Search Results (12,395)

Objectives: Although sex differences have been emphasized in stroke and congenital heart disease, there has been limited investigation into their role in patent foramen ovale (PFO) closure for secondary prevention of stroke. We aimed to explore differences by sex in baseline profiles, procedural characteristics, and short-term outcomes of patients undergoing transcatheter PFO closure. Methods: A retrospective analysis was conducted on 458 consecutive patients (265 women and 193 men) treated with PFO closure at Centro Cardiologico Monzino in Milan between 2006 and 2011. Baseline information included demographic characteristics, medical history, diagnostic and procedural information, and periprocedural complications. Post-closure outcomes were assessed at index hospitalization and during the first follow-up. Results: The indications for PFO closure were as follows: cryptogenic stroke/TIA in 78% of women vs. 88% of men (p = 0.04). Positive thrombophilic screening was observed in 16% of women vs. 19% of men (non-significant). We observed age-matched (mean age 44 ± 12 years) patients without sex-related differences in baseline and procedural characteristics, with the exception of greater arterial hypertension in women. The mean follow-up time was 13 years for both groups. Recurrent stroke was observed in 0.1% and TIA observed in 0.4% of the ‘cryptogenic stroke/TIA’ group; in the ‘other indications’ group, 1.4% experienced stroke and no TIA was reported. No significant differences were present between sexes. Conclusions: There were no differences in procedural and short-term outcomes between males and females undergoing transcatheter PFO closure, but significant baseline differences in risk factors were identified. There is a critical need for long-term, systematic studies to understand sex and gender differences in the PFO population. Full article

Background/Objective: Infectious bursal disease (IBD) is an acute and highly contagious immunosuppressive disease in chickens caused by infectious bursal disease virus (IBDV). In recent years, a novel variant IBDV (nVarIBDV) has emerged and spread widely, inducing severe immunosuppression and posing a substantial threat to the poultry industry. More importantly, owing to antigenic variations, nVarIBDV can escape the immune protection of the existing vaccines. Therefore, it is imperative to develop a new vaccine that is antigenically matched to nVarIBDV. Methods: The major protective antigen gene VP2 of the representative nVarIBDV strain SHG19 was inserted into the eukaryotic expression plasmid pCAGGS to construct the recombinant plasmid pCASHGVP2. Subsequently, pCASHGVP2 was encapsulated in lipid nanoparticles (LNPs) to form pCASHGVP2-LNP nanoparticles. Finally, using the SPF chicken model, the immune efficacy of pCASHGVP2-LNP was preliminarily assessed by administering two vaccine doses (10 and 20 μg) and two immunization regimens (single or double immunization). Results: Efficient VP2 protein expression from pCASHGVP2 was confirmed by in vitro transfection experiments. The prepared pCASHGVP2-LNP nanoparticles exhibited an optimal particle size distribution and acceptable polydispersity index, indicating a homogeneous formulation. Furthermore, animal experiments showed that the candidate DNA vaccine elicited specific neutralizing antibodies after double immunization and protected immunized chickens from disease induced by nVarIBDV challenge. Conclusions: This study reports the first development of an LNP-encapsulated VP2 DNA vaccine (pCASHGVP2-LNP) against nVarIBDV, highlighting its potential application for the prevention of nVarIBDV. Full article

Background/Objectives: To evaluate and compare the characteristics of clinical trials (CTs) involving patients with primary Sjögren’s syndrome (pSS), using biologics, and focusing on the features of the patients recruited. Methods: This systematic review assessed pSS CTs evaluating biologic drugs published from 2010 to 2024 according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the electronic databases was performed individually by the authors. The extracted variables regarding the baseline characteristics of participants and trial-related information were defined a priori, collected, and compared. Results: A total of 16 CTs were included in this review in line with the inclusion criteria. The trials were predominantly multicenter (75%) randomized controlled trials with a placebo arm (93.8%), with only five trials recruiting participants across multiple (≥3) continents. The search included a total of 1607 patients (mean age 51 years, 94% female) with a mean disease duration of 6.47 years. Race and ethnicity were underrepresented variables, found in 37.5% and 12.5% of the trials, respectively, with White patients comprising the majority (77.8%). The EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) was reported in 93.8% of the CTs. However, only recent studies have emphasized it as the primary outcome. Conclusions: Recent trials on biologics in pSS patients show better methodological quality, with a more standardized assessment of disease activity using ESSDAI, and an increased focus on patient-reported outcomes. Global participation is increasing, but limited racial and ethnic diversity, endpoint variability, and inconsistent biomarker reporting remain critical issues. Full article

