Search Results (1,849)

Background: Liver biopsy remains the gold standard for staging chronic hepatitis B (CHB), yet it is invasive, costly, and associated with potential complications. There is a critical need for non-invasive, cost-effective biomarkers to monitor disease progression. This study aimed to evaluate the correlation between the Prognostic Nutritional Index (PNI) and Systemic Immune–Inflammatory Index (SII) with histological fibrosis stages and the Histological Activity Index (HAI) in patients with CHB. Methods: This retrospective study analyzed 274 patients diagnosed with CHB (HBsAg positivity > 6 months) who underwent liver biopsy at the University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital between February 2016 and February 2022. Histopathological findings were staged using the Ishak fibrosis score and HAI. PNI and SII were calculated from peripheral blood parameters. Statistical discrimination power was assessed using Area Under the Receiver Operating Characteristic (AUROC) curves. Results: The cohort comprised 119 females (43.4%) and 155 males (56.6%), with a mean age of 45.25 ± 11.2 years. Mean values were 55.83 ± 5.33 for PNI and 494.37 ± 336.86 for SII. Fibrosis distribution showed 56.2% at stages F0–F1 and 43.8% at ≥F2. For fibrosis staging, SII demonstrated statistically significant but limited predictive ability for Ishak scores ≥F2, while PNI was significant for identifying advanced fibrosis (≥F4) (p < 0.05). SII showed moderate diagnostic performance for severe inflammation (HAI ≥12; AUROC = 0.848), although this finding should be interpreted cautiously. For lower HAI thresholds (≥6), both PNI and SII demonstrated poor discriminative ability (AUROC 0.5–0.6). Conclusions: Both indices were associated with histological parameters but showed limited overall diagnostic performance. SII appeared relatively better; however, this was descriptively observed without formal statistical comparison. These markers may provide complementary information but should not be used as standalone diagnostic tools. Full article

Background: Stretching exercises are strongly recommended as part of exercise training programs; however, their effects on blood pressure (BP) and other related cardiovascular parameters in adult individuals with elevated BP (pre-hypertension) or hypertension remain unclear. Methods: A systematic search was conducted in PubMed and databases accessed via the EBSCO platform up to 30 September 2025, following the PRISMA guidelines. An additional search of Scopus was performed on 8 April 2026. Studies eligible for inclusion were randomized controlled trials, randomized crossover trials, non-randomized clinical trials and single-arm trials investigating stretching interventions in adults with pre-hypertension and or hypertension. Risk of bias assessment was performed using RoB 2 for randomized trials and ROBINS-I for the non-randomized trials. A random-effect meta-analysis was performed when at least two studies reported sufficiently comparable BP outcomes. The quantitative synthesis was considered exploratory. Results: Eleven records published between 2014 and 2025 met the eligibility criteria and were included. All protocols used static stretching, although only a small number were clearly described as active stretching. The results were heterogeneous across the design, duration of intervention and outcomes. Chronic interventions more often reported favorable changes in indices of arterial stiffness, whereas acute interventions demonstrated more variable immediate BP responses. In the exploratory meta-analysis, the pooled estimate suggested a reduction in systolic blood pressure (SBP) in favor of stretching; however, this effect did not reach statistical significance (mean difference (MD) = −5.39 mmHg, 95% confidence interval (CI): −11.32 to 0.53; I² = 0%). For diastolic blood pressure (DBP), the pooled estimate favored stretching and reached statistical significance (MD = −3.93 mmHg, 95% CI: −7.25 to −0.60; I² = 0%). In sensitivity analyses including a third study, the pooled effects remained in favor of stretching for systolic BP (MD = −6.6 mmHg, 95% CI: −12.2 to −1.0; I² = 56%) and diastolic BP (MD = −5.4 mmHg, 95% CI: −7.1 to −3.7; I² = 8%). These pooled estimates should be interpreted with caution due to the small number of studies, heterogeneity in study design and participant characteristics, and overall limitations in methodological quality. Secondary findings suggested possible improvements in selected vascular parameters, including brachial–ankle pulse wave velocity, augmentation index, and cardio–ankle vascular index, whereas acute responses were more variable and protocol-dependent. Overall, the level of evidence was limited, with most randomized trials judged as having some concerns and non-randomized studies judged as having a critical risk of bias. Conclusions: Stretching interventions may improve BP and selected vascular parameters in adults with pre-hypertension and hypertension and may represent a practical adjunct within the non-pharmacological management of BP. However, the current evidence is limited by methodological heterogeneity, risk of bias, and the small number of studies available for quantitative synthesis. Therefore, the pooled findings should be considered exploratory and hypothesis-generating rather than definitive. Further high-quality randomized controlled trials are required to determine the optimal type, dose, and long-term clinical relevance of stretching interventions in this population. Full article

