Life

12 pages, 3120 KB

Open AccessArticle

Radiofrequency Echographic Multi-Spectrometry (REMS) for Bilateral Femoral Neck Assessment in Pregnant Women: A Cross-Sectional Study

by Elena Bischoff, Stoyanka Vladeva, Fabian Bischoff, Mira Hristova and Nikola Kirilov

Life 2026, 16(8), 1249; https://doi.org/10.3390/life16081249 - 28 Jul 2026

Abstract

Pregnancy is associated with physiological adaptations in calcium metabolism and skeletal homeostasis that may result in temporary reductions in bone mineral density (BMD). However, routine skeletal assessment during pregnancy remains limited because dual-energy X-ray absorptiometry (DXA) involves ionizing radiation. This study aimed to [...] Read more.

Pregnancy is associated with physiological adaptations in calcium metabolism and skeletal homeostasis that may result in temporary reductions in bone mineral density (BMD). However, routine skeletal assessment during pregnancy remains limited because dual-energy X-ray absorptiometry (DXA) involves ionizing radiation. This study aimed to compare bilateral femoral neck BMD and Z-scores in pregnant and non-pregnant women using Radiofrequency Echographic Multi-Spectrometry (REMS), a radiation-free ultrasound-based technology, and to assess correlation between bilateral measurements. In this cross-sectional study, 100 women were enrolled, including 40 pregnant women and 60 non-pregnant women with comparable age and body mass index (BMI). Bilateral femoral neck BMD and age-adjusted Z-scores were evaluated using REMS. Pregnant women had a mean age of 33 ± 5 years, pre-pregnancy BMI of 25.8 ± 6.5 kg/m², and gestational age of 21 ± 5 weeks, with no significant differences in age or pre-pregnancy BMI compared with controls. Pregnant women demonstrated significantly lower left femoral neck BMD than controls (0.805 vs. 0.862 g/cm²; p = 0.0018) and lower left femoral neck Z-scores (−0.08 vs. 1.18 SD; p = 0.003). A strong positive correlation between left and right femoral neck BMD was observed (R = 0.78). Similarly, right femoral neck BMD was significantly lower in pregnant women compared with controls (0.835 g/cm² vs. 0.892 g/cm²; p = 0.0026). The right femoral neck Z-score was 0.15 ± 1.15 SD in pregnant women and 1.45 ± 1.10 SD in controls (p = 0.002). REMS demonstrated the ability to detect differences in femoral neck bone parameters between pregnant and non-pregnant women while providing bilateral measurement consistency. These findings support the feasibility of REMS as a safe, radiation-free approach for assessing maternal skeletal status during pregnancy. However, the cross-sectional design and lack of longitudinal follow-up limit conclusions regarding the progression and reversibility of pregnancy-associated bone changes. Future prospective studies with larger cohorts and postpartum monitoring are needed to further define the clinical role of REMS in maternal bone health assessment. Full article

(This article belongs to the Section Medical Research)

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15 pages, 1229 KB

Open AccessArticle

Multivariate Neuromuscular Profile and Principal Component Analysis: A Pilot Study in Professional Female Soccer Players

by Luis Romero-Vera, David Ulloa-Díaz, Jonathan Concha-Poblete, Misael Sandoval-Cárcamo, Claudio Carvajal-Parodi, Francisco Guede-Rojas, Carlos Jorquera-Aguilera, Cristobal Ulloa-Barboza, Claudio Hernández-Mosqueira, Gustavo Pavez-Adasme, Eduardo Guzmán-Muñoz, Héctor Fuentes-Barría and Jorge Leschot-Gatica

Life 2026, 16(8), 1248; https://doi.org/10.3390/life16081248 - 28 Jul 2026

Abstract

Background: Professional women’s football requires precise neuromuscular characterisation because of the high mechanical demands associated with acceleration, deceleration, jumping, braking, landing, and rapid force production. The aim was to characterise the multivariate neuromuscular profile derived from the countermovement jump (CMJ) and isometric mid-thigh [...] Read more.

Background: Professional women’s football requires precise neuromuscular characterisation because of the high mechanical demands associated with acceleration, deceleration, jumping, braking, landing, and rapid force production. The aim was to characterise the multivariate neuromuscular profile derived from the countermovement jump (CMJ) and isometric mid-thigh pull (IMTP), and to examine neuromuscular components according to tactical positions in professional female football players. Methods: Twenty-three professional female football players were assessed using the CMJ and IMTP. Force-time, impulse, rate of force development, jump performance, landing, and inter-limb imbalance variables were extracted. Principal component analysis (PCA) was applied to the standardised variables, and individual component scores were compared according to tactical positions using one-way analysis of variance (ANOVA). Results: The first five principal components explained 79.19% of the total variance. PC1 represented the propulsive force and the rate of force development; PC2 reflected total force and mechanical impulse; PC3 represented early explosiveness; PC4 grouped indicators of inter-limb imbalance; and PC5 integrated jump performance and landing control. No statistically significant differences were observed between tactical positions. Conclusions: The combination of CMJ, IMTP, and PCA enabled multiple muscle-force variables to be synthesised into interpretable neuromuscular dimensions. The findings provide preliminary and exploratory evidence to support the individual monitoring of female football players. Given the low participant-to-variable ratio, the PCA findings should be considered exploratory. Full article

(This article belongs to the Special Issue Advanced Research in Exercise Medicine)

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23 pages, 10329 KB

Open AccessArticle

Genome-Wide Identification and Characterization of bHLH Family in Kandelia obovata Under Salt Stress

by Zhixia Zhao, Huizi Liu, Sheng Yang, Xing Liu, Qiuxia Chen and Jinwang Wang

Life 2026, 16(8), 1247; https://doi.org/10.3390/life16081247 - 28 Jul 2026

Abstract

Background/Objectives: bHLH transcription factors regulate key plant processes including development, stress adaptation, and metabolism. In Kandelia obovata, a mangrove species well known for its high tolerance to harsh environments, the bHLH gene family has not been systematically investigated. Here, this study [...] Read more.