Background and Objectives: Acute pancreatitis (AP) is an acute inflammatory disease ranging from mild, self-limiting forms to severe presentations associated with high morbidity and mortality. Early prognostic assessment is crucial for guiding clinical management. This study aimed to evaluate the prognostic value of the red cell distribution width-to-albumin ratio (RDW/Alb, RAR) in relation to clinically relevant outcomes, including intensive care unit (ICU) admission and in-hospital mortality, in patients with AP. Materials and Methods: This retrospective study included 282 patients diagnosed with AP who were hospitalized at Mersin University Hospital between January 2019 and February 2024. Clinical, laboratory, and radiological data were retrospectively analyzed. The predictive performance of RAR was evaluated and compared with established clinical scoring systems, including bedside index for severity in acute pancreatitis (BISAP), systemic inflammatory response syndrome (SIRS), harmless acute pancreatitis score (HAPS), and pancreatitis activity scoring system (PASS). Results: The median RDW-to-albumin ratio (RAR) was 3.9 (range: 2.6–36.7). Receiver operating characteristic (ROC) curve analysis demonstrated that RAR showed good predictive performance for ICU admission (Area Under the Curve (AUC): 0.781; p < 0.001; optimal cut-off: 4.15) and high predictive performance for in-hospital mortality (AUC: 0.927; p < 0.001; optimal cut-off: 5.26). RAR exhibited limited but statistically significant discriminatory performance when compared with the BISAP score (AUC: 0.591; p = 0.017), whereas no significant predictive performance was observed in relation to PASS, HAPS, or SIRS scores. Conclusions: Within the context of this retrospective cohort, RAR is a simple, inexpensive, and readily available biomarker that may be associated with ICU admission and in-hospital mortality in patients with AP. Given the absence of standard severity endpoints such as persistent organ failure or pancreatic necrosis, these findings should not be interpreted as evidence of conventional disease severity prediction but rather as hypothesis-generating observations that warrant validation in larger prospective studies. Full article

Background: Malnutrition is frequently under-investigated during remission in patients with Inflammatory Bowel Disease (IBD), despite its significant impact on clinical outcomes and quality of life. This study aimed to evaluate the increase in diagnostic performance of five nutritional screening tools (NSTs) when serially administered to IBD outpatients in sustained clinical remission. Methods: In this prospective, single-center cohort study, NSTs were administered, and body composition analysis was performed in IBD patients at baseline and after six months. At both time points, the sensitivity, specificity, predictive values, and accuracy of NSTs in detecting malnutrition and persistent malnutrition per ESPEN and GLIM criteria were evaluated, comparing repeated to single-point assessments. A sensitivity analysis using low FFMI as a reference was also performed. Results: Sixty-six IBD patients (32 Crohn’s disease; 34 ulcerative colitis) were enrolled. At baseline, 25.7% and 9% of patients were malnourished according to ESPEN and GLIM criteria, respectively, with 7.5% exhibiting low FFMI. Malnutrition prevalence increased over time to 53%, 16.6%, and 16.6%, respectively. Among NSTs, MUST and SaskIBD-NR consistently exhibited the highest specificity for malnutrition detection at baseline, at 6 months, and for persistent malnutrition for ESPEN, GLIM and low FFMI. Serial (repeated) NST administration markedly improved the specificity of all tools, compared to single-point assessments. Conclusions: Serial nutritional screening with MUST or SaskIBD-NR significantly enhances the specificity of malnutrition risk detection in IBD patients in remission, supporting the incorporation of repeated nutritional assessments into clinical practice to offer a practical strategy to enhance screening effectiveness in IBD outpatient care. Full article

