, mental illness, and medical prescriptions that prevent participation in the study. Intervention: Individuals will be randomly assigned to a supervised physical exercise group (2 days per week, 45 min per session), a multidimensional intervention group (same as supervised physical exercise group, and mindfulness 1 day per week, 2.5 h per session) or an active control group (usual care, 2 days per week, 45 min per session). The intervention will last 8 weeks. Main Outcome Measures: Primary outcome: pain threshold, perceived acute pain, and disability due to pain. Secondary measures: body composition, muscular fitness, gait parameters, device-measured physical activity and sedentary behavior, self-reported sedentary behavior, quality of life, pain catastrophizing, mental health, sleep duration and quality, and central sensitization. The groups will undergo pre-intervention, post-intervention, and a 2-month follow-up after a detraining period. Statistical Analysis: Both per-protocol and intention-to-treat approaches (≥70% attendance) will be used. Program effects will be assessed via one-way ANCOVA for between-group changes in primary and secondary outcomes. Conclusions: Given the complex nature of CPLBP, multidimensional approaches are recommended. If effective, this intervention may provide low-cost alternatives for health professionals. Full article
20 pages, 3523 KiB  
Article
Telerehabilitation After Surgery in Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial
by İrem Çetinkaya, Tuğba Kuru Çolak, Mehmet Fatih Korkmaz and Mehmet Aydoğan
Healthcare 2025, 13(16), 2063; https://doi.org/10.3390/healthcare13162063 - 20 Aug 2025
Abstract
Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns [...] Read more.
Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns in this population. Objectives: This study aimed to evaluate the effects of a synchronous telerehabilitation program—designed to support post-surgical recovery in individuals with adolescent idiopathic scoliosis (AIS)—on trunk muscle endurance, trunk flexibility, functional capacity, pain severity, perception of appearance, and quality of life. Methods: Thirty-two individuals with AIS, who had undergone surgery 6 months to 2 years prior, were randomly assigned to either an intervention group or a control group. The intervention group participated in a supervised telerehabilitation program twice weekly for eight weeks, while the control group received no exercise intervention. All outcome measures were assessed before and after the intervention. Results: The telerehabilitation group demonstrated significant improvements across all outcome measures compared with the control group (p < 0.05). Post-intervention, the telerehabilitation group had superior trunk muscle endurance, flexibility, and quality-of-life scores, as well as reduced pain intensity (p < 0.05). However, no significant differences were observed between the groups in functional capacity or perception of appearance (p > 0.05). Conclusions: A supervised telerehabilitation program initiated six months after surgery can effectively improve trunk muscle endurance, flexibility, pain intensity, and quality of life in individuals with AIS. These findings emphasize the value of structured post-surgical rehabilitation and raise awareness of the potential benefits of remotely delivered exercise programs in this population. Full article
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12 pages, 1250 KiB  
Case Report
Robotic Treatment of Adrenal Sclerosing PEComa: A Case Report with 13 Years of Follow-Up and a Literature Review
by Alessio Paladini, Raffaele La Mura, Michele Del Zingaro, Luca Lepri, Andrea Vitale, Jessica Pagnotta, Matteo Mearini, Guido Massa, Ettore Mearini and Giovanni Cochetti
Appl. Sci. 2025, 15(16), 9161; https://doi.org/10.3390/app15169161 (registering DOI) - 20 Aug 2025
Abstract
Background: Sclerosing perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms, typically benign but occasionally exhibiting aggressive behavior. This study reports a case of sclerosing PEComa of the adrenal gland that was treated with robotic partial adrenalectomy, with 13 years of follow-up and [...] Read more.
