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Search Results (41,556)

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17 pages, 789 KiB  
Article
Effectiveness and Safety of Sacituzumab Govitecan in Real-World Clinical Practice in Patients with Metastatic Triple-Negative and HR+/HER2-Negative Breast Cancer
by Fernando Lago-Ballester, Adrián Martínez-Orea, Ana Laorden-Carrasco, María Sacramento Díaz-Carrasco, José Carlos Titos-Arcos, María Carmen Mira-Sirvent, Ginés Luengo-Gil and Mónica Martínez-Penella
Biomedicines 2025, 13(9), 2059; https://doi.org/10.3390/biomedicines13092059 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: Sacituzumab govitecan (SG) is an antibody–drug conjugate targeting Trop-2 that has demonstrated clinical benefits in randomised trials for patients with metastatic triple-negative breast cancer (mTNBC) and metastatic hormone receptor-positive/HER2-negative (HR+/HER2− mBC) disease. However, real-world data on its effectiveness and safety are limited, [...] Read more.
Background/Objectives: Sacituzumab govitecan (SG) is an antibody–drug conjugate targeting Trop-2 that has demonstrated clinical benefits in randomised trials for patients with metastatic triple-negative breast cancer (mTNBC) and metastatic hormone receptor-positive/HER2-negative (HR+/HER2− mBC) disease. However, real-world data on its effectiveness and safety are limited, especially in patients with poor performance status or central nervous system (CNS) involvement. This study aimed to evaluate the real-world outcomes of SG in these two subtypes. Methods: We conducted a retrospective, multicentre, observational study across three tertiary hospitals in Spain. Patients with mTNBC or HR+/HER2− mBC treated with SG between June 2022 and March 2025 were included. Clinical data, treatment history, adverse events (AEs), and survival outcomes were also recorded. The median progression-free survival (mPFS) and median overall survival (mOS) were estimated using Kaplan–Meier analysis. Univariate and multivariate analyses were performed to identify the factors influencing outcomes. The association between granulocyte colony-stimulating factor (G-CSF) prophylaxis and neutropenia was assessed using Fisher’s exact test. Results: A total of 56 patients were included in this study (33 with mTNBC and 23 with HR+/HER2− mBC). In the mTNBC group, mPFS was 4.0 months (95% CI: 1.94–5.98) and mOS was 11.0 months (95% CI: 4.80–17.12). In the HR+/HER2− mBC group, mPFS was 3.7 months (95% CI: 2.02–5.44) and mOS was 20.2 months (95% CI: 3.9–36.5). Fatigue, neutropenia, and gastrointestinal toxicity were the most common AEs. Primary G-CSF prophylaxis was not associated with a reduced incidence of neutropenia (p = 0.434). Conclusions: In routine practice, SG shows effectiveness comparable to that of randomised trials across both subtypes, with a safety profile consistent with pivotal studies. The observed toxicity profile was consistent with that described in pivotal clinical trials and other studies. The prophylactic use of G-CSF was not associated with an impact on the occurrence of neutropenia, but the incidence of neutropenia was lower than that in clinical trials and other studies that did not administer G-CSF prophylactically. Full article
(This article belongs to the Section Drug Discovery, Development and Delivery)
18 pages, 725 KiB  
Article
Diagnostic Yield of the New Bárány Society Criteria for Pediatric Episodic Vestibular Syndrome
by Mar Rey-Berenguel, Javier Vallecillo-Zorrilla, Edith Karelly Burgueño-Uriarte, María del Carmen Olvera-Porcel and Juan Manuel Espinosa-Sanchez
J. Clin. Med. 2025, 14(17), 5971; https://doi.org/10.3390/jcm14175971 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: Pediatric episodic vestibular syndrome (EVS) is increasingly recognized, with recurrent vertigo of childhood (RVC) and vestibular migraine of childhood (VMC) being the most prevalent disorders. In 2021, the Bárány Society and the International Headache Society proposed new diagnostic criteria for RVC, [...] Read more.
