Search Results (638)

Background/Objectives: Pituitary tumors account for over 90% of all sellar region masses. However, a spectrum of rare neoplastic, inflammatory, infectious, and vascular lesions—benign and malignant—can arise in the intra- and parasellar compartments and clinically and radiologically mimic PitNETs. We report a cohort of 47 such rare and cystic midline intracranial lesions, emphasizing their distinctive morphological, clinical, and imaging features and the personalized treatment strategies applied. Methods: In this retrospective single-center study, we reviewed all patients treated for suspected PitNETs via transsphenoidal approach between 2015 and 2024. Of 529 surgical cases, we excluded confirmed PitNETs, meningiomas, and classical intradural craniopharyngiomas. Collected data encompassed patient demographics, tumor characteristics, presenting symptoms, extent of resection or medical therapy, endocrine outcomes, and follow-up information. Results: Among all 529 patients who underwent surgical treatment for sellar lesions from 2015 to 2024, 47 cases (8.9%) were identified as rare or cystic masses. Forty-six underwent transsphenoidal resection; one patient with hypophysitis received corticosteroid therapy alone. Presenting symptoms included headache (n = 16), dizziness (n = 5), oculomotor disturbances (n = 2), and visual impairment (n = 17). Endocrine dysfunction was found in 30 patients, 27 of whom required hydrocortisone replacement. Histopathological diagnoses were led by colloid cysts (n = 14) and Rathke’s cleft cysts (n = 11). The remaining 22 cases comprised plasmacytoma, germinoma, lymphoma, pituicytoma, inverted papilloma, metastatic carcinoma, chordoma, nasopharyngeal carcinoma, chloroma, and other rare entities. Preoperative imaging diagnosis proved incorrect in 38% (18/47) of cases, with several lesions initially misidentified as PitNETs. Conclusions: Nearly 9% of presumed PitNETs were rare, often benign or inflammatory lesions requiring distinct management. Most could be safely resected and demonstrated excellent long-term outcomes. Yet, despite advanced imaging techniques, accurate preoperative differentiation remains challenging, with over one-third misdiagnosed. Clinical red flags—such as early hormone deficits, rapid progression or atypical imaging findings—should prompt early interdisciplinary evaluation and, when indicated, image-guided biopsy to avoid unnecessary surgery and ensure tailored therapy. Full article

The capitula of Chrysanthemum indicum Linné or C. morifolium Ramatuelle (Kikuka in Japanese) are included in several formulae of Kampo medicines (traditional Japanese medicines), such as Chotosan, which is used for headache and dizziness. Luteolin, the principal constituent of C. indicum, has antioxidant and anti-inflammatory activities. However, the effects of other flavonoids on this crude drug have not yet been thoroughly investigated. To evaluate and compare anti-inflammatory effects, we used primary cultured rat hepatocytes, which produce proinflammatory mediators, such as nitric oxide (NO) and proinflammatory cytokines, in response to interleukin (IL)-1β. Eight derivatives of 5,7-dihydroxyflavone were purified and identified in the ethyl acetate-soluble fraction of a C. indicum capitulum extract: luteolin (Compound 1), apigenin (2), diosmetin (3), 5,7-dihydroxy-3′,4′,5′-trimethoxyflavone (4), acacetin (5), eupatilin (6), jaceosidin (7), and 6-methoxytricin (8). Luteolin is the most abundant compound in this fraction. All compounds significantly suppressed NO production in hepatocytes, with apigenin and acacetin showing the greatest efficacy. The comparison of the IC₅₀ values of the inhibition of NO production suggests that substitutions by hydroxyl and methoxy groups at the C-3′ and C-4′ positions of 5,7-dihydroxyflavone may be at least essential for the suppression of NO production. In hepatocytes, acacetin and luteolin decreased the levels of mRNAs encoding inducible nitric oxide synthase (iNOS), proinflammatory cytokines, including tumor necrosis factor, IL-6, and type 1 IL-1 receptor, which regulates inflammatory responses. Based on the comparison of the IC₅₀ values and the content, luteolin, jaceosidin, and diosmetin may be responsible for the anti-inflammatory effects of C. indicum capitula. Full article