Background: Sclerosing perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms, typically benign but occasionally exhibiting aggressive behavior. This study reports a case of sclerosing PEComa of the adrenal gland that was treated with robotic partial adrenalectomy, with 13 years of follow-up and a review of the literature. Methods: A 48-year-old woman presented with abdominal pain. Imaging revealed a 10 × 9 cm adrenal mass displacing adjacent structures. MRI and 18F-FDG PET-CT suggested angiomyolipoma. Robotic partial adrenalectomy was performed. Intraoperative frozen section analysis identified the mass as angiomyolipoma, while final histopathology confirmed it as a sclerosing PEComa. Results: This case highlights the advantages of robotic surgery in the management of large adrenal tumors, allowing complete tumor removal while preserving functional adrenal tissue. The extended 13-year follow-up is significant, given the potential for recurrence or malignant transformation reported in other cases. A literature review identified 39 reported cases of sclerosing PEComas, with few documenting long-term outcomes. Conclusions: This is a documented case of robotic partial adrenalectomy for sclerosing PEComa. The findings support robotic surgery as a safe effective approach for managing this rare tumor, with excellent functional and oncological results. Extended follow-up reinforces the tumor’s benign behavior and the importance of long-term monitoring in PEComas. Full article
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14 pages, 942 KiB  
Article
Chronic Pain Modulates Empathic Responses in People with Spinal Cord Injury
by Giulia Galli, Luca Sebastianelli, Giorgia De Santis, Giorgio Scivoletto, Marta Mascanzoni and Mariella Pazzaglia
J. Clin. Med. 2025, 14(16), 5878; https://doi.org/10.3390/jcm14165878 - 20 Aug 2025
Abstract
Background/Objectives: While the correlation between bodily states and cognitive processing has been extensively investigated concerning pain elaboration, little is known about how chronic, subjectively experienced pain (self-pain) following traumatic spinal cord injury (SCI) affects embodied cognition, such as empathy for pain. This study [...] Read more.
Background/Objectives: While the correlation between bodily states and cognitive processing has been extensively investigated concerning pain elaboration, little is known about how chronic, subjectively experienced pain (self-pain) following traumatic spinal cord injury (SCI) affects embodied cognition, such as empathy for pain. This study aimed to determine whether individuals with SCI differ from healthy controls in these cognitive responses, and if such differences can be quantified through varying reaction times to pain-related and non-pain-related stimuli involving others. Methods: We assessed reactions to others’ pain through behavioral responses in a classification task involving 15 participants with SCI (13 men; age range 19–56 years) and 15 healthy controls (11 men; age range 25–48 years). Additionally, we measured general empathic dispositions using the Interpersonal Reactivity Index (IRI) and subjective pain intensity using a numeric rating scale following standard guidelines for neuropathic pain assessment. Results: The findings revealed that participants with SCI exhibited lower empathy levels (IRI: mean SCI = 55.06 ± 3.64) than healthy controls (IRI: mean HC = 67.6 ± 2.46), as measured through both cognitive and affective components. We found that higher chronic pain unpleasantness was associated with lower empathic dispositions (r = −0.63; p = 0.01) in participants with SCI. Compared to healthy controls, individuals with SCI exhibited a reduced empathic response when observing others in pain from a third-person perspective. Conclusions: These findings reveal an association between chronic pain following SCI and diminished empathic processing, offering new insights into the mechanisms underlying interpersonal reactivity after SCI. Full article
(This article belongs to the Section Clinical Neurology)
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12 pages, 657 KiB  
Article
Sexual Dysfunction in Breast Cancer Survivors: The Role of Clinical, Hormonal, and Psychosocial Factors
by Pınar Karaçin and İrem Küçükşahin
Healthcare 2025, 13(16), 2061; https://doi.org/10.3390/healthcare13162061 - 20 Aug 2025
Abstract
Background and Objectives: This study aims to investigate female sexual dysfunction (FSD) and the clinical, pathological, and social factors affecting it in women diagnosed with non-metastatic breast cancer. Materials and Methods: The study included patients over the age of 18 who were followed [...] Read more.