Background/Objectives: Pediatric episodic vestibular syndrome (EVS) is increasingly recognized, with recurrent vertigo of childhood (RVC) and vestibular migraine of childhood (VMC) being the most prevalent disorders. In 2021, the Bárány Society and the International Headache Society proposed new diagnostic criteria for RVC, VMC, and probable VMC (pVMC), replacing the older term benign paroxysmal vertigo (BPV). This study aimed to evaluate the clinical applicability of these new criteria. Methods: We conducted a cross-sectional study at a pediatric neurotology clinic within a tertiary hospital, including patients under 18 years with episodic vestibular symptoms evaluated between 2018 and 2025. All patients underwent a standardized neuro-otological assessment. Diagnoses were assigned using both the 2018 ICHD-3 and the 2021 Bárány criteria. Patients who did not fulfill any of the three new diagnostic categories, nor met criteria for any other specific vestibular disorder, were grouped into an undetermined category referred to as episodic vestibular syndrome without hearing loss (EVSw/oHL). Demographic and clinical variables were compared across diagnostic groups using non-parametric and chi-squared tests. Results: Among the 202 children evaluated, 109 met the inclusion criteria and were classified as RVC (n = 55), VMC (n = 23), pVMC (n = 13), or EVSw/oHL (n = 18). All patients previously diagnosed with BPV met the new criteria for RVC. Application of the Bárány criteria significantly reduced the proportion of unclassified EVS cases (from 35.78% to 16.51%). Significant clinical differences were observed among the groups in terms of episode duration, presence of vomiting, migraine and headache, and family history of migraine. Conclusions: The new Bárány criteria provide a more inclusive and clinically meaningful framework for classifying pediatric EVS. They improve diagnostic clarity, reduce the proportion of unclassifiable cases, and support earlier and more tailored management strategies. Full article
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15 pages, 7210 KiB  
Article
Diagnosis-Related Outcome Following Palliative Spatially Fractionated Radiation Therapy (Lattice) of Large Tumors
by Gabriela Studer, Tino Streller, David Jeller, Dirk Huebner, Bruno Fuchs and Christoph Glanzmann
Cancers 2025, 17(17), 2752; https://doi.org/10.3390/cancers17172752 (registering DOI) - 23 Aug 2025
Abstract
Background: Lattice Radiotherapy (LRT), a spatially fractionated stereotactic radiotherapy (SBRT) technique, has shown promising results in the palliative treatment of large tumors. The focus of our first analysis of 56 lesions >/=7cm was on the extent of shrinkage following palliative LRT (mean 50%) [...] Read more.
Background: Lattice Radiotherapy (LRT), a spatially fractionated stereotactic radiotherapy (SBRT) technique, has shown promising results in the palliative treatment of large tumors. The focus of our first analysis of 56 lesions >/=7cm was on the extent of shrinkage following palliative LRT (mean 50%) and assessment of its effect duration (: mean 6 months). Herewith we present an updated analysis of our single-center LRT cohort, with a focus on LRT outcome across diagnoses and applied LRT regimens. Methods: We assessed the clinical outcome following LRT in 66 patients treated for 81 lesions between 01.2022 and 05.2025. LRT protocols included simultaneous integrated boost (sib-) LRT in 49 lesions (5 × 4–5 Gy to the entire mass with sib of 9–13 Gy to lattice vertices). Alternatively mainly in pre-irradiated and/or very large lesions—a single-fraction stereotactic LRT (SBRT-LRT) of 1 × 20 Gy to vertices only was delivered to 26 lesions. In six cases with modest response to single fraction SBRT-LRT, the sib-LRT schedule was added 4–8 weeks later. Results: The median age was 68 years (18–93). Main tumor locations were abdomino-pelvic (n = 34) and thoracic (n = 17). Histopathological diagnoses included carcinoma (n = 34), sarcoma (n = 31), and melanoma (n = 16). 31% of all lesions have been previously irradiated. 73% of cases underwent concurrent or peri-LRT systemic therapy. The mean/median overall survival (OS) time of the cohort was 7.6/4.6 months (0.4–40.2), 11.9/5.8 months in 16/66 alive, and 6.4/4.3 months in deceased patients, respectively. 82% of symptomatic patients reported immediate subjective improvement (PROM), with a lifelong response duration in most cases. Progressive disease (PD: >10% increase in initial volume) was found in 9%, stable disease (SD +/−10% of initial volume) in 19% of scanned lesions, and shrinkage (>10% reduction in initial volume) in 75%, with a mean/median tumor volume reduction of 51/60%. The extent of shrinkage was found to be 11–30%/31–60%/61–100% in 38/24/38% of lesions. Response rates (PD, SD, shrinkage) following the two applied LRT regimens, as well as those related to sarcoma and carcinoma diagnoses, were found to be comparable. Treatment tolerance was excellent (G0-1). Conclusions: Palliative LRT provides rapid subjective relief in ~80% of symptomatic patients. Radiologic shrinkage was stated in 75% of FU-scanned lesions, with a lifelong effect duration in most patients. LRT was found effective across histologies, with a similar extent of shrinkage in carcinoma and sarcoma following 1F SBRT- and 5F sib-LRT regimens, respectively. Full article
(This article belongs to the Special Issue Palliative Radiotherapy for Cancer)
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24 pages, 636 KiB  
Systematic Review
Effectiveness of the Internet of Things for Improving Pregnancy and Postpartum Women’s Health in High-Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Etsuko Nishimura, Noyuri Yamaji, Kiriko Sasayama, Md. Obaidur Rahman, Katharina da Silva Lopes, Citra Gabriella Mamahit, Mika Ninohei, Phyu Phyu Tun, Rina Shoki, Daichi Suzuki, Aya Nitamizu, Daisuke Yoneoka, Eiko Saito and Erika Ota
Healthcare 2025, 13(17), 2103; https://doi.org/10.3390/healthcare13172103 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: The Internet of Things (IoT), integrated with application software, has increasingly been used to support health management through monitoring indicators like physical activity, sleep, and heart rate, in pregnant and postpartum women. However, limited evidence exists regarding its effectiveness in improving [...] Read more.