Long-COVID (LC) is characterized by diverse and persistent symptoms, potentially mirroring different molecular pathways. Recent data might offer that one of them is mediated by functional autoantibodies (fAAb) targeting G protein-coupled receptors (GPCR). Thus, the aim of this study was to investigate the clinical phenotype of patients with LC in relation to their GPCR-fAAb seropositivity. The present study recruited 194 patients with LC and profiled them based on self-reported symptoms. GPCR-fAAb seropositivity was identified by using a cardiomyocyte bioassay, testing the presence and functionality of the AAbs. Logistic regression, clustering, and decision tree analyses were applied to examine associations between GPCR-fAAb profiles and self-reported symptoms considering age and gender. The most prevalent GPCR-fAAbs in patients with LC were fAAB targeting the β2 adrenergic receptor (β2-fAAb, 92.8%), the muscarinergic M2 receptor (M2-fAAb, 87.1%), the Angiotensin II type 1 receptor (AT1-fAAb, 85.6%), and angiotensin (1–7) Mas receptor (MAS-fAAb, 85.6%). β2-fAAb showed a significant relation with dizziness, lack of concentration, and POTS, while Endothelin Type A receptor functional autoantibody (ET-A-fAAb) was significantly related to deterioration of pre-existing neurological disorders. Statistical analysis indicated a strong positive correlation between M2- and β2-fAAb; as in addition, an association of β2-fAAb and gender was observed to one of the major clinical symptoms (fatigue/PEM), a critical impact of GPCR-fAAb on LC-pathogenesis can be assumed. Summing up, the present data show that specific GPCR-fAAb are associated with distinct clinical phenotypes. Especially, the combination of M2- and β2-fAAb seemed to be essential for the LC-phenotype with a combination of fatigue/PEM and lack of concentration as major clinical symptoms. Full article

Background and Objectives: Questionnaires are patient-reported outcome measures that require a validation process to assess their reliability and replicability. Over time, questionnaires have not only focused on a single health condition, such as neck pain, but also expanded their assessment spectrum to other areas in order to gather additional and relevant information from the patient. The main objective of this study was to conduct a systematic review of the different structural and psychometric characteristics of neck pain questionnaires. Materials and Methods: A systematic review was conducted following the PRISMA recommendations. The search strategy was implemented across various databases (PubMed, Cochrane, EMBASE, CINHAL, Trip Medical Database, Scopus) using terms such as neck pain, cervicalgia, cervical pain, questionnaire, survey, index, validity, validation, and reliability. COSMIN criteria were used to identify valid questionnaires for this systematic review based on their psychometric properties. Results: A total of 15 articles were identified in this systematic review, of which 8 assessed the level of disability, while the rest evaluated dizziness in neck pain, anxiety and/or depression, beliefs about fear and avoidance, and perception of scarring and symptoms after neck surgery. The main findings show that neck pain questionnaires exhibit very good values for reliability and internal consistency, along with a high variability for construct validity. Conclusions: This study highlights the good values exhibited by neck pain questionnaires despite their heterogeneity in structural characteristics, demonstrating good values in psychometric properties. Nevertheless, the latter should be further investigated to gather more information. Full article

