Search Results (32,013)

Background/Objectives: Lipedema is a chronic, progressive disorder of the adipo-fascial tissue characterized by abnormal subcutaneous fat accumulation, inflammation, fibrosis, pain, and edema. Despite its considerable impact on patients’ quality of life, it remains underdiagnosed. Recent studies have suggested a potential overlap between lipedema and hypermobility spectrum disorders (HSDs), both involving connective tissue dysfunction. This work explores the shared pathophysiological features of lipedema and HSD, highlighting clinical correlations, comorbidities, and the need for integrated diagnostic and therapeutic approaches. Methods: A cross-sectional observational study was conducted through an online survey targeting individuals with lipedema and a control group with lymphedema. The questionnaire assessed symptoms typically associated with HSD, including musculoskeletal, gastrointestinal, urogynecological, vascular, and neuropsychological manifestations. Descriptive statistics were used to evaluate clinical patterns in both groups. Results: Among the lipedema patients, 44% reported joint hypermobility and 60% recalled being hypermobile during childhood. High rates of pediatric overweight (50%), low muscle tone (55%), and exercise-induced fatigue (70%) were observed. Adult symptoms included joint pain (notably in the ankles, knees, cervical spine, sacrum, and feet), digestive issues (50%), and thyroid disorders (24.4%). Compared with the control group, patients with lipedema showed significantly more connective tissue-related motor deficits and systemic symptoms. Conclusions: Connective tissue laxity may play a critical role in the pathogenesis of lipedema, contributing to multisystemic manifestations through vascular, lymphatic, gastrointestinal, and musculoskeletal involvement. The high prevalence of HSD-like features calls for a paradigm shift in the understanding of lipedema as a systemic disorder. Early identification of connective tissue alterations, especially in children with familial predisposition, could enable timely interventions, potentially mitigating disease progression. A multidisciplinary, evidence-based approach is essential for accurate diagnosis and effective management. Full article

Background: Isometric handgrip (IHG) exercise reduces blood pressure (BP) in both normotensive and hypertensive individuals. However, there are few studies specifically addressing its effects in hypertensive patients with ischemic heart disease (IHD). This research aimed to compare acute hemodynamic responses and post-exercise hypotension to single bouts of IHG handgrip performed at two different intensities in patients with IHD. Methods: Fifty-four sedentary patients were enrolled and randomly assigned to one of three groups: (1) high-intensity isometric handgrip performed at 70% of maximal voluntary contraction (MVC) (IHG-70%); (2) low-intensity isometric handgrip performed at 30% of MVC (IHG-30%); (3) control group (no exercise). Heart rate and BP were measured, and transthoracic echocardiography was performed at baseline, during exercise (lasting 3 min), and after 15 min post-exercise. BP was also measured at 30, 45, and 60 min of recovery. Results: No significant changes in systolic BP occurred during the exercise phase between the three study groups. Systolic BP decreased significantly in IHG-70% compared to the control at 30 (−7.7 ± 1.9; p = 0.035) and 45 min (−8.1 ± 2.3; p = 0.021) post-exercise, while there were no significant differences between IHG-70% and IHG-30% at different time-points. There were no significant changes in diastolic BP between the two active groups and between IHG-70 and IHG-30 versus control at different time-points (repeated-measures ANOVA p = 0.257). Global work efficiency was unchanged in IHG-70% (−4%) and IHG-30% (+1%) compared to control (ANOVA p = 0.154). Conclusions: High-intensity and low-intensity isometric handgrip exercises did not cause hemodynamic impairment in IHD. High-intensity exercise was more effective than low-intensity in reducing post-exercise systolic BP. Full article

Hyper-IgE syndrome (HIES) is a rare genetic immunodeficiency characterized by elevated serum IgE levels and associated immune dysregulation, manifesting in recurrent infections, eczema, and skeletal abnormalities. Emerging evidence suggests a link between HIES and audiovestibular dysfunction, potentially mediated by IgE-driven inflammation in the inner ear, which is not immunologically privileged. However, the nature of this association remains poorly understood. This systematic review synthesizes current evidence on the characteristics, pathophysiology, diagnostic approaches, and management of audiovestibular dysfunction in HIES patients. Literature searches across PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect (up to 6 August 2025) were conducted in accordance with PRISMA guidelines. Key findings indicate that HIES-related audiovestibular issues, including sensorineural hearing loss and vestibular impairment, may arise from IgE-mediated endolymphatic sac inflammation, leading to hydrops and hair cell damage. Diagnostic tools such as audiometry, electrocochleography, and allergen challenge tests show promise, with elevated IgE correlating with abnormal otoacoustic emissions and prolonged auditory brainstem response latencies. Treatment focuses on immunomodulation (e.g., corticosteroids, dupilumab) to mitigate IgE effects, though evidence is limited to case reports. A proposed schematic diagram illustrates pathophysiology, emphasizing IgE’s role in inner ear toxicity. Timely recognition and intervention may prevent progression to permanent hearing loss or vestibular disability, improving quality of life. Future research should explore genetic–immunologic mechanisms and prospective trials for targeted therapies. Trial registration: PROSPERO CRD420251120600. Full article