This paper presents a unified analytical and computational framework for the study of typhoid fever transmission dynamics governed by a Caputo fractional-order compartmental model of order $\kappa \in (0,1]$. The population is stratified into five epidemiological classes, namely susceptible $\left(\mathcal{S}\right)$, asymptomatic $\left(\mathcal{A}\right)$, symptomatic $\left(\mathcal{I}\right)$, hospitalised $\left(\mathcal{H}\right)$, and recovered $\left(\mathcal{R}\right)$, and the governing system explicitly incorporates asymptomatic transmission, treatment dynamics, and temporary immunity with waning. The use of the Caputo fractional derivative is motivated by the well-documented existence of chronic asymptomatic Salmonella Typhi carriers, whose heavy-tailed sojourn times in the carrier state are naturally encoded by the Mittag–Leffler waiting-time distribution arising from the fractional operator. A complete qualitative analysis of the fractional system is carried out: the basic reproduction number ${\mathcal{R}}_0$ is derived via the next-generation matrix method; local and global asymptotic stability of both the disease-free equilibrium ${\mathcal{E}}_0$ (when ${\mathcal{R}}_0\le 1$) and the endemic equilibrium ${\mathcal{E}}^{*}$ (when ${\mathcal{R}}_0>1$) are established using fractional Lyapunov theory and the LaSalle invariance principle; and the normalised sensitivity indices of ${\mathcal{R}}_0$ are computed to identify transmission-amplifying and transmission-suppressing parameters. Existence, uniqueness, and Ulam–Hyers stability of solutions are established via Banach and Leray–Schauder fixed-point arguments. To complement the analytical results, a fractional physics-informed neural network ($\mathcal{PINN}$) framework is developed to simultaneously reconstruct compartmental trajectories and identify unknown biological parameters from sparse synthetic observations. $\mathcal{PINN}$ embeds the L1-Caputo discretisation directly into the training residuals and employs a four-stage Adam–L-BFGS optimisation strategy to recover five trainable parameters $\Theta$ = $\{\varphi ,\mu ,\sigma ,\psi ,\beta \}$ across three fractional orders $\kappa \in \{1.0,0.95,0.9\}$. The estimated parameters show strong agreement with the true values at the classical limit $\kappa =1.0$ ($\mathrm{MAPE}=2.27\%$), with the natural mortality rate $\mu$ recovered with $\mathrm{APE}\le 0.51\%$ and the transmission rate $\beta$ with $\mathrm{APE}\le 3.63\%$ across all fractional orders, confirming the structural identifiability of the model. Pairwise correlation analysis of the learned parameters establishes the absence of equifinality, validating that $\beta$ can be reliably included in the trainable set. Noise robustness experiments under Gaussian perturbations of $1\%$, $3\%$, and $5\%$ demonstrate graceful degradation ($\mathrm{MAPE}$: $0.82\%\to 3.10\%\to 7.31\%$), confirming the reliability of the proposed framework under realistic observational conditions. Full article