Background/Objectives: bHLH transcription factors regulate key plant processes including development, stress adaptation, and metabolism. In Kandelia obovata, a mangrove species well known for its high tolerance to harsh environments, the bHLH gene family has not been systematically investigated. Here, this study aims to perform genome-wide identification and expression profiling of KobHLH genes under normal and saline conditions. Methods: bHLH members were identified by homology searches (HMMER and BLASTp) against the K. obovata protein dataset and verified with SMART-based domain analysis. Subsequent analyses covered physicochemical features, conserved motif composition, and phylogenetic relationships. Transcript abundance was quantified via RNA-seq in various organs (roots, stems, leaves, flowers, and fruits) as well as under saline conditions. Differentially expressed transcripts were selected for co-expression network construction. Results: Phylogenetic analysis of the 118 identified KobHLH loci assigned them into 18 distinct clades. Organ-preferential expression patterns were observed, leading to their classification into three putative functional categories. Upon salinity exposure (10–30‰), 61 of the 118 KobHLH genes exhibited differential expression, grouped into ten significant clusters. A co-expression network comprising 20 hub genes and 198 edges was constructed. Conclusions: This study provides the first genome-wide characterization of the bHLH family in K. obovata, revealing its evolutionary divergence and identifying 61 salt-responsive candidates, notably KobHLH108 and KobHLH5 associated with secondary metabolism, for further functional validation. The findings provide a foundation for future functional studies on stress adaptation mechanisms in this ecologically valuable mangrove species. Full article

(This article belongs to the Section Plant Science)

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16 pages, 2773 KB

Open AccessArticle

The Prokaryotic Community of Hypersaline Soils from the Odiel Saltmarshes: Culturomics Versus Metagenomics

by Cristina Galisteo, Dáša Straková, Alicia García-Roldán, Rafael R. de la Haba, Cristina Sánchez-Porro and Antonio Ventosa

Life 2026, 16(8), 1246; https://doi.org/10.3390/life16081246 - 27 Jul 2026

Abstract

Hypersaline soils are poly-extreme terrestrial habitats characterized by high salinity, in some cases heavy-metal contamination, temperature fluctuations, and nutrient limitation. These conditions impose strong selective pressures, and many prokaryotic inhabitants still remain uncultured. Here, we conducted an extensive culturomics study of 549 isolates [...] Read more.

Hypersaline soils are poly-extreme terrestrial habitats characterized by high salinity, in some cases heavy-metal contamination, temperature fluctuations, and nutrient limitation. These conditions impose strong selective pressures, and many prokaryotic inhabitants still remain uncultured. Here, we conducted an extensive culturomics study of 549 isolates from the hypersaline soils of the Odiel Saltmarshes Natural Area (Southwest Spain) and compared the results with previously generated shotgun metagenomic datasets from the same environment in order to evaluate taxonomic composition, functional potential, and ecological representativeness. Cultivation across media containing 7.5%, 15%, and 25% (w/v) total salts yielded microorganisms belonging to three major phyla: Pseudomonadota, Bacillota (Bacteria) and Halobacteriota (Archaea). At the genus level, bacterial isolates were dominated by Marinobacter, Halomonas, and Aquibacillus at 7.5% (w/v) salinity, whereas extremely halophilic archaea, including Halorubrum, Halogeometricum, and Haloarcula, were predominantly recovered from media containing 25% (w/v) salts. Among the isolates, 57 strains displayed identity values < 98.65% for 16S rRNA gene sequence comparison, suggesting their putative status as new taxa. Comparison with metagenomic datasets showed that culture-dependent approaches successfully recovered the dominant haloarchaeal groups but missed some abundant bacterial phyla, such as Gemmatimonadota. Conversely, culturomics enabled the isolation of unknown species from the rare biosphere, including representatives of the novel genus Terrihalobacillus, which are typically detected at low abundance in metagenomic datasets. Together, these results demonstrate the complementarity of culturomics and metagenomics and provide an insight into the microbial communities inhabiting the hypersaline soils of the Odiel Saltmarshes. Full article

(This article belongs to the Special Issue Extremophiles Breakthrough: Hot Topics and Current Issues in Their Isolation, Identification and Biotechnological Applications—2nd Edition)

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21 pages, 7356 KB

Open AccessArticle

Growth Hormone–Insulin-like Growth Factor Axis and GDF-15 in Critical Illness: Implications for Survival Stratification

by Ioannis Ilias, Chrysi Keskinidou, Georgios Poupouzas, Vasileios Issaris, Nikolaos S. Lotsios, Efthymia Botoula, Marinella Tzanela, Dimitra A. Vassiliadi, Stelios Kokkoris, Charikleia S. Vrettou, Alice G. Vassiliou and Ioanna Dimopoulou

Life 2026, 16(8), 1245; https://doi.org/10.3390/life16081245 - 27 Jul 2026

Abstract

Background: The growth hormone (GH)–insulin-like growth factor (IGF) axis is profoundly dysregulated in critical illness. GDF-15 and individual IGF-binding proteins (IGFBPs) have separately been proposed as prognostic biomarkers, but to our knowledge, no prior study has simultaneously characterized all major GH–IGF axis [...] Read more.

