Search Results (1,030)

Background/Objectives: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders globally, significantly impacting quality of life across diverse populations. Despite its association with middle-aged and older populations, evidence indicates that LBP is increasingly prevalent among younger age groups. Health science students are considered a potential risk factor for LBP; however, longitudinal studies are scarce. This study aims to determine the risk factors for LBP among health science students over a 2-year follow-up. Methods: One hundred ninety-seven of the third-class health science students (Nursing, Physiotherapy, Medical laboratory science, and Emergency Medical services) were contacted in June 2024. A self-administered modified version of the Standardized Nordic Questionnaire, and data about sedentary and physical activity behavior, as well as 1-month LBP (lasting at least 12 h and numeric rating scale > 5) and stress scores, were recorded. Results: A total of 172/197 (87.3%) respondents completed the questionnaire at the end of the 2-year follow-up. The mean age was 25 ± 3.5 (years) and body mass index (BMI) value 23.5 ± 4.3 (kg/m²). About 49% (n = 84) and 20% (n = 34) of the participants had 1-month LBP and functional disability, respectively. No significant association was found between health science programs and the presence of 1-month LBP (χ² = 0.55, p > 0.05). The logistic regression analyses found that males (OR = 0.269, p = 0.005) and a history of pain frequency (OR = 3.377, p = 0.001) had a significant association with LBP over time. Conclusions: This prospective study shows a high prevalence of 1-month LBP (48.8%) among health science students at Zefat Academic College. LBP was significantly related to sex (female) and pain frequency, but not to health science students. We believe that implementing ergonomic and educational strategies is recommended for this population. Full article

Low back pain (LBP) represents a major societal and economic burden, with annual costs in the United States estimated at $90–134.5 billion. LBP disproportionately impacts postmenopausal women relative to age-matched men, suggesting a role for sex-specific biological factors. Although the mechanisms underlying this disparity are not fully understood, hormonal imbalance during menopause may contribute to LBP pathophysiology. This narrative review aimed to elucidate the impact of menopause on LBP, with emphasis on hormonal effects on spinal tissues and systemic processes. A literature search was conducted, followed by screening of titles, abstracts, and full texts of original clinical studies, preclinical research using human or animal samples, and relevant reviews. Rigour and reproducibility were evaluated using the ARRIVE Guidelines and the Modified Downs & Black Checklist. Evidence indicates that menopause is associated with changes in intervertebral discs, facet joint, ligamentum flavum, skeletal muscle, sympathetic innervation, and systemic systems such as the gut microbiome. However, most findings are correlational rather than causal. Evidence supporting hormone replacement therapy for LBP remains inconclusive, whereas exercise and other treatments, including parathyroid hormones, show more consistent benefits. Future studies should focus on causal mechanisms and adhere to rigour guidelines to improve translational potential. Full article

Low-back pain (LBP) is a leading cause of disability worldwide. When symptoms persist beyond 4–6 weeks, when red flags are suspected, or when precise patient selection for procedures is needed, imaging—primarily MRI (Magnetic Resonance Imaging)—becomes pivotal. The purpose is to provide a pragmatic, radiology-first roadmap that aligns an imaging phenotype with anatomical targets and appropriate image-guided interventions, integrating MRI-based phenotyping with image-guided interventions for subacute and chronic LBP. In this narrative review, we define operational MRI criteria to distinguish radicular from non-radicular phenotypes and to contextualize endplate/Modic and facet/sacroiliac degenerative changes. We then summarize selection and technique for major procedures: epidural and periradicular injections (including selective nerve root blocks), facet interventions with medial branch radiofrequency ablation (RFA), sacroiliac joint injections and lateral branch RFA, basivertebral nerve ablation (BVNA) for vertebrogenic pain, percutaneous disc decompression, minimally invasive lumbar decompression (MILD), and vertebral augmentation for painful fractures. For each target, we outline preferred and alternative guidance modalities (fluoroscopy, CT, or ultrasound), key safety checks, and realistic effect sizes and durability, emphasizing when to avoid low-value or poorly indicated procedures. This review proposes a phenotype-driven reporting template and a care-pathway table linking MRI patterns to diagnostic blocks and definitive image-guided treatments, with the aim of reducing cascade testing and therapeutic ambiguity. A standardized phenotype → target → tool approach can make MRI reports more actionable and help clinicians choose the right image-guided intervention for the right patient, improving outcomes while prioritizing safety and value. Full article

