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Search Results (619)

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15 pages, 1726 KiB  
Systematic Review
Application of Augmented Reality in Reverse Total Shoulder Arthroplasty: A Systematic Review
by Jan Orlewski, Bettina Hochreiter, Karl Wieser and Philipp Kriechling
J. Clin. Med. 2025, 14(15), 5533; https://doi.org/10.3390/jcm14155533 - 6 Aug 2025
Abstract
Background: Reverse total shoulder arthroplasty (RTSA) is increasingly used for managing cuff tear arthropathy, osteoarthritis, complex fractures, and revision procedures. As the demand for surgical precision and reproducibility grows, immersive technologies such as virtual reality (VR), augmented reality (AR), and metaverse-based platforms are [...] Read more.
Background: Reverse total shoulder arthroplasty (RTSA) is increasingly used for managing cuff tear arthropathy, osteoarthritis, complex fractures, and revision procedures. As the demand for surgical precision and reproducibility grows, immersive technologies such as virtual reality (VR), augmented reality (AR), and metaverse-based platforms are being explored for surgical training, intraoperative guidance, and rehabilitation. While early data suggest potential benefits, a focused synthesis specific to RTSA is lacking. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, and Cochrane Library databases was performed through 30 May 2025. Eligible studies included those evaluating immersive technologies in the context of RTSA for skill acquisition or intraoperative guidance. Only peer-reviewed articles published in English were included. Data were synthesized narratively due to heterogeneity in study design and outcome metrics. Results: Out of 628 records screened, 21 studies met the inclusion criteria. Five studies evaluated immersive VR for surgical training: four randomized controlled trials and one retrospective case series. VR training improved procedural efficiency and showed non-inferiority to cadaveric training. Sixteen studies investigated intraoperative navigation or AR guidance. Clinical and cadaveric studies consistently reported improved accuracy in glenoid baseplate positioning with reduced angular and linear deviations in postoperative controls as compared to preoperative planning. Conclusions: Immersive technologies show promise in enhancing training, intraoperative accuracy, and procedural consistency in RTSA. VR and AR platforms may support standardized surgical education and precision-based practice, but their broad clinical impact remains limited by small sample sizes, heterogeneous methodologies, and limited long-term outcomes. Further multicenter trials with standardized endpoints and cost-effectiveness analyses are warranted. Postoperative rehabilitation using immersive technologies in RTSA remains underexplored and presents an opportunity for future research. Full article
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23 pages, 789 KiB  
Perspective
Therapeutic Cancer Vaccines in Colorectal Cancer: Platforms, Mechanisms, and Combinations
by Chiara Gallio, Luca Esposito and Alessandro Passardi
Cancers 2025, 17(15), 2582; https://doi.org/10.3390/cancers17152582 - 6 Aug 2025
Abstract
Colorectal cancer (CRC) remains one of the most lethal malignancies worldwide, with high recurrence rates and limited curative options in metastatic settings. Cancer vaccines represent an emerging immunotherapeutic approach that aims to stimulate robust, tumor-specific immune responses. This review summarizes the current state [...] Read more.
Colorectal cancer (CRC) remains one of the most lethal malignancies worldwide, with high recurrence rates and limited curative options in metastatic settings. Cancer vaccines represent an emerging immunotherapeutic approach that aims to stimulate robust, tumor-specific immune responses. This review summarizes the current state of CRC vaccine development, including tumor cell-based, dendritic cell-based, peptide-based, nucleic acid-based (DNA and mRNA), and virus-based platforms. We highlight findings from key clinical trials that demonstrate immunogenicity, safety, and preliminary efficacy, with particular attention to combinations with chemotherapy and immune checkpoint inhibitors. Furthermore, we explore critical challenges such as tumor heterogeneity, immunosuppressive tumor microenvironments, and the logistical complexity; in this context, we particularly focus on the current development of personalized cancer vaccines, exploring the newly identified encouraging epitopes and their safety and efficacy in recent trials. The integration of cancer vaccines with in silico modeling, advanced delivery systems such as nanoparticles or AI-guided designs, and microbiome modulation represents a promising avenue for enhancing their clinical utility. Overall, therapeutic and prophylactic cancer vaccines may soon contribute meaningfully to the comprehensive management of CRC, especially in settings of minimal residual disease or early recurrence. Full article
(This article belongs to the Special Issue Exploring Immunotherapy in Colorectal Cancer)
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15 pages, 958 KiB  
Article
Can Plantar Pressure Distribution During Gait Be Estimated from Quiet Stance in Healthy Individuals?
by Marta Mirando, Chiara Pavese, Valeria Pingue, Stefania Sozzi and Antonio Nardone
J. Funct. Morphol. Kinesiol. 2025, 10(3), 301; https://doi.org/10.3390/jfmk10030301 - 5 Aug 2025
Viewed by 89
Abstract
Objectives: We assessed the difference between quiet stance and gait in the spatial distribution and intensity of foot plantar pressures and whether it is possible to estimate the distribution during gait from data obtained during stance. Methods: A total of 60 [...] Read more.
