Search Results (31,081)

Traumatic brain injuries (TBI) represent a leading cause of morbidity and mortality globally. Whilst clinical care has significantly improved in recent years, there is still significant scope to improve patient outcomes, particularly in relation to quality of life. However, there is a window of opportunity for clinical intervention, since most of the mortality and morbidity is associated with secondary injury processes that arise after the initial trauma. In the brain, as with any tissue, inflammation plays an important role in the response to injury. However, particularly with severe injuries, an excessive inflammatory response can have detrimental effects. Following TBI, inflammation can lead to the development of cerebral oedema and a rise in intracranial pressure. Without effective control, these processes can rapidly lead to patient deterioration. This narrative review focusses on the role of inflammation in TBI in order to examine the strategies that may help improve patient outcomes. Whilst there is clearly a relationship between the development of cerebral oedema, rising intracranial pressure (ICP), and poor patient prognosis, there are also discrepancies in terms of their impact on patient outcomes. In addition to causing a rise in ICP, this review examines in what other ways inflammation and the development of cerebral oedema may contribute to the injury process. The potential for these factors to impact upon microvascular function and reduce cerebral tissue perfusion and oxygenation is explored. In addition, the impact of TBI on glymphatic function is discussed. Following an evaluation of the potential injury processes, the scope for intervention and the development of novel therapeutic approaches is explored. Full article

Many recent progresses in the overall quality of life have allowed for an increase in life expectancy, both in humans and in dogs. In addition, long-lived individuals may develop neurodegenerative disorders, and one of the most important in human medicine is Alzheimer’s disease (AD). In veterinary medicine, the AD counterpart is Canine Cognitive Dysfunction Syndrome (CCDS), which, generally, affects elderly dogs from 8 years of age. These cognitive disorders are becoming frequently encountered conditions and, despite researchers’ attention towards pathogenesis, treatment and diagnosis, more efforts are required to outline which clinical and laboratory evaluations must be carried out to reach a presumptive antemortem diagnosis of CCDS. The biggest need is the establishment of standardized protocols and guidelines for a correct clinical and diagnostic approach towards dogs with clinical signs referrable to CCDS. In this narrative review, we examined the up-to-date scientific literature on the topic, focusing our attention on sensitive and reliable markers for clinical antemortem CCDS diagnosis. Even if some parameters analyzed are interesting and promising, more investigations are needed to confirm the results obtained so far. This is crucial because a correct diagnosis is fundamental to determine the best treatment and, thus, to guarantee animals’ health and welfare. Full article

Background: Spinal metastases can cause significant impairment of neurological function and quality of life. Hence, personalized clinical decision-making based on prognosis and likely outcome is desirable. The effectiveness of AI in predicting complications and treatment outcomes for patients with spinal metastases is assessed. Methods: A thorough search was carried out through the PubMed, Scopus, Web of Science, Embase, and Cochrane databases up until 27 January 2025. Included were studies that used AI-based models to predict outcomes for adult patients with spinal metastases. Three reviewers independently extracted the data, and screening was conducted in accordance with PRISMA principles. AUC results were pooled using a random-effects model, and the PROBAST program was used to evaluate the study’s quality. Results: Included were 47 articles totaling 25,790 patients. For training, internal validation, and external validation, the weighted average AUCs were 0.762, 0.876, and 0.810, respectively. The Skeletal Oncology Research Group machine learning algorithms (SORG-MLAs) were the ones externally validated the most, continuously producing AUCs > 0.84 for 90-day and 1-year mortality. Models based on radiomics showed promise in preoperative planning, especially for outcomes of radiation and concealed blood loss. Most research concentrated on breast, lung, and prostate malignancies, which limited its applicability to less common tumors. Conclusions: AI models have shown reasonable accuracy in predicting mortality, ambulatory status, blood loss, and surgical complications in patients with spinal metastases. Wider implementation necessitates additional validation, data standardization, and ethical and regulatory framework evaluation. Future work should concentrate on creating multimodal, hybrid models and assessing their practical applications. Full article