Background/Objectives: The objective of this study was to validate the Spanish version of the European Evaluation of Vertigo (EEV) and analyse its test–retest reliability, standard error of measurement (SEM), minimum detectable change (MDC), concurrent validity, and discriminant validity. Methods: A cross-sectional validation study was designed. Subjects were recruited from the Otolaryngology Service of the University Hospital of Jaen. Psychometric properties of the EEV were analysed, including the concurrent validity, the SEM, and the MDC. Discriminant validity was calculated using the receiver operating characteristic (ROC) curve. Results: The EEV test–retest reliability was nearly perfect (Kappa index = 0.97). The SEM and the MDC were set at 0.56 and 1.10, respectively. Regarding the discriminant validity, the area under the curve (AUC) was 0.831 (95% CI; 0.743–0.899) for the BPPV prediction, the AUC = 0.731 (95% CI; 0.633–0.815) for the disability prediction from the ABC-16 score, and the AUC = 0.846 (95% CI; 0.760–0.911) for the disability prediction from the ABC-6 score. Furthermore, a cut-off point greater than 12 was a good predictor of disability and the fall risk measured with the ABC scale, whereas a value of 11 points was a good predictor for discriminating BPPV patients. Conclusions: The Spanish version of the EEV is a valid and reliable instrument for evaluating the clinical symptoms of vestibular syndrome. This instrument demonstrated a nearly perfect test-retest reliability, a low measurement error, and good accuracy in discriminating between patients with vestibular disorders and those with BPPV. Full article

Vestibular migraine (VM) commonly causes recurrent vertigo, but diagnosing and managing it can be difficult due to symptom overlap with other vestibular and headache disorders. This review provides a comprehensive update on VM, beginning with the diagnostic criteria established by the International Headache Society and the Bárány Society, who have increased awareness of this condition. While the pathophysiology is not yet completely understood, there is evidence of a complex interaction between the nociceptive and vestibular systems. Treatment approaches are primarily empirical and lack robust, high-quality evidence. Often, antihistamines and benzodiazepines are used for quick symptom relief, while the efficacy of triptans is still uncertain. Preventive measures include lifestyle changes, vestibular rehabilitation, oral migraine prophylactics, Botulinum toxin type A, and, more recently, CGRP-targeted therapies. Due to diagnostic uncertainties and the absence of standardised treatment protocols, further research—particularly randomised controlled trials—is crucial for establishing evidence-based guidelines. Full article

Background and Objectives: Older adults are a vulnerable population to unintentional injuries due to age-related physiological decline and the presence of various chronic conditions. Unintentional injuries occurring in the home, such as falls, burns, poisoning, cuts, and suffocation, have been reported at higher rates in this age group compared to younger populations. This study examines the prevalence and types of unintentional in-home injuries in older adults and identifies the risk factors associated with falls and cuts/collisions. Materials and Methods: A cross-sectional study was conducted on 309 older adults (aged ≥ 65 years) recruited from eight senior welfare centers in South Korea. Results: The most frequent cause of injury was falls (28.7%), followed by cuts/collisions (27.0%), burns/fire (11.4%), and other injuries (8.1%). In the model adjusted for age and sex, risk factors for falls included a history of outdoor falls or indoor cuts/collisions, dizziness, and the use of two or more medications. Risk factors for cut/collision injuries included a history of indoor burns or falls, numbness in hands and feet, and visual impairment. Conclusions: To effectively prevent home injuries among older adults, it is crucial to focus not only on falls but also on frequent minor injuries caused by cuts and collisions. Full article

Background: There is a certain degree of overlap between persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) with regard to the phenomenological, pathological and neurobiological characteristics of both conditions. The implementation of an integrative psychotherapy programme may potentially result in the generation of synergistic effects across both patient groups. Objectives: This study assessed (1) whether psychological mechanisms similarly influence symptom severity in PPPD and ANX group, (2) the effectiveness of psychotherapy, and (3) potential neurofunctional biomarkers. Methods: Patients with PPPD (n = 14) and ANX (n = 20) underwent an integrative psychotherapy programme with balance training and mindfulness-based interventions. Emotional and neutral pictures were presented during MRI scans before and after therapy, with healthy controls (HC = 29) for comparison. Clinical and psychological questionnaires were administered, and brain activity was analysed in key regions. Results: The only diagnostic difference in the direct comparison between patients with PPPD and with ANX were the vertigo intensity values before and after therapy. PPPD with comorbid anxiety disorder had significantly more fear of physical symptoms than patients without comorbid anxiety disorder. PPPD showed no change regarding vertigo intensity (VSS), anxiety, or depression scores, but reported decreased impact of vertigo on social functioning (VHQ), and improved personal control after therapy (IPQ). By contrast, anxiety, dizziness, depression, alexithymia, and IPQ scores were significantly reduced after therapy in the ANX group. Neuroimaging revealed decreased activity in the hippocampus and superior temporal gyri (STG) in the PPPD group post-therapy as compared to the pre-therapy measurement, while the ANX group showed reduced activity in the insula, thalamus, hippocampus, and inferior frontal gyrus. Compared to the ANX and HC groups, patients with PPPD showed increased activity in the supramarginal gyrus and STG, both of which could serve as biomarkers for PPPD patients but need to be further validated. Conclusions: Anxiety and vertigo may reinforce each other in PPPD, as symptoms persisted post-therapy, whereas ANX patients improved significantly. Nevertheless, there is some evidence for a successful management of symptoms in the PPPD group. Findings are limited by small sample size and require further research. Full article