Objectives: We assessed the difference between quiet stance and gait in the spatial distribution and intensity of foot plantar pressures and whether it is possible to estimate the distribution during gait from data obtained during stance. Methods: A total of 60 healthy subjects with a mean age of 31.0 ± 9.4 years performed two trials for quiet stance and four trials for gait on a baropodometric walkway with their eyes open. Foot plantar pressures were recorded from 10 areas of the foot sole. Results: During quiet stance, the highest plantar pressure occurred at metatarsal heads (M2 to M4) and the medial (MH) and lateral halves of the heel (LH). During gait, the profile of plantar pressure values was like that during stance, but significantly higher. The differences concentrated at the big toe (T1), M2 to M4, MH, and LH, whilst toes (T2,3,4,5) and midfoot (MF) showed the smallest difference. A significant positive correlation was found between the corresponding areas of foot pressure during gait and stance. Conclusions: During quiet stance and gait, the overall profile of plantar pressure distribution was similar. During quiet stance, the subjects loaded more on the heels, in keeping with the known position of the center of pressure just in front of the ankles. During gait, higher pressures on the metatarsal areas are related to the forward propulsion of the center of mass. The correlation between the corresponding areas of foot pressure during gait and stance suggests that the pressure distribution during gait can partly be estimated from that during stance. This finding might be useful in most clinical settings when a single sensorized platform rather than a complete walkway is available. Full article
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39 pages, 2336 KiB  
Review
Omics-Mediated Treatment for Advanced Prostate Cancer: Moving Towards Precision Oncology
by Yasra Fatima, Kirubel Nigusu Jobre, Enrique Gomez-Gomez, Bartosz Małkiewicz, Antonia Vlahou, Marika Mokou, Harald Mischak, Maria Frantzi and Vera Jankowski
Int. J. Mol. Sci. 2025, 26(15), 7475; https://doi.org/10.3390/ijms26157475 - 2 Aug 2025
Viewed by 334
Abstract
Prostate cancer accounts for approximately 1.5 million new diagnoses and 400,000 deaths every year worldwide, and demographic projections indicate a near-doubling of both figures by 2040. Despite existing treatments, 10–20% of patients eventually progress to metastatic castration-resistant disease (mCRPC). The median overall survival [...] Read more.
Prostate cancer accounts for approximately 1.5 million new diagnoses and 400,000 deaths every year worldwide, and demographic projections indicate a near-doubling of both figures by 2040. Despite existing treatments, 10–20% of patients eventually progress to metastatic castration-resistant disease (mCRPC). The median overall survival (OS) after progression to mCPRC drops to 24 months, and efficacy drops severely after each additional line of treatment. Omics platforms have reached advanced levels and enable the acquisition of high-resolution large datasets that can provide insights into the molecular mechanisms underlying PCa pathology. Genomics, especially DDR (DNA damage response) gene alterations, detected via tissue and/or circulating tumor DNA, efficiently guides therapy in advanced prostate cancer. Given recent developments, we have performed a comprehensive literature search to cover recent research and clinical trial reports (over the last five years) that integrate omics along three converging trajectories in therapeutic development: (i) predicting response to approved agents with demonstrated survival benefits, (ii) stratifying patients to receive therapies in clinical trials, (iii) guiding drug development as part of drug repurposing frameworks. Collectively, this review is intended to serve as a comprehensive resource of recent advancements in omics-guided therapies for advanced prostate cancer, a clinical setting with existing clinical needs and poor outcomes. Full article
(This article belongs to the Special Issue Molecular Research on Prostate Cancer)
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17 pages, 3101 KiB  
Article
Comparison of Zeiss MEL90 and Alcon WaveLight EX500 Excimer Lasers in FDA Premarket Approval Trials for the Treatment of Myopia, Hyperopia, and Mixed Astigmatism
by Traeson M. Brandenburg, Mina M. Sitto, Phillip C. Hoopes and Majid Moshirfar
J. Clin. Med. 2025, 14(15), 5403; https://doi.org/10.3390/jcm14155403 - 31 Jul 2025
Viewed by 281
Abstract
Background/Objectives: Although both the MEL90 (Carl Zeiss Meditec AG, Jena, Germany) and WaveLight EX500 (Alcon Laboratories, Inc., Fort Worth, TX, USA) are two widely used excimer lasers, comparisons between the two remain limited. This study evaluates visual and refractive outcomes from the [...] Read more.