Objectives: Animal studies have demonstrated that mesenchymal stem cell-conditioned medium (MSC-CM) possesses various therapeutic effects, including anti-inflammatory and anti-fibrotic properties. This study investigated the efficacy and safety of administering MSC-CM as a treatment for patients with generalized fatigue. Methods: The MSC-CM used in this study was derived from human adipose tissue and umbilical cord-derived mesenchymal stem cells cultured in a medium free of animal-derived components to avoid the risk of infection. This MSC-CM has recently been shown to possess anti-inflammatory effects and has been reported to be safe for human administration. With the expectation of alleviating fatigue symptoms through its anti-inflammatory effects, it was administered to patients intravenously and by inhalation. Safety and changes in subjective symptoms were evaluated, and blood biomarkers related to inflammation and oxidative stress were measured. Results: In this trial involving 19 patients experiencing fatigue, no serious side effects were observed following MSC-CM administration. Nearly half of the patients reported symptom improvement after a single dose, and some exhibited signs of reduced inflammation. Conclusions: This report presents the first investigation of systemic MSC-CM treatment for generalized fatigue, paving the way for more targeted studies on dosage and treatment frequency. These findings offer new hope and possibilities for treating fatigue, providing valuable insights into the clinical application of MSC-CM. Full article

Background: This systematic review aims to summarize the most recent data from the literature on the psychological aspects of parents of children prenatally diagnosed with congenital heart defects (CHDs). Methods: A comprehensive literature search was conducted to identify relevant studies on the psychological issues faced by parents of children prenatally diagnosed with CHD. Searches were performed in multiple scientific databases, including PubMed, Science direct, Embase, Scopus, Medline, Clarivate, to ensure the broad coverage of the literature. The search was limited to studies published up until February 2025. The search strategy included the following terms and combinations: “congenital heart defect” OR “CHD” AND “prenatal diagnosis” AND “psychological impact” OR “parental distress” OR “coping”. Results: Eighteen studies involving the 673 parents of fetuses diagnosed with congenital heart defects were included. Studies spanned four continents and employed both qualitative (n = 14) and quantitative (n = 4) designs. Key psychological outcomes reported were anxiety, depression, stress, post-traumatic stress, coping strategies, maternal–fetal attachment, and life satisfaction. Anxiety and depression were the most frequent issues, with maternal anxiety reaching 65% and depression up to 45.7%. Stress related to diagnostic uncertainty was common. While some parents used adaptive coping (social support, emotional regulation), others experienced maladaptive patterns such as avoidance. One study reported increased maternal–fetal attachment following prenatal CHD diagnosis. Predictors of psychological distress included time of diagnosis, parental gender, education level, social support, and severity of the defect. Recommended interventions included early psychological screening, empathetic communication, structured counseling, and long-term emotional support. Despite heterogeneity in design and moderate overall bias, findings highlight a consistent psychological burden among parents, underscoring the need for integrated psychosocial care following a prenatal CHD diagnosis. Conclusions: Parents whose children have been prenatally diagnosed with a congenital heart defect are at an increased risk for psychological distress. To improve the quality of care, a multidisciplinary team is needed to provide parents with the necessary information on diagnosis, interventions, and potential outcomes. Full article

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

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

Spinal health depends on the dynamic interplay between mechanical forces, biochemical signaling, and cellular behavior. This review explores how key molecular pathways, including integrin, yeas-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ), Piezo, and Wingless/Integrated (Wnt) with β-catenin, actively shape the structural and functional integrity of spinal tissues. These signaling mechanisms respond to physical cues and interact with inflammatory mediators such as interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α), driving changes that lead to disc degeneration, vertebral fractures, spinal cord injury, and ligament failure. New research is emerging that shows scaffold designs that can directly harness these pathways. Further, new stem cell-based therapies have been shown to promote disc regeneration through targeted differentiation and paracrine signaling. Interestingly, many novel bone and ligament scaffolds are modulating anti-inflammatory signals to enhance tissue repair and integration, as well as prevent scaffold degradation. Neural scaffolds are also arising. These mimic spinal biomechanics and activate Piezo signaling to guide axonal growth and restore motor function. Scientists have begun combining these biological platforms with brain–computer interface technology to restore movement and sensory feedback in patients with severe spinal damage. Although this technology is not fully clinically ready, this field is advancing rapidly. As implantable technology can now mimic physiological processes, molecular signaling, biomechanical design, and neurotechnology opens new possibilities for restoring spinal function and improving the quality of life for individuals with spinal disorders. Full article