Fibromyalgia (FM) affects millions of people around the world, causing widespread physical pain, exhaustion, and psychological disorders. Through this study, we aim to observe the effectiveness of two different rehabilitation programs in reducing the impact of FM on daily functioning and psychological factors. Specifically, we compare a complex conservative program that combines physical therapy and hydrokinetotherapy in a hospital setting with a therapy focused on intrinsic relaxation. Methods: This comparative study involved 63 patients aged between 19 and 69 years diagnosed with FM, divided into two groups: the study group (SG, 32 participants) and the control group (CG, 31 participants). Over 90% of participants are female, 30 in the study group and 28 in the control group. SG followed a conservative physiotherapy combined with thermal water therapy, and CG followed a recovery program through intrinsic relaxation. Participants were evaluated on the first and last day of the rehabilitation program using the Revised Fibromyalgia Impact Questionnaire (FIQR) and the Hamilton Anxiety Rating Scale (Ham—A). The rehabilitation program consisted of 10 sessions conducted over a period of two weeks. Results: After the two-week recovery period, the results showed a significant improvement in both FIQR and Ham—A scores in the study group (p < 0.001). In the control group, there were no significant changes in FIQR variables (p > 0.05), while a significant improvement was observed on the anxiety scale (p < 0.001). Conclusions: The combination of hydrokineto-therapy and physical therapy is more effective in improving the overall condition of patients with FM compared to relaxation. Full article

Background/Objectives: Ischemia with non-obstructive coronary arteries (INOCA) remains an underdiagnosed and undertreated condition due to the extensive diagnostic testing required and heterogeneous pathophysiology of different endotypes, each of which require tailored treatment. This study aimed to explore the effect of intracoronary physiology testing-based endotype-specific medical therapy on quality of life in patients with INOCA. Methods: Intracoronary physiology testing was performed in patients presenting with cardiac symptoms, evidence of significant ischemia on non-invasive testing, and non-obstructive epicardial coronary arteries. Microvascular angina (MVA) was defined as coronary flow reserve ≤ 2.5 and an index of microvascular resistance ≥ 25. Vasospastic angina (VSA) was defined as a >90% vasoconstriction of an epicardial artery during acetylcholine provocation test in the presence of ischemic electrocardiogram changes and chest pain. Quality of life was evaluated using the Seattle Angina Questionnaire 7 (SAQ-7) before the start of new treatment and at the three months follow-up. Results: The total study population consisted of 35 patients (80% women), of whom MVA was observed in 19 (54.3%), VSA in 9 (25.7%), and the combination of MVA and VSA in 3 (8.6%) cases. Four patients (11.4%) had no pathology on intracoronary physiology testing detected. High rates of dyslipidemia (100%), arterial hypertension (85.7%), diabetes (17.1%), and depression and anxiety (34.3%) were documented. In the isolated MVA and VSA groups, adjustment of medical therapy resulted in an improvement in the SAQ-7 summary score at 3 months (p < 0.001 and p = 0.007, respectively). There was no change of SAQ-7 summary score in the mixed endotype group (p = 0.11). Conclusions: Adjustment of medical therapy according to intracoronary physiology testing-based phenotype resulted in improved quality of life as assessed by the SAQ-7. Our findings highlight the importance of invasive testing in patients with clinically suspected INOCA. Full article