Background/Objectives: Although both the MEL90 (Carl Zeiss Meditec AG, Jena, Germany) and WaveLight EX500 (Alcon Laboratories, Inc., Fort Worth, TX, USA) are two widely used excimer lasers, comparisons between the two remain limited. This study evaluates visual and refractive outcomes from the U.S. Food and Drug Administration (FDA) premarket approval trials of these platforms in the treatment of myopia with and without astigmatism, hyperopia with and without astigmatism, and mixed astigmatism. Methods: Clinical outcomes from FDA premarket approval trials were compared between the recently approved MEL90 and the WaveLight (now termed EX500) excimer lasers. Results: A total of 714 eyes (358 patients) from MEL90 and 1353 eyes (706 patients) from EX500 were analyzed up to 6 months postoperatively. In the hyperopia/hyperopic astigmatism cohort, the EX500 demonstrated greater efficacy relative to MEL90, with more eyes achieving a postoperative uncorrected distance visual acuity (UDVA) of 20/20 or better (48.6% vs. 68.7%, respectively; p < 0.001). In both the MEL90 and EX500, at least 85% of eyes with myopia/myopic astigmatism and 68% with mixed astigmatism achieved a postoperative UDVA of 20/20 or better. For all refractive cohorts, more than 95% of eyes achieved a UDVA of 20/40 or better at 6 months (all p > 0.05). The EX500 was more likely to demonstrate an improvement of more than two lines of UDVA compared to baseline CDVA (all p < 0.05). In contrast, the MEL90 showed greater predictability of spherical equivalent within ±0.50 D and ±1.00 D for the hyperopia/hyperopic astigmatism cohort (both p = 0.007), as well as within ±0.50 D for the myopia/myopic astigmatism cohort (p < 0.001). Postoperatively, both platforms were associated with decreased glare and halos, although findings were variable in the EX500 mixed astigmatism cohort. Conclusions: Both excimer lasers demonstrated safe and effective outcomes that exceed the threshold set by the FDA. Full article
(This article belongs to the Section Ophthalmology)
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24 pages, 3726 KiB  
Article
Telemedicine-Supported CPAP Therapy in Patients with Obstructive Sleep Apnea: Association with Treatment Adherence and Clinical Outcomes
by Norbert Wellmann, Versavia Maria Ancusa, Monica Steluta Marc, Ana Adriana Trusculescu, Camelia Corina Pescaru, Flavia Gabriela Martis, Ioana Ciortea, Alexandru Florian Crisan, Adelina Maritescu, Madalina Alexandra Balica and Ovidiu Fira-Mladinescu
J. Clin. Med. 2025, 14(15), 5339; https://doi.org/10.3390/jcm14155339 - 29 Jul 2025
Viewed by 229
Abstract
Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent disorder that significantly impacts quality of life and daily functioning. While continuous positive airway pressure (CPAP) therapy is effective, long-term adherence remains a challenge. This single-arm observational study aimed to evaluate clinical outcomes and [...] Read more.
Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent disorder that significantly impacts quality of life and daily functioning. While continuous positive airway pressure (CPAP) therapy is effective, long-term adherence remains a challenge. This single-arm observational study aimed to evaluate clinical outcomes and adherence patterns during telemedicine-supported CPAP therapy and identify distinct phenotypic response clusters in Romanian patients with OSA. Methods: This prospective observational study included 86 adults diagnosed with OSA, treated with ResMed Auto CPAP devices at “Victor Babeș” University Hospital in Timișoara, Romania. All patients were remotely monitored via the AirView™ platform and received monthly telephone interventions to promote adherence when necessary. Clinical outcomes were assessed through objective telemonitoring data. K-means clustering and t-distributed stochastic neighbor embedding (t-SNE) were employed to explore phenotypic response patterns. Results: During telemedicine-supported CPAP therapy, significant clinical improvements were observed. The apnea–hypopnea index (AHI) decreased from 42.0 ± 21.1 to 1.9 ± 1.3 events/hour. CPAP adherence improved from 75.5% to 90.5% over six months. Average daily usage increased from 348.4 ± 85.8 to 384.2 ± 65.2 min. However, post hoc analysis revealed significant concerns about the validity of self-reported psychological improvements. Self-esteem changes showed negligible correlation with objective clinical measures (r < 0.2, all p > 0.1), with only 3.3% of variance being explained by measurable therapeutic factors (R2 = 0.033). Clustering analysis identified four distinct adherence and outcome profiles, yet paradoxically, patients with lower adherence showed greater self-esteem improvements, contradicting therapeutic causation. Conclusions: Telemedicine-supported CPAP therapy with structured monthly interventions was associated with substantial clinical improvements, including excellent AHI reduction (22-fold) and high adherence rates (+15% after 6 months). Data-driven phenotyping successfully identified distinct patient response profiles, supporting personalized management approaches. However, the single-arm design prevents definitive attribution of improvements to telemonitoring versus natural adaptation or placebo effects. Self-reported psychological outcomes showed concerning patterns suggesting predominant placebo responses rather than therapeutic benefits. While the overall findings demonstrate the potential value of structured telemonitoring for objective CPAP outcomes, controlled trials are essential to establishing true therapeutic efficacy and distinguishing intervention effects from measurement bias. Full article
(This article belongs to the Special Issue Advances in Pulmonary Disease Management and Innovation in Treatment)
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21 pages, 529 KiB  
Review
Is Transmural Healing an Achievable Goal in Inflammatory Bowel Disease?