Background/Objectives: The Internet of Things (IoT), integrated with application software, has increasingly been used to support health management through monitoring indicators like physical activity, sleep, and heart rate, in pregnant and postpartum women. However, limited evidence exists regarding its effectiveness in improving health outcomes for pregnant and postpartum women. The objective of this systematic review and meta-analysis was to evaluate and synthesize the role of IoT in enhancing the health outcomes of pregnant and postpartum women. Methods: A systematic search was conducted on 13 February 2023, across CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PsycINFO, PubMed, and WHO ICTRP to identify all randomized controlled trials. Studies were included if they involved pregnant or postpartum women in high-income countries and used sensor-based data collection via smartphones or wearable devices. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias using the Cochrane Collaboration’s risk of bias assessment tool 2.0. We performed a pairwise meta-analysis using a random effects model. The findings were reported according to PRISMA guidelines. Results: Seven studies with 1638 pregnant and postpartum women were included in this review. Of the seven included studies, half targeted women with gestational diabetes and the other half targeted obese women. A meta-analysis revealed that IoT interventions may reduce gestational weight gain in women with obesity with a mean difference of −3.35 kg (95% confidence interval (CI): −5.23 to−1.46; I2 = 36%; two studies; 242 women; moderate certainty of evidence). Conclusions: This review suggested that IoT interventions may limit gestational weight gain in pregnant women with obesity. Future studies should evaluate the long-term effects of IoT-based interventions on maternal and neonatal health outcomes. Full article
27 pages, 3603 KiB  
Article
Enhancing Diagnostic Accuracy of Neurological Disorders Through Feature-Driven Multi-Class Classification with Machine Learning
by Çiğdem Gülüzar Altıntop
Diagnostics 2025, 15(17), 2132; https://doi.org/10.3390/diagnostics15172132 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: Neurological disorders (ND) are a global health challenge, affecting millions and greatly reducing quality of life. Disorders such as Alzheimer’s disease, mild cognitive impairment (MCI), schizophrenia, and depression often share overlapping symptoms, complicating diagnosis and treatment. Early detection is crucial for timely [...] Read more.
Background/Objectives: Neurological disorders (ND) are a global health challenge, affecting millions and greatly reducing quality of life. Disorders such as Alzheimer’s disease, mild cognitive impairment (MCI), schizophrenia, and depression often share overlapping symptoms, complicating diagnosis and treatment. Early detection is crucial for timely intervention; however, traditional diagnostic methods rely on subjective assessments and costly imaging, which are not universally accessible. Addressing these challenges, this study investigates the classification of multiple ND using electroencephalography (EEG) signals. Methods: Various feature extraction methods were employed, and the Least Absolute Shrinkage and Selection Operator (Lasso) algorithm was utilized for effective feature selection. Two-class (disease–disease and healthy control–disease), three-class (healthy control and two ND, as well as three ND), and four-class (healthy control and three ND) classifications were conducted using different machine learning algorithms with the selected features. An EEG dataset comprising 40 Alzheimer’s patients, 43 healthy controls, 42 schizophrenia patients, 28 MCI patients, and 28 depression patients served as the experimental benchmark. Results: The Linear Discriminant Analysis (LDA) classifier achieved the highest accuracy, distinguishing between healthy controls and Alzheimer’s with 100% accuracy and demonstrating strong performance in other comparisons. Multi-class classification reached 84.67% accuracy for distinguishing depression, MCI, and schizophrenia, while four-class classification achieved 57.89%, highlighting the complexity of differentiating among multiple ND. The frequent selection of frontal lobe channels across ND indicates their critical role in classification. Conclusions: This study contributes to the literature by emphasizing disease-to-disease classification over the traditional control-versus-patient framework, highlighting the potential for more effective diagnostic tools in clinical settings. Full article
(This article belongs to the Special Issue Artificial Intelligence in Brain Diseases)
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16 pages, 2529 KiB  
Article
Association of Gut Dysbiosis with Disease Phenotype and Treatment in Systemic Lupus Erythematosus
by Irene Medina-Martínez, Rocío Gil-Gutiérrez, Jorge García-García, Francisco Javier de la Hera-Fernández, Nuria Navarrete-Navarrete, Mónica Zamora-Pasadas, Norberto Ortego-Centeno, José Luis Callejas-Rubio, Federico García-García, Julio Gálvez-Peralta, Alba Rodríguez-Nogales, María Correa-Rodríguez and Blanca Rueda-Medina
Med. Sci. 2025, 13(3), 151; https://doi.org/10.3390/medsci13030151 (registering DOI) - 23 Aug 2025
Abstract
Introduction: Gut dysbiosis has been associated with the development of autoimmune diseases, including systemic lupus erythematosus (SLE). Although previous studies suggest microbial alterations in SLE, evidence at the species level and its clinical relevance remain limited. This study aimed to characterise the [...] Read more.
