Search Results (1,294)

Acute myeloid leukemia (AML), the most common acute leukemia among adults, poses significant therapeutic challenges due to diagnostic limitations and the frequent development of treatment resistance. While genomics-based approaches have advanced, DNA aberrations do not always reflect the expression levels of genes and proteins, which are more tightly connected to disease phenotypes. Recently, the role of the gut microbiota in AML has gained increasing attention. AML patients often exhibit gut microbiota dysbiosis, which is linked to disease progression and heightened infection risk. Mounting evidence indicates that gut microbiota metabolism influences hematopoiesis and immune function via the “gut-bone marrow axis,” with microbiota composition and diversity significantly affecting treatment outcomes and prognosis. High-throughput sequencing and metabolomics have identified correlations between gut microbiota composition and its metabolic products with AML clinical characteristics, paving the way for new biomarkers in diagnosis and prognosis. Additionally, treatments such as fecal microbiota transplantation (FMT) show promise in enhancing chemotherapy efficacy and improving patient outcomes. This review highlights recent advances in understanding the role of the gut microbiota in AML and explores new perspectives for its diagnosis and treatment. Full article

Introduction: Recent guidelines developed by the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) focused on the dietetic management of obesity in adults. The present study aimed to explore the perspectives of healthcare professionals regarding these guidelines. Methods: In total, 85 registered dietitians/nutritionists from Greece, the Netherlands, the Republic of Ireland, and the United Kingdom completed an online survey, and 10 were interviewed, in February–March 2023. Demographic data were also collected. Results: Awareness of the EASO-EFAD guidelines among registered dietitians/nutritionists was moderate (57.6%), but only 20% had read them in full. Dietitians with higher education and relevant experience were more likely to have read the guidelines. Less than half reported that key evidence-based recommendations, such as individualized medical nutrition therapy and intensive behavioral interventions, are already included in national guidance. Recommendations like portfolio or DASH diets, partial meal replacements, and calorie restriction were less commonly part of national guidance/usual practice. A small percentage of participants described their adoption of several nutritional approaches novel to them. These included the portfolio dietary pattern, partial meal replacements, and intermittent fasting or continuous calorie restriction. For some Irish dietitians, prioritizing weight as the main outcome conflicted with their emphasis on overall health and individualized nutrition therapy. Other barriers of recommendation implementation included exclusive availability in English, rapid changes in obesity management, staffing shortages, limited multidisciplinary collaboration, and inconsistent knowledge among healthcare providers. Conclusions: The present study identified gaps in the adoption of the EASO-EFAD guidelines into dietetic/clinical practice. EFAD will develop strategies to disseminate these guidelines at different levels of stakeholders (national/local authorities, dietitians/nutritionists, and patients). Full article

Background: Parenting styles are associated with various health outcomes among children, such as fruit and vegetable consumption, physical activity, and emotional well-being. Previous literature suggests that responsive parenting styles are associated with improved mental health outcomes. This study examines the association between an adult’s responsive parenting style and the psychosocial outcomes of emotion regulation and loneliness among children. Methods: Using data from the U.S. National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating (FLASHE) cross-sectional survey, this secondary data analysis study seeks to understand how perceived parental responsiveness is associated with adolescents’ emotional health outcomes from the perspective of the adolescent. The sample consisted of 12- to 17-year-olds (n = ~1560), mostly female (50.2%) and non-Hispanic White (63.7%), with a mean age of 14.48 years (SD = 1.61). Results: Through multivariable regression, we found that perceived parental responsiveness negatively predicted adolescent emotion suppression (β = −0.29, p < 0.001), even after controlling for sex, age, race/ethnicity, parental marital status, parental education level, parent’s time spent at work, and the number of kids in the household (β = −0.29, p < 0.001). We also found that perceived parental responsiveness was the strongest predictor for adolescent loneliness (β = −0.27, p < 0.001), even when controlling for sex, age, race/ethnicity, parental marital status, parental education level, parent’s time spent at work, and the number of kids in the household (β = −0.28, p < 0.001). Conclusions: These results suggest that implementing interventions targeting parental responsiveness may be beneficial to improving adolescents’ emotional well-being. Full article