Background and Objectives: Chronic kidney disease (CKD) and maintenance hemodialysis (HD) are frequently associated with psychological distress and impaired health-related quality of life (HRQoL). However, the relationships between depressive, anxiety, and stress symptoms, clinical factors, and HRQoL remain insufficiently understood in routine care. This study aimed to assess the prevalence of psychological distress and to explore cross-sectional correlates of kidney disease-specific and generic HRQoL in Romanian patients receiving long-term HD, providing one of the first detailed characterizations of these relationships in an Eastern European maintenance HD cohort. Materials and Methods: This single-center cross-sectional study included 125 adult patients undergoing maintenance HD for at least one year. Baseline assessment comprised socioeconomic, demographic and clinical and paraclinical data, including Charlson Comorbidity Index (CCI), dialysis adequacy (spKt/V), cognitive function, psychological distress assessed with the Depression, Anxiety and Stress Scale (DASS-21R), and HRQoL evaluated using the Kidney Disease Quality of Life Short Form (KDQOL-SF™ 1.3). HRQoL domains and physical and mental component summary scores (PCS, MCS) were analyzed using descriptive statistics, correlation analyses, and multivariable linear regression. Follow-up assessments at approximately one year were summarized descriptively. Results: Disease-specific HRQoL revealed marked impairment in perceived disease burden and work status, while physical HRQoL was substantially reduced (PCS 36.5 ± 9.6). Mental HRQoL was relatively preserved (MCS 48.8 ± 8.8). At baseline, 48.0% of patients reported at least mild depressive symptoms, 34.4% anxiety symptoms, and 44.0% stress symptoms. spKt/V showed a modest association with PCS. Psychological distress demonstrated weak associations with HRQoL; stress was independently associated with lower MCS, with limited explained variance (R² ≤ 0.15). Conclusions: Psychological distress is common among Romanian HD patients and is cross-sectionally associated with markedly impaired physical HRQoL. While the present design does not allow causal inferences, these findings support the implementation of routine psychological screening and the consideration of targeted psychosocial interventions in HD care. Full article

To investigate whether Echinacea purpurea polysaccharides (EPP) alleviate inflammatory bowel disease (IBD) by modulating gut microbiota, we utilized a mixed antibiotic (ABX)-induced gut dysbiosis model and a co-housing model in rats. ABX treatment severely reduces microbial richness and functional diversity, decreasing SCFA-producing bacteria and impairing the anti-inflammatory effect of SCFA-mediated EPP. Without ABX, EPP significantly ameliorates IBD symptoms and colonic pathology damage in rats, reduces the levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) (p < 0.05), inhibits the activation of the TRAF6/NF-κB signaling pathways, and reverses gut microbiota imbalance by partially restoring Bacteroidetes abundance and reducing Firmicutes levels. Among co-housed rats, the EPP-treated group exhibited significantly lower Disease Activity Index (DAI) scores, serum levels of pro-inflammatory factors, and colonic expression of pro-inflammatory pathway-related gene (TRAF6, STAT3) (p < 0.05) without ABX. 16S rRNA gene sequencing revealed a significant reduction in Firmicutes abundance (p < 0.05) alongside significant increases in Bacteroidetes and Actinobacteria abundances, accompanied by elevated levels of acetic acid and propionic acid (p < 0.05). These findings suggest recipient mice restored microbial function and acquired IBD-regulating ability post-microbial exchange. EPP alleviates IBD-related pathological injury by inhibiting the JAK2/STAT3 and TRAF6/NF-κB signaling pathways, with its therapeutic mechanism intricately linked to the microbiota–metabolite–host axis. Full article

