Search Results (115)

Background/Objectives: Pediatric cancer survivors frequently experience neuromuscular sequelae related to chemotherapy-induced neurotoxicity. Agents such as vincristine, methotrexate, and platinum compounds can lead to persistent gait alterations and sensorimotor deficits that impair mobility and quality of life. This study aimed to objectively assess gait in pediatric cancer survivors after the completion of oncological pharmacological treatment to identify specific spatiotemporal, kinematic, and kinetic alterations and characterize neuromechanical patterns associated with neurotoxic exposure. Methods: A cross-sectional observational study was conducted including pediatric cancer survivors (6–18 years) who had completed chemotherapy and age- and sex-matched healthy controls. Gait was analyzed using a Vicon^®3D motion capture system, with reflective markers placed on standardized anatomical landmarks. Spatiotemporal, kinematic, and kinetic variables were compared between groups using parametric tests and statistical parametric mapping (SPM) with Holm–Bonferroni correction (α = 0.05). Results: Pediatric cancer survivors showed slower gait velocity (Mean Difference (MD) = 0.17, p = 0.018, Confidence Interval CI95% = 0.04; 0.4), shorter step (MD = 0.1, p = 0.015, CI95% = 0.01; 0.19) and stride length (MD = 0.17, p = 0.018, CI95% = 0.03; 0.31), as well as reduced single support time (MD = 0.1, p = 0.043, CI95% = 0.01; 0.19), along with significant alterations in pelvic, hip, knee, and ankle kinematics compared with controls. Increased pelvic elevation (MD = 0.92, p = 0.018, CI95% = 0.25; 1.58), reduced hip extension during stance (MD = −2.99, p = 0.039, CI95% = −5.19; −0.74), knee hyperextension in mid-stance (MD = −3.84, p < 0.001, CI95% = −6.18; −0.72), and limited ankle dorsiflexion (MAS MD = −4.04, p < 0.001, CI95% = −6.79; −0.86, LAS MD = −3.16, p < 0.001) and plantarflexor moments in terminal stance (MAS MD = −149.65, p = 0.018, CI95% = −259.35; −48.25, LAS MD = −191.81, p = 0.008, CI95% = −323.81; −57.31) were observed. Ground reaction force peaks during loading response (MAS MD = −16.86, p < 0.001, CI95% = −26.12; −0.72 LAS MD = −11.74, p = 0.001, CI95% = −19.68; −3.94) and foot-off (MAS MD = 10.38, p = 0.015, CI95% = 0.41; 20.53, LAS MD = 11.88, p = 0.01, CI95% = 3.15; 22.38) were also reduced. Conclusions: Children who have completed chemotherapy present measurable gait deviations reflecting persistent neuromechanical impairment, likely linked to chemotherapy-induced neurotoxicity and deconditioning. Instrumented gait analysis allows early detection of these alterations and may support the design of targeted rehabilitation strategies to optimize functional recovery and long-term quality of life in pediatric cancer survivors. Full article

Pain catastrophizing (PC) and hopelessness are increasingly recognized as central determinants of pain severity, disability, and treatment response in individuals with rheumatic and immune-mediated diseases. Traditionally conceptualized as secondary emotional reactions to pain, these cognitive-affective constructs instead represent active mechanisms that shape symptom perception, behavioral responses, and long-term outcomes. In this review, we synthesize evidence across neurobiological, psychological, and clinical domains to elucidate the pathways linking PC and hopelessness to maladaptive coping, kinesiophobia, and functional decline. Early life stress, trauma, and maladaptive cognitive schemas emerge as upstream vulnerability factors that prime heightened emotional reactivity and reduced prefrontal regulatory control, facilitating amplified pain signaling and fear-based avoidance behaviors. Avoidance and inactivity foster physical deconditioning, fatigue, and higher perceived disability, creating a vicious circle that sustains distress and poor quality of life. Moreover, inactivity-related metabolic dysfunction and weight gain may contribute to low-grade inflammation, particularly in conditions such as psoriatic arthritis, thereby intersecting with biological disease pathways. Importantly, these psychological processes identify a distinct patient subgroup for whom further escalation of immunosuppressive therapy provides limited benefit. Instead, integrated psychological approaches—including cognitive behavioral therapy, acceptance and commitment therapy, and coping-skills training—demonstrate meaningful effects on catastrophizing, agency, and functional recovery. We emphasize the need for routine screening to detect patients with maladaptive cognitive–emotional profiles and propose a stratified care model prioritizing targeted psychological interventions alongside standard rheumatologic therapy. Future research should refine phenotyping strategies, clarify neuroimmune links, and develop scalable intervention models to break the avoidance cycle and improve patient-centered outcomes. Full article