Rural communities face persistent transport disadvantages due to low population density, limited-service availability, and high operational costs, restricting access to essential services and exacerbating social inequality. Autonomous public transport systems offer a transformative solution by enabling flexible, cost-effective, and inclusive mobility options. This study investigates the operational determinants for autonomous road-based transit systems in rural and peri-urban South-East Queensland (SEQ), employing a structured survey of 273 residents and analytical approaches, including General Additive Model (GAM) and Extreme Gradient Boosting (XGBoost). The findings indicate that small shuttles suit flexible, non-routine trips, with leisure travelers showing the highest importance (Gain = 0.473) and university precincts demonstrating substantial influence (Gain = 0.253), both confirmed as significant predictors by GAM (EDF = 0.964 and EDF = 0.909, respectively). Minibus shuttles enhance first-mile and last-mile connectivity, driven primarily by leisure travelers (Gain = 0.275) and tourists (Gain = 0.199), with shopping trips identified as a significant non-linear predictor by GAM (EDF = 1.819). Standard-sized buses are optimal for high-capacity transport, particularly for school children (Gain = 0.427) and school trips (Gain = 0.148), with GAM confirming their significance (EDF = 1.963 and EDF = 0.834, respectively), demonstrating strong predictive accuracy. Hybrid models integrating autonomous and conventional buses are preferred over complete replacement, with autonomous taxis raising equity concerns for low-income individuals (Gain = 0.047, indicating limited positive influence). Integration with Mobility-as-a-Service platforms demonstrates strong, particularly for special events (Gain = 0.290) and leisure travelers (Gain = 0.252). These insights guide policymakers in designing autonomous road-based transit systems to improve rural connectivity and quality of life. Full article

The lion’s paw scallop (Nodipecten subnodosus) is a commercially valuable pectinid whose postharvest quality strongly depends on storage and handling conditions. This study investigated the combined effects of seasonality, postmortem time, and storage temperature on energy metabolism in the adductor muscle, focusing on metabolites associated with rigor mortis and freshness. Adult scallops (~10 cm shell height) were harvested in four seasons (spring, summer, autumn, winter), transported under commercial conditions for approximately 2 h, and stored at 0, 5, and 10 °C for 48 h. Muscle samples were collected every 8 h and analyzed for ATP, ADP, AMP, glycogen, arginine phosphate (Arg-P), and free arginine using HPLC and enzymatic assays. In addition, the adenylate energy charge (AEC) was determined in freshly harvested and post-transport specimens. Initial ATP concentrations ranged from 4.2 to 6.5 µmol/g, with higher levels in winter, while Arg-P varied from 3.1 to 4.8 µmol/g. Seasonality significantly influenced all metabolites except arginine, and transport markedly reduced ATP and AEC, particularly in spring and autumn. Storage at 0 °C resulted in rapid ATP depletion (<1.0 µmol/g within 12 h) and AMP accumulation (>3.0 µmol/g), indicating accelerated energy collapse. In contrast, scallops stored at 5 and 10 °C maintained ATP levels above 2.5 µmol/g for up to 24 h, delaying rigor mortis, reducing postmortem contraction, and preserving muscle texture and appearance. Overall, these findings demonstrate that moderate refrigeration represents a physiologically suitable and technologically advantageous strategy to optimize scallop postharvest handling, extend shelf life, and enhance product quality for the fresh seafood market. Full article

Children with neuromuscular disorders (NMDs) are at high risk for respiratory complications due to impaired cough and weakness of respiratory muscles. Effective cough is essential for airway clearance, infections’ prevention, and maintaining lung function. This narrative review explores the physiology of cough, the consequences of cough insufficiency, and methods for assessing respiratory function in pediatric NMDs. It discusses current care strategies including airway clearance techniques, respiratory muscle training, and preventive and supportive interventions. Emphasis is placed on multidisciplinary management and early intervention to improve outcomes and quality of life. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) affects not only children but also their families. Mothers, as primary caregivers, frequently experience high stress and reduced well-being. This scoping review mapped recent literature (2015–2025) on the quality of life (QoL) of mothers of children with ADHD and identified key factors influencing maternal QoL. Methods: Following the Arksey and O’Malley framework and Joanna Briggs Institute guidance for scoping reviews, we searched PubMed, Scopus, and ERIC in June 2025 for peer-reviewed quantitative studies in English. Eligible studies focused on mothers of children (6–18 years) with ADHD and used validated parent QoL measures. Eight studies met inclusion criteria. Results: Eight studies published between 2015 and 2025 satisfied the inclusion criteria. Mothers regularly indicated a worse quality of life relative to control groups, demonstrating shortcomings in physical, psychological, social, and environmental domains. Severe ADHD symptoms in children, accompanying disruptive disorders, parental distress or anxiety, and inadequate social support were important variables. Adaptive coping strategies correlated with enhanced outcomes, and a longitudinal study showed that effective ADHD intervention reduced familial stress over several months. Several studies have identified maternal depression, child comorbidities, and inadequate social support as key factors that adversely affect parental quality of life. Conclusions: Mothers of children with ADHD are at heightened risk for compromised QoL. Family-centered strategies that support maternal mental health, strengthen social support, and enhance coping—alongside the child’s ADHD care—are warranted. Heterogeneity in QoL measures and limited longitudinal evidence highlight priorities for future research. Full article