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

Background/Objectives: The emergence of biologic therapies has transformed the management of severe asthma, offering targeted treatments that improve symptom control and reduce exacerbations. However, taking a biologic solely based on the initial response may not be optimal. Clinicians must regularly reassess the suitability of the selected biologic, considering evolving patient characteristics and the growing availability of treatment options. This article aims to highlight the importance of individualized decision making in the long-term management of pediatric patients receiving biologic therapy, exploring the various reasons that may justify switching biologic treatment. Methods: We present a case to illustrate this approach: a 14-year-old adolescent girl with severe allergic asthma who initially received Omalizumab, achieving clinical, laboratory, and functional improvements. Despite this positive response, the patient reported low-level satisfaction due to the frequency of injections and hospital visits, leading to poor adherence. After a comprehensive reassessment, the treatment was switched to Tezepelumab. Results: Following the switch, the patient maintained stable disease control with a slight improvement in lung function, while adherence, satisfaction, and quality of life improved significantly. The number of hospital visits was reduced from 24 to 12 per year, and the number of injections decreased from 104 to 12 annually. The patient reported high-level satisfaction with the new treatment plan, and the economic burden of therapy was also substantially reduced. We present a table summarizing the essential and secondary factors to consider when initiating or switching biologic therapy. Conclusions: This case highlights the need to go beyond the traditional criteria, such as lack of efficacy and adverse reactions, when evaluating a switch in biologic therapy for pediatric asthma. Factors such as comorbidities, injection frequency and number, route of administration, and cost should also be considered, as they can directly influence adherence and the clinical outcomes in children and adolescents. As the therapeutic options expand, regular reassessment and personalized adjustments remain essential. Full article

This review focuses specifically on pediatric patients with cystic fibrosis. Cystic fibrosis (CF) is a serious inherited disease that affects the respiratory and gastrointestinal systems in children and adolescents, causing chronic inflammation, infections, and impaired nutrient absorption. A key component of patient care is monitoring nutritional status, particularly based on BMI, which correlates with lung function and life expectancy. This paper presents the latest guidelines for dietary therapy, including a high-calorie and fat-rich diet supported by pancreatic enzymes, as well as the importance of vitamin and mineral supplementation in the context of CF pathophysiology. The role of modern therapies that modulate CFTR function to improve patients’ quality of life and support antimicrobial therapy is discussed. Particular attention is paid to the role of the gut microbiota and the potential for its modulation by probiotics, highlighting their potential to alleviate inflammation and support the immune system. The conclusions underscore the need for a comprehensive, individualized approach to diagnosis and therapy, which is crucial for improving the quality of life and health prognosis of children with CF. New visual tools and a clinical case study enhance the practical applicability of current recommendations, while emerging areas such as microbiome-targeted interventions and treatment inequalities are also addressed. Full article

Background: The therapeutic response in Graves’ Disease (GD) remains largely unpredictable. Patients often experience persistent symptoms that are poorly correlated with thyroid hormone levels, an undefined treatment duration, and the need for long-term or definitive therapies. Based on the nuclear antagonistic properties of L-carnitine (LCT) on thyroid hormone action and the immunomodulatory role of selenium (Se), we aimed to assess the impact of adding a combined LCT and Se supplement to standard methimazole (MMI) therapy on the biochemical profile and quality of life (QoL) of patients with overt GD. Methods: This multicenter prospective randomized trial enrolled 60 consecutive patients with newly diagnosed overt GD. Participants were randomized to receive either standard treatment with MMI alone (Control Group) or MMI plus the combined LCT/Se supplement (Intervention Group). TSH, fT3, fT4, and TSH–receptor antibodies (TRAb) levels were evaluated every two months for up to 24 months or until spontaneous remission or definitive therapy. At each visit, patients completed a symptom questionnaire addressing the frequency of typical thyrotoxic symptoms. Results: No significant differences were observed between groups in the trend or time-to-normalization of TSH, fT3, and fT4 levels. However, the Intervention Group reached TRAb negativity significantly earlier (HR = 2.35 (1.14–4.81), p = 0.016), with a synergistic interaction with MMI therapy. MMI requirements were consistently lower in the Intervention Group, both in average dosage (p = 0.013) and cumulative dose (p = 0.020). The rate of spontaneous remission was significantly higher (OR = 11.22 (3.35–46.11), p < 0.001). Overall symptom burden did not differ significantly between groups; however, the supplement exerted an independent effect in reducing the severity of tremor, irritability, mood lability, heat intolerance, and exertional dyspnea. Conclusions: Our findings suggest the clinical benefits of adding combined LCT and Se supplementation to MMI in the treatment of overt GD, including shorter disease duration, lower cumulative MMI exposure and earlier TRAb normality, that could positively influence TRAb-related prognostic outcomes. Full article