Background and Objectives: This study aims to investigate female sexual dysfunction (FSD) and the clinical, pathological, and social factors affecting it in women diagnosed with non-metastatic breast cancer. Materials and Methods: The study included patients over the age of 18 who were followed up between January 2020 and December 2024, diagnosed with breast cancer at least 12 months previously, and treated. The Female Sexual Function Index (FSFI) and its six subheadings (desire, arousal, lubrication, orgasm, satisfaction, and pain) were used to assess sexual dysfunction, and the Hospital Anxiety and Depression Scale (HADs) was used to assess depression. Results: FSD was identified in 86.6% of the 217 patients (mean FSFI score: 20.38). Among women undergoing breast cancer treatment, being over 45 years of age (p = 0.003) and the use of luteinizing hormone-releasing hormone (LHRH) agonists (p < 0.001) were significantly associated with reduced sexual desire. Conversely, premenopausal status (p = 0.012) was associated with increased sexual satisfaction. Independent risk factors for FSD included age, menopausal status, use of LHRH agonists, income level, and axillary dissection. Furthermore, depression was found to have a significant negative impact on sexual desire, lubrication, and orgasm. Conclusions: This study demonstrates that sexual dysfunction is common among women undergoing treatment for breast cancer and is influenced by numerous clinical and social factors. These findings highlight the need for strategic interventions to reduce the adverse effects of treatment processes on the sexual health of women with breast cancer. Full article
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17 pages, 1424 KiB  
Article
MiRNA-186 as a Biomarker of Disease Exacerbation in Rheumatoid Arthritis: Insights from Clinical Data and Molecular Marker Analysis
by Marek Cieśla, Dorota Darmochwał-Kolarz, Hubert Kubis and Bogdan Kolarz
Int. J. Mol. Sci. 2025, 26(16), 8039; https://doi.org/10.3390/ijms26168039 (registering DOI) - 20 Aug 2025
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by inflammation of the synovial tissue, leading to joint destruction, pain, stiffness, and progressive impairment of motor functions. Despite significant advances in diagnosis and treatment, RA remains a major clinical and social challenge, [...] Read more.
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by inflammation of the synovial tissue, leading to joint destruction, pain, stiffness, and progressive impairment of motor functions. Despite significant advances in diagnosis and treatment, RA remains a major clinical and social challenge, negatively impacting patients’ quality of life. The aim of this study was to assess the relationship between the expression of selected microRNAs (miRNAs) and the activity of the disease. A total of 46 RA patients and 20 healthy controls (HCs) were enrolled in the study. A quantitative real-time polymerase chain reaction was used to evaluate the expression of miRNAs in whole blood. MiRNA-186 exhibited decreased concentrations in RA patients compared to HCs (p = 0.03). Patients with an active form of the disease (DAS28 > 3.2) exhibited lower expression of miRNA-186 than HCs (p = 0.04). Additionally, ACPA-negative patients also demonstrated reduced miRNA-186 expression compared to controls. AUC analysis confirmed that the combination of miRNA-186, the erythrocyte sedimentation rate (ESR), and Visual Analog Scale—Patient Global Assessment (VAS PGA) may be effective in identifying RA exacerbation. The combination of classical laboratory markers, clinical data, and molecular markers enhances the ability to assess RA exacerbation. MiRNA-186 may be considered a potential marker of disease activity in RA. Full article
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20 pages, 495 KiB  
Review
Comorbidities Across Functional Neurological Disorder Subtypes: A Comprehensive Narrative Synthesis
by Ioannis Mavroudis, Katerina Franekova, Foivos Petridis, Alin Ciobîca, Dăscălescu Gabriel, Emil Anton, Ciprian Ilea, Sotirios Papagiannopoulos and Dimitrios Kazis
Life 2025, 15(8), 1322; https://doi.org/10.3390/life15081322 - 20 Aug 2025
Abstract
Background: Functional Neurological Disorder (FND) encompasses a spectrum of symptoms—including motor, cognitive, and seizure-like manifestations—that are not fully explained by structural neurological disease. Accumulating evidence suggests that comorbid psychiatric and somatic conditions significantly influence the clinical course, diagnostic complexity, and treatment response in [...] Read more.