Background: The growth hormone (GH)–insulin-like growth factor (IGF) axis is profoundly dysregulated in critical illness. GDF-15 and individual IGF-binding proteins (IGFBPs) have separately been proposed as prognostic biomarkers, but to our knowledge, no prior study has simultaneously characterized all major GH–IGF axis components and GDF-15 in the same critically ill cohort, precluding assessment of their joint intercorrelation structure. Aim: To provide the first simultaneous characterization of the intercorrelation structure among ten GH–IGF axis components and GDF-15 in a single ICU cohort, testing whether this structure is robust to adjustment for illness severity; and, secondarily, to describe admission discriminatory performance relative to APACHE II and SOFA. Methods: This was a prospective observational pilot study of 43 critically ill adults with admission (T01) measurement of ten GH–IGF axis biomarkers and longitudinal follow-up to day 15. Spearman correlations and hierarchical clustering characterized the admission intercorrelation structure; partial correlations adjusting for APACHE II and SOFA, and bootstrap confidence intervals, assessed robustness. Secondary analyses included the examination of admission discrimination (ROC/AUC), a leave-one-out cross-validated combined model, and longitudinal trajectories. All analyses were exploratory, hypothesis-generating, and unadjusted for multiple comparisons unless stated. Results: Hierarchical clustering identified a coherent cluster comprising GDF-15, IGFBP-1, IGFBP-2, and growth hormone-binding protein (GHBP), distinct from classical GH-resistance markers (GHR vs. healthy controls, GHR vs. admission) and from GH, IGF-1, acid-labile subunit (ALS), and IGFBP-3. Within this cluster, GDF-15 correlated with IGFBP-1 (ρ = 0.65, 95% bootstrap CI 0.44–0.78), IGFBP-2 (ρ = 0.50, CI 0.19–0.71), and GHBP (ρ = 0.47, CI 0.20–0.68); GDF-15 showed no correlation with classical GH-resistance markers. These correlations were essentially unchanged after adjusting for APACHE II or SOFA (partial ρ within 0.03–0.16 of unadjusted values), indicating the structure is not attributable to shared confounding by illness severity. This robustness extended to further adjustment for IL-6, age, BMI, and mechanical-ventilation duration, and results from all 45 pairwise T01 correlations were re-examined with Benjamini–Hochberg false-discovery-rate correction (9 of 11 nominally significant pairs retained q < 0.05). However, the GDF-15–GHBP correlation, unlike the GDF-15–IGFBP-1/IGFBP-2 correlations, attenuated substantially after adjustment for IL-6 and was not consistent across a brain-injury/non-brain-injury subgroup sensitivity analysis, indicating this specific link is less specific than the others. In secondary exploratory analyses, GDF-15 had the highest individual admission AUC (0.74) among biomarkers but was substantially outperformed by APACHE II (AUC 0.90) and SOFA (AUC 0.81); a combined GDF-15 + IGFBP-2 model did not improve on GDF-15 alone. Conclusions: This study identifies a severity-independent intercorrelation structure linking GDF-15 to inhibitory IGFBPs, distinct from classical GH-resistance signaling, in critically ill patients. Although the findings do not support any clinical application at this stage, further study in adequately powered, multicenter cohorts can be contemplated. Full article

(This article belongs to the Section Medical Research)

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16 pages, 936 KB

Open AccessArticle

Does Ossein–Hydroxyapatite Complex Improve the Results of Lower-Leg Lengthening Osteotomies with the Ilizarov Method?

by Piotr Morasiewicz, Monika Zaborska, Łukasz Tomczyk, Katarzyna Sznajder, Igor Kowal and Krystian Kazubski

Life 2026, 16(8), 1244; https://doi.org/10.3390/life16081244 - 27 Jul 2026

Abstract

Background: Good Ilizarov treatment outcomes are associated with low complication rates, rapid formation of strong bone regenerate, and relatively early removal of the Ilizarov external fixator. Some authors recommend the use of pharmaceutical agents that facilitate and accelerate bone union. There are no [...] Read more.

Background: Good Ilizarov treatment outcomes are associated with low complication rates, rapid formation of strong bone regenerate, and relatively early removal of the Ilizarov external fixator. Some authors recommend the use of pharmaceutical agents that facilitate and accelerate bone union. There are no previous studies evaluating Osteogenon in Ilizarov osteotomies. The purpose of our study was to assess radiological and clinical effects of Osteogenon in patients undergoing osteotomy combined with Ilizarov fixation. Methods: In this retrospective study we assessed 35 patients who had undergone lower leg lengthening osteotomies with the Ilizarov method in the years 2021–2022 and received adjunctive Osteogenon. The control group comprised 60 patients matched for age, sex, BMI, and comorbidities, who did not receive Osteogenon. We assessed the following clinical and radiological parameters: the duration of fixation, total initial limb shortening, total limb lengthening, achieving bone union following osteotomy, elongation index, alignment index, complications, analgesic use, and satisfaction with treatment. Results: The median duration of fixation was worse (longer) in the Osteogenon group (183 days) compared to the control group (143 days), p = 0.014. There were no differences between groups in initial limb shortening, median limb lengthening, median elongation index, median alignment index, and complication rate. A proportion of 22.9% of patients in the Osteogenon group and 80% patients in the control group took analgesics on post-treatment follow-up, p < 0.001. In the study, 65.71% of Osteogenon patients and 55% of control patients were very satisfied with the treatment. Conclusions: Taking Osteogenon improves patient’s satisfaction with treatment and limits analgesic use following osteotomies combined with Ilizarov fixation. Osteogenon was associated with a significantly longer external fixation period and failed to demonstrate measurable improvements in radiological outcomes. Any considerations regarding the potential benefits of using Osteogenon should be treated with caution. Full article

(This article belongs to the Special Issue Novel Insights into Musculoskeletal Disorders)

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19 pages, 4834 KB

Open AccessSystematic Review

Dose–Response Effects of Different Exercise Modalities on Blood Pressure Control in Patients with Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis

by Dongze Li, Kaiming Chen, Shibo Kong, Zhengyu Gou, Xinmiao Feng and Jiezhong Wu

Life 2026, 16(8), 1243; https://doi.org/10.3390/life16081243 - 27 Jul 2026

Abstract

Background: Uncertainty persists regarding the dose–response association between exercise exposure and blood pressure (BP) control in chronic kidney disease (CKD). This dose–response network meta-analysis examined whether different exercise modalities and model-estimated metabolic-equivalent exposure levels were associated with changes in systolic BP (SBP) and [...] Read more.