Alzheimer’s disease and related neurodegenerative disorders are associated with progressive cognitive decline, primarily driven by cholinergic dysfunction and impaired synaptic signaling. Hericium erinaceus, also known as lion’s mane mushroom, has been reported to promote neuronal differentiation and synaptic plasticity. In this study, a standardized H. erinaceus extract powder (HEP) was prepared from fruiting bodies and quantified using hericene A as a marker compound. The neuroprotective effects of HEP were then evaluated in both cellular and animal models of scopolamine-induced cognitive dysfunction. Pretreatment of SH-SY5Y human neuroblastoma cells with HEP (5–25 μg/mL) significantly improved cell viability and reduced scopolamine-induced apoptosis, while enhancing the activation of neuroplasticity-related signaling proteins, including brain-derived neurotrophic factor (BDNF), cAMP response element-binding protein (CREB), and extracellular signal-regulated kinase (ERK). In vivo, oral administration of HEP (300 mg/kg) to scopolamine-treated ICR mice markedly improved cognitive performance, increasing the recognition index to 63.8% compared with 41.6% in the scopolamine group, and enhancing spontaneous alternation in the Y-maze test to 59.6%. These cognitive improvements were accompanied by preserved hippocampal neuronal structure and increased BDNF immunoreactivity. Additionally, HEP improved cholinergic function by restoring serum acetylcholine levels and reducing acetylcholinesterase activity. Collectively, these findings suggest that standardized HEP exerts neuroprotective and cognition-enhancing effects via modulation of cholinergic markers and activation of BDNF-mediated neuroplasticity, highlighting its potential as a functional food ingredient or nutraceutical for preventing cognitive decline related to cholinergic dysfunction. Full article

Background/Objectives: Peripheral arterial disease (PAD) is a common yet often unrecognized complication in patients receiving peritoneal dialysis (PD). Considering that ankle–brachial index (ABI) can be difficult to interpret in this population, additional vascular biomarkers are needed. Selenoprotein P (SePP) is a major selenium transport protein with antioxidant and metabolic regulatory functions and may reflect vascular stress relevant to PAD. We investigated the association of circulating SePP levels with ABI-defined PAD in patients on PD. Methods: In this cross-sectional analysis of 98 patients on PD, ABI was assessed using an automated oscillometric device, and ABI < 0.9 was defined as ABI-defined PAD. Serum SePP levels were measured using enzyme-linked immunosorbent assay. Results: ABI-defined PAD was identified in 20 patients (20.4%). Compared with patients with normal ABI, those with ABI-defined PAD were older (p = 0.014) and had significantly higher prevalence of diabetes mellitus (p = 0.033), longer PD vintage (p = 0.036), higher fasting glucose (p = 0.005) and C-reactive protein (p = 0.003) levels, and lower SePP concentrations (p < 0.001). Low SePP level remained independently associated with ABI-defined PAD after multivariate adjustment (odds ratio 0.930, 95% confidence interval 0.771–0.997; p = 0.032) and consistently across reinforced bootstrap resampling. SePP correlated positively with ABI on the left (p = 0.001) and right (p = 0.002) sides. Conclusions: Among patients undergoing PD, a low serum SePP level was independently associated with ABI-defined PAD and positively associated with ABI, suggesting that SePP may serve as an associative biomarker reflecting vascular vulnerability rather than a diagnostic indicator in this population. Full article

