Search Results (51)

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized not only by motor impairments but also by debilitating non-motor symptoms (NMS) such as anxiety, depression, fatigue, and sleep disturbances. These symptoms are often resistant to dopaminergic therapies and significantly impact patients’ quality of life. Whole-body cryostimulation (WBC) has emerged as a promising non-pharmacological intervention with potential effects on stress modulation and psychological well-being. Materials and Methods: In total, 14 patients with idiopathic PD underwent 10 WBC sessions (−110 °C for 2 min) over two weeks. Blood samples for cortisol and serotonin were collected before and after the first and last sessions. Patients completed standardized questionnaires evaluating anxiety (STAI-Y1, Y2), depression (BDI), fatigue (FSS), sleep quality (SCI), and daytime sleepiness (ESS) at baseline and after the final session. Results: Significant reductions in serum cortisol and improvements in serotonin levels were observed. Psychological assessments showed decreased anxiety and depression scores, with improvements in fatigue and sleepiness (p < 0.05 for most scales). Discussion and Conclusions: Repeated WBC sessions were safe and well-tolerated and were associated with biochemical and psychological improvements. These preliminary findings support WBC as a promising complementary intervention for alleviating NMS in PD. Further randomized controlled studies are warranted to confirm these results. Full article

Light exposure profoundly influences human emotions and physiology. Yet, adolescents spend considerable time under artificial indoor lighting. Reduced daytime light exposure delays the circadian clock, negatively affecting sleep, cognition, and mood. This pilot study examined whether 470–490 nm enhanced LED lighting modulates mood, sleep quality, and attention among 65 male Korean high school students (mean age = 15.4 years) who participated in a two-week intervention. Both groups were exposed to natural daylight, but the experimental group additionally used LED lighting enriched in the 470–490 nm wavelength range, whereas the control group used LED lighting without modified spectral characteristics. Students were exposed to the assigned lighting from 08:00 to 17:00 during regular school hours for two consecutive weeks. To evaluate the effects of the two-week intervention, pre- and post-assessments included the Beck Depression Inventory (BDI-II), the Richards–Campbell Sleep Questionnaire (RCSQ), the Epworth Sleepiness Scale (ESS), the Perceived Stress Scale (PSS), and the Frankfurter Attention Inventory (FAIR), administered twice at each assessment point. The linear mixed-effect model showed a significant time × group interaction for line errors in the first FAIR trial (F (1, 52) = 5.21, p = 0.027, η² partial = 0.09), suggesting a greater relative reduction in attentional errors in the experimental group compared with the control group. No significant effects were observed for sleep- or mood-related outcomes. These results indicate the potential relevance of wavelength-optimized lighting in educational settings where sustained attention is critical. Future studies with larger samples and longer interventions are required to confirm and extend these findings. Full article

Background and Objectives: Lower-extremity injuries are common among female athletes; however, their multifactorial predictors remain insufficiently understood. Given the interplay between physiological and psychological readiness in athletic performance, identifying the factors that influence lower limb performance is crucial for effective injury prevention. This study aimed to evaluate the predictive effects of physiological (VO₂peak, anaerobic power, agility, and isokinetic strength) and psychological (resilience and self-efficacy) variables on functional performance related to risk of injury. Materials and Methods: This cross-sectional study included 60 athletes with a mean age of 24.5 ± 6.90 years and mean body mass index of 23.12 ± 3.6 kg/m² (range: 16–30 kg/m²). The testing protocol included anthropometric measurements, the Lower Extremity Functional Test (LEFT), Wingate anaerobic cycling test, assessments of aerobic capacity, isokinetic muscle strength, and jumping performance (Single-Leg Hop [SLH] and Standing Long Jump [SLJ] tests). Psychological assessments included the General Self-Efficacy Scale (GSES) and a resilience questionnaire. A hierarchical regression analysis was performed. Results: The participants trained 5 ± 2 days per week and had 42 ± 39 months of sports experience. The mean VO_2peak was 40.82 ± 5.8 mL·kg⁻¹·min⁻¹, relative anaerobic peak power was 7.53 ± 1.92 W/kg, and fatigue index was 60.63 ± 15.41%. The mean isokinetic knee extension and flexion torque were 184.55 ± 44.60 N·m and 95.08 ± 21.44 N·m, respectively, with a flexion-to-extension ratio of 53.5%. The mean LEFT completion time was 160 ± 22 s. The participants demonstrated moderate resilience (BRS = 21 ± 4) and good self-efficacy (GSES = 33 ± 7.5). Among the psychological variables, GSES exhibited a modest negative correlation with LEFT (r = −0.28, p = 0.02). No significant associations were found between LEFT and psychological resilience. Longer LEFT completion times were associated with lower VO_2peak, mean power, and jump distance (p < 0.01). In the final model (R² = 0.58, p = 0.02), SLH (β = −0.54), VO_2peak (β = −10.32), and GSES (β = −0.70) were the strongest independent predictors of LEFT performance. Conclusions: SLH distance, VO_2peak, and general self-efficacy are key predictors of functional performance on the LEFT among female athletes. These factors may serve as practical indicators for identifying athletes who could benefit from targeted injury prevention programs. Full article