Background: Uncertainty persists regarding the dose–response association between exercise exposure and blood pressure (BP) control in chronic kidney disease (CKD). This dose–response network meta-analysis examined whether different exercise modalities and model-estimated metabolic-equivalent exposure levels were associated with changes in systolic BP (SBP) and diastolic BP (DBP). Methods: Exercise dose was estimated as metabolic equivalents of task minutes per week (MET-min/week) from reported session duration, frequency, and intensity. Primary outcomes were changes in SBP and DBP, with exploratory subgroup analyses by dialysis status, baseline BP, and intervention duration. Results: The analysis included 26 randomized controlled trials (1218 participants). Aerobic exercise was associated with lower SBP, with the greatest model-estimated reduction at 880 MET-min/week (MD, −7.73 mm Hg). Resistance and mind–body exercise also showed model-estimated reductions, whereas combined aerobic-resistance training was not statistically significant. Dose–response estimates differed by dialysis status and intervention length, but several subgroup estimates were based on sparse data and wide uncertainty. Evidence certainty ranged from very low to high (CINeMA). Conclusions: Exercise interventions may be associated with BP reduction in CKD, but the identified MET-min/week ranges should be interpreted as exploratory, model-derived estimates rather than validated therapeutic thresholds. Better reported randomized trials are needed to confirm dose ranges, safety, adherence, and tolerability in dialysis and non-dialysis CKD populations. Full article

(This article belongs to the Special Issue Chronic Kidney Diseases: Epidemiology, Diagnosis, and Treatment)

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15 pages, 3349 KB

Open AccessReview

Impact of Indoor Air Pollution on Occupational Exposure: Rethinking the Major Health Threat for Airport Workers

by Alessia Perna, Adriano Paolucci, Teresa Esposito, Giulia Spernanzoni, Annalisa Bruno, Rosa Maria Russo, Maria Pierdomenico and Massimo Santoro

Life 2026, 16(8), 1242; https://doi.org/10.3390/life16081242 - 27 Jul 2026

Abstract

(1) Background: Airports workers are exposed to a mixture of airborne pollutants generated by aircraft operations, ground support equipment, road traffic, and indoor microenvironments. Indoor air quality, influenced by outdoor pollutant and ventilation dynamics, represents an important, but overlooked determinant of occupational exposure. [...] Read more.

(1) Background: Airports workers are exposed to a mixture of airborne pollutants generated by aircraft operations, ground support equipment, road traffic, and indoor microenvironments. Indoor air quality, influenced by outdoor pollutant and ventilation dynamics, represents an important, but overlooked determinant of occupational exposure. Fine and ultrafine particulate matter (PM) can induce oxidative stress, inflammation, and xenobiotic responses, affecting not only the respiratory system, but also other organs. (2) Methods: This review examines the health effects of occupational exposure among airport workers, with emphasis on indoor air pollution besides aircraft engine emissions. Studies addressing exposure characterization, biological effects, biomarkers, and risk management strategies were critically evaluated. (3) Results: Occupational exposure is driven by both combustion-derived pollutants and indoor–outdoor air exchange processes. Ultrafine particles, black carbon, polycyclic aromatic hydrocarbons, and trace metals contribute to oxidative stress, inflammatory responses, and xenobiotic pathway activation. Monitoring indoor microclimatic parameters, including temperature, atmospheric pressure, and humidity, may facilitate the identification of event-related deterioration in indoor air quality. (4) Conclusions: Indoor air pollution should be recognized as a key component of airport occupational exposure. Integrating indoor/outdoor air quality monitoring and biomarker-based surveillance may improve risk assessment and support more effective protection of airport workers, while advanced predictive tools, including AI-based exposure modelling, represent a promising direction that still requires dedicated validation. Full article

(This article belongs to the Section Epidemiology)

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28 pages, 14935 KB

Open AccessFeature PaperArticle

Integrated Chemical Profiling and Network Pharmacology Establish a Quality Evaluation Framework for the Four Medicinal Parts of Wolfiporia extensa (Peck) Ginns

by Shun-Xin Deng, Lih-Geeng Chen, Shih-Yi Hsiung, Vinh Tuyen T. Le, Chia-Jung Lee, Yves S. Y. Hsieh and Ching-Chiung Wang

Life 2026, 16(8), 1241; https://doi.org/10.3390/life16081241 - 27 Jul 2026

Abstract

Wolfiporia extensa (Peck) Ginns (WE) is a fungus widely used in Traditional Chinese Medicine. Its four medicinal parts, Poria (WP), Rubra Poria (RP), Poriae Cutis (PC), and Poria Cum Pini Radix (PPR), are prescribed for distinct therapeutic purposes; however, their quality standards and [...] Read more.

Wolfiporia extensa (Peck) Ginns (WE) is a fungus widely used in Traditional Chinese Medicine. Its four medicinal parts, Poria (WP), Rubra Poria (RP), Poriae Cutis (PC), and Poria Cum Pini Radix (PPR), are prescribed for distinct therapeutic purposes; however, their quality standards and pharmacological differences remain unclear. This study established reliable quality markers and compared the neuroprotective activities of four medicinal parts of WE. Seven triterpenoids were quantified using validated high-performance liquid chromatography (HPLC) assays, while monosaccharide profiles were analyzed using 1-phenyl-3-methyl-5-pyrazolone-HPLC. The International Commission on Illumination L*a*b* colorimetry and chemometric models were used for authentication. The neuroprotective effects of aqueous extracts were assessed in SH-SY5Y, BV-2, and HOG cell models. Network pharmacology was used to predict compound–target pathway relationships. The content of poricoic acid A (PAA) was the highest in PC; the content of pachymic acid (PA) was the highest in RP; whereas dehydrotumulosic acid (DTUA) was enriched in WP. WP demonstrated the highest mannose and galactose content. The water extract of WP reduced H₂O₂-induced cytotoxicity in SH-SY5Y cells, whereas the PC extract alleviated L-α-lysophosphatidylcholine-induced injury in human oligodendroglioma cells. Network analysis identified PA, PAA, and poricoic acid B (PAB) as candidate bioactive compounds involved in neuroprotective effects. The PA/PAB ratios of ≥10, 1–9, and ≤1 were used to identify WP, RP, and PC, respectively. L* values of >80, 55–79, and <55 effectively discriminated WP, RP, and PC, respectively. This integrative study identified chemical and functional quality markers and demonstrated distinct neuroprotective profiles in different parts of WE, supporting their standardized and rational application in traditional medicine and nutraceuticals. Full article

(This article belongs to the Section Pharmaceutical Science)

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Graphical abstract

23 pages, 1777 KB

Open AccessSystematic Review

Comparative Efficacy of Exercise Modalities for Motor Function Recovery After Acute Ischemic Stroke: A Systematic Review and Bayesian Network Meta-Analysis

by Ziyang Yu, Shuaiwang Huang and Xiyang Peng

Life 2026, 16(8), 1240; https://doi.org/10.3390/life16081240 - 27 Jul 2026

Abstract

Background: Exercise rehabilitation (ER) has become an important treatment regimen during the recovery phase of acute ischemic stroke (AIS). Optimal exercise prescriptions for post-stroke motor recovery remain controversial. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched through November [...] Read more.