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fluctuating skeletal muscle weakness and fatigue, leading to reduced functional independence and impaired quality of life (QoL). Although exercise has historically been discouraged due to concerns about symptom exacerbation, emerging evidence suggest that structured exercise programs may be safe and beneficial in clinically stable patients. This systematic review critically evaluates current evidence on exercise and physical activity interventions in MG, focusing on effectiveness, safety, and impact on functional outcomes, fatigue, and QoL. Materials and Methods: A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Web of Science, Google Scholar, Scopus and ScienceDirect for studies published between 2015 and 2025. Keywords included MG, physical activity, aerobic training, resistance training, and respiratory muscle training. Methodological quality was assessed using the Downs and Black checklist. Results: Eight controlled studies met the inclusion criteria, encompassing aerobic, resistance, combined, and respiratory muscle training interventions. Sample sizes ranged from small pilot studies to moderate-size randomized controlled trials. Overall, exercise interventions were well tolerated, with no evidence of sustained symptoms exacerbation. Aerobic and combined programs consistently improved functional capacity, muscle strength, and activities of daily living. Respiratory muscle training demonstrated improvements in pulmonary function and inspiratory muscle strength, although findings were more heterogeneous. Study quality ranged from poor to excellent, with common limitations including small sample size, short follow-up duration, and heterogeneity in exercise programs. Conclusions: Current evidence supports the safety and potential efficacy of individualized, symptom-guided exercise interventions in clinically stable MG. Regular physical activity exercise may reduce secondary deconditioning, improve functional outcomes, and enhance QoL. However, larger, high-quality randomized controlled trials with standardized programs and longer follow-up periods are required to strengthen clinical recommendations and clarify long-term effects. Full article

Objective: This study aimed to evaluate the health-related quality of life (HRQoL) of informal caregivers providing primary care to elderly chronically ill patients receiving home health care services in Türkiye and to identify patient and caregiver characteristics independently associated with HRQoL. Methods: This cross-sectional study included 499 patient–caregiver dyads enrolled in home health care services at a training and research hospital in İzmir, Türkiye. Data were collected through face-to-face interviews using a sociodemographic questionnaire, the Palliative Performance Scale (PPS), and the Short Form 36 (SF-36). One-sample t-tests compared SF-36 scores with Turkish normative values. Multivariate linear regression identified independent predictors of the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Results: Caregivers scored significantly lower than population norms across all SF-36 subdimensions (p < 0.001), with the largest impairments in Role Physical (mean difference: −53.0) and Role Emotional (−42.9). In multivariate analyses, independent predictors of poorer physical health (PCS) were severe patient functional dependence (PPS ≤ 30: β = −0.260, p < 0.001), older caregiver age (≥65 years: β = −0.089, p = 0.044), unemployment (β = −0.118, p = 0.014), additional care recipients (β = −0.095, p = 0.026), and caregiver’s own chronic illness (β = −0.169, p < 0.001). Poorer mental health (MCS) was independently associated with caregiver’s own chronic illness (β = −0.138, p = 0.002), receipt of caregiving payment (β = −0.137, p = 0.004), and university-level education (β = −0.108, p = 0.040), whereas the presence of a support person was protective (β = 0.096, p = 0.038). Conclusions: Informal caregivers of home health care-dependent elderly patients experience significantly reduced quality of life across all health domains compared with the general population. The independent determinants of caregiver health are multidimensional, encompassing patient-related factors, socioeconomic characteristics, and psychosocial resources. These findings underscore the urgent need for health systems to implement tailored interventions that address the distinct physical and mental health needs of caregivers, with particular attention to those who are elderly, chronically ill, socioeconomically disadvantaged, or highly educated. Full article

Trained immunity is a concept that is currently in development and refers to the long-term functional reprogramming of innate immune cells in response to microbial or inflammatory stimuli. This process serves a dual purpose in the gastrointestinal tract, contributing to chronic inflammatory conditions like inflammatory bowel disease and maintaining host defense. The production of pro-inflammatory mediators is augmented by epigenetic and metabolic changes that are induced by the persistent activation of innate immune cells, which is triggered by microbial components and damage-associated signals. Although this increased responsiveness may initially be protective, sustained activation leads to tissue damage, epithelial barrier dysfunction, and chronic inflammation. These mechanisms are significant contributors to colorectal carcinogenesis, particularly in colitis-associated cancer. Through the activation of oncogenic signaling pathways, the establishment of a pro-tumorigenic microenvironment, and an increase in oxidative stress, trained immunity also influences tumor development. Additionally, the systemic reprogramming of hematopoietic progenitor cells has the potential to exacerbate inflammation and facilitate the progression of tumors. The identification of epigenetic and metabolic biomarkers associated with trained immunity can lead to novel diagnostic opportunities. Targeting metabolic and epigenetic pathways, as well as regulating the intestinal microbiota, is a promising therapeutic approach that could enhance the effectiveness of treatments for colorectal cancer while minimizing adverse effects on the immune system. Nevertheless, it is necessary to maintain a delicate equilibrium to suppress pathological inflammation without compromising protective immune responses. In general, trained immunity may represent a potentially relevant mechanistic link between chronic inflammation and colorectal cancer; however, its role remains context-dependent and not yet fully defined. Full article