Background: Functional Neurological Disorder (FND) encompasses a spectrum of symptoms—including motor, cognitive, and seizure-like manifestations—that are not fully explained by structural neurological disease. Accumulating evidence suggests that comorbid psychiatric and somatic conditions significantly influence the clinical course, diagnostic complexity, and treatment response in FND. Objective: This study systematically explores psychiatric and medical comorbidities across major FND subtypes—Functional Cognitive Disorder (FCD), Functional Movement Disorder (FMD), and Psychogenic Non-Epileptic Seizures (PNES)—with an emphasis on subtype-specific patterns and shared vulnerabilities. Methods: We conducted a narrative review of the published literature, guided by systematic principles for transparency, covering both foundational and contemporary sources to examine comorbid conditions in patients with FCD, FMD, PNES, PPPD and general (mixed) FND populations. Relevant studies were identified through structured research and included based on methodological rigor and detailed reporting of comorbidities (PRISMA). Extracted data were organized by subtype and comorbidity type (psychiatric or medical/somatic). Results: Across all FND subtypes, high rates of psychiatric comorbidities were observed, particularly depression, anxiety, PTSD, and dissociative symptoms. FCD was predominantly associated with internalizing symptoms, affective misattribution, and heightened cognitive self-monitoring. FMD demonstrated strong links with trauma, emotional dysregulation, and personality vulnerabilities. PNES was characterized by the highest burden of psychiatric illness, with complex trauma histories and dissociation frequently reported. Somatic comorbidities—such as fibromyalgia, chronic pain, irritable bowel syndrome, and fatigue—were also prevalent across all subtypes, reflecting overlapping mechanisms involving interoception, central sensitization, and functional symptom migration. Conclusions: Comorbid psychiatric and medical conditions are integral to understanding the presentation and management of FND. Subtype-specific patterns underscore the need for individualized diagnostic and therapeutic approaches, while the shared biopsychosocial mechanisms suggest benefits of integrated care models across the FND spectrum. Full article
(This article belongs to the Section Medical Research)
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32 pages, 1131 KiB  
Systematic Review
The Effect of Nutrition Impact Symptoms on Nutrition Status After Completion of Curative-Intent Treatment for Gastric, Oesophageal, and Pancreatic Cancer: A Systematic Review
by Emma McShane, Lauren Hanna, Carmel Zoanetti, Lisa Murnane, Brenton Baguley and Kate Furness
Nutrients 2025, 17(16), 2691; https://doi.org/10.3390/nu17162691 - 20 Aug 2025
Abstract
Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This [...] Read more.
Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This review explored the types of nutrition impact symptoms following curative-intent treatment for upper gastrointestinal (UGI) cancers and assessed their impact on nutrition status. Methods: A systematic search of four electronic databases identified studies involving adults treated with curative intent for UGI cancers. Included studies reported both nutrition impact symptoms and nutrition outcomes using validated tools. Study quality was assessed, and results were synthesised narratively. Results: Eleven studies (n = 953 participants), predominantly from the Asia–Pacific region, met the inclusion criteria. Participants were mostly male (68%), with surgery as the primary treatment (91%). Most studies (n = 10) used validated assessment tools to identify nutrition impact symptoms. Reflux was the most commonly reported symptom (n = eight studies), followed by abdominal pain and diarrhoea. Nutrition status was assessed using various validated tools: Patient-Generated Subjective Global Assessment (n = six studies, 55%), Mini Nutritional Assessment (n = two studies, 18%), and Global Leadership Initiative on Malnutrition as well as Subjective Global Assessment and Prognostic Nutritional Index (both n = one study, 9%). Malnutrition prevalence was up to 87% one year post-treatment. Conclusions: Nutrition impact symptoms are common and persistent after curative-intent treatment for UGI cancers. Future research should incorporate validated assessment tools and extend follow-up beyond 12 months. Integrating long-term, tailored dietetic support to identify and manage symptoms post-treatment is vital to improve outcomes for patients. Full article
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10 pages, 265 KiB  
Article
Age-Specific Characteristics and Malignancy Risk of Ovarian Teratomas: A Retrospective Single-Centre Study
by Su Hyeon Choi, Haeng Jun Jeon, Bohye Gil, Seyeon Won, Nara Lee, Sohyun Shim, Mi Kyoung Kim, Yong Wook Jung, Seok Ju Seong and Mi-La Kim
J. Clin. Med. 2025, 14(16), 5872; https://doi.org/10.3390/jcm14165872 - 20 Aug 2025
Abstract
Aim: The aim of this study was to determine the age-specific characteristics of ovarian teratoma and associated malignancies. Methods: This retrospective single-centre cohort study included 2181 women with ovarian teratoma who underwent surgery at our institution between January 2008 and April 2019. Malignancies [...] Read more.
Aim: The aim of this study was to determine the age-specific characteristics of ovarian teratoma and associated malignancies. Methods: This retrospective single-centre cohort study included 2181 women with ovarian teratoma who underwent surgery at our institution between January 2008 and April 2019. Malignancies associated with ovarian teratoma were divided into immature teratoma, combined ovarian malignancy, and malignant transformation of mature cystic teratoma. The median patient age was 30 years (range, 7–82) and the median follow-up duration was 10 months (range, 0–152). Results: Most ovarian teratomas were detected incidentally, except in patients with abdominal pain under 20 years of age; torsion was significantly more common in this age group (p < 0.001). Tumours were larger in the younger age group (p < 0.01). The incidence of immature teratoma was 0.5% (n = 11), that of combined ovarian malignancy was 0.4% (n = 9), and that of malignant transformation was 0.4% (n = 9). The median patient age was 24.0 years for immature teratoma and 27.0 years for combined ovarian malignancy. The most common cell type was mucinous borderline tumour (55.6%, n = 5). The median patient age of malignant transformation was 33.0 years, and the most common cell type was carcinoid tumour (77.8%, n = 7). At our institution, the clinical manifestations of ovarian teratoma varied according to age group, with younger patients being more likely to be symptomatic and to have larger tumours and bilateral tumours. Although there was no statistically significant relationship between age and associated malignancy (p = 0.442), most of the malignancies associated with ovarian teratoma were found in childbearing age, not in older age. Conclusions: Given the possible associated malignancy with ovarian teratoma, surgeons should perform detailed preoperative evaluations, avoid intraoperative spillage, and perform intraoperative frozen biopsy when appropriate. Full article
(This article belongs to the Section Oncology)
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12 pages, 275 KiB  
Article
Factors Associated with Persistent Metatarsal Pain in Patients with Rheumatoid Arthritis in Remission: Clinical Implications and Multivariable Analysis in a Cross-Sectional Study
by Rebeca Bueno Fermoso, Maria Rosario Morales Lozano, Carmen Martínez Rincón, Pablo García-Fernández, Juan Miguel López González and Maria Luz González Fernandez
Biomedicines 2025, 13(8), 2024; https://doi.org/10.3390/biomedicines13082024 - 20 Aug 2025
Abstract
Background: Foot pain often persists in patients with rheumatoid arthritis (RA), even during clinical remission. However, its causes are not fully understood. Identifying factors specifically associated with metatarsal pain, rather than generalized foot pain, may improve targeted management strategies. Objectives: The [...] Read more.
