Search Results (1,782)

Background/Objectives: Understanding the relationship between metabolism and eating behavior may improve how we treat and prevent obesity. Fibroblast growth factor 21 (FGF21) is a hormone secreted by the liver with a putative role in energy expenditure, energy intake, and weight regulation. In this secondary analysis, we studied how fasting FGF21 is correlated with eating behavior and decision making, as measured by the Three-Factor Eating Questionnaire (TFEQ) and the Iowa Gambling Task (IGT), respectively. Methods: Participants (n = 98; women = 19; white = 31) were medically healthy, between 18 and 55 years of age, weight-stable 6 months before admission, and had normal glucose regulation. Women were premenopausal and not pregnant. Pearson partial correlations were determined, accounting for age, sex, and body fat percentage. A mediation analysis examining whether the association between hunger and IGT score was mediated by FGF21 values was performed using general linear models. Results: In partial correlations adjusted for age, sex, and body fat percentage, we found that fasting FGF21 concentrations were positively correlated with hunger susceptibility (sum of internal and external cues) (partial r = 0.26, p = 0.02) and internal hunger (partial r = 0.22, p = 0.04), disinhibition (partial r = 0.27, p = 0.01), and better decision making (higher IGT scores) (partial r = 0.40, p = 0.0001). We also found a correlation between hunger susceptibility and better decision making, including the same covariates (partial r = 0.25, p = 0.03). However, this correlation was mediated (36%) by fasting FGF21. Conclusions: In this study, participants with greater susceptibility to hunger cues had higher IGT scores (better decision making) in the setting of higher fasting FGF21 concentrations. This provides further evidence of the role of FGF21 in the interplay between eating behavior and decision making. Further studying this topic may improve our understanding of the complex relationship between assessing energy requirements and cognitive processes related to eating behavior. Full article

Objectives: Histopathological growth patterns (HGPs) of liver metastases have been shown to possess prognostic significance. To date, only 2 studies have evaluated the reproducibility of HGP assessment. The aim of our study was to assess the interobserver reproducibility of HGP classification in liver metastases. Methods: A retrospective, consecutive, single-center cohort study was conducted, including patients who underwent surgical resection for liver metastases at the University of Szeged between 2011 and 2023. A comprehensive database was established, incorporating basic histopathological data for each case. Histological slides were independently reviewed by 2 pathologists, 3 pathology specialist trainees, and 2 medical students with varying levels of experience in gastrointestinal pathology. Interobserver agreement was evaluated using intraclass correlation coefficients (ICC) and Fleiss’ kappa. Results: The study included resection specimens from 205 patients, comprising 336 metastatic lesions, predominantly of gastrointestinal origin (n = 188). Excellent interobserver agreement was observed among specialist trainees (ICC = 0.911) and board-certified pathologists (ICC = 0.984). Overall agreement among all 7 evaluators was good (ICC = 0.822). Conclusions: Our findings demonstrate that HGPs can be reliably assessed by individuals with at least 2 years of experience in general pathology. To our knowledge, this is the first study to include the largest number of board-certified pathologists and pathology specialist trainees in a HGP reproducibility analysis. Additionally, no comprehensive literature review on this topic has been previously conducted. Full article

Background: Pain is a disabling issue in athletes, with significant impact on performance and career longevity. Many randomized clinical trials (RCTs) have explored interventions to reduce pain, leading to multiple systematic reviews with meta-analysis, but their methodological rigor and clinical applicability remain unclear. Objective: To provide an overview of systematic reviews with meta-analysis on interventions aimed at alleviating pain intensity in athletes, identifying knowledge gaps and appraising methodological quality. Methods: CINAHL, Embase, Epistemonikos, PubMed, Scopus, SPORTDiscus, and Cochrane Library were searched from inception to February 2025. Systematic reviews with meta-analysis of RCTs evaluating interventions to manage pain in athletes were considered. Athletes without restrictions in terms of sports, clinical, and sociodemographic characteristics were included. Overlap between reviews was calculated using the corrected covered area. Results: Twelve systematic reviews met inclusion criteria. Physical exercise modalities (e.g., gait retraining, hip strengthening), acupuncture, photo biomodulation, and topical medication showed potential benefits in reducing pain intensity. Other interventions, such as certain manual therapy techniques, platelet-rich plasma, or motor imagery, did not show consistent effects. All reviews focused solely on pain intensity, with minimal stratification by sport or clinical condition which may affect the extrapolation of meta-analyzed findings to the clinical practice. Methodological quality was often low, with flaws in reporting funding sources, lists of excluded studies, and certainty of evidence (was mostly rated as low/very low). Overlap was variable across the interventions. Conclusions: Given low/sparse certainty and minimal sport-specific analyses, no strong clinical recommendations can be made; preliminary signals favor proximal hip strengthening, gait retraining, photo biomodulation (acute soreness), and topical NSAIDs pending higher-quality syntheses. Future reviews should consider mandatory GRADE; pre-registered protocols; sport- and condition-specific analyses; and core outcome sets including multi-dimensional pain. Full article