Background: Acne vulgaris is a multifactorial disease with significant clinical and psychosocial impacts. Methods: The purpose of this study was to evaluate the efficacy of a combination therapy including oral isotretinoin and a non-ablative 675 nm red-light laser compared with laser monotherapy. Thirteen young patients with active facial acne of varying severity were enrolled and divided into two groups: Seven subjects received laser monotherapy treatment (RT group), while six underwent combined laser and isotretinoin therapy (RTI group). The laser protocol consisted of six weekly sessions, with a 5-point pain scale used to monitor tolerability. Standardized photographs were obtained at baseline and at a 3-month follow-up after the last treatment. Each patient completed the Acne Radar Questionnaire, and lesion severity was assessed using the Global Evaluation Acne (GEA) scale. Results: All patients completed the study without adverse events. Scores from the Acne Radar Questionnaire improved in both groups, while the GEA scale demonstrated a significant reduction in lesion severity, confirmed by photographic comparison. Pain was reported as mild in most cases, and no discontinuations occurred. Conclusions: These findings indicate that the 675 nm laser is a safe and effective therapeutic option for acne vulgaris, with isotretinoin addition resulting in more rapid and pronounced clinical improvement. Full article

Background and Objectives: Traditionally regarded as a purely motor disorder, amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by the degeneration of upper and lower motor neurons. However, it is increasingly recognized as a condition with a broader clinical spectrum, encompassing a variety of non-motor symptoms (NMS) that significantly impact patients’ quality of life and may influence disease progression and prognosis. Materials and Methods: The study included 44 patients diagnosed with probable or definite ALS and 35 healthy controls (HC). Functional neurological status, non-motor manifestations, and cognitive and affective domains were evaluated using the revised ALS Functional Rating Scale (ALSFRS-R), the Non-Motor Symptoms Questionnaire (NMSQuest), the Frontal Assessment Battery (FAB), and the Beck Depression Inventory (BDI), respectively. Results: A majority of ALS patients exhibited non-motor symptoms (NMS). Significant associations were identified between specific NMS domains and ALSFRS-R subdomains: sleep disturbances were associated with lower fine motor, respiratory, and total scores; digestive symptoms with lower bulbar, respiratory, and total scores; cardiovascular symptoms with lower total scores; urinary symptoms with higher bulbar subscores and a significantly slower progression rate (ΔPR); and sensory symptoms with higher gross motor subscores. BDI scores were negatively correlated with respiratory and bulbar functions, whereas FAB scores showed positive correlations with both bulbar and total ALSFRS-R scores. Conclusions: Non-motor symptoms are highly prevalent in this ALS cohort. These symptoms do not consistently correlate with greater motor impairment, as urinary and somatosensory involvement may occur independently of functional decline. Cognitive, affective, and behavioral alterations co-exist with motor symptoms and are associated with poorer overall functional performance. Full article