Viscum coloratum (Komar.) Nakai (V. coloratum) is a traditional Chinese herbal medicine. It is used in treating rheumatism and paralysis, lumbar and knee soreness, weakness of the muscles and bones, excessive leakage of menstruation, leakage of blood in pregnancy, restlessness of the fetus, dizziness and vertigo. All information about V. coloratum was collected through databases such as PubMed, Google Scholar, Web of Science, and the China National Knowledge Infrastructure and supplemented by consulting classical Chinese medical books. To date, 111 compounds have been isolated and identified from V. coloratum, including flavonoids, phenylpropanoids, terpenoids, diarylheptanoids, alkaloids, other components, and macromolecular compounds, such as polysaccharides and lectins. These chemical components exhibit anti-inflammatory, anticancer, antioxidant, and anti-cardiovascular disease effects, among other beneficial effects. According to the reports, alkaloids, lectins, and other chemical components present in V. coloratum may induce toxicity due to excessive intake or accidental ingestion. However, there are few reports on the toxicology of V. coloratum, and there is a lack of studies on the toxicity of V. coloratum with known in vitro or preclinical activity. It is suggested that further studies on the toxicology of V. coloratum should be conducted in the future. In this paper, the botany, traditional uses, phytochemistry, pharmacology, and pharmacokinetics of V. coloratum are summarized, and the progress and shortcomings in toxicology are discussed, so as to provide a possible direction for future research on V. coloratum. Full article

Acute vertigo or dizziness that is accompanied by a sudden sensorineural hearing loss (SSNHL) often poses a diagnostic challenge. While a combined audiovestibular deficit makes an inner ear pathology most likely, this does not necessarily exclude a vascular pathology that may be a harbinger of future sinister events. This is especially true for strokes within the territory of the anterior inferior cerebellar artery (AICA), because the labyrinth receives its vascular supply most often by branches of the AICA. Thus, acute labyrinthine ischemia may present in combination with focal neurologic deficits, but also in isolation or as a warning sign before focal stroke signs arise. How can labyrinthine ischemia be differentiated from an idiopathic SSNHL? In this critical review, we discuss both the pathophysiology and the differential diagnosis of acute audiovestibular deficits. We will also address the value of state-of-the-art MR imaging in visualizing labyrinthine ischemia. Finally, we will discuss treatment options and review the prognosis of acute audiovestibular deficits. Full article