by Ilaria Faggiani, Virginia Solitano, Ferdinando D’Amico, Tommaso Lorenzo Parigi, Alessandra Zilli, Federica Furfaro, Laurent Peyrin-Biroulet, Silvio Danese and Mariangela Allocca
Pharmaceuticals 2025, 18(8), 1126; https://doi.org/10.3390/ph18081126 - 27 Jul 2025
Viewed by 525
Abstract
Background/Objectives: In the era of treat-to-target strategies in inflammatory bowel disease (IBD), transmural healing (TH) is gaining recognition as a promising therapeutic goal. TH has been associated with significantly better long-term outcomes, including reduced rates of hospitalization, surgery, and the need for [...] Read more.
Background/Objectives: In the era of treat-to-target strategies in inflammatory bowel disease (IBD), transmural healing (TH) is gaining recognition as a promising therapeutic goal. TH has been associated with significantly better long-term outcomes, including reduced rates of hospitalization, surgery, and the need for therapy escalation. Cross-sectional imaging techniques, such as intestinal ultrasound (IUS), magnetic resonance imaging (MRI), and computed tomography enterography (CTE), offer a comprehensive, non-invasive means to assess this deeper level of healing. This review explores how TH is currently defined across various imaging modalities and evaluates the feasibility and cost-effectiveness of achieving TH with available therapies. Methods: A literature search was conducted across PubMed, Scopus, and Embase using keywords, including “transmural healing”, “intestinal ultrasonography”, “magnetic resonance imaging”, “computed tomography enterography”, “Crohn’s disease”, “ulcerative colitis”, and “inflammatory bowel disease”. Only English-language studies were considered. Results: Despite growing interest, there is no standardized definition of TH across imaging platforms. Among the modalities, IUS emerges as the most feasible and cost-effective tool, owing to its accessibility, accuracy (sensitivity 62–95.2%, specificity 61.5–100%), and real-time capabilities, though it does have limitations. Current advanced therapies induce TH in roughly 20–40% of patients, with no consistent differences observed between biologics and small molecules. However, TH has only been evaluated as a formal endpoint in a single randomized controlled trial to date. Conclusions: A unified and validated definition of transmural healing is critically needed to harmonize research and guide clinical decision-making. While TH holds promise as a meaningful treatment target linked to improved outcomes, existing therapies often fall short of achieving complete transmural resolution. Further studies are essential to clarify its role and optimize strategies for deep healing in IBD. Full article
(This article belongs to the Special Issue Pharmacotherapy of Inflammatory Bowel Disease)
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17 pages, 4394 KiB  
Article
Nonclinical Human Cardiac New Approach Methodologies (NAMs) Predict Vanoxerine-Induced Proarrhythmic Potential
by M. Iveth Garcia, Bhavya Bhardwaj, Keri Dame, Verena Charwat, Brian A. Siemons, Ishan Goswami, Omnia A. Ismaiel, Sabyasachy Mistry, Tromondae K. Feaster, Kevin E. Healy, Alexandre J. S. Ribeiro and Ksenia Blinova
J. Cardiovasc. Dev. Dis. 2025, 12(8), 285; https://doi.org/10.3390/jcdd12080285 - 26 Jul 2025
Viewed by 454
Abstract
New approach methodologies (NAMs), including microphysiological systems (MPSs), can recapitulate structural and functional complexities of organs. Vanoxerine was reported to induce cardiac adverse events, including torsade de points (TdP), in a Phase III clinical trial. Despite earlier nonclinical animal models and Phase I–II [...] Read more.