Background and Objectives: Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Early recognition is crucial to improve outcomes, but conventional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) show limited diagnostic accuracy. Materials and Methods: We performed a narrative review of the literature on sepsis biomarkers, with a focus on their biological role, diagnostic performance, clinical applicability, and limitations. Particular attention was given to presepsin (P-SEP) and monocyte distribution width (MDW), which have recently gained relevance. Results: Several novel biomarkers—including lipopolysaccharide-binding protein (LBP), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), mid-regional pro-adrenomedullin (MR-proADM), neutrophil gelatinase-associated lipocalin (NGAL), Proenkephalin (PENK), and circulating microRNAs—have been studied, though most remain investigational. Among them, P-SEP shows rapid kinetics and correlation with disease severity, while MDW, derived from routine complete blood count, offers encouraging sensitivity and cost-effectiveness in emergency settings. Both biomarkers appear practical and potentially valuable for early sepsis detection. Conclusions: P-SEP and MDW emerge as the most promising biomarkers for timely sepsis recognition and risk stratification. Further validation and standardization are required to include them into routine clinical practice. Full article

Inflammatory bowel diseases (IBD) are increasingly acknowledged not merely as confined gastrointestinal disorders but as systemic immunometabolic syndromes. Central to this paradigm is the gut microbiota including non-bacterial components such as the virome, whose functional disruption marked by reduced short-chain fatty acids (SCFAs), increasingly implicated in pathogenic processes extending beyond intestinal mucosa. This review outlines how these alternations compromise the epithelial barrier and immune regulation, increasing the risk of recurrent Clostridioides difficile infections to anemia, neuropsychiatric comorbidities, and extraintestinal manifestations. We critically evaluate emerging microbiota-targeted strategies, including fecal microbiota transplantation (FMT), live biotherapeutic products (LBPs), and precision postbiotics, positioning them as potential adjuncts to conventional immunosuppression. Finally, we discuss the current barriers to clinical translation, such as safety and heterogeneity, and propose a future framework for personalized, functionally integrated IBD care aimed at restoring long-term microbiota homeostasis. Full article

Background/Objectives: Low back pain (LBP) is the leading cause of disability in Saudi Arabia and contributes substantially to healthcare utilisation, reduced quality of life, and lost productivity. This guideline provides nationally standardised, evidence-based recommendations for the assessment and management of non-specific LBP and sciatica in adults, adapted to the clinical and health-system context in Saudi Arabia. Methods: A multidisciplinary Task Force developed the guideline using the GRADE ADOLOPMENT approach, using NICE guideline NG59 as the primary evidence source. One additional clinical question was formulated to address pain neuroscience education, informed by a relevant systematic review. Update literature searches were conducted in PubMed, Embase, and the Cochrane Library (2016–2022). The evidence was appraised using GRADE, and recommendations were formulated through structured Evidence-to-Decision deliberations and consensus voting. Results: The Task Force addressed eleven clinical questions in this guideline. Strong recommendations were provided for the use of validated risk assessment tools (very low certainty of evidence) and stratified management (moderate certainty of evidence). Conditional recommendations were made for indications for imaging, pharmacological treatment for sciatica, psychological interventions, multidisciplinary return to work programmes, epidural injections, prognostic value of image-concordant pathology, spinal decompression, radiofrequency denervation, and pain neuroscience education, with certainty of evidence ranging from very low to low. Conclusions: The findings indicate that management of non-specific LBP and sciatica in Saudi Arabia should be guided by clinical assessment, with restricted use of imaging, careful selection of pharmacological treatments, and appropriate use of psychological, multidisciplinary, and procedural interventions. Full article