Background/Objectives: Dystonia, traditionally regarded as a purely motor disorder, is now increasingly recognized as involving clinically significant non-motor symptoms (NMSs) that can adversely affect patients’ health-related quality of life (HRQoL). This study aimed to assess HRQoL in Romanian patients with isolated dystonia and to evaluate the impact of two key NMSs, depression and cognitive impairment, on their HRQoL. We hypothesized that depression would have a greater adverse effect on HRQoL than cognitive impairment. Methods: A cross-sectional study was conducted involving 65 adult Romanian patients with isolated dystonia. HRQoL was measured using the Short Form-36 Health Survey (SF-36), including the physical component summary (PCS) and mental component summary (MCS). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA). Descriptive statistics, correlation analysis, and parametric and non-parametric tests were used. Multiple regression analysis was employed to evaluate associations between NMS and HRQoL. Results: The mean (SD) age was 56.6 (14.3) years, and 80% of participants were female. Depression and cognitive function were significantly associated with PCS (0.33 and −0.51, respectively) and MCS (0.26 and −0.78, respectively). Multiple regression analysis showed that the two NMS explained 38% of the variance in PCS and 58% of the variance in MCS. Depression had a greater impact on PCS and MCS than cognitive impairment (−0.47 vs. 0.33 and −0.72 vs. 0.16, respectively). Cognitive impairment (MoCA < 26) was present in 35.4% of patients, while 46.2% had at least mild depressive symptoms (PHQ-9 ≥ 5); 23.1% met criteria for moderate-to-severe depression (PHQ-9 ≥ 10). Depressive symptoms showed strong negative correlations with all SF-36 domains, while cognitive performance correlated modestly. Conclusions: Both depression and cognitive impairment have a significant negative impact on HRQoL in dystonia, with depression having a stronger effect, as we hypothesized. Routine screening for non-motor symptoms is essential to support better clinical outcomes and enhance patients’ quality of life. Full article

Background: During the initiation of routine orthodontic treatment with fixed appliances, placing elastic separators (ESs) may lead to the patient experiencing considerable pain. Earlier studies evaluating the effects of low-level laser therapy (LLLT) on reducing pain caused by orthodontic ESs have reported contradictory results. The aim of our study was to evaluate the effect of a single application of LLLT on the experience of pain following ES placement. Methods: A double-blind, placebo-controlled randomized controlled trial was performed—with implementation of the split-mouth technique—where n = 33 volunteers (12 male and 21 female; aged between 19 and 36 years) were enrolled. ESs were placed at the mesial and distal surfaces of the first permanent molars in the upper or lower jaws. Jaws were divided into two quadrants; the treatment group received LLLT (using a GaAlAs diode laser, at a 980 nm wavelength, with 100 mW producing 6 J of energy; continuous wave), while the other quadrant served as the placebo side receiving a similar treatment, but without laser irradiation, immediately after separation. A questionnaire with a visual analogue scale (VAS; 0–100) was used for the assessment of pain (spontaneous pain and pain on mastication) scored for each first permanent molar directly after separation and after 6, 24, 48 and 72 h of both laser and placebo treatment application. Results: Mean VAS values were lower, but not significantly different, between the treatment vs. placebo groups for spontaneous pain at either measurement point (p > 0.05). Mean VAS values were significantly lower in the treatment groups for pain on mastication at the 6 (9.29 ± 12.65 vs. 19.07 ± 20.99; p = 0.025), 24 (21.96 ± 21.11 vs. 37.19 ± 26.35; p = 0.012) and 48 h (28.01 ± 21.40 vs. 42.60 ± 26.29; p = 0.016) measurement points. The analgetic effect of LLLT was most effective after 6 h, both in the resting position (−49% decrease) and during mastication (−51% decrease). Conclusions: A single application of LLLT with 6 J of energy may have beneficial effects on reducing the pain caused by orthodontic ESs used at the initiation of treatment with fixed appliances, especially during mastication, after 6–48 h following the separation procedure. Trial registration: clinicaltrials.gov ID NCT06816537 (date of registration: 7 February 2025, retrospectively registered). Full article