Mining involves daily descents underground and enduring dangerous and difficult conditions. Hence, it is very important to use solutions that will reduce the risk in miners’ work and ensure the greater safety and comfort of work in accordance with the goals of sustainable development. One way is training using virtual reality. Virtual reality provides greater safety (safe training conditions, the possibility of making a mistake without health consequences, practicing emergency scenarios, etc.) and aligns with the Sustainable Development Goals—particularly SDG 3 (health), SDG 8 (decent work), SDG 9 (innovation), and SDG 12 (sustainable production). However, it is also a technology that has its weaknesses (occurrence of contraindications, side effects, etc.). Therefore, the use of VR-based training should be examined in terms of the well-being and health of training employees. Due to this, this article examines the occurrence of psychophysical complaints during VR training; the tolerance and adequacy of the duration of a 50 min training session in VR was assessed; and the average time needed to adapt to the virtual environment was determined. The VR training was developed as a result of a research project conducted by JSW Nowe Projekty S.A. (ul. Ignacego Paderewskiego 41, 40-282 Katowice, Poland), Główny Instytut Górnictwa—Państwowy Instytut Badawczy (plac Gwarków 1, 40-160 Katowice, Poland), JSW Szkolenie i Górnictwo Sp. z o.o. at Jastrzębska Spółka Węglowa Capital Group (ul. Górnicza 1, 44-335 Jastrzębie-Zdrój, Poland) on the development and implementation of innovative training using VR for miners. The solution was developed in the context of mining’s striving for sustainable development in the area of improving working conditions and human safety. The first method used in the study is a survey completed by participants of training courses using virtual reality. The second method is the analysis of trainer observation sheets, which contain observations from training courses. The results revealed that for over 70% of respondents, the need to carry out activities in VR was not associated with fatigue. No average score for psychophysical symptoms assessed by respondents on a scale of 1 to 6 (including disorientation, blurred vision, dizziness, confusion, etc.) exceeded 1.4. The vast majority (85.5%) did not take off the goggles before the end of the training—the training lasted 50 min. This research contributes to the discussion on sustainable industrial transformation by demonstrating that VR training not only improves worker safety and preparedness but also supports development goals through human-centered innovation in the mining sector. Full article

Background: PP-007 (SANGUINATE^®, PEGylated carboxyhemoglobin, bovine) is under development to treat conditions of ischemia/hypoxia. Hemorrhagic/hypovolemic shock (H/HVS) becomes a life-threatening comorbidity due in part to hypotension and hypoxia. Blood transfusions are indicated, but supply and compatibility issues may limit subject access or when blood is not an option due to religious restriction or concern for clinical complications. PP-007 is universally compatible with an effective hydrodynamic radius and colloidal osmotic pressure facilitating perfusion without promoting extravasation. Methods: A review of previous clinical trials was performed and revealed an Open-Label Phase 1 safety study of acute severe anemia (hemoglobin ≤ 5 g/dL) in adult (≥18 y) patients unable to receive red blood cell transfusion (NCT02754999). Primary outcomes included safety events with secondary efficacy measures of organ function and survival at 1, 14, and 28 days. Additionally, a retrospective review of published, peer-reviewed case reports was performed, evaluating the administration of Sanguinate for Expanded Access in those patient populations where blood was not an option over the past 12 years. Results: A total of 103 subjects were enrolled in the Phase I safety study with significant co-morbidities that most commonly included hypertension (n = 43), acute and chronic kidney disease (n = 38), diabetes mellitus (n = 29), gastrointestinal bleeds (n = 18), and sickle cell disease (n = 13). Enrollment characteristics included decreased hemoglobin and severe anemia (mean baseline hemoglobin of 4.2 g/dL). Treatments included an average of three infusions [range 1–17]. Secondary efficacy measures were mean Hb levels, respiratory support, and vasopressor requirements, all demonstrating clinically relevant improvements. Fourteen additional cases were identified in the literature. Though one patient died due to pre-treatment conditions, all patients but one were discharged home in stable condition. Conclusion: Collectively, these observations are encouraging and provide support for the continued evaluation of PP-007 in advanced clinical trials in severe anemia including H/HVS. The review of published case reports underscored the potential of Sanguinate to reduce early mortality. Adverse effects included transient hypertension, lethargy, dizziness, and troponin elevation. These findings highlight the need for continued research and funding of blood alternatives to improve outcomes when standard blood transfusions are unavailable or contraindicated. Full article