Low back pain (LBP) is a common cause of activity limitation in individuals that can result in socioeconomic costs up to $200 billion per year. Most cases of LBP lack a known underlying pathology. The L4/L5 motion segment is the most impaired lumbar segment, likely due to high load-bearing function. The ability to model L4/L5 compressive loading from surface electromyography (sEMG) data during dynamic activity may add to the understanding of LBP. Eight volunteers with no history of LBP participated in this study. Muscle activity of the erector spinae, rectus abdominus, and external obliques were recorded by a wireless EMG system (Trigno, Delsys, Natick, MA, USA) during a straight-leg stoop-to-stand task. L4/L5 compressive loading was estimated using a subject-specific sEMG model and validated by comparison with an AnyBody model and publicly available data from OrthoLoad. A specific trendline showed a significant decrease in percent error of estimated force for all muscles. Significantly lower impulse values were estimated by the AnyBody model than the sEMG subject-specific model (p = 0.007). Although our sEMG model was subject to high variability, loading values largely remained within those reported in the literature. Significant variation was found comparing the sEMG model with the AnyBody model, which may validate continued development and testing of personalized measurements of L4/L5 loading. Full article

Outcomes of influenza virus infection vary widely across individuals, reflecting not only viral genetics and host factors but also the composition and function of the airway microbiome. Over the past few years, mechanistic work has clarified how specific commensals (for example, Staphylococcus epidermidis and Streptococcus oralis) restrict influenza replication by priming epithelial interferon-λ programs, reshaping intracellular metabolite pools (notably polyamines), dampening host protease activity, and maintaining barrier integrity; meanwhile, pathobionts (notably Staphylococcus aureus and Streptococcus pneumoniae) can enhance viral fitness via secreted proteases and neuraminidases that activate hemagglutinin and remodel sialylated glycoconjugates and mucus, setting the stage for secondary bacterial disease. Recent studies also highlight the gut–lung axis: gut microbiota-derived short-chain fatty acids (SCFAs), especially acetate, protect tight junctions and modulate antiviral immunity in influenza models. Together, these insights motivate translational strategies—from intranasal live biotherapeutics (LBPs) to metabolite sprays and decoy/dual neuraminidase approaches—that complement vaccines and antivirals. We synthesize recent evidence and outline a framework for leveraging the airway microbiome to prevent infection, blunt severity, and reduce transmission. Key priorities include strain-level resolution of commensal effects, timing/dosing windows for metabolites and LBPs, and microbiome-aware clinical pathways for anticipating and averting bacterial coinfection. Overall, the airway microbiome emerges as a tractable lever for influenza control at the site of viral entry, with several candidates moving toward clinical testing. Full article

Background: Chronic low back pain (cLBP) with kinesiophobia is difficult to treat, and traditional graded activity approaches often show limited adherence and short-term effects. Virtual reality (VR) may enhance treatment engagement by providing immersive game-based environments that encourage therapeutic movement. This randomized controlled trial aimed to examine the effects of VR interventions designed to promote lumbar spine flexion in individuals with cLBP and elevated movement-related fear. Methods: Participants were randomized to one of two nine-week VR game conditions that differed only in the amount of lumbar flexion required. Primary outcomes were changes in pain intensity and disability from baseline to one-week post-treatment. Secondary analyses examined lumbar flexion and expectations of pain/harm as potential mediators. Follow-up assessments were conducted at multiple time points through 48 weeks to assess maintenance of treatment gains. Results: Both VR groups showed significant and clinically meaningful reductions in pain and disability at post-treatment. Improvements were maintained throughout the 48-week follow-up period. Depression symptoms continued to improve during follow-up. Expectations of pain and harm decreased significantly during treatment and remained reduced, whereas objective lumbar flexion did not change appreciably over time. Mediator analyses indicated that improved expectations of pain/harm, rather than increased lumbar flexion, were more closely associated with treatment response. Conclusions: Immersive VR gaming produced sustained reductions in pain, disability, and movement-related fear in individuals with cLBP and kinesiophobia. Findings suggest that VR may enhance rehabilitation outcomes by modifying maladaptive expectations rather than altering lumbar motion. VR-based interventions represent a promising and engaging approach for long-term cLBP management. Full article