Introduction: Gut dysbiosis has been associated with the development of autoimmune diseases, including systemic lupus erythematosus (SLE). Although previous studies suggest microbial alterations in SLE, evidence at the species level and its clinical relevance remain limited. This study aimed to characterise the gut microbiota at species level in SLE patients and evaluate its association with clinical features. Materials and methods: A total of 57 SLE patients and 57 matched controls were included. Faecal samples were collected using the OMNIgene-GUT kit, and microbial DNA was extracted with the Maxwell RSC PureFood GMO kit. Metagenomic sequencing was performed using the Illumina MiSeq platform, and the data was analysed with QIIME2. Microbial diversity and relative abundance were assessed using the phyloseq package, and differentially abundant taxa were identified using DESeq2. Clinical subgroups among SLE patients were identified via k-means clustering. Results: SLE patients exhibited significantly different beta diversity compared to controls (p = 0.001), with increased abundance of Pseudomonadota (3.81% vs. 6.80%, p < 0.05) and decreased Bacteroidota (53.42% vs. 38.04%, p < 0.05). Only 10 bacterial species were consistently present across all SLE samples, including Akkermansia muciniphila, Bacteroides dorei, and Lactobacillus gasseri. Hypertensive patients and those treated with corticosteroids presented a marked depletion of key microbial taxa. Conversely, Belimumab-treated patients displayed a distinct microbiota enriched in species such as Alistipes shahii and Prevotella corporis. Conclusions: This study confirms significant gut microbiota alterations in SLE and pinpoints microbial profiles associated with clinical subgroups. These findings suggest gut dysbiosis may contribute to SLE pathogenesis and indicate biomarkers for disease stratification. Full article
(This article belongs to the Section Immunology and Infectious Diseases)
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22 pages, 608 KiB  
Systematic Review
Effects of Cognitive Training with Virtual Reality in Older Adults: A Systematic Review
by Christian Daniel Navarro-Ramos, Joselinn Murataya-Gutiérrez, Christian Oswaldo Acosta-Quiroz, Raquel García-Flores and Sonia Beatriz Echeverría-Castro
Brain Sci. 2025, 15(9), 910; https://doi.org/10.3390/brainsci15090910 (registering DOI) - 23 Aug 2025
Abstract
Background/Objective: The use of immersive virtual reality (VR) for cognitive training in older adults has shown promising results in recent years. However, the number of well-designed studies remains limited, and variability in methodologies makes it difficult to draw generalizable conclusions. This systematic review [...] Read more.
Background/Objective: The use of immersive virtual reality (VR) for cognitive training in older adults has shown promising results in recent years. However, the number of well-designed studies remains limited, and variability in methodologies makes it difficult to draw generalizable conclusions. This systematic review aims to examine the effects of VR-based cognitive training in older adults, describe the technological characteristics of these interventions, identify current gaps in the literature, and suggest future research directions. Methods: Following PRISMA guidelines, a search was conducted across major databases (PubMed, PsycINFO, Scopus, ProQuest, ACM, and Web of Science) from 2018 to 2025. The database search identified 156 studies, of which 12 met the inclusion criteria after screening and eligibility assessment. Across these studies, a total of 3202 older adult participants (aged 60 years or older) were included. Interventions varied in duration from 4 to 36 sessions, targeting domains such as memory, executive function, attention, and global cognition. Most interventions were based on cognitive training, with a few employing cognitive stimulation or cognitive rehabilitation approaches. Quality was assessed using the Effective Public Health Practice Project tool. Results: Most studies reported positive effects of VR interventions on cognitive domains such as attention, executive functions, and global cognition. Fewer studies showed improvements in memory. The majority used head-mounted displays connected to computers and custom-built software, often without public access. Sample sizes were generally small, and blinding procedures were often unclear. The average methodological quality was moderate. Conclusions: Immersive VR has potential as an effective tool for cognitive training in older adults. Future research should include larger randomized controlled trials, long-term follow-up, standardized intervention protocols, and the development of accessible software to enable replication and broader application in clinical and community settings. Full article
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10 pages, 641 KiB  
Study Protocol
Sport-Based Exercise in Pediatric Acquired Brain Injury: Protocol for a Randomized Controlled Trial
by Andrea Gutiérrez-Suárez, Marta Pérez-Rodríguez, Agurtzane Castrillo and Javier Pérez-Tejero
J. Clin. Med. 2025, 14(17), 5970; https://doi.org/10.3390/jcm14175970 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: Pediatric acquired brain injury (ABI) often results in persistent challenges that extend beyond motor impairments, affecting quality of life (QoL), social participation, and engagement in physical activity. Given the complexity and chronicity of these outcomes, there is a pressing need for [...] Read more.