Background: Cutaneous melanoma (CM) is a malignant tumor originating from melanocytes. Despite improvements in prevention, Central and Eastern European countries continue to report higher rates of advanced-stage melanoma and lower survival rates. This study aims to characterize CM and the associated risk factors in Northwestern Romania. Methods: This cross-sectional cohort study was conducted in Cluj and Bihor counties. Between January 2023 and May 2024, 172 patients with histopathologically confirmed melanoma completed a standardized questionnaire addressing demographics, sun exposure history, nevi count, and melanoma-specific characteristics. Results: The median age at diagnosis of participants was 44 years. The median Breslow index (BI) was 1.5 mm, and 39% of cases presented with a BI > 2 mm. Superficial spreading melanoma (SSM) was the most common subtype, predominantly affecting women, while nodular melanoma (NM) was more frequent in men. Higher BI was associated with NM and acral lentiginous melanoma (ALM). Limbs were women’s most frequent tumor site, whereas the trunk was predominant in men. Significant associations were observed between younger age at diagnosis and factors such as high nevus count, indoor activity, and smoking status. Rural residents reported a higher history of sunburns compared to urban residents. Conclusions: Our findings underscore the importance of targeted public health interventions to promote early detection and primary prevention of melanoma. Establishing a national melanoma registry is crucial to improving epidemiological surveillance and reducing the burden of melanoma in Romania. Full article

Background/Objectives: Vaginal laser therapy is a promising treatment for menopausal vulvovaginal atrophy (VVA). This study evaluates the efficacy of a dual-wavelength diode laser (980 + 1470 nm) in treating VVA. Methods: Thirty postmenopausal patients with moderate-to-severe VVA were recruited, and twenty-nine completed the study. Patients underwent a screening visit (T0); three laser sessions at 4-week intervals (T1, T2, and T3); and a follow-up visit 4 weeks after the last treatment (T4). At T0 and T4, the Schiller test and Vaginal Maturation Index (VMI) were performed; sexual function was assessed through the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). At each visit, the Vaginal Health Index (VHI) and the Visual Analog Scale (VAS) for dyspareunia were administered. Potential side effects were investigated, and the VAS for the pain associated with the procedure was assessed. Data analysis included the overall group and two subgroups: women with (group A) and without (group B) a history of breast cancer (BC). Results: Significant improvements in the VHI and reduced dyspareunia were observed at T4 compared to T0 in all groups. The improvement was already seen after the first procedure, with further improvement after the other procedures, being persistent at the 1-month follow-up. The Schiller test showed significant improvements from T0 to T4 in all groups. The VMI showed a significant improvement from T0 to T4 in the overall group and group B. The FSFI questionnaires showed a significant improvement in all areas for the whole population, whereas the FDSF-R questionnaire showed an improvement only in the overall group. Procedural pain was low (mean VAS 1.6), and no side effects were reported. Conclusions: The dual-wavelength diode laser is an effective and safe option for the treatment of VVA in patients with and without a history of BC. Full article

The European Society for Laser Dermatology (ELSD) has established recommendations for safe and effective photo epilation; however, short-term common adverse effects occur as a result of laser treatment, such as edema and perifollicular erythema. Post-inflammatory hyperpigmentation also appears in certain skin types. Very few clinical studies have been conducted on the topical application of cosmetic skin care products aimed at decreasing the adverse effects on the skin epidermis following laser-assisted epilation procedures. Stem cells are found in plant and animal organisms and are responsible for the growth and restoration of damaged tissues. Plant stem cells divide throughout the life of the plant, creating new plant parts. Our aim was to develop a new cosmetic cream to decrease the intensity of some of the side effects of laser epilation and thus reduce the administration of topical medication. We developed a formulation with the active substance Olea europaea (Olive) Callus Culture Lysate (OLEA VITAE™ 02), which is derived from plant stem cells of the Mediterranean wild variety of Olea europaea, for application following laser epilation with an Nd:YAG 1064 nm laser. The new skin care cream was tested for its physicochemical and microbiological stability, according to the European Pharmacopoeia. The impacts of this substance on the potential side effects of Nd:YAG 1064 nm application, i.e., trans-epidermal water loss, keratin hydration, melanin, erythema, and skin elasticity, in comparison with the appropriate placebo, were investigated using biophysical measurements and a self-assessment questionnaire. Skin biopsies were also performed to evaluate the influence of the procedure and the application of the products on the epidermis and papillary dermis thickness. According to our findings, the incorporation of the plant stem cell extract of Olea europaea into our cream resulted in a stable cream with an appealing texture. Furthermore, the activity of erythema and hyperpigmentation was decreased when the cream was applied after Nd:YAG 1064 nm laser epilation. Full article