Background/Objectives: Digital health interventions are increasingly used to support person-centered care (PCC) in chronic disease management, yet it remains unclear which PCC components are most consistently enabled by digital tools and how these relate to outcomes. This study synthesized evidence on digitally supported PCC for adults with chronic conditions, examining how interventions operationalize PCC and which clinical, patient-reported, and implementation outcomes are reported. Methods: A structured literature synthesis was conducted according to PRISMA guidelines across a heterogeneous evidence base, including randomized and pragmatic trials, observational studies, qualitative studies, and systematic reviews. The review protocol was pre-registered in the Open Science Framework (OSF) Registries. Results: Across 16 included studies, digital solutions most consistently supported PCC through enhanced situational awareness via self-monitoring, strengthened partnership through two-way communication and coaching, and reinforced shared documentation through co-created health plans. Benefits were reported most consistently for process and experience outcomes, such as perceived access to support, engagement, and empowerment. Evidence for sustained long-term clinical improvements, such as glycemic control, was mixed and frequently limited by short follow-up periods and variation in intervention integration. Conclusions: Digitalization can strengthen PCC when embedded within relational care models and organizational workflows that translate patient-generated data into meaningful action. Future work should utilize clearer PCC operationalization, longer follow-up, and routine reporting of equity outcomes, alongside targeted training for healthcare professionals delivering PCC in digital encounters. Full article

Atmospheric particulate matter poses a high risk by carrying potentially toxic components such as polycyclic aromatic hydrocarbons (PAHs). The major sources of these potentially toxic compounds include traffic-related emissions and winter heating, implying the combustion of fossil fuels or biomass. Air pollution, especially chronic exposure, poses the most serious human health hazard in childhood, and several studies emphasise the importance of research on the potential impacts of air pollution in school environments. While indoor air quality studies are already available in Hungary, investigations on outdoor air pollution in school environments are missing. To fill this gap, in a medium-sized Hungarian town, Veszprém, six schools were selected to assess air quality in the outdoor environments where schoolchildren spend their breaks and have physical training. These schools represent different locations and conditions, from high-trafficked sites to suburban environments. Using resuspended dust samples, environmental quality was assessed based on PAH contents of the samples and ecotoxicity tests (Vibrio fischeri bacterial bioassay). Ecotoxicity of the samples moved in a wide range, from highly toxic to non-toxic. PAH measurements indicated considerable contamination in the case of one sample taken from a suburban area. Source apportionment demonstrated that winter heating is also an important pollution source. Full article

Background/Objectives: In-hospital critical outcome among palliative inpatients remains high, often driven by acute physiological instability rather than chronic comorbidities. Although diabetes mellitus (DM) is common in this population, its independent impact on critical outcome is unclear. This study aimed to determine whether acute metabolic and inflammatory markers—specifically glucose, C-reactive protein (CRP), albumin, and oxygen requirement—better predict short-term outcomes, defined as in-hospital critical outcome or ICU transfer during the same hospitalization period, than DM status alone. Methods: This retrospective study included 200 palliative inpatients admitted to the Internal Medicine Clinic of Kestel State Hospital, Bursa, Turkey, between January 2024 and January 2025. Demographic, clinical, and laboratory data were obtained from electronic records. The primary outcome was in-hospital critical outcome or ICU transfer (“critical outcome”). Logistic regression and receiver-operating characteristic (ROC) analyses identified independent predictors. The study was approved by the Bursa Yüksek İhtisas Training and Research Hospital Ethics Committee (ethics approval: protocol code 2024-TBEK 2025/05-12). Results: The mean age was 77.7 ± 12.3 years, and 47% were male. DM was present in 30.5% but did not independently predict critical outcome (p = 0.904). In contrast, oxygen requirement (OR = 4.08, p = 0.002), mean glucose (OR = 1.01, p = 0.001), and cancer (OR = 3.28, p = 0.016) were significant predictors. ROC analysis identified CRP > 64.1 mg/L and albumin < 25 g/L as optimal thresholds, and these two markers formed the basis of the low-, intermediate-, and high-risk stratification, with critical-outcome rates of 39.0%, 45.1%, and 85.4% (p < 0.001). Conclusions: Acute metabolic and inflammatory disturbances—particularly hyperglycemia, elevated CRP, hypoalbuminemia, and oxygen requirement—are stronger prognostic indicators than DM. A simple bedside model incorporating these parameters may improve prognostic accuracy and communication in palliative care. Full article