Background: Management of patients in closed-door intensive care units (ICUs) is often associated with limited family visits and a highly technological environment, which can lead to patient deconditioning through altered circadian rhythms and depersonalization, contributing to psychological distress in addition to physiological distress. In recent years, there has been a shift in trends in the management of ICU patients with an emphasis on more social and psychological support, with the option of an open-door ICU. Objective: This study aims to evaluate the role of humanized care through social and psychological support in improving patients’ outcomes through the concept of open-door ICUs. Methods: This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Six databases were searched (LILACS, SciELO, PubMed, Scopus, ScienceDirect, and Dialnet) using a strategy based on MeSH and DeCS terms. Studies published between 2018 and 2025, in English, Spanish, and Portuguese, were included. Fifty studies were selected and analyzed using open, axial, and selective coding techniques. The review protocol was registered in PROSPERO (CRD420251080952). Results: Three main categories emerged: (1) Patient and Family Perceptions of ICU Care; (2) flexible visitation and technological mediation; and (3) humanization-centered care. These factors were linked to improved emotional well-being, reduced anxiety, enhanced communication, and stronger trust between families and healthcare professionals. Conclusions: Based on the results of our systematic review, we emphasize the importance of adopting humanized care practices in open-door ICUs. In particular, strategies like flexible visitation, emotional and spiritual support, respectful communication, and family involvement contribute to compassionate, patient-centered care. We recommend institutional policies that need to be designed that support humanization for patients and families. Full article

Skeletal muscle dysfunction is a major systemic manifestation of COPD that shapes symptoms, exercise tolerance and mortality. Current evidence can be integrated within a Damage–Regeneration–Remodeling framework linking mechanics and biology to clinical phenotypes. Pulmonary hyperinflation and chest wall geometry chronically load the diaphragm and other respiratory muscles in COPD, whereas inactivity and exacerbation-related disuse underload locomotor muscles. Across muscle compartments, oxidative/nitrosative stress, activation of proteolytic pathways, mitochondrial and endoplasmic reticulum stress, microvascular limitations, neuromuscular junction instability, and myosteatosis degrade muscle quality. The diaphragm adapts with a fast-to-slow fiber shift, greater oxidative capacity, and sarcomere foreshortening, improving endurance, whereas limb muscles show atrophy, a glycolytic shift, reduced oxidative enzymes, extracellular matrix accrual, and fat infiltration. Translational levers that address these mechanisms include: (I) Reduce damage: bronchodilation, lung-volume reduction, oxygen, non-invasive ventilation, early mobilization, pulmonary rehabilitation, neuromuscular stimulation, and corticosteroid stewardship; (II) Enable regeneration: progressive resistance plus high-intensity/heavy-load endurance training; adequate protein and vitamin-D intake, and endocrine correction; and (III) Steer remodeling: increase physical activity (with/without coaching/telecoaching), functional assessment and CT or MRI monitoring, inspiratory-muscle training, and phenotype-guided adjuncts in selected cases. This framework clarifies why lung deflation strategies benefit inspiratory mechanics, whereas limb recovery requires behavioral and metabolic interventions layered onto systemic optimization. Full article