While face recognition systems are increasingly deployed in critical domains, they remain vulnerable to presentation attacks and exhibit significant demographic bias, particularly affecting African populations. This paper presents a fairness-aware Presentation Attack Detection (PAD) system using Local Binary Patterns (LBPs) with novel ethnicity-aware processing techniques specifically designed for African contexts. Our approach introduces three key technical innovations: (1) adaptive preprocessing with differentiated Contrast-Limited Adaptive Histogram Equalization (CLAHE) parameters and gamma correction optimized for different skin tones, (2) group-specific decision threshold optimization using Equal Error Rate (EER) minimization for each ethnic group, and (3) three novel statistical methods for PAD fairness evaluation such as Coefficient of Variation analysis, McNemar’s significance testing, and bootstrap confidence intervals representing the first application of these techniques in Presentation Attack Detection. Comprehensive evaluation on the Chinese Academy of Sciences Institute of Automation-SURF Cross-ethnicity Face Anti-spoofing dataset (CASIA-SURF CeFA) dataset demonstrates significant bias reduction achievements: a 75.6% reduction in the accuracy gap between African and East Asian subjects (from 3.07% to 0.75%), elimination of statistically significant bias across all ethnic group comparisons, and strong overall performance, with 95.12% accuracy and 98.55% AUC. Our work establishes a comprehensive methodology for measuring and mitigating demographic bias in PAD systems while maintaining security effectiveness, contributing both technical innovations and statistical frameworks for inclusive biometric security research. Full article

The objective of this research was to combine three plant-derived polysaccharides, Lycium barbarum polysaccharides (LBP), peach gum polysaccharide (PGP), and citrus pectin (CP), with alginate (SA) to co-encapsulate probiotics and investigate the survival of cells during in vitro gastrointestinal digestion, storage, and application in yogurt. The incorporation of different polysaccharides into SA all improved the encapsulation efficiencies and surface regularities of probiotic capsules. Texture analysis showed that the PGP-incorporated microspheres exhibited the highest values for hardness, springiness, and resilience, while in terms of chewiness, the highest values were observed for the LBP and CP groups. In vitro gastrointestinal digestion analysis revealed that the incorporation of different polysaccharides all further enhanced the cell survival rates, and the SA: PGP group demonstrated superior probiotic protection with the minimal viability loss of only 0.40 log CFU/g after 6h digestion. During storage, SA: PGP group also exhibited the highest stability, which still maintained 7.7 Log CFU/g of viable cells at the end of 20 days storage, and after incorporation of SA: PGP into yogurt, 7.8 Log CFU/g of viable cells were still detected at the end of 21 days storage. Full article

Background/Objective: The purpose of this study was to determine whether the effects of pain education combined with physiotherapy could be explained by changes in psychological well-being and self-efficacy in individuals with chronic low back pain (LBP). Methods: This study includes a secondary analysis (mediation analysis) of a randomized controlled trial (RCT) that compares the effect of physiotherapy and pain education with physiotherapy alone. The Roland-Morris Disability Questionnaire, assessed at six weeks, was used as a primary outcome in this study, with pain intensity as a secondary outcome. The World Health Organization Five Well-Being Index (WHO-5) and the General Self-Efficacy Scale were evaluated as potential mediators. Causal mediation analysis based on a counterfactual framework was employed to estimate both direct and indirect effects. Results: The analyses comprised 46 participants (mean age = 42.2 years; 54.3% female) who received pain education along with physiotherapy. In the mediation models, improvements in emotional well-being (assessed by WHO-5) explained approximately one quarter of the effect of the intervention on disability (average causal mediation effect = −1.66, 95% CI [−2.8, −0.72], p < 0.001). By contrast, self-efficacy did not significantly mediate disability, and neither factor accounted for changes in pain intensity. Sensitivity analyses suggested that the indirect effect on psychological well-being was reasonably robust against potential unmeasured confounding factors. Conclusions: Enhancements in psychological well-being were associated with reductions in disability following pain education, whereas self-efficacy did not emerge as a significant mediator. These findings may support the value of incorporating mental well-being strategies within rehabilitation programs for chronic LBP. Full article