Objectives: Muscular dysfunction of the cervical spine is the most likely cause of somatosensory tinnitus and dizziness. Some patients can modulate their tinnitus through movement or palpation. This study aimed to investigate the effect of manual therapy on muscle pressure pain, range of motion in the cervical spine, and tinnitus and dizziness. Methods: A pilot randomized controlled trial with a waiting-group design was conducted in a university hospital setting. Participants in the intervention group received manual therapy to the head and neck region combined with stretching exercises and muscle relaxation techniques such as releasing tense muscles and myofascial trigger point therapy involving muscle and connective tissue techniques. The primary and secondary outcome measures were pressure pain, tinnitus modulation by head and neck muscles, and range of motion of the cervical spine. Tinnitus and dizziness were assessed before and after the intervention using the Tinnitus Handicap Inventory and the Dizziness Handicap Inventory. Results: After the intervention, significant differences were observed in pressure pain, tinnitus modulation, and range of motion as well as the Tinnitus Handicap Inventory (U = 644; p < 0.001) and the Dizziness Handicap Inventory (U = 133.5; p = 0.010), favoring the intervention group. Conclusions: The results demonstrate that manual therapy significantly altered pressure pain in the head and neck muscles as well as symptoms such as tinnitus and dizziness in the intervention group. Manual therapy may be beneficial in treating cervicogenic somatosensory tinnitus, provided that other potential causes such as otorhinolaryngological pathology have been ruled out. Full article

Harmful gases produced by diesel locomotives tend to accumulate within tunnels, posing risks such as dizziness, vomiting, coma, and even death to the working staff, particularly in long tunnels with high traffic density. As the number of such structures increases, ventilation in extra-long tunnels represents a critical challenge within the engineering area. In this study, the ventilation of an extra-long single-bore double-track tunnel operating with diesel locomotives is investigated. Through scale model tests and based on the inspection sensor data, the natural diffusion patterns of harmful gases under various operating conditions were elucidated. Based on the local resistance coefficient optimization theory and numerical simulations, the ventilation shafts of the tunnel were optimally designed, and an overall ventilation scheme was developed. The ventilation effect of the tunnel was verified through improved scale model tests. The results show that harmful gases primarily diffuse towards the higher elevation tunnel entrance, with only gases near the lower entrance escaping from it. Under the same operating conditions, NO₂ diffuses more slowly than CO, making it harder to discharge. Applying the local resistance coefficient optimization theory, the inclined and vertical shafts of the tunnel can be effectively optimized. The optimized ventilation shafts, coupled with jet fans, can reduce harmful gas concentrations below safety limits within one minute. The methodologies and findings presented here can offer valuable guidance for the ventilation design of similar infrastructures. Full article

Background/Objectives: Cognitive impairment and vestibular dysfunction commonly co-occur in older adults and may share overlapping neuroanatomical pathways. Understanding their association may enhance the early identification of cognitive decline using clinically feasible vestibular assessments. This study aimed to examine the relationship between vestibular dysfunction and early cognitive impairment, assess the diagnostic accuracy of vestibular markers, and explore the association of subjective dizziness and balance measures with cognitive performance. Methods: Our cross-sectional study included 90 participants aged ≥60 years, classified into cognitively healthy, mild cognitive impairment (MCI), and early Alzheimer’s disease (AD) groups. Cognitive function was assessed using the MoCA and the MMSE; vestibular function was evaluated via posturography sway and horizontal vHIT gain. Subjective dizziness and balance were measured using the Dizziness Handicap Inventory (DHI), gait speed, and eyes-closed balance time. The data were analyzed using SPSS v24 with ANOVA, Pearson correlations, linear regression, and ROC curve analyses. Results: Significant group differences were found across the cognitive and vestibular scores (MoCA: p = 0.001. Sway: p = 0.001. vHIT: p = 0.001). vHIT gain and posturography sway independently predicted the MoCA and MMSE scores (adjusted R² = 0.68 and 0.65, respectively). The ROC analysis showed a strong diagnostic accuracy for posturography sway (AUC = 0.87) and vHIT gain (AUC = 0.82). Conclusions: Vestibular dysfunction is significantly associated with early cognitive impairment and may serve as a useful clinical marker for cognitive screening in older adults. Full article