Long-term spaceflight induces multisystem stress, including cardiovascular deconditioning, skeletal muscle atrophy, immune suppression, and neuro-ocular syndromes. Current countermeasures reduce symptoms but cannot replicate the synergistic resilience needed for extended missions or critical illness. Hibernating animals, specifically brown bears (Ursus arctos), survive prolonged immobility, starvation, and bradycardia without resultant pathology. This review incorporates adaptations observed in bears and certain torpid species, including reversible insulin resistance, suppression of muscle atrophy genes MuRF1 and Atrogin-1, and maintenance of the heart despite seasonal production decline. The thirteen-lined ground squirrels (Ictidomys tridecemlineatus) maintain retinal structure and synaptic stability throughout torpor, avoiding neuro-ocular complications despite prolonged inactivity. Mechanisms span from RBM3-dependent synaptic maintenance, titin isoform remodeling under the control of RBM20, mTOR and FOXO pathway regulation, remodeled hydrogen sulfide metabolism, and microbiome-mediated nitrogen salvage. These adaptations are different from human adaptation to microgravity and disuse and offer translational candidates for synthetic torpor, probiotic engineering, neuroprotection, and protein-sparing therapy. Hibernators are not passive stress subjects; they perform coordinated anticipatory responses in multiple organs. Comparing these systems in large and small hibernators, we aim to uncover a biologically realistic path to human resilience. These findings guide a shift from reactive, pharmacological measures for preserving human health during space flight, intensive care, and extreme environments towards proactive, biologically initiated measures. Full article

Introduction: Nowadays, there is evidence regarding a beneficial effect of heat on neuromuscular strength and muscle hypertrophy development. The aim of this study is to evaluate the effects of a 4-week passive sauna bathing program to extreme heat (100 ± 2 °C) as a support for a resistance strength training program on maximal strength and body composition. Methods: 30 young male subjects participated in the study. They were randomly assigned to a Hyperthermia group (HG, n = 14; age: 20.48 (19.12–22–30) years; weight: 76.30 (71.00–79.00) Kg; BMI: 23.92 (22.93–24.87) Kg/m²), or to a Normothermia group (NG, n = 15; age: 19.95 (19.10–21–94) years; weight: 61.70 (59.45–72.90) Kg; BMI: 21.56 (20.42–23.26) Kg/m²). All participants followed the same lower limb strength training program (2 exercises; 4 sets of 10 repetitions at 75% 1RM with progressive loading). Additionally, HG underwent two weekly sessions of exposure to extreme heat in a sauna (100 ± 2 °C and 24 ± 1% relative humidity, four sets of 10 min, 2 days per week). The intervention lasted for 4 weeks, followed by a 4-week deconditioning period. Maximum isometric knee flexion-extension strength, maximum counter-resistance strength, as well as body composition and anthropometric variables were assessed. Results: The HG group significantly increased body weight (p < 0.05) and muscle mass (p < 0.05), while their sum of six skinfolds (Σ6 skinfolds) significantly decreased (p < 0.05). Both groups improved their 1RM squat performance following the intervention program (p < 0.05; HG: r = 0.86; NG: r = 0.89). However, only the HG group continued to improve their squat 1RM after the deconditioning period (p < 0.001; r = 0.93), as well as their leg press 1RM (p < 0.01; r = 0.94). Maximal isometric strength increased only in the NG group at the end of the training program, with a significant increase in knee flexion torque (p < 0.05; r = 0.76). In contrast, the HG group showed significant increases in isometric strength after the deconditioning period in both knee extension (p < 0.05; r = 0.76) and knee flexion (p < 0.05; r = 0.75). Conclusions: A four-week period of passive sauna bathing at extreme heat appears to alter the chronology of strength responses. It also seems to induce favorable responses in terms of strength development and body composition. Full article