Background and Objectives: Patellofemoral pain (PFP) is frequent in the young and active population. The effect of muscle strength in the lower extremities after aerobic activity in patients with this condition has yet to be detailed. Our objective was to determine if patients with PFP show alterations in lower extremity muscle strength measurements after performing a session of ten minutes of aerobic activity on a treadmill compared to people without patellofemoral pain. Materials and Methods: We conducted a prospective experimental study with a stratified, non-randomized, and non-blinded population sample with group matching, including an experimental group with PFP and a control group with no pain. Subjects completed self-reported functional questionnaires (IKDC, Kujala, KOOS, SF-12), underwent radiographic studies, and were evaluated by measuring the strength of hip and knee muscles and the Single-Leg Triple-Hop (SLTH) test before and after ten minutes of exercise on a treadmill. Results: Seventeen subjects diagnosed with PFP and seventeen control subjects were evaluated. Both groups were homogeneous and had no significant differences in the demographic variables. A wider sulcus angle at 30° (136.8 ± 3.8° vs. 132.5 ± 5.6°, p = 0.0140), a decrease strength post-exercise in the hip abductor (37.9 ± 7.1 N⋅m vs. 45.6 ± 7.7 N⋅m, p < 0.05) and knee extensor (36.0 ± 9.1 N⋅m vs. 47.7 ± 14.0 N⋅m, p < 0.05), and a shorter distance in the SLTH test (337.9 ± 74.9 cm vs. 438.6 ± 65.8 cm, p < 0.01) was recorded in subjects with patellofemoral pain. Conclusions: Subjects with PFP had an overall lower strength of hip and knee muscles, showing significant differences in the hip abductors and knee extensors between people with PFP and healthy matched controls after aerobic exercise. Full article

Background/Objectives: With the increasing prevalence of Crohn’s disease (CD), treatment options for patients who fail conventional and advanced therapy are highly needed. Therefore, we explored the safety and efficacy of extracorporeal photopheresis (ECP) using 5-aminolevulinic acid (ALA) and blue light (405 nm). Methods: Patients with active CD who failed or were intolerant to biological therapy were eligible. Mononuclear cells (90 mL) were collected from each patient using a Spectra Optia^® apheresis system and diluted with 100 mL of 0.9% sodium chloride in a collection bag. The cells were incubated with ALA at a concentration of 3 millimolar (mM) for 60 min ex vivo and illumination with an LED blue light (405 nm) source (BLUE-PIT^®) before reinfusion to the patient. Recording of vital signs and adverse events were regularly performed. At week 13, we assessed the patients with colonoscopy, the Harvey Bradshaw Index (HBI), the Inflammatory Bowel disease Health Related Quality of Life Questionnaire, and the measurement of serum C-reactive protein and fecal calprotectin (FC) levels. Biopsies of the intestines were taken for immunohistochemistry. Results: Seven patients were included. Four patients completed the treatments, with a total of 24 treatments. Three of the four patients achieved a favorable response, including a lower HBI, lower FC levels, and/or endoscopic improvement. No significant adverse events were observed. The remaining three patients received only one, three, or five treatments due to technical difficulties, medical reasons, or the withdrawal of informed consent. Conclusions: ALA-based ECP appears safe and seems to give some clinical improvement for the patients with active CD who failed to respond to conventional and advanced therapies. Full article

Background and Objectives: Melasma, a hypermelanotic dermatologic condition that mainly affects women, poses challenges due to its complex etiology involving environmental and genetic factors. Its pathophysiology, marked by intricate histological changes, is not fully understood. This study explored the efficacy and safety of a new 785 nm picosecond laser in treating facial melasma. Materials and Methods: An 11-participant cohort, comprising women with Fitzpatrick phototypes II-III, underwent a treatment protocol with a new 785 nm picosecond laser. The clinical evaluation used the Global Aesthetic International Score (GAIS) and the Five-Point Likert Scale Questionnaire. The aim of the study was to understand the capacity of the 785 nm wavelength laser to interact with both the pigmentary and vascular components of melasma. Results: The GAIS outcomes revealed excellent (18.2%), good (54.5%), poor (18.2%), and no results (9.1%). The Likert Scale responses varied from very satisfied (18.2%) to slightly satisfied (9.1%). Clinical images at three months demonstrated resolution of melasma with no adverse events. Conclusions: This non-invasive procedure showed positive outcomes and high patient tolerance, emphasizing its potential in melasma management. However, in order to fully understand the interactions of pigmentary and vascular components with the 785 nm wavelength laser, further research is required. The small cohort represents a limitation for this study, therefore studies that include a larger number of patients are needed to assess the effectiveness of this laser treatment for facial melasma. Full article