New approach methodologies (NAMs), including microphysiological systems (MPSs), can recapitulate structural and functional complexities of organs. Vanoxerine was reported to induce cardiac adverse events, including torsade de points (TdP), in a Phase III clinical trial. Despite earlier nonclinical animal models and Phase I–II clinical trials, events of QT prolongation or proarrhythmia were not observed. Here, we utilized cardiac NAMs to evaluate the functional consequences of vanoxerine treatment on human cardiac excitation–contraction coupling. The cardiac MPS used in this study was a microfabricated fluidic culture platform with human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) capable of evaluating voltage, intracellular calcium handling, and contractility. Likewise, the hiPSC-CM comprehensive in vitro proarrhythmia assay (CiPA) was employed based on multielectrode array (MEA). Vanoxerine treatment delayed repolarization in a concentration-dependent manner and induced proarrhythmic events in both NAM platforms. The complex cardiac MPS displayed a frequency-dependent vanoxerine response such that EADs were eliminated at a faster pacing rate (1.5 Hz). Moreover, exposure analysis revealed a 99% vanoxerine loss in the cardiac MPS. TdP risk analysis demonstrated high to intermediate TdP risk at clinically relevant concentrations of vanoxerine and frequency-independent EAD events in the hiPSC-CM CiPA model. These findings demonstrate that nonclinical cardiac NAMs can recapitulate clinical outcomes, including detection of vanoxerine-induced delayed repolarization and proarrhythmic effects. Moreover, this work provides a foundation to evaluate the safety and efficacy of novel compounds to reduce the dependence on animal studies. Full article
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33 pages, 1777 KiB  
Review
Immunomodulatory Natural Products in Cancer Organoid-Immune Co-Cultures: Bridging the Research Gap for Precision Immunotherapy
by Chang-Eui Hong and Su-Yun Lyu
Int. J. Mol. Sci. 2025, 26(15), 7247; https://doi.org/10.3390/ijms26157247 - 26 Jul 2025
Viewed by 619
Abstract
Natural products demonstrate potent immunomodulatory properties through checkpoint modulation, macrophage polarization, and T cell/natural killer (NK) cell activation. While cancer organoid-immune co-culture platforms enable physiologically relevant modeling of tumor–immune interactions, systematic investigation of natural product immunomodulation in these systems remains entirely unexplored. We [...] Read more.
Natural products demonstrate potent immunomodulatory properties through checkpoint modulation, macrophage polarization, and T cell/natural killer (NK) cell activation. While cancer organoid-immune co-culture platforms enable physiologically relevant modeling of tumor–immune interactions, systematic investigation of natural product immunomodulation in these systems remains entirely unexplored. We conducted a comprehensive literature analysis examining natural products tested in cancer organoids, immunomodulatory mechanisms from traditional models, technical advances in organoid-immune co-cultures, and standardization requirements for clinical translation. Our analysis reveals a critical research gap: no published studies have investigated natural product-mediated immunomodulation using organoid-immune co-culture systems. Even though compounds like curcumin, resveratrol, and medicinal mushroom polysaccharides show extensive immunomodulatory effects in two-dimensional (2D) cultures, and organoid technology achieves high clinical correlation for drug response prediction, all existing organoid studies focus exclusively on direct cytotoxicity. Technical challenges include compound stability, limited matrix penetration requiring substantially higher concentrations than 2D cultures, and maintaining functional immune populations in three-dimensional (3D) systems. The convergence of validated organoid-immune co-culture platforms, Food and Drug Administration (FDA) regulatory support through the Modernization Act 2.0, and extensive natural product knowledge creates unprecedented opportunities. Priority research directions include systematic screening of immunomodulatory natural products in organoid-immune co-cultures, development of 3D-optimized delivery systems, and clinical validation trials. Success requires moving beyond cytotoxicity-focused studies to investigate immunomodulatory mechanisms in physiologically relevant 3D systems, potentially unlocking new precision cancer immunotherapy approaches. Full article
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19 pages, 5345 KiB  
Article
Identification of Novel Biomarkers in Huntington’s Disease Based on Differential Gene Expression Meta-Analysis and Machine Learning Approach
by Nayan Dash, Md Abul Bashar, Jeonghan Lee and Raju Dash
Appl. Sci. 2025, 15(15), 8286; https://doi.org/10.3390/app15158286 - 25 Jul 2025
Viewed by 204
Abstract
Huntington’s disease (HD) is a severe and progressive neurodegenerative disease for which therapeutic options have so far been confined to symptomatic treatment. Currently, the diagnosis relies on the signs and symptoms shown by patients; however, by that stage, the psychomotor issues have progressed [...] Read more.