Background: The Space Omics and Medical Atlas (SOMA) is an extensive database containing gene expression information from samples collected during the short-duration Inspiration4 spaceflight mission in 2021. Given our prior understanding of the genetic basis for cardiovascular diseases in spaceflight, including orthostatic intolerance and cardiac deconditioning, we aimed to characterize changes in differential gene expression among astronauts using SOMA-derived data and curated cardiovascular pathways. Methods: Using the KEGG 2021 database, we curated a list of genes related to cardiovascular adaptations in spaceflight, focusing on pathways such as fluid shear stress and atherosclerosis, lipid metabolism, arrhythmogenic ventricular hypertrophy, and cardiac muscle contraction. Genes were cross-matched to spaceflight-relevant datasets from the Open Science Data Repository (OSDR). Differential expression analysis was performed using DESeq2 (v1.40.2, R) with normalization by median-of-ratios, paired pre-/post-flight covariates, and log2 fold change shrinkage using apeglm. Differentially expressed genes (DEGs) were defined as |log2FC| ≥ 1 and FDR < 0.05 (Benjamini–Hochberg correction). Module score analyses were conducted across SOMA cell types to confirm conserved cardiac adaptation genes. Results: A total of 185 spaceflight-relevant genes were analyzed. Statistically significant changes were observed in immune-related cardiovascular pathways, particularly within monocytes and T cells. Persistent upregulation of arrhythmogenic genes such as GJA1 was noted at post-flight day 82. WikiPathways enrichment revealed additional pathways, including focal adhesion, insulin signaling, and heart development. Conclusions: Short-duration spaceflight induces significant gene expression changes that are relevant to cardiovascular disease risk. These changes are mediated largely through immune signaling and transcriptional regulation in peripheral blood mononuclear cells. Findings highlight the need for tailored countermeasures and longitudinal monitoring in future long-duration missions. Full article

(1) Background: Over the years, technology and space missions have advanced, although the development of potential functional food and food supplements must be improved for maintaining astronauts’ health and helping them overcome space-specific challenges during long missions. (2) Scope and approach: Using a review approach, this study aimed to investigate the potential of functional food to counteract radiation and microgravity spaceflight-related health problems. (3) Results: Microgravity and space radiation affect the body’s biochemical processes and increase levels of reactive oxygen species, which may lead to health problems, including musculoskeletal deconditioning, cardiovascular degeneration, disruptions in gastrointestinal health, ocular problems, alterations to the immune system, and hormonal imbalances, among others. In addition to medical care, functional food plays a key role as a countermeasure against space-induced physiological issues. Previous research showed that functional food rich in flavonoids, omega-3 fatty acids, vitamins, minerals, antioxidant compounds, proteins, probiotics, or prebiotics strengthens the immune system and reduces risks associated with long spaceflights, such as bone density loss, muscle atrophy, oxidative stress, and other health alterations. (4) Conclusions: Despite the fundamental role of functional food in spaceflights, the main challenges remain in preserving and packaging these foods to ensure their safety on long space missions. Future innovations include 3D food printing, space algae cultivation, and novel preservation technologies. Full article

Pregnancy induces substantial anatomical, hormonal, and biomechanical changes in the spine and pelvis to accommodate fetal growth and maintain postural adaptation. This narrative review synthesizes peer-reviewed evidence regarding pregnancy-related spinal biomechanics, with a particular focus on low back pain, spinopelvic alignment, sacroiliac joint dysfunction, and potential contributions to degenerative spinal conditions. A systematic search of PubMed, Embase, and Google Scholar was conducted using Boolean operators and relevant terms, yielding 1050 unique records, with 53 peer-reviewed articles ultimately cited. The review reveals that increased lumbar lordosis, ligamentous laxity, altered gait mechanics, and muscular deconditioning elevate mechanical load on the lumbar spine, predisposing up to 56% of pregnant individuals to low back pain. These changes are often associated with sacroiliac joint laxity, anterior pelvic tilt, and multiparity. Long-term risks may include degenerative disc disease and spondylolisthesis. Conservative interventions such as pelvic floor muscle training, prenatal exercise, and surface topography monitoring offer symptom relief and support early rehabilitation, although standardized protocols and longitudinal outcome data remain limited. Pregnancy-related spinal changes are multifactorial and clinically relevant; an interdisciplinary approach involving spinal biomechanics, physical therapy, and obstetric care is critical for optimizing maternal musculoskeletal health. Full article