Upper airway function has received limited attention as a potentially relevant component of respiratory physiology in aquatic athletes. Repeated exposure to chlorinated indoor environments, combined with high ventilatory demand during training, may contribute to the development of chronic irritant rhinitis characterized by nasal obstruction and mucosal hyperreactivity. Although often perceived as a minor inconvenience, increased nasal resistance may influence breathing comfort, perceived exertion, and recovery stability in swimmers and other aquatic athletes. In addition to environmental exposure, the widespread use of topical nasal decongestants may result in rebound congestion and rhinitis medicamentosa, thereby contributing to a self-reinforcing cycle of airway dysfunction. Performance-related pressure and uncertainty related to anti-doping regulations may further shape medication behavior within athletic environments. This narrative review integrates environmental exposure mechanisms, mucosal pathophysiology, and behavioral medication patterns to provide a unified conceptual framework for understanding upper airway dysfunction in aquatic athletes. Particular emphasis is placed on nasal airflow stability as a potentially relevant factor in breathing comfort, sleep quality, and training consistency. Given that the available evidence is predominantly mechanistic and observational, the proposed relationships should be interpreted as hypothesis-generating and translational rather than as evidence of direct causal effects on athletic performance. Full article

Background: Chronic kidney disease (CKD) is highly prevalent among older adults, particularly those living in care homes, where early identification and effective management are essential to improving outcomes. Aim: This scoping review aimed to explore and map educational interventions designed to support care home staff in the prevention, assessment, and management of CKD. Methods: A scoping review (ScR) was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR) checklist. A systematic search of six major databases was conducted following the Joanna Briggs Institute methodology. Results: A total of 6599 records were identified and 5573 titles and abstracts were screened; 10 full texts were assessed, but no studies met the inclusion criteria. Conclusions: This empty review highlights a significant gap in the literature and reinforces the need for targeted research to develop and evaluate training interventions for care home staff managing residents with CKD. Full article

Chronic obstructive and inflammatory lung diseases share overlapping clinical manifestations and spirometric features, complicating differential diagnosis and monitoring. In this study, we performed an integrative real-time proton-transfer-reaction time-of-flight mass spectrometry (PTR-TOF-MS) breathomics analysis to assess whether exhaled volatile organic compound (VOC) profiles enable multiclass discrimination among bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), and lymphangioleiomyomatosis (LAM), with healthy individuals as controls. Breath VOC data from 843 subjects were analyzed using a stratified 70/30 train/test split. An ensemble feature selection strategy based on gradient boosting (XGBoost with SMOTE within cross-validation) identified stable VOC panels (top 25% selection probability), yielding 29 VOCs and 31 features including clinical covariates. On the independent test set, the VOC-only model achieved a macro-averaged one-vs-one (OvO) AUC of 0.866 (95% CI 0.829–0.903), while the combined model improved to 0.888 (95% CI 0.853–0.919), indicating modest value of clinical variables. Pairwise analysis demonstrated highest discrimination for CF (AUC up to 0.988), whereas BA and LAM showed lower sensitivity (<0.60), likely reflecting heterogeneity and limited sample size. Given differences in age, sex, BMI, and smoking status across cohorts, confounding effects were assessed, confirming that VOC signatures retain independent diagnostic information. Disease-specific VOC interaction networks revealed distinct remodeling patterns, with central metabolites not captured by univariate analysis. Overall, PTR-TOF-MS breathomics demonstrates proof-of-concept multiclass discrimination across chronic lung diseases. Full article