Background/Objectives: Pediatric acquired brain injury (ABI) often results in persistent challenges that extend beyond motor impairments, affecting quality of life (QoL), social participation, and engagement in physical activity. Given the complexity and chronicity of these outcomes, there is a pressing need for multidimensional interventions grounded in the International Classification of Functioning, Disability and Health (ICF). Sport-based exercise interventions, when developmentally adapted and tailored to individual interests, may promote intrinsic motivation, peer connection, and sustainable engagement—factors especially relevant in pediatric ABI populations, who often experience reduced physical activity and social isolation. However, standardized, replicable protocols specifically tailored to this population remain scarce. This study presents the protocol for a randomized controlled trial evaluating the effects of a 16-week sport-based intervention on QoL, social participation, physical activity engagement, and motor functioning tailored for adolescents with pediatric ABI. Methods: Participants will be randomly assigned to an intervention group or a control group receiving usual care. The intervention consists of one weekly 60-minute session, led by trained professionals in adapted physical activity and pediatric neurorehabilitation. It combines sport-based motor skill training, cooperative games, and group activities specifically tailored to each child’s developmental level, motor abilities, and preferences. Outcomes will be assessed at baseline and following the 16-week intervention period, focusing on QoL, participation, physical activity engagement, and motor functioning. Discussion: This study introduces a structured, child-centered model that bridges clinical rehabilitation and community-based sport. By integrating motor and psychosocial targets through a group sport-based intervention, it aims to enhance recovery across ICF domains. Findings may inform interdisciplinary practice and support the development of sustainable strategies to promote long-term engagement and well-being in adolescents with ABI. Full article
(This article belongs to the Special Issue Clinical Advances in Traumatic Brain Injury)
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16 pages, 1673 KiB  
Article
Workflow Efficiency in Vaginal Cuff High Dose Rate Brachytherapy Using Artificial Intelligence-Based Organ Segmentation and Multi-Channel Cylinder Modeling
by Yohan A. Walter, Lane Rosen, Olivia Moncrief, Bethany Broekhoven, Troy Jacobs, Joseph Syh, Joseph Dugas, Kelsi Hoffnung, Mitchell Wolden, Heidi Wimberly, Jessica Nash, Melissa Camden, Daniel Speir, Krystal Jeffery, Philip Finley Durham, Kaylee Kallam and Hsinshun Terry Wu
Cancers 2025, 17(17), 2751; https://doi.org/10.3390/cancers17172751 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: High dose rate brachytherapy (HDR-BT) is resource-intensive. Workflow efficiency and inter-user variability remain prevalent issues in HDR-BT. To improve workflow efficiency and reduce inter-user variability, we introduced artificial intelligence (AI)-based organ contouring (AC) and applicator modeling (AM) into our clinical workflow. [...] Read more.
Background/Objectives: High dose rate brachytherapy (HDR-BT) is resource-intensive. Workflow efficiency and inter-user variability remain prevalent issues in HDR-BT. To improve workflow efficiency and reduce inter-user variability, we introduced artificial intelligence (AI)-based organ contouring (AC) and applicator modeling (AM) into our clinical workflow. Here, we present results on the impact of these tools on workflow efficiency, inter-user variability, and plan quality for vaginal cuff HDR-BT cases. Methods: 260 treated fractions were included in the analysis, half of which were treated before implementing AC and AM. Five different medical physicists performed the treatment planning. Using built-in timestamps, contouring, dose planning, and total treatment planning times were recorded for each fraction. Dosimetric data, including the dose to the highest 2cc (D2cc) of bladder and rectum, and percentage volumes of the target covered by 90–200% isodose lines (V90-200) were recorded. Analysis of variance with post-hoc Tukey tests were used to determine statistical differences between treatment planners before and after implementing AC and AM. Results: Implementing AC and AM resulted in an overall 13.7 ± 1.7-min reduction in planning time. Inter-user variability in organ and target dose metrics was reduced for most structures. Most notably, statistically significant differences in rectum D2cc and target V95 were observed between planners before, but not after, AC and AM implementation. Conclusions: AC and AM significantly improve workflow efficiency while maintaining plan quality. Reductions in inter-user variability and standardization of workflows may facilitate user training and robust outcome assessment. Full article
(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)
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18 pages, 1059 KiB  
Review
Between Promise and Proof: Evaluating PRP’s Role in Modern Gynecology
by Andreea Borislavschi and Aida Petca
Medicina 2025, 61(9), 1514; https://doi.org/10.3390/medicina61091514 (registering DOI) - 23 Aug 2025
Abstract
Autologous platelet-rich plasma (PRP) has emerged as a promising regenerative therapy in various medical fields, including the treatment of stress urinary incontinence (SUI) in women. PRP promotes regeneration by delivering a concentrated dose of platelets to damaged tissues, triggering healing mechanisms such as [...] Read more.