Background/Objectives: Patients undergoing open aortic and valvular surgery often experience postoperative deconditioning, yet research on the role of inpatient cardiac rehabilitation (CR) in this population remains limited. This study aimed to examine the effects of inpatient CR on muscle strength, mobility, psychological well-being, and quality of life in patients recovering from open aortic surgery. Methods: We conducted a retrospective study using the medical records of patients who participated in inpatient CR after open aortic surgery. Functional and psychological outcomes were evaluated using the Medical Research Council (MRC) sum score, Timed Up and Go (TUG) test, Five Times Sit-to-Stand test (5STS), Six-Minute Walk Distance (6MWD), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Patient Health Questionnaire-9 (PHQ-9), and the EuroQol-5D (EQ-5D). Pre- and post-rehabilitation scores were compared to assess changes in functional status, mobility, and quality of life. A post-discharge satisfaction survey was also analyzed. Results: A total of 33 patients were included. Significant improvements were observed in MBI (p < 0.001), MRC sum score (p < 0.001), 6MWD (p < 0.001), BBS (p < 0.001), TUG (p = 0.003), 5STS (p < 0.001), EQ-5D (p = 0.011), and PHQ-9 (p = 0.009) following inpatient CR. Patients with lower baseline mobility (6MWD ≤ 120 m) exhibited greater improvement in MBI (p = 0.034). Of the 33 patients, 26 completed the satisfaction survey; most reported high satisfaction, perceived health improvements, and willingness to recommend the program. Conclusions: Inpatient CR following open aortic and valvular surgery resulted in significant gains in muscle strength, mobility, psychological health, and overall quality of life. Patients with greater initial impairment demonstrated especially notable functional improvement, supporting the value of tailored CR in this population. Full article

Aging is a complex biological process marked by a progressive decline in cellular function, leading to age-related diseases such as neurodegenerative disorders, cancer, and cardiovascular diseases. Despite significant advancements in aging research, finding effective interventions to decelerate aging remains a challenge. This review explores microgravity as a novel therapeutic approach to combat aging and promote healthy longevity. The hallmarks of aging, including genomic instability, telomere shortening, and cellular senescence, form the basis for understanding the molecular mechanisms behind aging. Interestingly, microgravity has been shown to accelerate aging-like processes in model organisms and human tissues, making it an ideal environment for studying aging mechanisms in an accelerated manner. Spaceflight studies, such as NASA’s Twins Study and experiments aboard the International Space Station (ISS), reveal striking parallels between the physiological changes induced by microgravity and those observed in aging populations, including muscle atrophy, bone density loss, cardiovascular deconditioning, and immune system decline in a microgravity environment. However, upon microgravity recovery, cellular behavior, gene expression, and tissue regeneration were seen, providing vital insights into aging mechanisms and prospective therapeutic approaches. This review examines the potential of microgravity-based technologies to pioneer novel strategies for decelerating aging and enhancing healthspan under natural gravity, paving the way for breakthroughs in longevity therapies. Full article

Early detection and the rise of targeted cancer treatment have led to increased overall survival and decreased mortality among cancer patients. As the cancer survivor population ages, there is an increased risk for cardiovascular disease due to pre-existing comorbidities, deconditioning during therapy, or the natural progression of aging. Furthermore, with emerging oncologic therapies, there is an increased recognition of their potential cardiovascular toxicities. Indeed, heart disease is the leading cause of death in cancer survivors, which may reflect upon both the success of novel oncologic therapies and their potential cardiovascular toxicities. This recognition has driven the development of cardio-oncology, a multi-disciplinary field that involves collaboration between hematologists, oncologists, and cardiologists to screen, prevent, and manage cardiovascular disease in cancer patients and cancer survivors. The field focuses on early cardiovascular detection and prevention for these patients before, during, and after their oncologic treatment. As oncologic therapies evolve and our knowledge of short- and long-term adverse cardiovascular effects grows, it is critical for physicians to identify those at risk for increased morbidity and mortality, while also balancing the importance of their oncologic treatment plan. Multimodality cardiac imaging is the crux of the diagnosis and surveillance of these patients within cardio-oncology, and includes echocardiography, nuclear, computed tomography (CT), and cardiac magnetic resonance (CMR). Cardiac imaging is essential to establish the baseline function and assess various cardiotoxicities, including left ventricular dysfunction, heart failure, atherosclerosis, vascular injury, and arrhythmias. This review will discuss common oncologic therapies and their cardiotoxic profiles, the cardiac multimodality imaging modalities used in cardio-oncology, and the various approaches for the diagnosis and surveillance of this population. Full article

Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum disorders (G-HSD) are a group of genetic, connective multi-systemic disorders that can affect the musculoskeletal, gastrointestinal, cardiovascular, and respiratory systems. Respiratory manifestations in EDS/G-HSD can contribute to decrements in health-related quality of life (HRQL); however, these relationships have not been previously characterized. We aimed to review the association of respiratory manifestations with the physical, psychological, and social domains of HRQL in EDS/G-HSD. A comprehensive search was conducted using Ovid Medline, Embase, and CINAHL with the following terms: “Ehlers-Danlos Syndrome”, “Hypermobility Spectrum Disorders”, and “Quality of Life”. Selected studies in English that investigated the relationship between respiratory manifestations and HRQL domains in EDS/G-HSD were included in this narrative review from inception to March 2024. Twelve studies described the physical, psychological, or social domains of HRQL relating to respiratory manifestations. Dyspnea, wheezing, and expiratory flow limitations were associated with limitations in physical function and exercise intolerance. Respiratory manifestations were associated with increased fatigue, pain, anxiety, kinesiophobia, and deconditioning. This review highlights the consequences that respiratory manifestations have on the physical domains of HRQL, through limitations on physical activity and exercise. Future studies should aim to identify the impact that respiratory manifestations have on the psychosocial domains of HRQL and develop disease-specific patient-reported measures to evaluate these relationships. Full article

This narrative review provides an overview of the link between the sensorimotor system, cognition, emotion and pain syndromes in persons due to deconditioning or delayed sensorimotor development, then applied to persons with cerebral palsy (CP). The brain damage that occurs before, during or even after birth pathophysiologically alters the structure and subsequent function of the sensorimotor function, which is inseparably linked to cognition, emotion, behavior and pain. This damage results in a functional developmental disorder that also affects the structure and function of the neuromatrix in a graded manner due to chronic deconditioning. It is the basis for both primary and secondary chronic degenerative diseases. This leads to an increasing prevalence of chronic pain syndromes, which may be very high in persons with CP. Thus, CP is both a disposing factor and a causal factor for nociplastic pain, defined as persistent pain arising from altered nociception without evidence of tissue or somatosensory damage. Therapy interventions are crucial to optimize movement, cognition and emotion, as well as pain reduction in persons with CP. Full article

This longitudinal study investigated the incidence and characteristics of injuries among U9, U11, and U13 male football players in an academy setting over a six-season period, from 2016/17 to 2021/22. A total of 374 injuries were analyzed, with a particular focus on muscle injuries, including Delayed Onset Muscle Soreness (DOMS), muscle ruptures, and contusions. The study revealed that the highest injury incidence occurred in the U13 group, with quadriceps injuries being most prevalent in both the U13 and U11 groups. The study found that muscle injuries accounted for a significant proportion of all injuries, particularly in the U13 group, where muscle injuries increased over time. Intrinsic factors such as physical development during puberty and extrinsic factors like training intensity and psychological pressures may contribute to the higher injury rates in older age groups. Additionally, seasonal fluctuations in injury rates were observed, with a notable decline during the COVID-19 lockdowns in 2019/20 and 2020/21, followed by an increase post-lockdown due to deconditioning. The study highlights the vulnerability of young athletes to muscle injuries, particularly during growth spurts, and calls for further research into training methods and injury prevention strategies to mitigate these risks. Full article