This paper aims to analyze adults’ responses to children’s argumentative contributions within children–adult dialogic interactions. More precisely, we focus on the phenomenon of children opening subdiscussions within argumentative interactions with peers and adults. This phenomenon occurs when a child problematizes and calls into question some proposition in the ongoing discussion, hence the opening of a subdiscussion is an initiative that comes as unexpected from the perspective of the adult. In this contribution, we examine what happens after a child opens a subdiscussion and how the adult’s reaction to such initiatives can shape the development of dialogue. This means that we observe adult behaviour in dialogic interactions with children, given the complexity of the adult’s role in such interactions. Drawing on the dialogical approach to argumentation, we present and discuss some excerpts of children–adult subdiscussions at a kindergarten. The data analysis uses concepts and tools from a linguistics-based approach to argumentation, i.e., the pragma-dialectical theory, and it highlights conversational dynamics of children–adult argumentative discourse. The study’s contribution is twofold: (1) it presents the important and delicate role of the adult in dialogic children–adult interactions; (2) it shows how the development of children’s arguments is intrinsically linked to the flexibility of the discussion space organized by the adult. Full article

Objectives: Type1 diabetes (T1D) is one of the most common chronic diseases in pediatric age. Continuous glucose monitoring (CGM) has been shown to improve glycaemic control in adults compared to self-monitoring of blood glucose (SMBG); however, evidence about its use in the pediatric field is limited and fragmented and needs to be improved. This paper aims to address all the critical aspects linked to the use of CGM in a pediatric population while also describing a methodology for conducting health technology assessment (HTA) to support the decision-making process. Methods: The use of CGM and SMBG in a pediatric population was compared by using a decision-making support tool (DoHTA method). Twenty-seven Key Performance Indicators (KPIs) were identified, defining safety, clinical effectiveness, organizational, patient perspective, and economic aspects. Performance scores for both monitoring systems were assessed based on these KPIs, leading to a final comparative ranking. Results: CGM demonstrated a 29.3% performance advantage over SMBG, highlighting its benefits in terms of clinical effectiveness, patient perspectives, safety, and economic evaluation. No substantial differences were identified in terms of organizational aspects. Conclusions: This study critically evaluates the benefits and drawbacks of the use of CGM in a pediatric population. It integrates the assessment of the clinical effectiveness with the organizational aspects, the cost, the patient perspective, and the safety, providing a valuable proof of evidence as well as a reliable and transferable method for conducting decision-making processes in a hospital setting. Full article

This study explores the clinical, behavioural, and environmental risks of chronic proton pump inhibitor (PPI) use in older adults through a One Health perspective. Among 246 participants, 32.5% were receiving PPI therapy, with 91.3% on long-term treatment, frequently lacking clear clinical justification. Polypharmacy, drug interactions, and risky lifestyle behaviours were common. Environmental review highlighted the potential persistence of PPI transformation products in water systems, raising concerns about ecological impact and antimicrobial resistance. These findings underscore the urgency of implementing deprescribing strategies, enhancing patient education, and adopting sustainable prescribing practices that align human and environmental health. Full article

The growing number of older adults with cancer confront practical and organizational limitations that hinder their ability to obtain care that is adapted to their health status, needs, expectations, and life choices. The integration into practice of evidence-based and institutional recommendations for a geriatric approach and person-centered high-quality care remains incomplete. This study uses an action research design to explore stakeholders’ perspectives of the challenges involved in translating the established care priorities into a compassionate geriatric approach in oncology and identify promising pathways to improvement. Fifty-three stakeholders participated in focus groups to create cognitive maps representing perceived relationships between concepts related to compassionate care of older adults with cancer. Combining maps results in a single model constructed in Mental Modeler software to weigh relationships and calculate concept centrality (importance in the model). The model represents stakeholders’ collective perspective of the determinants of compassionate care that need to be addressed at different decision-making levels. The results reveal pathways to improvement at systemic, organizational, practice, and societal levels. These include connecting policies on ageing and national cancer programs, addressing fragmented care through interdisciplinary teamwork, promoting person-centered care, cultivating relational proximity, and combatting ageism. Translating evidence-based practices and priority orientations into compassionate care rests on collective capacities across multiple providers to address the whole person and their unique trajectory. Full article