Chronic skin wounds are difficult to heal or nonhealing. These wounds may become infected and progress to tissue necrosis, potentially leading to limb amputation, sepsis, reduced quality of life, depression, economic burden on the healthcare system, and social isolation. Several clinical strategies, including negative pressure wound therapy, antibiotic-based infection control, and wound debridement, have been developed to treat skin wounds. However, these approaches primarily target local wound conditions and offer only short-term relief, not achieving sustained functional regeneration. Stem cell-based therapy has emerged as an alternative therapeutic method for skin wound treatment owing to its ability to suppress inflammation, stimulate angiogenesis, and promote cellular proliferation. However, the low post-transplantation survival rate of stem cells remains a major limitation. Exosomes, nanosized extracellular vesicles, transport proteins, lipids, mRNAs, and miRNAs and mediate regenerative functions, including anti-inflammatory effects, angiogenesis promotion, and extracellular matrix remodeling. Stem cell-derived exosomes (SC-Exos) offer several advantages over their parent cells, including greater stability, lower immunogenicity, absence of tumorigenic risks, and ease of storage and distribution. These attributes render SC-Exos particularly attractive for cell-free regenerative therapies. In this review, we introduce exosomes derived from various types of stem cells and explore their therapeutic applications in skin wound regeneration. Full article

Peripheral and autonomic neuropathy are common in type 2 diabetes; they are associated with oxidative stress and inflammation. Cocoa, rich in polyphenols, may offer neuroprotective benefits. This study evaluated the effect of cocoa supplementation on the biochemical, clinical, and somatosensory profile of neuropathy in individuals with type 2 diabetes. A 12-week, double-blind controlled trial involved 39 subjects randomized to receive cocoa capsules (50 mg polyphenols) or placebo (methylcellulose). Evaluations included glycemic and lipid profiles, neutrophil/lymphocyte ratio, blood pressure, standardized questionnaires, anthropometric measurements, and the rate-dependent depression of the H-reflex. In the cocoa group, the Toronto score decreased by 2.63 points and the BEST score decreased by 1.45 points. In the placebo group, these reductions were 1.84 and 2.21 points, respectively. Neither difference was statistically significant between groups (p > 0.05). Quality-of-Life questionnaire score decreased by 9.2 points in the cocoa group, but without significant difference to the placebo group (p = 0.501). Fasting glucose and HbA1c levels decreased in the placebo group by 38 mg/dL (0.28%) but were not significantly different from the cocoa group (p > 0.05). No other intra- or inter-group differences were significant (p > 0.05). Cocoa supplementation did not show significant improvements over the placebo in the measured outcomes. Both groups showed persistent abnormalities in spinal somatosensory processing, with an RDD of the H-reflex ≥ 0.5. Full article

Background/Objectives: Advances in cancer diagnosis and treatment improved survivorship rates, but survivors’ long-term quality of life remains a critical concern. Survivors of esophageal and gastric cancer often undergo extensive curative surgery, which can have lasting impacts on nutritional status. This study aimed to assess the nutritional status, dietary challenges, and supportive care needs of this population of cancer survivors. Methods: In this cross-sectional study, adults diagnosed with esophageal or gastric cancer were invited to complete an anonymous survey to assess their nutritional status, quality of life, and psychological well-being. Results: A total of 114 responses were analyzed. Although over 70% of participants were more than two years post-diagnosis, more than 30% remained at risk of malnutrition. Additionally, over 36% reported ongoing dietary complications such as swallowing difficulties, dumping syndrome, diarrhea, and reflux. Impaired quality of life was observed in 31.7% of respondents, defined as having a global health status score below 66.1 on the EORTC QLQ-C30. Psychological distress was also evident, with over 25% screening positive for anxiety or borderline anxiety, and more than 22% for depression or borderline depression. Conclusions: Malnutrition, gastrointestinal symptoms, impaired quality of life, and psychological distress remain prevalent among esophageal and gastric cancer survivors many years after diagnosis. These findings underscore the need for ongoing monitoring and the provision of targeted supportive care to improve long-term survivorship outcomes. Full article