Huntington’s disease (HD) is a severe and progressive neurodegenerative disease for which therapeutic options have so far been confined to symptomatic treatment. Currently, the diagnosis relies on the signs and symptoms shown by patients; however, by that stage, the psychomotor issues have progressed to a point where reversal of the condition is unattainable. Although numerous clinical trials have been actively investigating therapeutic agents aimed at preventing the onset of disease or slowing down the disease progression, there has been a constant need for reliable biomarkers to assess neurodegeneration, monitor disease progression, and assess the efficacy of treatments accurately. Therefore, to discover the key biomarkers associated with the progression of HD, we employed bioinformatics and machine learning (ML) to create a robust pipeline that integrated differentially expressed gene (DEG) analysis with ML to select potential biomarkers. We performed a meta-analysis to identify DEGs using three Gene Expression Omnibus (GEO) microarray datasets from different platforms related to HD-affected brain tissue, applying both relaxed and strict criteria to identify differentially expressed genes. Subsequently, focusing only on genes identified through the inclusive threshold, we employed 19 diverse ML techniques to explore the common genes that contributed to the top three selected ML algorithms and the shared genes that had an impact on the ML algorithms and were observed in the meta-analysis using the stringent condition were selected. Additionally, a receiver operating characteristic (ROC) analysis was conducted on external datasets to validate the discriminatory power of the identified genes. Based on the results of an inverse variance weighted meta-analysis of the AUCs across both human and mouse cohorts, GABRD and PHACTR1 were identified as the most robust candidates and were selected as key biomarkers for HD. Our comprehensive methodology, which integrates DEG meta-analysis with ML techniques, enabled a systematic prioritization of these biomarkers, providing valuable insights into their biological significance and potential for further validation in clinical research. Full article
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13 pages, 442 KiB  
Review
Sensor Technologies and Rehabilitation Strategies in Total Knee Arthroplasty: Current Landscape and Future Directions
by Theodora Plavoukou, Spiridon Sotiropoulos, Eustathios Taraxidis, Dimitrios Stasinopoulos and George Georgoudis
Sensors 2025, 25(15), 4592; https://doi.org/10.3390/s25154592 - 24 Jul 2025
Viewed by 328
Abstract
Total Knee Arthroplasty (TKA) is a well-established surgical intervention for the management of end-stage knee osteoarthritis. While the procedure is generally successful, postoperative rehabilitation remains a key determinant of long-term functional outcomes. Traditional rehabilitation protocols, particularly those requiring in-person clinical visits, often encounter [...] Read more.
Total Knee Arthroplasty (TKA) is a well-established surgical intervention for the management of end-stage knee osteoarthritis. While the procedure is generally successful, postoperative rehabilitation remains a key determinant of long-term functional outcomes. Traditional rehabilitation protocols, particularly those requiring in-person clinical visits, often encounter limitations in accessibility, patient adherence, and personalization. In response, emerging sensor technologies have introduced innovative solutions to support and enhance recovery following TKA. This review provides a thematically organized synthesis of the current landscape and future directions of sensor-assisted rehabilitation in TKA. It examines four main categories of technologies: wearable sensors (e.g., IMUs, accelerometers, gyroscopes), smart implants, pressure-sensing systems, and mobile health (mHealth) platforms such as ReHub® and BPMpathway. Evidence from recent randomized controlled trials and systematic reviews demonstrates their effectiveness in tracking mobility, monitoring range of motion (ROM), detecting gait anomalies, and delivering real-time feedback to both patients and clinicians. Despite these advances, several challenges persist, including measurement accuracy in unsupervised environments, the complexity of clinical data integration, and digital literacy gaps among older adults. Nevertheless, the integration of artificial intelligence (AI), predictive analytics, and remote rehabilitation tools is driving a shift toward more adaptive and individualized care models. This paper concludes that sensor-enhanced rehabilitation is no longer a future aspiration but an active transition toward a smarter, more accessible, and patient-centered paradigm in recovery after TKA. Full article
(This article belongs to the Section Biosensors)
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25 pages, 7428 KiB  
Article
Sialic Acid-Loaded Nanoliposomes with Enhanced Stability and Transdermal Delivery for Synergistic Anti-Aging, Skin Brightening, and Barrier Repair
by Fan Yang, Hua Wang, Dan Luo, Jun Deng, Yawen Hu, Zhi Liu and Wei Liu
Pharmaceutics 2025, 17(8), 956; https://doi.org/10.3390/pharmaceutics17080956 - 24 Jul 2025
Viewed by 323
Abstract
Objectives: Sialic acid (SA), a naturally occurring compound abundantly found in birds’ nests, holds immense promise for skincare applications owing to its remarkable biological properties. However, its low bioavailability, poor stability, and limited skin permeability have constrained its widespread application. Methods: [...] Read more.