Rice blast, caused by the fungal pathogen Pyricularia oryzae, remains one of the most destructive diseases threatening global rice production. Although the deployment of resistant cultivars is widely regarded as the most effective and sustainable control strategy, resistance based solely on host genetics often has limited durability due to the rapid adaptation of the pathogen. Increasing evidence suggests that plant-associated microbial communities contribute to host health and disease resistance, yet the role of seed-associated microbiota in shaping rice blast resistance remains insufficiently understood. In this study, we investigated seed endophytic bacterial communities across multiple indica–japonica hybrid rice varieties from the Yongyou series that exhibit contrasting levels of resistance to rice blast. By integrating amplicon sequencing, we identified distinct seed bacterial assemblages associated with blast-resistant and blast-susceptible varieties were identified. Notably, the microbial communities in blast-resistant varieties exhibited significantly higher Shannon index, with a median value of 3.478 compared to 2.654 in susceptible varieties (p < 0.001), indicating a greater diversity and more balanced community structure compared to those in susceptible varieties. Several bacterial taxa consistently enriched in resistant varieties showed negative ecological associations with P. oryzae, both at the local scale and across publicly available global metagenomic datasets. These findings indicate that seed endophytic bacterial communities are non-randomly structured in relation to host resistance phenotypes and may contribute to rice blast resistance through persistent ecological interactions with the pathogen. This work highlights the potential importance of seed-associated microbiota as intrinsic components of varietal resistance and provides a microbial perspective for improving durable disease resistance in rice breeding programs. Full article

Exercise training has demonstrated potential benefits in addressing the adverse effects of cardiovascular diseases, particularly myocardial infarction (MI). This study analyzed the cardioprotective effects of moderate exercise before and after MI in rats subjected to isoproterenol (ISO)-induced heart damage. Wistar rats were assigned to five groups: controls (CTRL), isoproterenol-treated (ISO), swimming before ISO (PRE + ISO), swimming after ISO (ISO + POST), and swimming both before and after ISO (PRE + ISO + POST). Cardiac function was assessed through echocardiography, while oxidative stress markers, Heme Oxygenase-1 (HO-1) and Myeloperoxidase (MPO), were quantified using biochemical assays and enzyme-linked immunosorbent assay (ELISA). Statistical analyses were conducted by one-way analysis of variance (ANOVA), accompanied by Tukey’s post hoc test. Exercise performed post-MI and both pre- and post-MI significantly reduced ISO-induced infarct size and improved left ventricular function (stroke volume (SV), ejection fraction (EF), and Tei index). HO-1 protein concentration and HO enzyme activity were restored, while swim training reduced the activity of MPO compared to the ISO group. Moderate exercise training, when appropriately timed, provides cardioprotection against ISO-induced myocardial damage by reducing oxidative stress and cardiac dysfunction. Full article

Background: Solid organ transplantation (SOT) is a life-saving treatment for patients with end-stage diseases and/or organ failure. However, access to healthy organs is often limited by challenges in organ preservation. Furthermore, upon transplantation, ischemia–reperfusion injury (IRI) can lead to increased organ rejection or graft failures. The work presented aims to address both challenges using an innovative nanomedicine platform for simultaneous drug and oxygen delivery. In recent studies, resveratrol (RSV), a natural antioxidant, anti-inflammatory, and reactive oxygen species (ROS) scavenging agent, has been reported to protect against IRI by inhibiting ferroptosis. Here, we report the design, development, and scalable manufacturing of the first-in-class dual-function perfluorocarbon-nanoemulsion (PFC-NE) perfusate for simultaneous oxygen and antioxidant delivery, equipped with a near-infrared fluorescence (NIRF) reporter, longitudinal, non-invasive NIRF imaging of perfusate flow through organs/tissues during machine perfusion. Methods: A Quality-by-Design (QbD)-guided optimization was used to formulate a triphasic PFC-NE with 30% w/v perfluorooctyl bromide (PFOB). Drug-free perfluorocarbon nanoemulsions (DF-NEs) and RSV-loaded nanoemulsions (RSV-NEs) were produced at 250–1000 mL scales using M110S, LM20, and M110P microfluidizers. Colloidal attributes, fluorescence stability, drug loading, and RSV release were evaluated using DLS, NIRF imaging, and HPLC, respectively. PFC-NE oxygen loading and release kinetics were evaluated during perfusion through the BMI OrganBank^® machine with the MEDOS HILITE^® oxygenator and by controlled flow of oxygen. The in vitro antioxidant activity of RSV-NE was measured using the oxygen radical scavenging antioxidant capacity (ORAC) assay. The cytotoxicity and ferroptosis inhibition of RSV-NE were evaluated in RAW 264.7 macrophages. Results: PFC-NE batches maintained a consistent droplet size (90–110 nm) and low polydispersity index (<0.3) across all scales, with high reproducibility and >80% PFOB loading. Both DF-NE and RSV-NE maintained colloidal and fluorescence stability under centrifugation, serum exposure at body temperature, filtration, 3-month storage, and oxygenation. Furthermore, RSV-NE showed high drug loading and sustained release (63.37 ± 2.48% at day 5) compared with the rapid release observed in free RSV solution. In perfusion studies, the oxygenation capacity of PFC-NE consistently exceeded that of University of Wisconsin (UW) solution and demonstrated stable, linear gas responsiveness across flow rates and FiO₂ (fraction of inspired oxygen) inputs. RSV-NE displayed strong antioxidant activity and concentration-dependent inhibition of free radicals. RSV-NE maintained higher cell viability and prevented RAS-selective lethal compound 3 (RSL3)-induced ferroptosis in murine macrophages (macrophage cell line RAW 264.7), compared to the free RSV solution. Morphological and functional protection against RSL3-induced ferroptosis was confirmed microscopically. Conclusions: This study establishes a robust and scalable PFC-NE platform integrating antioxidant and oxygen delivery, along with NIRF-based non-invasive live monitoring of organ perfusion during machine-supported preservation. These combined features position PFC-NE as a promising next-generation acellular perfusate for preventing IRI and improving graft viability during ex vivo machine perfusion. Full article