Background/Objectives: Obesity is a global health issue with profound humanistic and financial implications. Novel pharmacological treatments, such as tirzepatide and semaglutide, offer promising options for sustained weight management; however, their cost-effectiveness warrants assessment. This study investigates the short-term cost-effectiveness of tirzepatide compared to semaglutide in achieving weight loss targets over 72 weeks in Greece. Methods: A short-term cost-effectiveness analysis was conducted from the perspective of the Greek third-party payer (EOPYY), comparing treatment costs and clinical outcomes for semaglutide and tirzepatide over a 72-week horizon. Clinical efficacy was assessed by the proportion of patients achieving weight loss targets of ≥10%, ≥15%, ≥20%, ≥25%, and ≥30%, using data from the SURMOUNT-5—a 72-week, phase 3b, head-to-head study among overweight adults or those with obesity without diabetes. Only direct medical costs were included, and no discount was employed due to the short time horizon. Price scenario, deterministic, and probabilistic sensitivity analyses were performed. Results: Over 72 weeks, the deterministic analysis found the total treatment cost was EUR 5645.70 for tirzepatide and EUR 3201.68 for semaglutide. These base-case results indicated the cost per responder for tirzepatide at higher weight loss targets (e.g., EUR 28,658 and EUR 46,401 at ≥30%) and lower costs for semaglutide at lower targets (e.g., EUR 1627 lower at ≥10%). However, probabilistic sensitivity analysis revealed overlapping 95% confidence intervals at all thresholds, indicating no statistically significant difference in the cost of control between the treatments. Conclusions: Semaglutide showed a numerically lower cost of control at lower weight loss targets, while tirzepatide was favoured at higher targets; however, these differences were not statistically significant. Full article

Aim: The purpose of this study was to explore the broad experience of continuous glucose monitoring from the perspective of patients diagnosed with type 1 diabetes mellitus, including not only their emotions and feelings but also the lifestyle changes, perceptions, and social aspects associated with its use. Design: This is a phenomenological qualitative study. Patient or Public Contribution: The sample consisted of 10 adult patients diagnosed with type 1 diabetes who had been using the continuous glucose monitoring system for at least 6 months and were patients of the Endocrinology and Nutrition Service of the University Hospital Complex of Ourense. Methods: The recorded interviews were conducted in November 2024. The conversations were audio-recorded with the participants’ consent, and then transcribed for thematic analysis. Results: Three main categories were identified: “experience prior to continuous glucose monitoring” (accessibility, prior knowledge, and expectations), “experience with the use of continuous glucose monitoring” (perception of healthcare support, concerns, strengths, and alarm management), and “experience regarding the disease” (self-management of the disease and safety). Despite the fact that diabetes mellitus is a complex chronic disease, all participants provided a positive assessment of their progress and improved control through continuous glucose monitoring. Conclusions: All participants felt more secure and protected with continuous glucose monitoring, improving their quality of life. The main concern among the subjects was the possibility of the sensor failing. They positively valued the alarm system in case of hypoglycemia. The CGM is a highly effective tool for the management and self-control of diabetes and promotes the relationship between patients and professional health. Impact: The findings of this study have important implications for clinical care, highlighting the need for more training and more health education at the first level of health care, such as health centers. Full article