Background: Exercise rehabilitation (ER) has become an important treatment regimen during the recovery phase of acute ischemic stroke (AIS). Optimal exercise prescriptions for post-stroke motor recovery remain controversial. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched through November 2025. The Cochrane risk-of-bias (RoB 1) assessment tool was utilized to assess the risk of bias in the original studies. Results: This study included 66 trials comprising 3675 patients. For balance, whole-body tilting postural training (WTPT), unilateral strength training (UST) and robot-assisted unilateral gait training (RAUGT) showed high SUCRA rankings. Activities of daily living likely improved most with robot-assisted Tai Chi training (RATCT), home rehabilitation guidance (HRG) and robot-assisted gait training (RAGT). Fugl-Meyer Assessment (FMA) gains appeared greatest following robot-assisted hand training with electrical stimulation (RAHT + ES), neural inhibition therapy (NIT) and graded motor imagery with electrical stimulation (GMI + ES). Walking endurance seemed most responsive to visual feedback training (VFT), UST and visual aids training (VAT), while functional mobility showed greatest improvement with tilt sensor-assisted gait training with electrical stimulation (TAGT + ES), gait training (GT) and virtual reality therapy with motor imagery (VRT + MI). Conclusions: This study provides the first comprehensive evidence synthesis evaluating the comparative effectiveness of specific exercise modalities across distinct recovery domains after AIS. Rather than supporting generic interventions, the findings highlight the distinct comparative advantages of various emerging technologies and traditional practices. These results offer an evidence-based framework for clinicians to optimize post-stroke rehabilitation protocols and highlight priority areas for future research on dose–response and long-term outcomes. Full article

(This article belongs to the Section Physiology and Pathology)

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15 pages, 1361 KB

Open AccessArticle

Morning Headaches as a Specific Obstructive Sleep Apnea Characteristic in a Large Sleep Clinic Population

by Aliki Karkala, Alexandros Kalkanis, Serafeim-Chrysovalantis Kotoulas, Şakir Kaan Çetindağ, Dries Testelmans, Vasileios Paraschou, Dionisios Spyratos, Dimitrios G. Raptis, Paschalis Steiropoulos and Athanasia Pataka

Life 2026, 16(8), 1239; https://doi.org/10.3390/life16081239 - 27 Jul 2026

Abstract

Morning headaches (MHs) are a recognized but incompletely understood symptom in obstructive sleep apnea (OSA). Because symptoms and comorbidities that commonly coexist with OSA may influence both headache susceptibility and perceived sleep quality, the respective contributions of respiratory abnormalities and sleep disruption to [...] Read more.

Morning headaches (MHs) are a recognized but incompletely understood symptom in obstructive sleep apnea (OSA). Because symptoms and comorbidities that commonly coexist with OSA may influence both headache susceptibility and perceived sleep quality, the respective contributions of respiratory abnormalities and sleep disruption to MHs remain uncertain, particularly in women. We therefore aimed to identify clinical and sleep study factors associated with frequent MHs in patients with OSA. In this retrospective cohort study, 3227 adults with confirmed OSA evaluated between 2013 and 2023 were classified according to MH frequency (<1 episode/week vs. ≥1 episode/week). Demographic, clinical, questionnaire and sleep study variables were analyzed using univariate and multivariable logistic regression. Frequent MHs were reported by 35.2% of patients. On univariate analysis, MHs were associated with female sex, higher body mass index and waist circumference, greater OSA severity, worse nocturnal oxygenation, fatigue, excessive daytime sleepiness, and insomnia symptoms. However, in multivariable analysis restricted to patients with complete polysomnographic data (N = 501), female sex (OR 4.23, 95% CI 1.39–12.85), waist circumference (OR 1.03, 95% CI 1.01–1.06), and arousal index (OR 1.05, 95% CI 1.01–1.08) emerged as independent predictors, whereas conventional respiratory severity indices did not. These findings suggest that sleep fragmentation, rather than OSA severity alone, may be a key determinant of MHs, particularly in women, underscoring the need for sex-specific approaches beyond apnea–hypopnea index-based assessment. Full article

(This article belongs to the Special Issue Chronic Respiratory Comorbidities in Sleep-Disordered Breathing: A Holistic Approach)

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18 pages, 2299 KB

Open AccessCase Report

Lamotrigine-Induced Toxic Epidermal Necrolysis with Multiorgan Failure, Pneumatosis Intestinalis and Chronic Ocular Complications

by Jakub Szrama, Piotr Smuszkiewicz, Amadeusz Woźniak, Ashish Lohani, Krzysztof Zwoliński, Paweł Sobczyński, Nina Łabędź, Aleksandra Dańczak-Pazdrowska, Paweł Pazdrowski, Anna Mikołajczyk-Lorkiewicz, Joanna Wojciechowska, Marcin Stopa and Adriana Polańska

Life 2026, 16(8), 1238; https://doi.org/10.3390/life16081238 - 27 Jul 2026

Abstract

Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous adverse drug reaction associated with extensive epidermal necrosis and severe systemic complications. We report the case of a 25-year-old woman who developed severe lamotrigine-induced TEN four weeks after treatment initiation. The disease rapidly progressed [...] Read more.

Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous adverse drug reaction associated with extensive epidermal necrosis and severe systemic complications. We report the case of a 25-year-old woman who developed severe lamotrigine-induced TEN four weeks after treatment initiation. The disease rapidly progressed to involve approximately 60% of the body surface area, requiring intensive care unit admission, mechanical ventilation, and multidisciplinary management. Treatment included high-dose intravenous methylprednisolone, intravenous immunoglobulins, etanercept, plasmapheresis, and comprehensive supportive care. During hospitalization, the patient developed gastrointestinal complications manifested by pneumatosis intestinalis and portal venous gas, raising suspicion of bowel ischemia and prompting exploratory laparotomy. Following treatment, gradual clinical improvement and complete resolution of the cutaneous lesions were achieved. However, persistent ocular sequelae developed, including meibomian gland dysfunction, punctate epithelial erosions, conjunctival scarring, trichiasis, tear film instability, and early corneal neovascularization, requiring long-term ophthalmological follow-up. To provide clinical context, a narrative review of the literature on the diagnosis, multidisciplinary management, gastrointestinal manifestations, ocular complications, and systemic treatment of TEN was performed. A comprehensive literature search was conducted to identify relevant articles focusing on the intensive care management and specific organ-related manifestations of Toxic Epidermal Necrolysis (TEN). The gathered literature was narratively synthesized to present a cohesive update on current clinical practices and management controversies. This case highlights the potentially devastating multiorgan course of TEN and emphasizes the importance of early recognition, specialized intensive care, and long-term multidisciplinary follow-up. Full article

(This article belongs to the Special Issue Skin Diseases and Dermatologic Comorbidities)

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14 pages, 764 KB

Open AccessArticle

Corneal Endothelial Safety and Intraocular Pressure Outcomes of MicroPulse Laser Trabeculoplasty in Treatment-Naïve Glaucoma: A Six-Month Retrospective Study

by Ahmet Mehmet Somuncu and Ahmet Taner Uysal

Life 2026, 16(8), 1237; https://doi.org/10.3390/life16081237 - 27 Jul 2026

Abstract

MicroPulse laser trabeculoplasty (MLT) lowers intraocular pressure (IOP) with subthreshold pulses that spare the surrounding tissue, yet its effect on the corneal endothelium is far less studied than that of selective laser trabeculoplasty, and almost unstudied in treatment-naïve eyes. We retrospectively reviewed 70 [...] Read more.

MicroPulse laser trabeculoplasty (MLT) lowers intraocular pressure (IOP) with subthreshold pulses that spare the surrounding tissue, yet its effect on the corneal endothelium is far less studied than that of selective laser trabeculoplasty, and almost unstudied in treatment-naïve eyes. We retrospectively reviewed 70 treatment-naïve glaucoma patients (one eye each) treated with a 577 nm yellow laser (Easyret^®) in micropulse mode (300 µm, 300 ms, 1000 mW, 360°). Endothelial cell density, mean cell area, hexagonality, the coefficient of variation in cell size, and central corneal thickness were recorded by specular microscopy (SP-1P, Topcon), and IOP by Goldmann applanation, at baseline and 1, 3, and 6 months. Linear mixed-effects models used every available observation, so no patient was excluded for a missed visit. IOP fell from 25.9 ± 2.5 mmHg to 20.6 and 21.0 mmHg at one and three months (−5.32 and −5.00 mmHg, roughly 20%; both p < 0.001), then returned to 24.8 mmHg by six months, and the proportion reaching a 20% reduction fell from 62.5% to 4.6%. Endothelial cell density, mean cell area, and central corneal thickness held steady, and every morphological change stayed within the device’s repeatability limits on equivalence testing. MLT lowered IOP early but transiently; over six months no clinically meaningful change in corneal endothelial morphology was detected. Full article

(This article belongs to the Special Issue Vision Science and Optometry: 2nd Edition)

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14 pages, 1539 KB

Open AccessFeature PaperArticle

Ultrasound-Guided Mini Fluid Challenge via Velocity–Time Integral to Assess Fluid Responsiveness in Upper Gastrointestinal Bleeding: A Prospective Quasi-Experimental Feasibility Study

by Ilker Çermikli, Tufan Alatli and Salih Kocaoglu

Life 2026, 16(8), 1236; https://doi.org/10.3390/life16081236 - 27 Jul 2026

Abstract

Background: Acute upper gastrointestinal bleeding (UGIB) remains a leading cause of emergency department (ED) admission and carries a mortality of 5–10%. Static hemodynamic parameters perform poorly as predictors of fluid responsiveness, exposing patients either to under-resuscitation or to the harms of fluid overload. [...] Read more.

Background: Acute upper gastrointestinal bleeding (UGIB) remains a leading cause of emergency department (ED) admission and carries a mortality of 5–10%. Static hemodynamic parameters perform poorly as predictors of fluid responsiveness, exposing patients either to under-resuscitation or to the harms of fluid overload. The mini fluid challenge (MFC), in which a 100 mL bolus is used to elicit a measurable change in the left ventricular outflow tract velocity–time integral (ΔVTI), is a validated dynamic test in intensive care but has not been evaluated in undifferentiated ED haemorrhagic shock. We aimed to determine whether ΔVTI-guided resuscitation is feasible at the bedside in UGIB and to explore how ΔVTI relates to in-hospital mortality. Methods: Prospective, single-centre, randomised quasi-experimental comparative study conducted between February 2024 and February 2025. Adults presenting with UGIB were allocated by treatment period, and credentialed emergency physicians to an ultrasound-guided protocol group (UGPG) or a standard care protocol group (SCPG). ΔVTI was measured in both groups but was disclosed to the treating team only in UGPG; in SCPG, it was recorded offline and analysed post hoc. The primary outcome was the feasibility of ΔVTI acquisition; the association of ΔVTI with in-hospital mortality was a secondary, exploratory outcome. Results: Eighty-five patients were enrolled (UGPG n = 47; SCPG n = 38). ΔVTI acquisition was completed within the intended time window in all enrolled patients, establishing bedside feasibility. Across the whole cohort, ΔVTI discriminated non-survivors poorly (AUC 0.55, 95% CI 0.44–0.66), and its performance differed markedly by group: AUC 0.83 (95% CI 0.67–0.93) in SCPG versus 0.69 (95% CI 0.54–0.82) in UGPG. In SCPG, non-survivors had substantially higher ΔVTI than survivors (58.6 ± 30.5% vs. 28.4 ± 30.9%; p = 0.030), a pattern consistent with persistent, uncorrected fluid responsiveness. In UGPG, the association ran in the opposite direction, mortality being concentrated among ΔVTI < 10% non-responders (p = 0.020). Conclusions: ΔVTI-guided resuscitation is feasible in the ED management of UGIB. The direction of the ΔVTI–mortality association differed according to whether ΔVTI was visible to clinicians, generating the testable hypothesis that unrecognised fluid responsiveness contributes to death in standard care. These findings are hypothesis-generating only: the small sample and the low number of events preclude any causal inference and require confirmation in an adequately powered, randomised, etiology-stratified trial. Full article