Background/Objectives: Childhood obesity remains a major public health issue, particularly in Mediterranean countries such as Greece. Although parental influences on children’s weight have been extensively studied, fewer studies have jointly examined parental mental health, feeding practices, sociodemographic factors, and biological stress markers. This study aimed to investigate associations between psychological status, educational level, feeding behaviors, and children’s Body Mass Index (BMI) in a Greek sample. A pilot assessment of salivary cortisol was included in evaluating its feasibility as an objective biomarker of parental stress. Subjects and Methods: A total of 103 parent–child dyads participated in this cross-sectional study. Children’s BMI was classified using World Health Organization (WHO) growth standards. Parental stress, anxiety, and depressive symptoms were assessed using the Perceived Stress Scale-14 (PSS-14) and the Depression Anxiety Stress Scale-21 (DASS-21) questionnaires. Feeding practices were evaluated with the Comprehensive Feeding Practices Questionnaire (CFPQ). Statistical analyses included Pearson correlations, independent samples t-tests, one-way ANOVA, Mann–Whitney U, and Kruskal–Wallis tests. A subsample provided saliva samples for cortisol analysis to assess feasibility and explore the potential associations with parental stress indicators. Results: Parental BMI showed a strong positive association with child BMI (p = 0.002). Higher parental anxiety (p = 0.002) and depression (p = 0.009) were also associated with increased child BMI. Restrictive (p < 0.001) and emotion-driven (p < 0.001) feeding practices were associated with higher child BMI, whereas monitoring (p = 0.013) and health-promoting feeding practices (p = 0.001) appeared protective. Lower parental education was related to a higher BMI in both parents (p = 0.001) and children (p = 0.002) and to more frequent use of restrictive feeding strategies (p = 0.001). WHO charts identified a greater proportion of children as overweight or obese compared with the Centers for Disease Control and Prevention (CDC) criteria. The analysis showed statistically significant differences between the two classification systems (χ² (4) = 159.704, p < 0.001), indicating that BMI categorization varies considerably depending on the reference system used. No significant associations were observed with residential environment or salivary cortisol, likely due to the limited size of the pilot biomarker subsample. Conclusions: The findings highlight the combined effect of parental mental health status, educational level, and feeding practices on child BMI within the Greek context. The preliminary inclusion of a biological stress marker provides added value to the existing research in this area. These results underscore the importance of prevention strategies that promote parental psychological wellbeing and responsive feeding practices while addressing socioeconomic disparities to reduce the childhood obesity risk. Full article