Objectives: Sialic acid (SA), a naturally occurring compound abundantly found in birds’ nests, holds immense promise for skincare applications owing to its remarkable biological properties. However, its low bioavailability, poor stability, and limited skin permeability have constrained its widespread application. Methods: To overcome these challenges, SA was encapsulated within nanoliposomes (NLPs) by the high-pressure homogenization technique to develop an advanced and efficient transdermal drug delivery system. The skincare capabilities of this novel system were comprehensively evaluated across multiple experimental platforms, including in vitro cell assays, 3D skin models, in vivo zebrafish studies, and clinical human trials. Results: The SA-loaded NLPs (SA-NLPs) substantially improved the transdermal penetration and retention of SA, facilitating enhanced cellular uptake and cell proliferation. Compared to free SA, SA-NLPs demonstrated a 246.98% increase in skin retention and 1.8-fold greater cellular uptake in HDF cells. Moreover, SA-NLPs protected cells from oxidative stress-induced damage, stimulated collagen synthesis, and effectively suppressed the secretion of matrix metalloproteinases, tyrosinase activity, and melanin production. Additionally, zebrafish-based assays provided in vivo evidence of the skincare efficacy of SA-NLPs. Notably, clinical evaluations demonstrated that a 56-day application of the SA-NLPs-containing cream resulted in a 4.20% increase in L*, 7.87% decrease in b*, 8.45% decrease in TEWL, and 4.01% reduction in wrinkle length, indicating its superior brightening, barrier-repair, and anti-aging effects. Conclusions: This multi-level, systematic investigation strongly suggests that SA-NLPs represent a highly promising transdermal delivery strategy, capable of significantly enhancing the anti-aging, barrier-repair, and skin-brightening properties of SA, thus opening new avenues for its application in the fields of dermatology and cosmeceuticals. Full article
(This article belongs to the Special Issue Lipid/Polymer-Based Drug Delivery Systems)
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14 pages, 787 KiB  
Article
Preimplantation Genetic Testing for Aneuploidy Versus Morphological Selection in Women Aged 35–42: Results of a Pilot Randomized Controlled Trial
by Yusuf Beebeejaun, Daniela Bakalova, Anastasia Mania, Timothy Copeland, Ippokratis Sarris, Kypros Nicolaides, Antonio Capalbo and Sesh K. Sunkara
J. Clin. Med. 2025, 14(14), 5166; https://doi.org/10.3390/jcm14145166 - 21 Jul 2025
Viewed by 516
Abstract
Background/Objectives: Embryo selection in IVF is traditionally based on morphology, yet many high-quality embryos fail to implant. Preimplantation genetic testing for aneuploidy (PGT-A) using next-generation sequencing (NGS) has been proposed to improve selection by identifying euploid embryos. However, its effectiveness in women [...] Read more.
Background/Objectives: Embryo selection in IVF is traditionally based on morphology, yet many high-quality embryos fail to implant. Preimplantation genetic testing for aneuploidy (PGT-A) using next-generation sequencing (NGS) has been proposed to improve selection by identifying euploid embryos. However, its effectiveness in women of advanced maternal age remains unclear due to limited randomized data. This pilot trial assessed the feasibility of a full-scale RCT comparing PGT-A to morphology-based selection in women aged 35–42. Methods: This single-centre, two-arm parallel RCT (NCT05009745) enrolled women aged 35–42 undergoing IVF/ICSI with ≥3 good-quality day-3 embryos. Participants were randomized (1:1) to either embryo selection by morphology with fresh transfer or PGT-A with frozen transfer of a single euploid embryo. Allocation concealment was achieved via a secure web-based randomization platform; patients and clinicians were unblinded, but the biostatistician remained blinded. The primary outcome was feasibility of recruitment, randomization, and adherence. Results: Between June 2021 and January 2023, 138 women consented (recruitment rate: 55.8%, 95% CI: 49.7–62.0%) and 100 were randomized. Protocol adherence was 94%. Barriers to recruitment included preference for private PGT-A (19%) or fresh transfer (6%). Among biopsied embryos, 51.4% were euploid and 6.6% low-level mosaic. Intention-to-treat analysis showed no significant differences between PGT-A and control groups in clinical pregnancy rate (50% vs. 40%), live birth rate (50% vs. 38%), or miscarriage rate (12% vs. 8%). Cumulative live birth rate after up to three SETs was 72% vs. 52%, respectively (p > 0.05). No multiple pregnancies occurred. Conclusions: RCTs of PGT-A in older women are feasible. A multicentre design with broader inclusion criteria could improve recruitment and allow better assessment of clinical benefit. Full article
(This article belongs to the Special Issue Female Infertility: Clinical Diagnosis and Treatment)
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13 pages, 725 KiB  
Systematic Review
Impact of Perioperative Antibiotic Prophylaxis in Caesarean Section on the Maternal Gut Microbiome: A Systematic Review
by Elisabeth AL Feles, Claudio Neidhöfer, Christina Wessels, Rosalie Gruber and Frauke Mattner
J. Clin. Med. 2025, 14(14), 5104; https://doi.org/10.3390/jcm14145104 - 18 Jul 2025
Viewed by 309
Abstract
Background/Objectives: Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain [...] Read more.