Background and Objectives: This study is aimed at evaluating periodontal health in patients with psoriasis and investigating its impact on dermatology-specific and oral health-related quality of life. Materials and Methods: A total of 226 individuals were enrolled, including 113 patients with clinically diagnosed psoriasis and 113 age- and gender-matched healthy controls. The periodontal parameters recorded included plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL). Oral health-related quality of life was assessed using the Oral Health Impact Profile-14 (OHIP-14), while dermatology-specific quality of life was evaluated with the Psoriasis Quality of Life Questionnaire (PQLQ). Psoriasis severity was measured by the Psoriasis Area and Severity Index (PASI). Results: Patients with psoriasis demonstrated significantly poorer periodontal parameters compared to controls, with higher PI (p = 0.006), PD (p = 0.001), and CAL (p = 0.041), as well as a lower number of teeth (p = 0.027). No significant differences in GI were observed (p = 0.331). Subdomain analysis of OHIP-14 indicated significantly greater functional limitation in the psoriasis group (p = 0.001), although no differences were detected in other domains. Positive and significant correlations were found among all the OHIP-14 subscales in both groups, and PQLQ scores were strongly correlated with OHIP-14 outcomes in the psoriasis group (p < 0.05). PASI scores tended to be higher among patients with periodontitis than those with gingivitis or periodontal health, but this difference did not reach statistical significance (p = 0.257). Conclusions: Psoriasis patients exhibited poorer periodontal status and reduced oral health-related quality of life compared to healthy individuals. However, differences in oral hygiene habits may also have contributed to these findings. Our findings suggest an association between psoriasis and impaired periodontal health, but due to the cross-sectional design, a causal relationship cannot be established. Full article

With the widespread adoption of mobile devices in daily life, efficiently capturing and digitizing documentation has emerged as a critical research question. The acquisition of documents via mobile devices is often compromised by shadow interference and geometric distortions, which degrade image quality and adversely affect both OCR accuracy and readability. To address this, we propose a novel method that utilizes control points and illumination prediction to effectively rectify distortions and eliminate shadows in captured document images. Spatial attention is employed to guide the interpolation between control points and reference points, effectively eliminating geometric distortions in the captured document images. Following geometric unwarping, an illumination correction model is applied to remove shadows and enhance surface clarity, improving both human readability and OCR accuracy. Our method demonstrates robust performance in effectively rectifying document distortions across diverse scenarios. Evaluation on the DocUNet benchmark dataset shows that our approach achieves competitive results compared with state-of-the-art techniques. Full article

Background and Objectives: Sciatica is a common condition associated with significant pain and reduced quality of life (QoL). However, its impact and associated determinants remain underexplored in Saudi Arabia. Therefore, this study aimed to examine determinants of quality of life among Saudi adults with sciatica. Materials and Methods: A cross-sectional study was conducted in Saudi Arabia between February and March 2024 using an online Arabic questionnaire disseminated via social media. Participants (n = 927) aged ≥18 years completed a 50-item questionnaire covering sociodemographic characteristics, clinical history, lifestyle factors, and the Short Form-12 (SF-12) QoL scale. Results: Of the 927 adults (mean age 30 ± 11 years), 76% (n = 706) were female and 24% (n = 221) male; 10% (n = 92) reported sciatica. Overall, 57% (n = 531) reported good QoL. Multivariate analysis revealed that increasing age (Odds ratio (OR) = 1.04; 95% CI: 1.01–1.07), urban residence (OR = 1.49; 95% CI: 1.11–2.00), and higher income (>15,000 Saudi Arabia Riyal (SAR); OR = 1.53; 95% CI: 1.03–2.27) were associated with better QoL. Conversely, diabetes (OR = 0.42; 95% CI: 0.22–0.79), arthritis (OR = 0.52; 95% CI: 0.32–0.83), and sciatica duration >1 year (OR = 0.29; 95% CI: 0.12–0.69) were associated with poorer QoL. Gender, body mass index (BMI), smoking, and physical activity showed no significant associations. Conclusions: Sciatica, prolonged symptom duration, and comorbidities such as diabetes and arthritis negatively affect QoL in Saudi adults, whereas socioeconomic and demographic factors contribute positively. The results underscore the importance of early intervention and tailored support for sciatica patients with long-standing symptoms or specific comorbidities to improve health outcomes. Longitudinal studies are warranted to assess causality and the impact of interventions. Full article