Autologous platelet-rich plasma (PRP) has emerged as a promising regenerative therapy in various medical fields, including the treatment of stress urinary incontinence (SUI) in women. PRP promotes regeneration by delivering a concentrated dose of platelets to damaged tissues, triggering healing mechanisms such as hemostasis, revascularization, and connective tissue regeneration through the release of growth factors. Despite evidence supporting the short- and medium-term benefits of PRP, its long-term efficacy remains unclear, largely due to the limited duration of follow-up in existing studies. Furthermore, the lack of standardized protocols for both preparation and administration of PRP poses a significant challenge to accurately assessing and comparing its sustained therapeutic outcomes. This literature review utilized comprehensive searches of PubMed and Google Scholar databases to analyze current evidence regarding PRP’s role in managing SUI in women. SUI, often resulting from weakened pubo-urethral ligament or intrinsic sphincter dysfunction due to childbirth, aging, or hormonal changes, significantly impacts quality of life. PRP offers a safe, minimally invasive, and cost-effective treatment option; however, further large-scale, well-designed studies are necessary to define optimal protocols and confirm long-term benefits. Advancing understanding of PRP therapy could substantially improve clinical management and patient quality of life in SUI. Full article
(This article belongs to the Section Obstetrics and Gynecology)
16 pages, 1267 KiB  
Systematic Review
Epidemiology and Diversity of Paratuberculosis in the Arabian Peninsula: A Systematic Review and Meta-Analysis with Implications for One Health
by Md Mazharul Islam, Ahmed K. Elfadl, Aisha Naeem, Randa Abdeen, Haya M. Al-Hajri, Md Abu Sayeed, Haileyesus Dejene, John I. Alawneh and Mohammad Mahmudul Hassan
Pathogens 2025, 14(9), 841; https://doi.org/10.3390/pathogens14090841 (registering DOI) - 23 Aug 2025
Abstract
Paratuberculosis is a chronic zoonotic bacterial infection, primarily affecting ruminants. This review examines the disease in the Arabian Peninsula, focusing on distribution, molecular diversity, prevalence, and associated risk factors. Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, and Web of [...] Read more.
Paratuberculosis is a chronic zoonotic bacterial infection, primarily affecting ruminants. This review examines the disease in the Arabian Peninsula, focusing on distribution, molecular diversity, prevalence, and associated risk factors. Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, and Web of Science. After duplicate removal and eligibility screening, data extraction, analysis, and quality assessment were performed. Pathogen sequences were retrieved from NCBI GenBank for phylogenetic analysis. The review included a total of 31 published articles from 1997 to 2025, of which 23 were used in the meta-analysis. Most studies (n = 12) were published between 2011 and 2015, predominantly from Saudi Arabia (n = 22), with no reports from Qatar, Bahrain, or Yemen. The majority of the studies involved camels and sheep (n = 16 on each species), followed by cattle (n = 9), goats (n = 7), humans (n = 2), and buffalo (n = 1). Phylogenetic analysis delineates two major clades—Type S and Type C—suggesting greater genetic diversity in Type S. The estimated pooled seroprevalence and pathogen prevalence in livestock ruminants were 8.1% and 22.4%, respectively. Herd-level estimated pooled seroprevalence was 26.9%. Small ruminants (19.3%) were more sero-prevalent than large ruminants (7.4%), with goats (28.7%) significantly (p < 0.01) more affected than sheep (21.5%), camel (9.8%), and cattle (6.6%). Clinical signs in ruminants included chronic diarrhea, emaciation, anorexia, alopecia, wry neck, and dehydration. The reviewed study patterns and findings suggest high pathogen diversity and a significant risk of transboundary transmission at the human–animal interface in this region. A One Health surveillance approach is crucial, particularly on farms with diarrheic and emaciated animals. Establishing a national surveillance plan and phased (short-, intermediate-, and long-term) control programs is essential to mitigate economic losses, limit transmission, overcome the cultural barrier, and protect public health. Full article
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17 pages, 2271 KiB  
Article
A Novel Protocol for Integrated Assessment of Upper Limbs Using the Optoelectronic Motion Analysis System: Validation and Usability in Healthy People
by Luca Emanuele Molteni, Luigi Piccinini, Daniele Panzeri, Ettore Micheletti and Giuseppe Andreoni
Bioengineering 2025, 12(9), 905; https://doi.org/10.3390/bioengineering12090905 (registering DOI) - 23 Aug 2025
Abstract
(1) Background: Upper limb (UL) function plays a central role in daily life, enabling essential tasks such as reaching, grasping, and eating. While numerous tools exist to evaluate UL kinematics, their application in pediatric populations is often limited by a lack of age-specific [...] Read more.
