Search Results (1,116)

A patch-enabled delayed SLBP computer-virus model is extended by replacing the fixed delay in the breaking-out class with a distributed memory. Two gamma kernels are considered: the weak (single-stage) kernel, which encodes an exponentially fading memory, and the strong (two-stage) kernel, which encodes a memory peaked at a positive past time. The linear-chain trick converts the integro-differential equations into finite-dimensional ODE systems of dimension five and six, respectively, yielding polynomial characteristic equations amenable to a Routh–Hurwitz and Hopf analysis. We then carry out a direct numerical comparison of the three formulations on a common parameter set. The discrete-delay model loses stability through a Hopf bifurcation at a critical delay; both gamma models retain stability up to a substantially larger mean memory time, the weak kernel being the most stabilising and the strong kernel intermediate between the weak kernel and the discrete delay. The smearing of the past contribution by the gamma kernels therefore delays the onset of oscillations by a sizeable factor at fixed mean memory. Full article

Background: Microbiome-oriented therapies, including fecal microbiota transplantation (FMT), phage therapy, and live biotherapeutic products (LBPs), represent a promising direction in modern biomedicine for addressing antimicrobial resistance (AMR), recurrent Clostridioides difficile infection (rCDI), and dysbiosis-associated conditions. Despite encouraging clinical outcomes, their integration into routine clinical practice remains limited due to regulatory heterogeneity and unresolved ethical challenges. Objective: This review aims to analyze international regulatory approaches to microbiome-based therapies and to identify key bioethical issues associated with their clinical application. Main content: The paper summarizes current scientific evidence and regulatory frameworks governing microbiome therapies in the United States, the European Union, Ukraine, and selected Asia-Pacific countries. Particular attention is given to differences in classification, approval pathways, and safety requirements. The review also examines major ethical concerns, including informed consent, donor screening, biosafety, data protection, and equitable access to innovative treatments. Conclusions: The analysis demonstrates that microbiome therapies have significant potential for improving clinical outcomes and supporting antimicrobial stewardship. However, their broader implementation requires the harmonization of regulatory frameworks, strengthening of biosafety standards, and development of clear ethical guidelines. International cooperation and accumulation of clinical evidence are essential for the safe and effective integration of microbiome-based interventions into healthcare systems. Full article

Background: Vertebrogenic low back pain (LBP) is a distinct subtype of chronic LBP (cLBP) arising from nociceptive sensitization of the basivertebral nerve (BVN) within pathologically altered vertebral endplates. Modic type 1 and type 2 changes on MRI are primary imaging biomarkers for patient selection. Basivertebral nerve ablation (BVNA), a minimally invasive intraosseous radiofrequency procedure, has emerged as a targeted treatment for this condition. This narrative review aims to synthesize current evidence on the pathophysiology of vertebrogenic LBP, patient selection criteria, procedural outcomes, safety profile, and cost-effectiveness of BVNA. Methods: We conducted this narrative review of the literature, encompassing randomized controlled trials (including the SMART and INTRACEPT studies), prospective registries, and real-world cohort studies evaluating BVNA for vertebrogenic LBP. Clinical and imaging-based selection criteria, procedural techniques, outcome measures, adverse events, opioid utilization, and healthcare utilization data were examined. Results: Evidence demonstrates consistent and durable reductions in pain and disability following BVNA, with a favorable safety profile. Complication rates are low, with vertebral compression fracture and procedure-related radicular pain reported as the most frequent adverse events. BVNA is associated with reduced opioid consumption and decreased overall healthcare utilization. Moreover, emerging data suggest efficacy beyond originally defined inclusion criteria, including cases of osteoporosis, multilevel Modic changes, adult spinal deformity, and complex comorbid presentations. Conclusions: BVNA represents an effective and safe treatment option within the multimodal management of vertebrogenic LBP. Current evidence supports a gradual expansion of procedural indications, with implications for healthcare resource optimization and opioid stewardship. Full article