Background: Medication adherence is one of the critical factors in optimizing treatment outcomes for chronic diseases such as atopic dermatitis (AD). Existing studies use aggregate data, but there is a need for assessment of medication adherence phases, such as the initiation and discontinuation of therapy. The aim of this study was to assess medication adherence across patients with moderate to severe AD, investigating the impact of drug treatment characteristics, particularly the route of administration, on adherence levels during treatment. Methods: A retrospective observational study on an Italian sample included 821 newly diagnosed AD patients from January 2021 to June 2022. Medication adherence was evaluated by EMERGE guidelines, focusing on initiation and discontinuation. Discontinuation was assessed at 6 and 12 months, comprising sensitivity analysis. Statistical analysis included chi-square tests and descriptive statistics on treatment duration. Results: Treatment initiation is significantly lower for tacrolimus ointment (38% non-initiation) than for dupilumab injection (12% non-initiation), due to initial healthcare support for dupilumab patients. After six months, 75.6% of dupilumab injection patients remained on therapy, while 24.4% of patients continued tacrolimus ointment treatment. After one year, therapy persistence was 68.7% among users of dupilumab, while only 22.5% of patients remained on tacrolimus therapy. Dupilumab demonstrated a significantly longer median treatment duration compared to tacrolimus (4.4 vs. 2.6 months; p < 0.01). Conclusions: The observed differences in adherence patterns between topical tacrolimus and subcutaneous dupilumab suggest that distinct contextual and behavioral factors influence patient adherence during therapy. Full article

Background: The Pharm2Home Initiative’s Community Health Arm adopts a health-equitable approach to chronic disease education and medication therapy management (MTM). We serve senior residents of Solano County, California, who live in affordable housing and have limited financial resources. Aim: This evaluation assesses the uptake of chronic disease management recommendations provided by clinical pharmacists during MTM sessions at community events. Methods: The program engaged clinical pharmacists to provide tailored education and healthcare interventions in senior housing facilities. The goal was to empower seniors to manage their health effectively. The sessions covered various topics, including expired or duplicated medications, incorrect medication use, consultations on medication management, immunizations, and lifestyle adjustments. Results: Over an 18-month period, from January 2022 to August 2023, the program involved 65 participants across ten community health events. These events provided approximately 65 h of direct intervention. Many participants reported significant improvements in understanding their treatment plans and navigating their health needs more confidently. Feedback from 60 seniors after the sessions indicated that 88% felt much better informed about their medications, and 75% expressed that their concerns were addressed extremely well. Conclusions: These outcomes demonstrate the importance of clinical pharmacist-led interventions in improving seniors’ medication use and chronic disease management. The initiative’s approach advocates for integrating clinical pharmacists into community health settings, suggesting a scalable model for enhancing person-centered care. However, further studies are necessary to assess the long-term impacts of these interventions and explore their effectiveness across diverse age groups and more complex conditions. Full article

Background/Objectives: Black hairy tongue syndrome (BHT) is characterized by structural epithelial changes and a dark discoloration on the surface of the tongue, causing a variety of symptoms such as xerostomia, altered taste, and nausea. Methods: Herein, we report a 70-year-old female patient with a history of Sjogren’s syndrome, rheumatoid arthritis, and occasional use of intranasal and inhaled corticosteroids, who presented with BHT exacerbated by consumption of colored beverages and carbohydrates. We also provide a review of the literature on published articles reporting cases of BHT syndrome. Results: Our patient’s condition improved after implementing dietary restrictions in combination with local care. A literature review revealed that the most common reported exposures and underlying conditions in patients with BHT were the recent administration of antibiotics, solid organ or hematologic malignancy, immunosuppressants, smoking, corticosteroids, autoimmune conditions, receipt of antidepressants, local radiation therapy, proton pump inhibitors, and alcohol. The majority of cases were successfully managed with the elimination of implicated factors when possible and local hygiene. Conclusions: Different factors may contribute to the development of BHT. Discontinuation of implicated medications together with measures for topical care constitute the most effective ways to achieve resolution. Full article