(1) Background: Upper limb (UL) function plays a central role in daily life, enabling essential tasks such as reaching, grasping, and eating. While numerous tools exist to evaluate UL kinematics, their application in pediatric populations is often limited by a lack of age-specific validation. This study presents a novel motion analysis protocol featuring a customized marker set, aimed at assessing UL movements in the three anatomical planes across different age groups, with a focus on pediatric applicability. (2) Materials and Methods: A SmartDX motion capture system was used, with 30 markers positioned on the upper body, referencing the trunk as the root of the kinematic chain. Ten healthy participants (mean age: 18.69 ± 12.45 years; range: 8.0–41.4) without UL impairments were recruited. The broad age range was intentionally selected to assess the protocol’s transversal applicability. (3) Results: Results showed excellent intra-operator reliability for shoulder and wrist kinematics (ICC > 0.906) and good reliability for elbow movements (ICC > 0.755). Inter-operator reliability was good to excellent (shoulder ICC > 0.958; elbow ICC > 0.762; wrist ICC > 0.826) Usability, measured via the System Usability Scale, was rated as good (83.25). (4) Conclusions: The proposed protocol demonstrated strong reliability and practical usability, supporting its adoption in clinical and research settings. Its design allows for adaptability across motion capture platforms, promoting wider implementation in pediatric UL functional assessment. Full article
(This article belongs to the Special Issue Biomechanics and Motion Analysis)
15 pages, 865 KiB  
Article
The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles
by Katarina Ivanovic, Lidija Tulic, Ivan Tulic, Stefan Ivanovic, Jelena Stojnic, Jovan Bila, Tatjana Dosev, Zeljka Vukovic and Branislav Milosevic
J. Clin. Med. 2025, 14(17), 5965; https://doi.org/10.3390/jcm14175965 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: The success of artificial reproductive technologies (ARTs) depends on different factors, such as patient-specific reproductive features, ovarian response to stimulation, oocyte and embryo quality, and endometrial receptivity. This study aimed to evaluate their association with oocyte yield, fertilization, endometrial thickness, and pregnancy [...] Read more.
Background/Objectives: The success of artificial reproductive technologies (ARTs) depends on different factors, such as patient-specific reproductive features, ovarian response to stimulation, oocyte and embryo quality, and endometrial receptivity. This study aimed to evaluate their association with oocyte yield, fertilization, endometrial thickness, and pregnancy outcomes. Methods: A prospective clinical study included 128 women undergoing IVF/ICSI. Baseline hormone levels (E2, P4, FSH, LH, AMH) were assessed prior to stimulation. E2 levels were monitored during stimulation, and P4 was measured on the day of oocyte retrieval. Patients were grouped based on P4 levels (<2 ng/mL vs. ≥2 ng/mL). IVF outcomes and endometrial characteristics were statistically analyzed. Results: Lower P4 levels (<2 ng/mL) on the day of oocyte retrieval were significantly associated with higher fertilization rates (p < 0.003), more fertilized oocytes (p < 0.001), and increased pregnancy rates (p < 0.001). Elevated P4 (≥2 ng/mL) correlated with a higher frequency of thin endometrium (<7 mm, p < 0.007). E2 levels on the hCG trigger day correlated positively with the number of retrieved and mature oocytes and fertilization outcomes (p < 0.05). Patients who achieved pregnancy had lower P4 and BMI, and higher E2, AMH, and endometrial thickness. ROC identified a P4 threshold of 1.99 ng/mL with moderate predictive value. Conclusions: Elevated progesterone levels on the day of oocyte retrieval negatively impact fertilization and pregnancy outcomes, likely due to impaired endometrial receptivity. Combined assessment of P4, E2, AMH, and endometrial thickness may enhance embryo transfer planning and improve IVF success rates. Full article
(This article belongs to the Special Issue Female Infertility: Clinical Diagnosis and Treatment)
27 pages, 3086 KiB  
Article
Trimetazidine–Profen Hybrid Molecules: Synthesis, Chemical Characterization, and Biological Evaluation of Their Racemates
by Diyana Dimitrova, Stanimir Manolov, Iliyan Ivanov, Dimitar Bojilov, Nikol Dimova, Gabriel Marc, Smaranda Oniga and Ovidiu Oniga
Pharmaceuticals 2025, 18(9), 1251; https://doi.org/10.3390/ph18091251 (registering DOI) - 23 Aug 2025
Abstract
Background: Trimetazidine is a clinically established cardioprotective agent with anti-ischemic and antioxidant properties, widely used in the management of coronary artery disease. Combining its metabolic and cytoprotective effects with the potent anti-inflammatory activity of profens presents a promising therapeutic strategy. Methods: Five novel [...] Read more.