In construction, risk is inherent in each project, and success involves meeting defined objectives beyond budget and schedule. Factors vary for infrastructure projects, and their correlation with performance must be studied. In the case of public–private partnership (PPP) transportation, the level of complexity is higher due to more involved parties. Risks and success factors in PPP projects affect each other, which may lead to project failure. Recognizing the critical risk factors (CRFs) and critical success factors (CSFs) is indispensable to ensure the success of PPP infrastructure project implementation. However, the existing research on the PPP risk and success relationship has not gone into sufficient detail, and more support to address the existing gaps in the body of knowledge and literature is necessary. Therefore, in response to the missing area in the public–private partnership transportation industry, this paper analyzed the correlation between PPP risks and success factors. It identified, explored, and categorized various risk and success factors by combining a literature review, expert panel interviews, and a questionnaire survey among both the public and private sectors, a win–win principle. The data collected were analyzed using the structural equation modeling (SEM) approach and relative significance. Results show the relationship between risk and success factors, their influence on PPPs, and the most important factors, known as CRFs and CSFs, with high loading factors (LF > 0.5) and high relative importance (NMS > 0.5). The top five CRFs include “Contract quality (incomplete, conflicting)”, “Staff expertise and experience”, “Financial market risk”, “Conflicting objectives and expectations”, and “Inefficient feasibility study”. The top five CSFs were found as “Appropriate risk allocation and risk-sharing”, “Strong financial capacity and capability of the private sector”, “Government providing guarantees”, “Employment of professional advisors”, and “Realistic assessment of the cost and benefits”. This study advances the understanding of risk and success factors in PPPs and contributes to the theoretical foundations, which will benefit not only public management, policy consultants, and investors but also academics interested in studying PPP transportation projects. Full article

Background and Objectives: Currently, no tool exists to predict clinical outcomes in patients with advanced Parkinson’s disease (PD) under levodopa–carbidopa intestinal gel (LCIG) treatment. The aim of this study was to develop a novel deep neural network model to predict the clinical outcomes of patients with advanced PD after two years of LCIG therapy. Materials and Methods: This was a longitudinal, 24-month observational study of 59 patients with advanced PD in a multicenter registry under LCIG treatment from September 2019 to September 2021, including 43 movement disorder centers. The data set includes 649 measurements of patients, which make an irregular time series, and they are turned into regular time series during the preprocessing phase. Motor status was assessed with the Unified Parkinson’s Disease Rating Scale (UPDRS) Parts III (off) and IV. The NMS was assessed by the NMS Questionnaire (NMSQ) and the Geriatric Depression Scale (GDS), the quality of life by PDQ-39, and severity by Hoehn and Yahr (HY). Multivariate linear regression, ARIMA, SARIMA, and Long Short-Term Memory–Recurrent NeuralNetwork (LSTM-RNN) models were used. Results: LCIG significantly improved dyskinesia duration and quality of life, with men experiencing a 19% and women a 10% greater improvement, respectively. Multivariate linear regression models showed that UPDRS-III decreased by 1.5 and 4.39 units per one-unit increase in the PDQ-39 and UPDRS-IV indexes, respectively. Although the ARIMA-(2,0,2) model is the best one with AIC criterion 101.8 and validation criteria MAE = 0.25, RMSE = 0.59, and RS = 0.49, it failed to predict PD patients’ features over a long period of time. Among all the time series models, the LSTM-RNN model predicts these clinical characteristics with the highest accuracy (MAE = 0.057, RMSE = 0.079, RS = 0.0053, mean square error = 0.0069). Conclusions: The LSTM-RNN model predicts, with the highest accuracy, gender-dependent clinical outcomes in patients with advanced PD after two years of LCIG therapy. Full article