Erythema ab igne (EAI), also known as “hot water bottle rash” or “toasted skin syndrome”, is a benign cutaneous condition caused by chronic exposure to low-level infrared heat. It typically begins as transient erythema and evolves into a reticulated brown pigmentation with telangiectasias. A skin biopsy, ideally taken from the central area of the hyperpigmented lesion, is recommended to exclude differential diagnoses. Although usually benign, EAI has been associated with rare malignant transformations, supported only by low-level evidence. Elimination of the heat source is essential, and topical treatments such as hydroquinone or retinoids may be considered, while agents like 5-fluorouracil or imiquimod are reserved for dysplastic lesions. Women with endometriosis frequently use heating devices to alleviate dysmenorrhea and chronic pelvic pain. However, prolonged or inappropriate heat application can lead to chronic thermal injury, including EAI, and may delay medical consultation. While controlled trials confirm short-term analgesic efficacy of heat therapy, extrapolating these findings to unrestricted home use without standardized safety recommendations can be misleading. EAI illustrates the broader impact of chronic pain in endometriosis, linking cutaneous manifestations with neuroplastic alterations and psychiatric comorbidities. A nuanced approach combining patient education on safe use of heat, close dermatologic monitoring, and multidisciplinary pain management is warranted. Full article

Glaucoma is a chronic, progressive optic neuropathy characterized by the degeneration of retinal ganglion cells. It is one of the leading causes of blindness worldwide, with elevated intraocular pressure (IOP) being the most significant modifiable risk factor. The objective of this paper is to assess the effectiveness of Direct Selective Laser Trabeculoplasty (DSLT) in the management of glaucoma and OHT based on analysis of available literature. Topical hypotensive medications are the preferred first-line therapy for both newly diagnosed open angle glaucoma (OAG) and ocular hypertension (OHT) over other treatment modalities for most patients. Medical glaucoma management, despite proven efficacy, is limited by issues of patient adherence, quality-of-life decrease, side effects, and ocular surface disease (OSD). Selective Laser Trabeculoplasty (SLT) has emerged as a safe, effective, and repeatable alternative to medical therapy for patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). Direct Selective Laser Trabeculoplasty (DSLT) is a novel, non-contact laser treatment that delivers energy transsclerally to the trabecular meshwork (TM) without the use of a gonioscope. In recent studies, DSLT has demonstrated comparable efficacy to conventional SLT, including the multicenter randomized GLAUrious trial. It reduces IOP by 18–27%, often enabling reduction in or discontinuation of hypotensive topical medications. The non-contact, automated nature of DSLT simplifies the procedure, enhances patient comfort, and may expand access to laser therapy across diverse clinical settings. In conclusion, DSLT represents an innovative advancement in laser therapy for glaucoma, combining the clinical benefits of SLT with enhanced procedural efficiency and safety. Further long-term studies are needed to validate its durability, but existing evidence supports its use as a first-line or adjunctive treatment for OAG and OHT. Full article

Background: The European Doctoral Conference in Nursing Science provides a unique platform for doctoral students in nursing and health sciences to present their research in a supportive environment. Celebrating its 20th anniversary, the 2024 conference embraced the motto “looking back and looking forward,” offering an opportunity to reflect on the development of nursing science and future challenges. Results: Held at the Medical University of Graz, Austria, the conference hosted 90 participants from 13 countries. It featured two keynote lectures, three workshops, 48 presentations, and a science slam. Abstract submissions underwent peer review to ensure the quality of presentations. The presentations highlighted key challenges and opportunities across nursing practice, healthcare work environments, education and digitalization in nursing, and health perspectives. Topics included, for example, workforce retention, artificial intelligence in nursing practice, leadership in error management, and culturally sensitive care. The keynotes emphasized the importance of patient and public involvement in research and the benefits of survey data in nursing science. Workshops imparted knowledge and skills regarding funding acquisition, guideline development, and effective research presentation. A science slam introduced innovative and creative ways to present research. Conclusions: The conference showcased the evolving landscape of nursing science, emphasizing the importance of evidence-based practice, supportive working conditions, and constructive collaboration. It demonstrated the enthusiasm and readiness of a new generation of researchers to advance nursing science in a rapidly changing healthcare environment. Full article