Background/Objectives: Given the growing need for prenatal care, Nordic Walking (NW) is a promising intervention for maintaining maternal physical activity and quality of life (QoL). We aimed to investigate the influence of NW on gait kinematics, pelvic girdle pain, low back pain (LBP), and QoL during pregnancy. Methods: This is a single-blind randomized controlled trial. A total of 44 pregnant women aged 20 to 40 years with 13–28 weeks of gestation and mild to moderate musculoskeletal pain were included. Participants were randomly assigned to either the study (NW) group or the control group. The study group received the NW program for 12 weeks, three sessions per week, each lasting 45 min. The control group received standard prenatal care plus 30 min of moderate walking three days a week. The GAITRite system was used to measure gait kinematics, and the Visual Analog Scale (VAS) for pain and the SF-36 for QoL were administered at baseline, the fourth week, and the twelfth week. Results: NW significantly improved gait kinematics and reduced musculoskeletal pain (p < 0.001) with improvements in pain and gait speed exceeding the previous reported MCID thresholds. QoL improved across all SF-36 domains in the NW group (p < 0.001) compared with the control group, with large effect sizes observed for the primary outcomes. Conversely, the control group experienced declines in several QoL domains, including energy/fatigue and emotional well-being, despite moderate walking exercise and standard prenatal care over 12 weeks. Conclusions: NW may represent an effective prenatal exercise regimen associated with improved gait, reduced pain, and better overall QoL compared with moderate exercise, consistent with standard prenatal care. Full article

Lower back pain (LBP) is highly prevalent, and while non-pharmacological treatments exist such as heat or massage, they are rarely combined in a convenient manner. We examined the impact of two different heated massage protocols delivered from an automotive seat on LBP within typical commute times. Seventeen adults (eight females) with chronic, non-specific LBP (~6/10 initial back pain) evaluated a heated effleurage or heated tapotement massage—in a randomized order—applied to the lower back, upper thighs, and gluteal region while seated. Each visit included a 20 min control followed by a 20 min heated massage (30 min rest between), with thermal and subjective measurements assessed throughout. Before and after each 20 min session, viscoelastic properties of participants’ lower back muscles were assessed with a myotonometer. Heated massage increased skin temperature, thermal sensation and comfort vs. control (p ≤ 0.039). Both heated massage conditions reduced LBP at 10- and 20 min and reduced subjective tightness at 20 min (p ≤ 0.023). Tapotement produced an earlier reduction in tightness at 10 min and had a greater reduction than effleurage at 20 min (p ≤ 0.026). Increased tissue elasticity was observed in the heated tapotement condition (p ≤ 0.031). Seat-based heated massage offers a convenient method to alleviate LBP, potentially from changes to posterior chain tissue properties. Full article

Heart failure (HF) continues to be a major global health burden, with persistent morbidity and mortality despite guideline-directed and device-based therapies. Evidence suggests the gut–heart axis is a critical and underrecognized contributor to HF progression. Alterations in cardiac output and systemic venous congestion in HF lead to intestinal hypoperfusion, mucosal edema, and loss of barrier integrity, increasing intestinal permeability, gut dysbiosis, and translocation of microbial products. This systemic translocation is associated with chronic low-grade inflammation that activates innate immune pathways that correlate with endothelial dysfunction, oxidative stress, fibroblast activation, and adverse cardiac remodeling. Gut-derived metabolites derived by microbial metabolism modulate cardiovascular health by altering the metabolic profiles. Dysbiosis results in loss of protective short-chain fatty acid (SCFA)-producing bacteria and enriches pro-inflammatory taxa such as trimethylamine N-oxide (TMAO)-producing bacteria. Elevated TMAO is associated with increased mortality and hospitalization in HF, whereas SCFAs enhance barrier integrity and immune tolerance. Secondary bile acids and uremic toxins such as indoxyl sulfate and p-cresyl sulfate further link dysbiosis to fibrosis and vascular stiffness. Circulating markers such as TMAO, lipopolysaccharide-binding protein (LBP), and soluble CD14 carry prognostic value beyond traditional cardiac biomarkers. This review highlights current experimental, translational, and clinical evidence describing gut dysbiosis and its molecular links to HF progression. Targeting the gut–heart axis represents a novel therapeutic approach in HF. Dietary modulation, probiotics/prebiotics, fecal microbiota transplantation, and inhibitors of microbial metabolic pathways show promise. Future research should emphasize microbiota-based interventions in HF management. Full article