Background/Objectives: Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain underexplored. This systematic review synthesizes current evidence on how antibiotic prophylaxis during CS affects maternal gut microbiome composition and diversity—an underrepresented, but clinically relevant aspect of maternal–fetal medicine. Methods: A systematic literature search was conducted in Medline (PubMed), the Cochrane Library, and the WHO International Clinical Trials Registry Platform (ICTRP) through November 2024. Inclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies used molecular techniques to report maternal gut microbiome outcomes (alpha- and beta-diversity). The search concentrated on beta-lactam antibiotics. Reference lists were screened, but no additional grey literature was searched. Synthesis followed the Synthesis Without meta-analysis (SWiM) approach. No review protocol was registered. The review received no external funding. Results: Out of 1011 records, three studies (total 286 mothers) met the inclusion criteria. All reported maternal microbiome outcomes secondarily to infant-focused research. Only one study provided pre- and post-birth stool samples. Applied antibiotic regimens, sequencing methods, and reported microbiome metrics for alpha- and beta-diversity varied considerably, thus limiting comparability of results. Due to high heterogeneity, no formal risk of bias was assessed. While taxonomic diversity changes were inconsistent, significant shifts in functional diversity metrics were observed postpartum. Conclusions: Evidence on maternal microbiome disruption following perioperative antibiotic prophylaxis in CS is methodologically fragmented and limited by small sample sizes and inconsistent antibiotic protocols. Nonetheless, functional diversity appears sensitive to antibiotic exposure. To improve clinical understanding and safety, maternal-focused studies using standardized protocols are urgently needed. The maternal microbiome may play a key role in both recovery and shaping the newborn’s early microbial environment. Full article
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24 pages, 1808 KiB  
Systematic Review
Effectiveness and Safety of Acupuncture for Nausea and Vomiting in Cancer Patients: A Systematic Review and Meta-Analysis
by Sung-A Kim, Sujung Yeo and Sabina Lim
Medicina 2025, 61(7), 1287; https://doi.org/10.3390/medicina61071287 - 17 Jul 2025
Viewed by 543
Abstract
Background and Objectives: Nausea and vomiting (NV) are common and distressing adverse effects among cancer patients undergoing treatment. Despite the widespread use of pharmacological antiemetics, these medications are often insufficient for controlling nausea and may cause medication interactions and side effects. Acupuncture [...] Read more.
Background and Objectives: Nausea and vomiting (NV) are common and distressing adverse effects among cancer patients undergoing treatment. Despite the widespread use of pharmacological antiemetics, these medications are often insufficient for controlling nausea and may cause medication interactions and side effects. Acupuncture has been proposed as a complementary therapy; however, the comprehensive analysis of its effects on NV across all emetogenic cancer treatments remains limited. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of acupuncture in managing NV in cancer patients undergoing chemotherapy, radiotherapy, or surgery. Materials and Methods: We conducted a comprehensive search across three electronic databases and two clinical registry platforms from inception to December 2024. Randomized controlled trials (RCTs) evaluating acupuncture for NV in cancer patients were included. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Safety outcomes were assessed based on the Common Terminology Criteria for Adverse Events (CTCAE). Results: Seventeen RCTs met the inclusion criteria, with twelve studies included in the meta-analysis. Acupuncture did not demonstrate significant effects on acute nausea (RR: 0.98; 95% CI: 0.84–1.15; p = 0.80) or acute vomiting (RR: 0.93; 95% CI: 0.65–1.32; p = 0.67). However, it significantly reduced delayed vomiting (RR: 0.76; 95% CI: 0.61–0.95; p = 0.02). Subgroup analysis demonstrated significant effects when acupuncture was administered for at least five days (RR: 0.56; 95% CI: 0.39–0.81; p = 0.002). The most frequently used acupoints were PC6, ST36, CV12, LI4, LR3, and ST25. No serious adverse events related to acupuncture treatments were reported, with only minor AEs such as localized bleeding and mild bruising observed. Conclusions: Acupuncture represents a safe and effective complementary therapy for managing delayed vomiting in cancer patients receiving emetogenic treatments. Clinicians can anticipate optimal benefits from at least five days of treatment, particularly using acupoints PC6, ST36, CV12, LI4, LR3, and ST25. Further high-quality studies are needed to establish standardized treatment regimens and explore its comprehensive effects on NV. Full article
(This article belongs to the Section Oncology)
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