(This article belongs to the Special Issue Pathophysiology, Diagnosis, and Treatments of Intestinal Diseases—2nd Edition)

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25 pages, 961 KB

Open AccessArticle

Association Between Body Mass Index and Physical Fitness Among University Students in a Sub-Plateau Region of Gansu Province, China: A Cross-Sectional Study

by Ming Chen, Linlin Zhao, Liting Yang, Mingxia Jin, Jiaqi Kong and Qin Yang

Life 2026, 16(8), 1235; https://doi.org/10.3390/life16081235 - 26 Jul 2026

Abstract

While the relationship between body mass index (BMI) and physical fitness in youth often follows an inverted U-shape, populations-based data from sub-plateau settings remain scarce. This study characterized the cross-sectional BMI–fitness association among 14,744 students (9931 females) at a single university in Gansu [...] Read more.

While the relationship between body mass index (BMI) and physical fitness in youth often follows an inverted U-shape, populations-based data from sub-plateau settings remain scarce. This study characterized the cross-sectional BMI–fitness association among 14,744 students (9931 females) at a single university in Gansu Province, China (altitude ~1483 m). Fitness was assessed across seven components (vital capacity, speed, power, flexibility, endurance, and muscular strength/endurance) and summarized as a standardized Physical Fitness Index (PFI). Overweight/obesity prevalence was 11.2% (males 18.3%, females 7.7%)—lower than the 14.0% national average for same-aged university students. BMI displayed a monotonic inverse association with PFI; underweight and normal-weight groups performed comparably, while overweight and obese groups showed progressively lower PFI, with a stronger association in males (β = −0.46) than females (β = −0.36). The weight-normalized vital capacity index (VCWI)—a derived indicator of pulmonary function—showed the strongest inverse correlation (males r = −0.47; females r = −0.40). Associations were most pronounced for VCWI and endurance, whereas flexibility exhibited a negligible BMI-related gradient. These findings describe a cohort-specific pattern, emphasizing the need for broader investigation of regional variations, and should not be interpreted as evidence of an altitude-mediated effect. Full article

(This article belongs to the Section Physiology and Pathology)

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14 pages, 4076 KB

Open AccessFeature PaperArticle

Ascorbic Acid Neuroprotection Against Hippocampal Injury and Gliosis Induced by E621 in Albino Rats Through Modulation of GFAP, Synaptophysin, and Caspase-3

by Enas N. Morgan, Ayman M. Mousa, Rasha A. Elmansy, Hanan Seleem, Marwa M. Fawzi, Amany Refaat Mahmoud, Reham Abdulla Aboukhalil, Hagir H. T. Ahmed, Reem A. Younis, Tarek Hamdy Abd-ElHamid, Asmaa Jabeen, Ashwag Alsharidah, Samah M. Abozaid, Abdullah M. Alnuqaydan, Khaled E. A. Soliman and Enas Haridy Ahmed

Life 2026, 16(8), 1234; https://doi.org/10.3390/life16081234 - 26 Jul 2026

Abstract

Monosodium glutamate (E621) is a common flavor enhancer in highly processed food. Although it makes food more enjoyable, chronic intake may lead to excitotoxicity in brain areas. The current study investigates histological and biochemical neurodegenerative alterations in the rat hippocampus following E621 administration [...] Read more.

Monosodium glutamate (E621) is a common flavor enhancer in highly processed food. Although it makes food more enjoyable, chronic intake may lead to excitotoxicity in brain areas. The current study investigates histological and biochemical neurodegenerative alterations in the rat hippocampus following E621 administration and evaluates the potential neuroprotective properties of ascorbic acid (AA) against E621-induced adverse effects. Forty adult male albino rats were divided into four groups: control group (G1), AA group (G2), E621 group (G3), and AA + E621 group (G4). All animals received a daily intraperitoneal (IP) injection for 30 days. Hippocampal samples were processed and stained with hematoxylin and eosin (H&E), immunostained for GFAP, synaptophysin (a synaptic protein), and caspase-3, and biochemically analyzed for oxidative markers, including malondialdehyde (MDA) and superoxide dismutase (SOD). G3 exhibited significant neurodegenerative changes, characterized by pyknotic granular cells and cytoplasmic vacuolation, with significantly elevated GFAP, synaptophysin, and caspase-3 immunoreactivity in the dentate gyrus (DG). These structural deficits correlated with elevated MDA levels and reduced SOD levels in G3. In contrast, simultaneous administration of AA with E621 resulted in substantial preservation of neuronal morphology, a reduction in caspase-3 immunoreactivity, and a restoration of synaptic vesicle density in G4. E621 induces hippocampal injury by increasing ROS levels and dysregulating GFAP, synaptophysin, and caspase-3. At the same time, AA preserves neuronal integrity and synaptic homeostasis, suggesting its potential role as a protective dietary supplement against brain injury induced by the E621 flavor enhancer. Full article

(This article belongs to the Section Pharmaceutical Science)

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20 pages, 1226 KB

Open AccessArticle

Effects of Halotherapy as an Adjunct to Preseason Training on Respiratory and Aerobic Outcomes in Elite Female Football Players: A Randomized Controlled Trial

by Derya Çetin Sarışık, Ahmet Serhat Aydın, Mehmet Söyler, Raif Zileli, Ali Özkurt, Coskun Yılmaz, Hamza Küçük and Mevlüt Karataş

Life 2026, 16(8), 1233; https://doi.org/10.3390/life16081233 - 25 Jul 2026

Abstract

Background: Aerobic capacity and respiratory efficiency are critical determinants of performance in elite female football, characterized by repeated high-intensity efforts and rapid recovery demands. Halotherapy, involving the inhalation of dry salt aerosol, has been shown to improve pulmonary health; however, its effects on [...] Read more.