Facial recognition is widely employed in identification systems where access restriction is a desirable quality, providing greater security and preventing the access of unauthorized parties. With this problem in mind, this paper proposes a new texture descriptor that works in the RGB, YCbCr and HSV color modes. It obtains perceptual descriptive data from the photographs; the descriptor considers similarities between neighboring pixels and diminishing noise interference, making it robust to minor disturbances and bringing greater stability between similar images. Furthermore, the descriptor achieves good classification performance when used with both a neural network (NN) and the statistical classifier Support Vector Machine (SVM) on color images. A performance comparison of the proposed descriptor against LBP and OC_LBP employing three different face databases is presented to demonstrate that the proposed descriptor can work with the RGB, YCbCr and HSV color modes, presenting the best results when employing a neural network as a classifier with color image databases in the three studied color modes. Full article

Low back pain (LBP) is a major global health problem and can result in a variety of movement impairments. Advances in smart technology have enabled the collection of novel streams of movement data, and machine learning (ML) methods have been increasingly used for data analysis. However, many existing technologies remain expensive and unsuitable for widespread clinical use, and ML approaches have largely focused on distinguishing people with LBP from healthy controls rather than identifying meaningful subgroups within the LBP population. Motion Tape (MT) is a recently developed wearable strain sensor that translates skin deformation from underlying movement and muscle engagement into electrical signals. In this exploratory study involving 10 participants with LBP, we demonstrate that MT data from six sensors applied on the lower back capture rich movement information capable of characterizing movement patterns among participants with LBP. We propose a feature engineering approach based on biomechanical features as well as time-series causal discovery applied to multivariate sensor time-series data to extract directed inter-segment coordination patterns. We further develop an exploratory subgroup discovery pipeline by aggregating clustering coassociation information across diverse movement tasks. Our causal coordination features show promising discriminative information across several movement types, capturing aspects of motor control not reflected in amplitude-based or embedding-based features alone, such as asymmetries and movement restrictions. Preliminary ensemble clustering analysis indicates three potential LBP subgroups distinguished by biomechanical and inter-segment coordination patterns, which may reflect varied strategies under different movement demands. We investigate the differences in clinical characteristics among these LBP subgroups. We show that time-series foundation models are not well suited for LBP subgrouping due to their uninterpretability, which is improved in our feature engineering pipeline. This framework could reveal additional subgroups with larger cohorts and may generalize to other sensor modalities. Full article

Background: Low back pain (LBP) is a major cause of disability in later life. We aimed to assess the population-level burden, demographic and epidemiological drivers, GBD-defined risk attribution, and future trajectory of LBP among Chinese adults aged 45 years and older. Methods: Using population-level estimates from the Global Burden of Disease Study 2023 (GBD 2023), we analyzed incidence, prevalence, and years lived with disability (YLDs) among Chinese adults aged 45 years and older from 1990 to 2023. We assessed temporal trends, decomposed changes in burden, evaluated age–period–cohort patterns, quantified YLDs attributable to three GBD-defined risk factors—high body mass index, occupational ergonomic factors, and smoking—and projected burden to 2040 using Bayesian age–period–cohort models. Results: In 2023, population-level GBD estimates indicated that LBP accounted for 30.29 million incident cases, 71.54 million prevalent cases, and 7.90 million YLDs among Chinese adults aged 45 years and older. Compared with 1990, these numbers increased by 101.54%, 97.08%, and 96.11%, respectively, despite declining age-restricted age-standardized incidence, prevalence, and YLD rates. Expansion of the population aged 45 years and older was the main driver of the increasing absolute burden, whereas favorable epidemiological change offset part of this increase. High body-mass index showed the largest increase in attributable burden and was the only risk factor with rising age-standardized attributable YLD rates. Model-based projections suggested that age-restricted age-standardized burden would continue to decline through 2040. Conclusions: LBP remains a growing absolute burden among middle-aged and older adults in China despite declining age-restricted age-standardized rates. Future disability reduction will require integrated strategies combining risk-factor control, rehabilitation, functional support, and age-sensitive care. Full article