With rapid global aging, the community environment has become a critical factor influencing cognitive health in older adults. However, most existing studies focus on single environmental attributes and rely on linear analytical methods, which fail to capture the complex and synergistic effects of community features. Guided by an integrated theoretical perspective on environmental psychology, aging, and cognitive health, this study examines how multiple community environmental factors jointly affect cognitive function in elderly people. A case study was conducted among 215 older residents in Shanghai, China. An exploratory factor analysis (EFA) identified the following five key dimensions of community environment: pedestrian friendliness, blue–green spaces, infrastructure, space attractiveness, and safety. We then applied both Partial Least Squares Structural Equation Modeling (PLS-SEM) and Fuzzy Set Qualitative Comparative Analysis (fsQCA) to reveal linear and configurational relationships. The findings showed that pedestrian friendliness, blue–green spaces, and space attractiveness significantly enhance cognitive health, while fsQCA highlighted multiple pathways that underscore the non-linear and synergistic interactions among environmental features. These results provide theoretical insights into the mechanisms linking community environments and cognitive function and offer practical guidance for designing age-friendly communities. Full article

Introduction: The wellbeing of humans and the planet is negatively impacted by unhealthy eating behaviors and excessive food waste. Mindfulness approaches have the potential to help people modify their behavior to achieve healthier outcomes. Pilot testing methods to sustainably support healthy eating and reduce food waste are essential for identifying effective ways to promote human and planetary health. Methods: A pilot study was conducted to test a virtual mindful eating program to improve eating behaviors and reduce food waste among a small sample of U.S. adults. Mixed-methods approaches were used to identify the efficacy of the piloted intervention on mindfulness, eating behaviors, and food waste while identifying participant perspectives of the mindful eating program. Results: Quantitative study outcomes indicated positive intervention effects on hunger/satiety cues and food appreciation. No significant intervention effects were detected on mindfulness or food waste. Qualitative findings highlighted participant reports of experiencing greater self-awareness, an improved relationship with food, and a sense of creativity with meal preparation. Conclusions: This pilot study tested a novel mindful eating program that improved eating behaviors related to hunger/satiety and increased food appreciation. The program was accepted by participants, but it did not increase mindfulness or reduce food waste. Future iterations of this mindful eating program will require modifications to test different approaches for increasing mindfulness and reducing food waste while expanding the positive effects on healthy eating. Full article

Human induced pluripotent stem cells (hiPSCs) are widely used in basic research because of their versatility and ability to differentiate into multiple cell types. In particular, differentiating hiPSCs into cardiac cells (hiPSC-CMs) has been an important milestone in cardiac pathophysiology studies. Although hiPSC-CMs offer a model for human cardiomyocytes, they still exhibit characteristics linked to the fetal cardiac cell phenotype. One important feature that prevents hiPSC-CMs from being identified as adult cells relates to their metabolism, which is a key factor in defining a mature phenotype capable of sustaining the workload requirements characteristic of fully differentiated cardiomyocytes. This review aims to present the most relevant strategies in terms of culture medium composition, culture times, and 3D culture methods that have been developed to promote the metabolic maturation of hiPSC-CMs, which are now widely used. Defining a standardized and universally accepted protocol would enable the creation of a cellular model for studies of cardiac pathophysiology from a patient-specific perspective and for drug screening. Full article

Background/Objectives: Septoplasty is a commonly performed surgical procedure aimed at correcting nasal septal deviations, to improve nasal airflow and respiratory function. Traditional approaches to septal correction rely on either direct visualization or endoscopic guidance. Recently, a novel technology known as exoscopy has been introduced into surgical practice. Exoscopy is an “advanced magnification system” that provides an enlarged, three-dimensional view of the operating field. In this article, we present our experience with exoscope-assisted septoplasty, developed over the last two years, and compare it with our extensive experience using the endoscopic approach. Methods: Our case series includes 26 patients, predominantly males and young adults, who underwent exoscope-assisted septoplasty. We discuss the primary advantages of this technique and, most importantly, provide an analysis of its learning curve. The cohort of patients treated using the exoscopic approach was compared with a control group of 26 patients who underwent endoscope-guided septoplasty, randomly selected from our broader clinical database. Finally, we present a representative surgical case that details all phases of the exoscope-assisted procedure. Results: Our surgical experience has demonstrated that exoscopy is a safe and effective tool for performing septoplasty. Moreover, the learning curve associated with this technique exhibits a rapid and progressive improvement. Notably, exoscopy provides a substantial educational benefit for trainees and medical students, as it enables them to share the same visual perspective as the lead surgeon. Conclusions: Although further studies are required to validate this approach, we believe that exoscopy represents a promising advancement for a wide range of head and neck procedures, and certainly for septoplasty. Full article