Objectives: Prediabetes is characterized by elevated blood glucose levels associated with insulin resistance, increasing the risk of progression to type 2 diabetes mellitus (T2DM) and cardiovascular disease. High-intensity interval training (HIIT) has emerged as an effective non-pharmacological strategy to improve insulin sensitivity and cardiorespiratory fitness. This study aimed to analyze the effects of HIIT alone or combined with a hypocaloric diet on metabolic and cardiorespiratory parameters in individuals with prediabetes. Methods: A controlled, longitudinal, single-blind intervention study enrolled 68 adults with prediabetes (mean age 42.22–46.60 years; 73.5% women) and randomized them to HIIT plus hypocaloric diet (n = 23), HIIT only (n = 23), or hypocaloric diet only (n = 22) for 13 weeks, with pre/post assessments of glucose, VO₂max, blood pressure, FINDRISC. Results: Significant post-intervention differences were observed among groups in body mass index (p = 0.049), VO₂max (p < 0.001), fasting glucose (p < 0.001), systolic blood pressure (p < 0.001), and diabetes risk (p = 0.038), with the greatest improvements consistently observed in Group A. In Group A, fasting glucose decreased from 111.94 to 91.28 mg/dL (−20.66 mg/dL; −18.5%), VO₂max increased from 21.27 to 24.02 mL·kg⁻¹·min⁻¹ (+2.75; +12.9%), and systolic blood pressure decreased from 163.56 to 150.13 mmHg (−13.43 mmHg; −8.2%). No significant between-group differences were found for body weight (p = 0.271) or waist circumference (p = 0.174). Conclusions: HIIT combined with a hypocaloric diet is an effective and safe strategy for managing prediabetes, producing superior improvements in cardiorespiratory fitness, glycemic control, and reduction in diabetes risk compared with either intervention alone. Full article

Background/Objectives: Following lumbar fusion procedures, adjacent segment degeneration (ASD) at cranial levels presents as a well-documented long-term complication, manifesting through recurrent pain, neurological deficits, and progressive functional decline. The prone single-position technique for lateral lumbar interbody fusion (PSP-LLIF) streamlines surgical workflow by eliminating the need for intraoperative patient repositioning; however, comprehensive evidence supporting its clinical and radiological effectiveness in managing cranial ASD remains insufficient. Material and Methods: This retrospective cohort study examined 30 consecutive patients presenting with symptomatic cranial adjacent segment disease who were treated with PSP-LLIF at a single institution. Patient-reported outcome measures included visual analog scale (VAS) assessments for axial and radicular pain, alongside the Oswestry Disability Index (ODI) for functional status evaluation. Radiological parameters included overall and segmental lumbar lordotic measurements, anterior and posterior disk height, fusion status, and instrumentation-related complications. Results: At 12-month postoperative evaluation, substantial clinical improvements were demonstrated. Mean VAS reductions measured 4.7 points for axial pain and 6.5 points for radicular pain, while ODI decreased by 28.5 points (p < 0.05). Radiological assessment demonstrated mean increases of 6.3° in lumbar lordosis and 5.1° in segmental lordosis, along with significant gains in both anterior and posterior disk height (p < 0.05). Solid fusion was radiographically confirmed at all instrumented levels. Temporary postoperative neurological symptoms developed in several patients but resolved spontaneously without requiring revision surgery. Conclusions: PSP-LLIF yields substantial clinical benefit and reliable radiological correction in patients with symptomatic cranial ASD. Optimal outcomes necessitate rigorous adherence to position-specific technical modifications, particularly maintenance of perpendicular fluoroscopic trajectories and implementation of continuous neural monitoring to account for prone-induced anatomical shifts. This approach represents a viable treatment strategy for patients with symptomatic cranial ASD. Full article