Intervertebral disk degeneration (IVDD) is widely recognized as a major contributor to discogenic low back pain (LBP), imposing a substantial burden on global public health and socioeconomic systems. Growing evidence confirms that disrupted redox homeostasis, excessive reactive oxygen species (ROS) accumulation, and oxidative stress act as major convergent mechanisms that propagate inflammatory cascades, nucleus pulposus cell dysfunction, and extracellular matrix degradation. Although conventional conservative therapies and surgical interventions are clinically effective in relieving macrostructural compression, they remain limited in resolving localized molecular dysregulation. In recent years, nanotechnology has emerged as a promising strategy for overcoming the limitations of traditional therapy for IVDD. This review provides an analysis of four categories of antioxidant nanotherapies for IVDD, including inorganic functional nanozymes, bioactive nanomaterials, stimuli-responsive nanosystems, and nanocomposite scaffolds. We elaborate on their mechanisms in scavenging excessive ROS, restoring redox equilibrium, protecting mitochondrial function, and ameliorating oxidative stress-induced degeneration. Integrating structural biomimicry with microenvironmental responsiveness enables the engineering of composite nanosystems with multi-pathway ROS-scavenging capabilities. Therefore, these platforms emerge as promising therapeutic strategies for arresting IVDD progression. Finally, we discuss the key obstacles to clinical translation. Overall, this review provides insights into the development of redox-targeted therapies. Full article

Background/Objective: Low back pain (LBP) is a leading cause of disability worldwide, and patient-reported outcome measures such as the Roland–Morris Disability Questionnaire (RMDQ) are essential for assessing LBP-related disability. While the Modern Standard Arabic version of the RMDQ has demonstrated preliminary reliability, its structural validity has not been thoroughly evaluated. This study aimed to assess the structural validity of the Modern Standard Arabic RMDQ using confirmatory factor analysis (CFA). Methods: A cross-sectional study was conducted for 113 patients with LBP recruited from outpatient physical therapy clinics in Saudi Arabia. Participants completed the Modern Standard Arabic RMDQ, a 24-item instrument scored dichotomously. CFA was performed using the Weighted Least Squares Mean and Variance adjusted estimator to test a unidimensional model. Model fit was assessed using Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), Tucker–Lewis Index (TLI), and Comparative Fit Index (CFI). Reliability was evaluated using McDonald’s omega (ω). Results: The initial one-factor CFA model showed close to acceptable fit (RMSEA = 0.044; SRMR = 0.149; TLI = 0.94; CFI = 0.93). After accounting for significant residual correlations between item pairs (items 4 & 21; 13 & 18), model fit improved (Δχ² = 22.33; Δdf = 2; p < 0.001) (RMSEA = 0.038; SRMR = 0.145; TLI = 0.95; CFI = 0.95). Most items had significant loadings on the latent construct, except item 2. McDonald’s ω was 0.91, indicating excellent internal consistency. Conclusions: The findings of this study provide supportive evidence for the structural validity and internal consistency of the Modern Standard Arabic version of the RMDQ and suggest the presence of a dominant unidimensional structure. The Arabic RMDQ may be useful for assessing LBP-related disability in Arabic-speaking patients with LBP, although further validation studies are warranted. Full article

The global probiotic market is expanding rapidly, driven by growing demand for accessible strategies to support gut health, preventive care, and microbiome-based interventions. However, this commercial growth contrasts with the limited number of clinically validated, mechanism-driven products, highlighting a persistent gap between market expansion, scientific evidence, and therapeutic translation. Most current probiotics remain dominated by conventional genera, including Lactobacillus, Bifidobacterium, Bacillus, Saccharomyces, and Streptococcus, whereas live biotherapeutic products (LBPs) remain scarce. Synthetic biology is beginning to address this gap by transforming probiotics from empirically selected strains into programmable microbial platforms that sense disease-associated signals and produce defined therapeutic outputs. Escherichia coli Nissle 1917 (EcN) offers a valuable model chassis for engineered probiotics because of its long history of human use, safety record, genetic tractability, transient gut colonization, and scalable cultivation. As a rare Gram-negative probiotic, EcN naturally produces outer membrane vesicles that support host interaction, immunomodulation, and therapeutic cargo delivery. This review links probiotic market expansion with live biotherapeutic development and uses EcN to discuss emerging engineering strategies, therapeutic opportunities, and remaining translational barriers. Full article