The current opinion paper puts into perspective how altered microbiota transplanted from Alzheimer’s patients initiates the impairment of the microbiota–gut–brain axis of a healthy recipient, leading to impaired cognition primarily arising from the hippocampus, dysfunctional adult hippocampal neurogenesis, dysregulated systemic inflammation, long-term spatial memory impairment, or chronic pain with hippocampal involvement. This altered microbiota may induce acquired Piezo2 channelopathy on enterochromaffin cells, which, in turn, impairs the ultrafast long-range proton-based oscillatory synchronization to the hippocampus. Therefore, an intact microbiota–gut–brain axis could be responsible for the synchronization of ultradian and circadian rhythms, with the assistance of rhythmic bacteria within microbiota, to circadian regulation, and hippocampal learning and memory formation. Hippocampal ultradian clock encoding is proposed to be through a Piezo2-initiated proton-signaled manner via VGLUT3 allosteric transmission at a distance. Furthermore, this paper posits that these unaccounted-for ultrafast proton-based long-range oscillatory synchronizing ultradian axes may exist not only within the brain but also between the periphery and the brain in an analogous way, like in the case of this depicted microbiota–gut–brain axis. Accordingly, the irreversible Piezo2 channelopathy-induced loss of the Piezo2-initiated ultradian prefrontal–hippocampal axis leads to Alzheimer’s disease pathophysiology onset. Moreover, the same irreversible microdamage-induced loss of the Piezo2-initiated ultradian muscle spindle–hippocampal and cerebellum–hippocampal axes may lead to amyotrophic lateral sclerosis and Parkinson’s disease initiation, respectively. Full article

Memory is a fundamental neurological function, essential for animal survival. Over the course of vertebrate evolution, elaborations in the forebrain telencephalon created new memory mechanisms, meaning basal vertebrates such as amphibians must have a less sophisticated system of memory acquisition, storage, and retrieval than the well-known hippocampal-based circuitry of mammals. Personality also appears to be a fundamental vertebrate trait and is generally defined as consistent individual behavior over time and across life history stages. In anuran amphibians (frogs), personality studies generally ask whether adult frogs retain the personality of their tadpole stage or whether personality shifts with metamorphosis, an idea behavioral ecologists term adaptive decoupling. Using a multidisciplinary perspective and recognizing there are ~7843 species of frogs, each with some molecular, morphological, physiological, or behavioral feature that makes it unique, we review, clarify, and provide perspective on what we collectively know about memory and personality and their mechanisms in anuran amphibians. We propose four working hypotheses: (1) as tadpoles grow, new telencephalic neurons become integrated into functional networks, producing behaviors that become more sophisticated with age; (2) since carnivores tend to be more bold/aggressive than herbivores, carnivorous anuran adults will be more aggressive than herbivorous tadpoles; (3) each amphibian species, and perhaps life history stage, will have a set point on the Shy–Bold Continuum; and (4) around this set point there will be a range of individual responses. We also suggest that several factors are slowing our understanding of the variety and depth of memory and personality possibilities in anurans. These include the scala natura approach to comparative studies (i.e., the idea that one frog represents all frogs); the assumption that amphibians are no more than simple reflex machines; that study species tend to be chosen more for convenience than taxonomic representation; and that studies are designed to prove or disprove a construct. This latter factor is a particular hindrance because what we are really seeking as scientists is not the confirmation or refutation of ideas, but rather what those ideas are intended to produce, which is understanding. Full article