Background: Aerobic capacity and respiratory efficiency are critical determinants of performance in elite female football, characterized by repeated high-intensity efforts and rapid recovery demands. Halotherapy, involving the inhalation of dry salt aerosol, has been shown to improve pulmonary health; however, its effects on exercise-related outcomes in athletic populations remain insufficiently investigated. This study aimed to examine the effects of a 12-week post-training halotherapy intervention on respiratory muscle strength, pulmonary function, and aerobic performance in elite female football players. Methods: Twenty-eight elite female football players competing in the Turkish Women’s First League were randomly assigned to a halotherapy group (HG, n = 14) or a control group (CG, n = 14). Both groups completed an identical preseason training program, while the HG additionally performed 45 min halotherapy sessions three times per week in a controlled halochamber. Pre- and post-intervention assessments included maximal inspiratory and expiratory pressures (MIP, MEP), spirometric parameters (FVC, FEV₁, PEF, MVV), and maximal oxygen uptake (VO₂max) estimated using the Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IRT1), along with total distance covered. A 2 × 2 mixed-model ANOVA was used to assess time and group × time interaction effects. Results: Significant group × time interactions were observed for MIP, MEP, VO₂max, FEV₁, PEF, MVV, and Yo-Yo IRT1 performance (p < 0.05), with large effect sizes (ηp² = 0.269–0.924), favoring the halotherapy group. Forced vital capacity (FVC) increased over time in both groups (p = 0.141), with no significant interaction effect. Changes in the control group were comparatively smaller across most outcomes. Conclusion: Post-training halotherapy was associated with improvements in respiratory muscle strength, ventilatory function, aerobic capacity, and intermittent running performance in elite female football players. These findings suggest that halotherapy may be considered as a complementary, non-invasive strategy to support respiratory and aerobic adaptations. Further research is required to confirm these findings and to clarify the underlying physiological mechanisms. Trial registration: NCT07406386; 6 February 2026. Full article

(This article belongs to the Special Issue Advanced Research in Exercise Medicine)

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17 pages, 1928 KB

Open AccessArticle

Drug-Associated Vanishing Bile Duct Syndrome: Screening for Potential Pharmaceutical Triggers Using the WHO Pharmacovigilance Database

by João Pereira Soares, Andreas E. Kremer and Jérôme Bonzon

Life 2026, 16(8), 1232; https://doi.org/10.3390/life16081232 - 25 Jul 2026

Abstract

Vanishing bile duct syndrome (VBDS) is a rare cholestatic liver disease often associated with drug-induced liver injury, yet systematic data on pharmaceutical triggers remain limited. Using WHO VigiBase, we applied Bayesian disproportionality analysis (IC_0.25) to identify drug-event associations that may not [...] Read more.

Vanishing bile duct syndrome (VBDS) is a rare cholestatic liver disease often associated with drug-induced liver injury, yet systematic data on pharmaceutical triggers remain limited. Using WHO VigiBase, we applied Bayesian disproportionality analysis (IC_0.25) to identify drug-event associations that may not be readily apparent in clinical trials or pre-marketing studies. Product labels approved by Swissmedic or the FDA, as well as LiverTox, were reviewed to determine whether VBDS was already acknowledged as an adverse event. Signal detection was deliberately restricted to reports naming a single suspect drug. Among these single-agent reports, 22 drugs demonstrated a positive IC_0.25 signal, of which nevirapine, dapsone and azithromycin showed the strongest disproportionality signal. Only one of these agents (carbamazepine) explicitly labelled VBDS as an adverse event. These findings are based on spontaneous reporting data: disproportionality analysis is a hypothesis-generating signal-detection method that does not establish causality and requires further validation. This study expands the current understanding of drug-induced VBDS by reinforcing the associations with known drugs and generating pharmacovigilance signals for new potential VBDS triggers across several drug categories. Full article

(This article belongs to the Special Issue Drug Safety)

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13 pages, 2639 KB

Open AccessArticle

Comparative Mitogenomic and Phylogenetic Insights of Three Aulacophora Species (Coleoptera: Chrysomelidae) Associated with Cucurbit Crops

by Liancheng Liu, Huanhuan Li, Gonghua Lin, Tianjuan Su, Fang Zhao, Bo He and Zuhao Huang

Life 2026, 16(8), 1231; https://doi.org/10.3390/life16081231 - 25 Jul 2026

Abstract

This study sequenced and comparatively analyzed the mitochondrial genomes of three agriculturally important Aulacophora pests: the polyphagous A. indica, the oligophagous A. lewisii, and the early-diverging A. nigripennis. All three mitogenomes contained the typical 37 genes with conserved gene order. [...] Read more.

This study sequenced and comparatively analyzed the mitochondrial genomes of three agriculturally important Aulacophora pests: the polyphagous A. indica, the oligophagous A. lewisii, and the early-diverging A. nigripennis. All three mitogenomes contained the typical 37 genes with conserved gene order. However, total length varied substantially (15,258–18,766 bp), driven primarily by control region length variation. All species exhibited pronounced AT bias, and relative synonymous codon usage analysis revealed marked interspecific divergence. Phylogenetic analysis based on 13 protein-coding genes resolved A. nigripennis as the basal lineage and A. lewisii and A. indica as closely related sister species. Both widespread species displayed maximum haplotype diversity (Hd = 1.000); however, A. indica exhibited approximately 2.4-fold higher nucleotide diversity (Pi = 0.00478) than A. lewisii (Pi = 0.00198), indicating differential population genetic architectures between the two species. These findings established a comparative mitogenomic framework for Aulacophora and provide baseline data for future phylogenomic and phylogeographic investigations. Full article

(This article belongs to the Special Issue Insect Taxonomy in the Era of Mitogenomics)

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