Endurance performance is regulated through dynamic interactions between physiological capacity, nutritional status, and psychological control processes. While traditional endurance models have emphasized metabolic and cardiorespiratory determinants, growing evidence indicates that energy availability also influences cognitive function, perceived effort, and decision-making during prolonged exercise. This narrative review synthesizes current literature on the interplay between nutritional strategies and psychological regulation in endurance sports, with particular emphasis on low energy availability, carbohydrate availability, mental fatigue, and pacing behavior. Acute and chronic reductions in energy availability are associated not only with endocrine and metabolic disturbances but also with amplified perceived exertion, impaired executive functioning, reduced effort tolerance, and altered risk-related decision-making, even in the absence of overt physiological failure. Carbohydrate availability emerges as a central modulator operating through both peripheral mechanisms (substrate supply and glycogen preservation) and central neurocognitive pathways influencing perception, motivation, and fatigue regulation. Hydration status, caffeine ingestion, and gastrointestinal tolerance further interact with perceptual and cognitive processes to shape real-time pacing and endurance sustainability. Integrating sport nutrition and sport psychology provides a unifying framework for understanding endurance regulation as a multilevel process linking metabolic state to perceptual experience and behavioral decision-making. From an applied perspective, optimizing endurance performance requires maintenance of adequate long-term energy availability, strategic carbohydrate periodization aligned with training demands, and systematic monitoring of perceived effort alongside physiological load. Future research should prioritize interdisciplinary, ecologically valid designs combining metabolic, perceptual, and cognitive measurements, supported by wearable and data-driven technologies capable of capturing real-time endurance regulation. Bridging nutritional and psychological mechanisms within a unified conceptual model offers a stronger scientific basis for improving performance sustainability while safeguarding athlete health in modern endurance sport. Full article

Obesity is a chronic disease characterized by excessive fat accumulation. Irisin, released during exercise, regulates energy metabolism and may contribute to exercise-induced metabolic adaptations. This study aimed to compare the effects of 24 weeks of two different training programs on body composition, physical capacities, and irisin levels in male adults with obesity, and to investigate the relationship between irisin and metabolic parameters. Thirteen male adults with obesity were randomly assigned to polarized (POL) or threshold (THR) training programs. Anthropometric measurements, physical capacity parameters, serum and salivary samples were collected before (T0) and after the training period (T1). Irisin levels were measured by ELISA. After training, body composition significantly improved, with reductions in body mass and body mass index, and an increase in fat-free mass. Maximal oxygen consumption (V’O₂max) significantly increased, while a decrease in HRmax indicated improved cardiac efficiency. Although serum and salivary irisin levels did not significantly increase overall, a trend toward increased irisin was observed in the THR group. Furthermore, serum irisin at T1 positively correlated with V’O₂ at the respiratory compensation point (p = 0.019), and V’O₂max (p = 0.031). Both POL and THR training programs significantly improved body composition and cardiometabolic fitness after 24 weeks. The positive association of irisin with aerobic fitness parameters suggests that irisin may reflect physiological adaptations to exercise. Full article

As stroke survivors often manifest not only physical dysfunction but also cognitive impairment, interventions that address both physical and cognitive aspects may be beneficial for individuals with chronic stroke. However, a randomized clinical trial (RCT) examining the effects of physical–cognitive telerehabilitation exergaming across physical and cognitive domains in chronic stroke survivors remains scarce. Therefore, this study aims to investigate the effectiveness of the web-based physical–cognitive telerehabilitation exergaming on the physical and cognitive performance of chronic stroke survivors as compared to control. A two-arm RCT with a blinded assessor will be conducted. Fifty-two participants will be randomly assigned to either the intervention or the control group. Participants in the intervention group will receive a 12-week training program, whereas those in the control group will continue with usual care. Motor function, gait speed, balance, fall risk, muscle power, weight distribution, body composition, global cognition, executive function, attention, memory, as well as enjoyment will be assessed. Existing evidence has established the health benefits of physical–cognitive exergaming. It is expected that a physical–cognitive exergaming program may further exhibit positive effects on both physical function and cognition beyond the results of usual care. In addition, incorporating physical–cognitive training into a web-based telerehabilitation program may improve adherence and provide a feasible and enjoyable rehabilitation option for individuals with chronic stroke. Full article