This study aimed to elucidate the structure–activity relationship between the structural characteristics of three plant-derived polysaccharides, Lycium barbarum polysaccharide (LBP), citrus pectin (CP) and peach gum polysaccharide (PGP), and their prebiotic functionalities. Structural analysis indicated that LBP exhibited a medium molecular weight and was rich in galactose and rhamnose, which contributed to its high uronic acid content, strong antioxidant activity, and sustained fermentation profile with enhanced butyrate production. In contrast, CP, with its low molecular weight and neutral linear glucan backbone, was rapidly utilized by gut microbiota, leading to accelerated propionate accumulation. Meanwhile, PGP, characterized by an ultra-high molecular weight and a highly branched arabinogalactan configuration, acted as a specific substrate that promoted mid- to late-stage fermentation and significantly increased butyrate yield, highlighting its prebiotic property driven by structural complexity. The functional differences among these polysaccharides were determined by their monosaccharide composition, molecular weight distribution, and chain conformation. These findings provide a scientific basis for the targeted development of plant-derived prebiotics aimed at specific metabolic functions. Full article

Background and Objectives: Low back pain (LBP) is one of the most frequent complications during pregnancy, with a high and variable incidence. LBP has been associated with physical inactivity, but it has not been evaluated exclusively in physically active (PA) pregnant women. This study aimed T to estimate the incidence of LBP in PA pregnant women and describe its clinical, functional, emotional, and occupational impact. Materials and Methods: A prospective cohort of 147 women with PA pregnancies was recruited between gestational weeks 11 and 13⁺⁶. Most (92.5%) hold a university degree. All received standardized informational intervention based on international recommendations on PA during pregnancy and LBP prevention. Data were collected through an in-person interview in the first trimester and a postpartum follow-up phone interview. PA was assessed using the International Physical Activity Questionnaire (IPAQ, short version), and LBP intensity was evaluated using the Visual Analog Scale (VAS). Results: LBP occurred in 64.6% of participants, despite maintaining regular PA. Pain intensity was higher in standing position (VAS = 4.9) and lower in lateral decubitus (VAS = 2.7). More than half (55.8%) did not seek medical consultation. LBP was associated with functional limitations (work, sleep, walking), emotional distress (52.6%), and work leave (30.5%; mean 9.4 weeks). In the multivariable logistic regression analysis, standing occupational position showed a borderline association with LBP (OR = 2.14; 95% CI: 1.00–4.55; p = 0.047), while a history of LBP in a previous pregnancy showed a statistically significant association (OR = 2.89; 95% CI: 1.12–7.48; p = 0.029). Higher PA levels during pregnancy were associated with slightly lower odds of LBP (OR = 0.91 per 500 MET·min/week; 95% CI: 0.83–0.99; p = 0.032), although the magnitude of this association was small. Conclusions: LBP showed a high incidence even among PA and highly educated pregnant women. More than half of the women did not seek medical consultation, suggesting potential under-recognition of LBP. Standing occupational position and a previous pregnancy-related LBP were identified as independent risk factors associated with LBP in the multivariable model. Higher PA levels were inversely associated with LBP. Full article

Previous reports suggest that the progression from subacute to chronic non-specific low back pain (nsLBP) involves functional changes in both the nervous and immune systems. The purpose of the present study was to characterize the gene expression profiles of circulating immune cells that affect the interaction between these two systems when subacute nsLBP turns into chronic nsLBP. Participants aged 18–55 were included based on the presence or duration of LBP, with peripheral blood mononuclear cells collected for RNA sequencing from 20 healthy controls (no nsLBP), 20 subclinical patients (intermittent nsLBP), and 19 chronic patients (long-term nsLBP). The data revealed that chronic nsLBP is linked to a distinct gene expression profile, with 139 uniquely differentially expressed genes (DEGs), differing from those in the subclinical and control groups. Interestingly, comparing chronic and subclinical groups showed minimal overlap in DEGs, indicating a clear inflammatory distinction between subclinical nsLBP and chronic nsLBP. The findings also indicated that patients with chronic nsLBP were different from other individuals regarding axon guidance, indicating neuroplastic changes when intermittent nsLBP turns into chronic nsLBP. Hence, early recognition of the transition from subclinical to chronic nsLBP using RNA profiling may pave the way for more precise therapeutic strategies targeting neuroplastic changes and inflammatory processes. Full article