Background: Foot pain often persists in patients with rheumatoid arthritis (RA), even during clinical remission. However, its causes are not fully understood. Identifying factors specifically associated with metatarsal pain, rather than generalized foot pain, may improve targeted management strategies. Objectives: The aim of this study was to compare the clinical, biomechanical, and radiological characteristics of RA patients in remission with isolated metatarsal pain versus those with pain in other foot regions, and to identify independent predictors of metatarsal pain. Methods: This cross-sectional study included 118 RA patients in remission, classified into two groups: isolated metatarsal pain (n = 61) and pain in other foot regions (n = 57). Clinical variables (demographics, disease duration, treatment, comorbidities), biomechanical measures (ankle, first metatarsophalangeal and subtalar joint mobility, hallux valgus severity, foot type), radiographic findings (erosions, subluxations), and ultrasound-detected synovitis in the 2nd–5th metatarsophalangeal (MTP) joints were recorded. Independent predictors were identified using binary logistic regression. Results: Patients with metatarsal pain had higher rates of severe hallux valgus, MTP synovitis, and dislocations ≥ 50%. Independent predictors were hallux valgus (OR = 5.428, 95% CI: 1.528–19.287, p = 0.009), MTP synovitis (OR = 2.093, 95% CI: 1.337–3.275, p = 0.001), and MTP dislocations (OR = 2.092, 95% CI: 1.275–3.432, p = 0.003). Conclusions: Persistent metatarsal pain in RA remission is associated with a distinct structural and biomechanical profile. Comparing foot pain by location may help identify clinically relevant patterns and support more individualized assessment and treatment strategies. Due to the cross-sectional design, causality cannot be established. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnostics, and Therapeutics for Rheumatic Diseases)
10 pages, 227 KiB  
Article
Balance Assessment Under Different Conditions in Patients with Surgically Treated Pilon Fracture Compared to Healthy Controls: A Pilot Study
by Andrei-Daniel Bolovan, Gheorghe-Bogdan Hogea, Elena-Constanta Amaricai, Alexandra-Roxana Tapardea, Alina-Daniela Totorean, Anca-Raluca Dinu, Adrian-Emil Lazarescu, Mihai-Alexandru Sandesc and Jenel-Marian Patrascu
Life 2025, 15(8), 1319; https://doi.org/10.3390/life15081319 - 20 Aug 2025
Abstract
Background: Tibial pilon fractures are usually high-energy fractures that are linked to higher rates of complications and poor clinical outcomes, particularly concerning pain and walking impairments. However, few studies have evaluated postural stability among patients surgically treated for pilon fractures. Objective: This pilot [...] Read more.
Background: Tibial pilon fractures are usually high-energy fractures that are linked to higher rates of complications and poor clinical outcomes, particularly concerning pain and walking impairments. However, few studies have evaluated postural stability among patients surgically treated for pilon fractures. Objective: This pilot study aimed to evaluate static and dynamic balance in patients who have undergone unilateral pilon fracture fixation, compared to matched healthy controls. Methods: Ten adult patients, post-fixation for unilateral pilon fracture (with clinical and radiological evidence of fracture healing and ability to bear full weight on the affected lower limb), completed a series of balance tests on K-Force plates. Ten matched healthy controls performed the same tests. Outcomes included CoP path length, CoP mean velocity, time to stabilisation (TTS), and peak force normalized to body weight. Results: Patients showed significantly increased mediolateral sway during bipodal stance (mean CoP velocity of 33.7 vs. 22.4 mm/s, p < 0.01), especially under eyes-closed conditions. In single-leg stance, CoP velocity on the affected limb was more than double that of controls (118 vs. 54 mm/s, p = 0.036). Dynamic tests revealed longer TTS after landing (1563 vs. 501 ms, p = 0.048) and lower force output during squats. The unaffected limb performed nearly normally in static tasks but was slower during dynamic stabilization. Conclusions: Even after fracture healing, patients with tibial pilon fractures show persistent sensorimotor deficits and impaired balance. Full article
(This article belongs to the Section Physiology and Pathology)
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