Background: Peritoneal dialysis (PD) depends on patients’ self-management abilities, supported by nursing interventions that extend beyond technical skills to include psychosocial and educational domains. Evidence from Saudi Arabia on how these behaviors relate to clinical and quality-of-life outcomes remains limited. Aim: To assess self-management behaviors among adult PD patients, examine their associations with clinical and quality-of-life outcomes, and explore the mediating role of emotional well-being, with implications for nursing practice. Methods: A descriptive cross-sectional study was conducted among 158 adult PD patients at King Saud University-affiliated centers in Riyadh. Validated Arabic versions of the Chronic Illness Self-Management Scale and KDQOL-SF were administered. Clinical indicators were extracted from medical records. Data were analyzed using descriptive statistics, t-tests, multivariate linear regression, and mediation analysis. Results: Technical skills achieved the highest self-management scores (mean 3.78 ± 0.62), while emotional coping was lowest (mean 2.71 ± 0.69). Participants with higher self-management had fewer hospitalizations (0.9 ± 0.5 vs. 1.6 ± 0.8, p = 0.01), higher serum albumin (3.60 ± 0.56 vs. 3.44 ± 0.61 g/dL, p = 0.04), and better emotional well-being (60.1 ± 14.9 vs. 55.3 ± 12.4, p = 0.03) than their counterparts. Educational level (β = 0.208, p = 0.001) and emotional well-being (β = 0.197, p = 0.001) were independent predictors of self-management, with partial mediation by emotional well-being (indirect β = 0.062, p = 0.004). Conclusions/Clinical Implications: Optimizing nursing support for PD patients requires moving beyond technical instruction to address health literacy, emotional resilience, and culturally sensitive education. Nurse-led interventions integrating psychosocial support with skill-building may enhance self-management, reduce hospitalizations, and improve quality of life in PD populations. Full article

Celiac disease (CeD) is an autoimmune disorder where adherence to a lifelong gluten-free diet (GFD) is the only available treatment. While this approach is rather effective, some patients experience ongoing symptoms, and this factor, along with the rigidity of the GFD, may predispose some to disordered eating behaviors, including Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID is characterized by persistent food avoidance that is not driven by body image concerns, resulting in nutritional, psychological, and social impairment. This scoping literature review explores the emerging intersection between ARFID and CeD, examining prevalence, pathophysiology, clinical features, complications, and management strategies. Recent studies report that 14–57% of individuals with CeD may meet the criteria for ARFID, depending on the population and screening tools used. Factors contributing to ARFID in CeD may include ongoing gastrointestinal symptoms, anxiety over gluten exposure, negative conditioned responses to food, social challenges related to GFD adherence, and psychiatric co-morbidities. ARFID in CeD is associated with worsened nutritional deficiencies, anxiety, depression, and impaired social functioning, making the diagnosis of ARFID challenging due to symptom overlap with CeD and other psychiatric conditions. Management requires a multidisciplinary approach, including medical, nutritional, and psychological interventions. Routine screening, early intervention, and integrated care models may improve outcomes and quality of life. Full article

Strawberries are among the most consumed fruits in Europe, but intensive cultivation requires frequent pesticide use, raising food safety concerns. This study evaluated pesticide residues and dietary risk in strawberries from the Agro Aversano area (Southern Italy). A total of 83 samples collected in 2023–2024 were analyzed using a validated QuEChERS-LC–MS/MS method targeting 850 active substances. Thirty-one pesticides were detected, predominantly fungicides, followed by acaricides and insecticides. Cyflumetofen and pyrimethanil were the most frequent residues, while compounds with low toxicological thresholds, including emamectin benzoate, lambda-cyhalothrin, acetamiprid, and tetraconazole, were also identified. Dietary risk assessment was conducted with the EFSA PRIMo model (v.3.1), focusing on the NL toddler subgroup. Despite occasional exceedances of European Maximum Residue Limits (MRLs), both acute and chronic exposures remained well below toxicological reference values (ADI and ARfD). Overall, the results indicate negligible health risks but highlight the relevance of cumulative exposure, underscoring the need for continuous monitoring and sustainable pest management practices to ensure strawberry safety. Full article