Background: Selective serotonin reuptake inhibitors (SSRIs) are one of the most frequently used medication classes in psychiatry, with many approved and off-label uses. One common side effect of SSRIs is sexual dysfunction, leading to the off-label use of SSRIs to manage inappropriate sexual behaviors in psychiatric settings. However, no official guidelines exist for this off-label use of SSRIs, so a review of this use is warranted. Methods: This review was conducted using the PubMed and Google Scholar databases. Grey literature was considered for inclusion in this review, but only one report by the United Kingdom’s Care Quality Commission was included. Peer-reviewed references discussing the theoretical mechanisms of SSRI-induced sexual dysfunction, case reports/studies examining the off-label use of SSRIs, and reviews discussing relevant disorders like post-SSRI sexual dysfunction (PSSD) were included in this review. Results: The literature proposes that SSRIs act through a variety of serotonin receptors such as 5-HT_1A, 5-HT_2A, and 5-HT_2C to inhibit dopaminergic tone in the mesolimbic and spinal pathways to cause sexual dysfunction. Discussion: SSRIs are frequently considered for off-label use in managing inappropriate sexual behavior, particularly in geriatric patients with dementia, given their superior safety profile compared to antipsychotics in that population. However, the risk and treatment options for PSSD are unclear, which poses a risk for patients taking SRRIs, as it can be a severe and enduring condition. High-quality clinical trials are needed, as the majority of the literature on the topic consists of case reports or theoretical papers. Full article

Background/Objectives: Multiple studies indicate that self-perceived health accurately reflects a person’s overall health, and that poor self-perceived health is associated with chronic diseases, the use of health services, increased health expenditure, and mortality. There is little research on this topic in people with newly diagnosed diabetes mellitus (DM). The objectives of this study were to analyse self-perceived health in adult patients with newly diagnosed DM (mostly T2DM, but also T1DM), identify associated characteristics, including a Mediterranean diet and physical activity, and examine differences by sex. Methods: This is a cross-sectional study of 796 patients. Participants were evaluated through physical examination, electronic medical records, self-perceived health assessment, lifestyle, personal and family history, and laboratory parameters. A multivariate analysis was performed on the total sample and on sex subgroups to identify factors associated with self-perceived health. Results: In total, 25.8% of participants reported poor/fair health (33.4% women, 20.2% men). The variables associated with poorer self-reported health were being female, a lack of family support, morbid obesity, low physical activity, and anxiety/depression. In women: morbid obesity, cancer, and antiplatelet therapy. In men: lack of family support, age < 60, anxiety/depression, low physical activity, and previous treatment with ACEIs/ARBs. Conclusions: Poor self-perceived health is common in patients newly diagnosed with diabetes, similar to the general population. The factors found explained 24.2% of the variance and showed different associations by sex. The cross-sectional design did not allow for inferences of causality. These findings could suggest personalised interventions to address psychosocial and lifestyle factors at the onset of diabetes. Full article

Background/Objectives: Family meetings (FMs) are clinical encounters in a structured space between the patient, family members, and care teams. Healthcare professionals (HPs) often lack formal training in conducting FMs. The scoping review aims to provide an overview of the available research evidence on FMs’ education for HPs. Methods: We searched MEDLINE, Embase, CINAHL, PsycINFO, and Scopus. The PCC (Population-Concept-Context) framework was used to define inclusion criteria: educational intervention on FMs aimed at HPs in all settings of care and students of medicine and nursing sciences treating adult patients with oncological and non-oncological diseases. Results: The search retrieved 1017 articles, of which 26 were eligible. The training had as its primary aims the development of communication skills and curriculum development/evaluation. For the most part, palliative care physicians served as trainers, while medical students and residents represented a major part of trainees, underscoring a focus on early-career learners. FM training is mainly provided in the American countries and intensive care settings. Role-play or simulation was the most common teaching method. Pre- and post-interventional designs were the most common, with few studies incorporating longitudinal follow-up to assess skill retention. Quantitative and qualitative methodologies were used to evaluate interventions. Conclusions: The training topics are related to advanced communication, but there is a lack of an interprofessional perspective and long-term assessment of the skills learned. It is necessary to consider different family types as subjects of communication. Full article