Background: Trimetazidine is a clinically established cardioprotective agent with anti-ischemic and antioxidant properties, widely used in the management of coronary artery disease. Combining its metabolic and cytoprotective effects with the potent anti-inflammatory activity of profens presents a promising therapeutic strategy. Methods: Five novel trimetazidine–profen hybrid compounds were synthesized using N,N′-dicyclohexylcarbodiimide-mediated coupling and structurally characterized by NMR and high-resolution mass spectrometry. Their antioxidant activity was evaluated by hydroxyl radical scavenging assays (HRSA), and the anti-inflammatory potential was assessed via the inhibition of albumin denaturation (IAD). Lipophilicity was determined chromatographically. Molecular docking and 100 ns molecular dynamics simulations were performed to investigate the binding modes and stability in human serum albumin (HSA) binding sites. The acute toxicity of the hybrid molecules was predicted in silico using GUSAR software. Results: All synthesized hybrids demonstrated varying degrees of biological activity, with compound 3c exhibiting the most potent antioxidant (HRSA IC₅₀ = 71.13 µg/mL) and anti-inflammatory (IAD IC₅₀ = 108.58 µg/mL) effects. Lipophilicity assays indicated moderate membrane permeability, with compounds 3c and 3d showing favorable profiles. Docking studies revealed stronger binding affinities of S-enantiomers, particularly 3c and 3d, to Sudlow sites II and III in HSA. Molecular dynamics simulations confirmed stable ligand–protein complexes, highlighting compound 3c as maintaining consistent and robust interactions. The toxicity results indicate that most hybrids, particularly compounds 3b3d, exhibit a favorable safety profile compared to the parent trimetazidine. Conclusion: The hybrid trimetazidine–profen compounds synthesized herein, especially compound 3c, demonstrate promising dual antioxidant and anti-inflammatory therapeutic potential. Their stable interaction with serum albumin and balanced physicochemical properties support further development as novel agents for managing ischemic heart disease and associated inflammatory conditions. Full article
(This article belongs to the Special Issue Advances in the Medicinal Synthesis of Bioactive Compounds)
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11 pages, 393 KiB  
Systematic Review
Systematic Review of the Treatment of Anosognosia for Hemiplegia in Stroke
by Dong Chan Kim, Junghyeon Park and Min Wook Kim
Brain Sci. 2025, 15(9), 906; https://doi.org/10.3390/brainsci15090906 (registering DOI) - 23 Aug 2025
Abstract
Background/Objectives: Anosognosia for hemiplegia (AHP) is a multifaceted syndrome in which stroke survivors fail to recognize motor impairments. Although AHP has significant clinical implications, rehabilitation strategies have remained fragmented and underexplored. This systematic review aimed to critically evaluate rehabilitation interventions for AHP [...] Read more.
Background/Objectives: Anosognosia for hemiplegia (AHP) is a multifaceted syndrome in which stroke survivors fail to recognize motor impairments. Although AHP has significant clinical implications, rehabilitation strategies have remained fragmented and underexplored. This systematic review aimed to critically evaluate rehabilitation interventions for AHP published between 2006 and 2025, categorize intervention types, and assess clinical outcomes to inform future research and practice. Methods: A structured search was conducted in the PubMed and PsycINFO databases on 31 March 2025, using predefined keywords related to stroke, anosognosia, and rehabilitation. The eligible studies included randomized controlled trials, case–control studies, and case studies. Following title, abstract, and full-text screening, nine studies focusing on rehabilitation interventions for AHP were selected and analyzed. Results: The interventions reviewed included sensorimotor recalibration techniques, neuromodulatory approaches, error-based cognitive training, and self-observation in video replay strategies. Interventions emphasizing motor intention monitoring, error correction, and self-observation were more consistently associated with durable improvements in motor awareness than neglect-based spatial interventions were. However, many studies were limited by small sample sizes and a lack of standardized outcome measures. Assessment methodologies vary widely, highlighting the need for multidimensional theory-driven evaluation tools. Conclusions: Effective rehabilitation for AHP requires strategies targeting disrupted self-monitoring and agency mechanisms, rather than spatial realignment alone. The video self-observation and error-based learning paradigms show particular promise. Future research should focus on controlled trials, longitudinal tracking, and the integration of individualized, mechanism-specific rehabilitation models to optimize outcomes for stroke survivors with AHP. Full article
(This article belongs to the Special Issue Anosognosia and the Determinants of Self-Awareness)
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