Background: Brain-derived neurotrophic factor (BDNF) is crucial in the nociception and mechanisms underlying chronic and neuropathic pain. The evaluation of circulating BDNF in patients with multimodal analgesia has not been reported previously. We hypothesized that opioid-based multi-analgesia induces changes in BDNF values and that BDNF correlates with pain intensity in neuropathic pain. Methods: Adult patients who met low back pain (LBP) criteria and received multimodal opioid-based therapy were included. The control group included patients with LBP who did not receive any pharmacotherapy. Plasma measurements obtained with the ELISA test were analyzed. The study was registered at Clinical Trials.gov (NCT 04227223). Results: Patients with multimodal opioid-based analgesia had significantly higher BDNF values compared to the monotherapy: 3.6 ng/mL vs. 2.7 ng/mL, p = 0.01. No statistical differences were observed compared to the non-pharmacologically treated group: 3.6 ng/mL vs. 5.0 ng/mL, p = 0.75. The median BDNF values were lowest in the mild-pain group, and significant differences were observed between the severe and moderate-pain groups (p = 0.006) and the mild-pain group (p = 0.0001). BDNF was significantly higher in the neuropathic-pain group compared to the group of patients without neuropathic pain (p = 0.0005). A significant correlation was demonstrated between the BDNF and numerical rating pain score (NRS) in the neuropathic-pain component (rho = 0.6, p = 0.001). Conclusions: Multimodal opioid-based analgesia decreases plasma BDNF concentrations less than opioid monotherapy, which offers an opportunity to limit opioid-induced adverse effects. BDNF influences pain intensity and predicts neuropathic pain in multimodal opioid-based analgesia. Full article

Lower back pain (LBP) is a leading cause of disability globally, characterized by multifactorial origins that complicate accurate diagnosis and effective treatment planning. Artificial intelligence (AI), including machine learning (ML), deep learning (DL), and radiomics, has shown promise for improving the reproducibility and quantitative assessment of spine neuroimaging. This narrative review synthesizes current evidence on AI-derived imaging biomarkers in magnetic resonance imaging (MRI) and computed tomography (CT), with emphasis on disc degeneration, spinal stenosis, endplate signal abnormalities, paraspinal muscle composition, vertebral fractures, and spinal alignment. AI-based reconstruction, segmentation, and classification methods may reduce reader variability and enable standardized quantification of imaging features. However, the current evidence base remains dominated by technical and retrospective validation studies, and high diagnostic performance should not be interpreted as proof of improved patient-centered outcomes. The present review distinguishes technical feasibility, diagnostic assistance, prognostic association, and clinical utility, and highlights the persistent efficacy-effectiveness gap in AI-based spine imaging. Although multimodal models integrating imaging, clinical, biomechanical, and patient-reported data may improve future risk stratification, clinical translation remains constrained by heterogeneous datasets, limited external validation, incomplete interpretability, and evolving regulatory frameworks. Prospective multicenter validation and outcome-linked evaluation are required before AI-derived imaging biomarkers can be considered established tools for routine LBP management. Full article

Pregnancy-related low back pain (LBP) is a highly prevalent condition with substantial consequences. However, its relationship with objective perinatal outcomes has been scarcely investigated. The aim of this study was to analyze the association between the presence and intensity of pregnancy-related LBP with delivery and perinatal outcomes. An analysis of a prospective cohort was performed including 147 physically active (PA) pregnant women, defined as those meeting the World Health Organization recommendations for PA (≥600 MET·min/week), assessed using the short version of the International PA Questionnaire. Participants were classified according to the presence (64.6%) or absence of LBP during pregnancy. Umbilical artery pH was significantly lower in neonates born to women with LBP compared with those without LBP (7.24 ± 0.10 vs. 7.29 ± 0.06; p < 0.001). Within the LBP group, higher pain intensity was moderately and inversely correlated with umbilical artery pH (Spearman ρ = −0.42, p = 0.037) and remained independently associated with lower umbilical artery pH values in multivariable linear regression analysis after adjustment for relevant maternal characteristics and PA. Apgar scores were globally normal, with no clinically relevant differences between groups. No significant differences were observed in other delivery and perinatal outcomes. These findings suggest an association between pregnancy-related LBP and subtle changes in fetal acid-base status at birth but should be interpreted cautiously from a clinical perspective. Full article