Psoriasis is a chronic inflammatory autoimmune skin disease characterized by erythematous plaques covered with silvery-white scales, often accompanied by systemic complications such as psoriatic arthritis and cardiovascular diseases. The disease and its systemic complications substantially impair quality of life, compromise socioeconomic status, and threaten patient safety. The occurrence and progression of this disease are related to the IL-23/IL-17 axis and involve the aberrant activation and interactions of multiple immune cells, along with genetic predispositions and environmental triggers. Although current therapeutic approaches, including topical agents, systemic medications, biologic agents targeting key cytokines, and Janus Kinase inhibitors, can control symptoms and delay disease progression, a complete cure has not been achieved. Furthermore, these strategies face challenges relating to the cost, safety, efficacy and precision of targeting. This review summarizes recent advances in mechanistic research, highlighting the interplay among microorganisms, innate and adaptive immunity in psoriasis. We also evaluate a range of emerging therapies, including biologics, small-molecule inhibitors, Chimeric antigen receptor T-cell cell therapy, RNA interference-based strategies, and alternative medicine. Specifically, we focus on their novel mechanisms, efficacy challenges, safety profiles, and targeting accuracy. Finally, we assess their potential in personalized treatment, aiming to achieve long-term remission, and propose the future prospects of precision medicine in psoriasis management. Full article

Background: There is no consensus on the best treatment method for calcaneal fractures. The topic of lower limb biomechanics following calcaneal fracture treatment with various fixation methods has not been fully explored. The aim of the study was to assess the balance and load distribution of the lower limbs in patients after various methods of stabilization of calcaneal fractures. Methods: In this two-center study, we retrospectively collected data from 19 patients treated with internal plate fixation at a mean age of 46 years and 27 patients treated with Ilizarov external fixation at a mean age of 50 years. Using the Zebris Medical pedobarophragmatic platform, we assessed the percentage distribution of lower limb loads and balance. Results: There were no significant differences in total load distribution for both the operated (p = 0.489) and non-operated limb (p = 0.46), between the Ilizarov method group and the internal plate group. In the Ilizarov fixation group, total load distribution was 46.89% on the treated limb, and 53.11% on the uninjured limb, p = 0.077. In the internal plate fixation group, the mean total load distribution was 41.57% in the treated limb, and 57.89% in the uninjured limb, p = 0.008. The median CoG (center or gravity) sway path length was 132.41 cm and 170.21 cm in the Ilizarov and internal plate group, respectively, p = 0.023. The median CoG sway areas were 0.84 cm² and 7.57 cm² in the Ilizarov method group and internal plate fixation group, respectively, p < 0.001. Conclusions: The Ilizarov method was associated with more symmetrical load distribution and improved balance performance compared to internal plate fixation. Static biomechanical parameters of calcaneal fracture treatment were better in the Ilizarov group compared to patients with internal plate fixation. Full article

Neurodegenerative diseases, including Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, and Huntington’s disease, represent unmet medical and social needs. Still, no definitive cure exists for these illnesses, hence a therapeutic approach with molecules able to prevent/downtone/modify the disease seems highly attractive. Remarkably, a higher risk of neurodegenerative disease is associated with low vitamin D levels. Vitamin D is a multifaceted molecule able to target critical neuroinflammatory processes underlying neurodegeneration, acting through genomic or rapid signaling. This narrative review aims to focus on vitamin D’s potential to be an optimal neuroprotective molecule, based on its ability to target and counteract aberrant biomolecular processes involved in neuroinflammation/neurodegeneration. Noticeably, exercise can potentiate vitamin D’s protective effect through some anti-inflammatory actions exerted on shared biomolecular targets. Thus, although vitamin D is not strictly a drug, it could be potentially allocated within the therapeutic approach to neurodegenerative diseases in combination with adapted exercise, best as an early intervention. Topics on the complexity concerning the doses for supplementation and data discrepancy from trials are addressed. The urgent demand is to test and clarify vitamin D efficacy and safety, combined or not with exercise, in clinical settings. Full article