Search Results (3,908)

Objective: The objective of this study was to examine how functional, mental, and physical health outcomes differ between younger (<age 50) and older (≥age 50) stroke survivors. Methods: Data from adult stroke survivors examined health-related outcomes (physical and mental health) over the past 30 days. Logistic regression models were used for binary functional outcomes, and Poisson regression models were used to estimate count outcomes for poor mental and physical health days. Results: Compared with older adults, younger stroke survivors were more likely to report difficulty concentrating or remembering (41.1% vs. 23.2%, p < 0.0001) and difficulty doing errands alone (27.11% vs. 23.67%, p = 0.00), but less likely to report difficulty walking or climbing stairs (34.3% vs. 47.6%, p < 0.0001). Additionally, younger adults with stroke reported significantly more poor mental health days (10.81 vs. 5.76, p < 0.0001) than older adults. In adjusted models, being out of work or out of the labor force was consistently associated with greater odds of functional limitations (e.g., OR for activity difficulty = 2.07, 95% CI: 1.56–2.75) and higher counts of poor mental and physical health days. Younger stroke survivors who were out of the labor force had significantly greater odds of difficulty concentrating (OR = 2.02, 95% CI: 1.17–3.48) and increased days of poor mental (IRR = 1.27, 95% CI: 1.19–1.70) and physical health (IRR = 1.26, 95% CI: 1.19–1.53). Conclusions: These findings highlight the intersection of age and employment on stroke outcomes. Younger stroke survivors face unique and disproportionate challenges in functional and mental health. Full article

This second part of this expert panel review explores the broader impact of vaccines across the lifespan, emphasizing their role beyond immediate infection control. Vaccines not only extend life expectancy but also influence long-term health trajectories, particularly during the critical first 1000 days of life, where they prevent severe infections, disability, and mortality. They contribute to cancer prevention through vaccination against human papillomavirus and hepatitis B, reduce cardiovascular events and complications in individuals with chronic diseases, and protect against late-life functional decline. Furthermore, vaccines exert lasting effects on healthy aging by modulating inflammation and preserving independence, while proposed vaccination schemes illustrate the need for a comprehensive, life-course approach. Together with Part 1, which focused on immunosenescence and immune modulation, this closing installment underscores vaccination as a cornerstone of sustainable health policy, reinforcing its pivotal role in extending both lifespan and healthspan for future generations. Full article

Objectives: Type-D personality, characterized by negative affectivity (NA) and social inhibition (SI), has been associated with adverse outcomes in chronic pain and cardiovascular populations. Evidence in spine outpatient settings remains limited. We aimed to assess the prevalence of Type-D personality and its association with pain, disability, and psychological distress in patients presenting to a university spine outpatient clinic. Methods: This exploratory cross-sectional study included 300 consecutive patients (18–85 years) presenting to a university spine outpatient clinic between 2023 and 2025. Patients completed the Type-D Scale-14 (DS14; Type-D defined as NA ≥10 and SI ≥10), the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale for pain (VAS, 0–10), and the Oswestry Disability Index (ODI, 0–100). Demographic and clinical characteristics were recorded. Comparisons between Type-D and non-Type-D patients were performed. Results: The prevalence of Type-D personality was 32.3% (95% CI: 27.0–37.6%). Compared with non-Type-D patients, Type-D patients reported higher pain intensity (VAS: 5.23 vs. 3.88), disability (ODI: 38.6 vs. 31.3), anxiety (HADS-A: 10.0 vs. 6.5), and depression (HADS-D: 8.4 vs. 6.4); all p < 0.01. Between-group differences were clinically relevant, with large effect sizes for pain intensity (VAS; Cohen’s d ≈ 1.10) and moderate-to-large effect sizes for functional disability (ODI; Cohen’s d ≈ 0.75). Correlation analyses showed moderate to strong associations between Type-D personality traits (negative affectivity and social inhibition) and psychological distress. In stratified analyses, longer pain duration was descriptively associated with greater disability, particularly among patients with Type-D personality. Conclusions: Type-D personality is common in spine outpatient populations and is associated with greater pain, disability, and psychological distress. These findings underscore the relevance of psychosocial factors in spine outpatient care and highlight the need for further longitudinal research to clarify prognostic implications and potential targets for intervention. Full article

Background/Objectives: Musculoskeletal disorders and their surgical treatment significantly affect global disability, healthcare utilization, and costs. Artificial intelligence (AI) is a key enabler of data-driven musculoskeletal care. Their applications include diagnostic imaging, surgical planning, risk prediction, rehabilitation, and digital health ecosystems. This narrative review synthesizes current evidence on the use of AI in orthopaedics and musculoskeletal care across five areas: diagnostic imaging, surgical planning and intraoperative augmentation, predictive analytics and patient-reported outcomes, rehabilitation intelligence and teleorthopaedics, and system-level management. An additional task is to identify translational gaps and priorities for safe, ethical, and equitable implementation of AI. Methods: A structured narrative review was conducted using targeted searches in PubMed, Scopus, and Web of Science supplemented by semantic and citation-based explorations in Semantic Scholar, OpenAlex, and Google Scholar. The main search period was January 2019 to December 2025. The retrieved peer-reviewed articles were analyzed for clinical relevance to human musculoskeletal care, quantitative outcomes, and the translational implications of the results. From the broader pool of eligible publications, 40 clinically relevant studies were selected for detailed synthesis covering imaging, surgical planning, predictive modeling, rehabilitation, and system-level applications. Owing to the significant heterogeneity in the model architectures, datasets, and endpoints, the results were organized into five predefined thematic areas. Results: The most mature evidence is for AI-assisted detection of bone fractures on radiographs, identification of implants, and use of sizing templates in preoperative planning for arthroplasty, where deep learning systems have achieved expert-level diagnostic performance (e.g., fracture detection sensitivity of approximately 90% and specificity of approximately 92% and implant identification accuracy of 97–99%) and improved the accuracy of preoperative planning compared to conventional templating. AI-based planning increases the likelihood of reducing intraoperative corrections, shortening surgery time, reducing blood loss, and improving the final functional outcomes. Predictive models can support the stratification of risk for complications, rehospitalizations, and patient-reported outcomes, although external validation remains limited and is often single-center at this stage of research. Emerging applications in rehabilitation and teleorthopaedics, including sensor-based monitoring and learning systems integrated with Patient-Reported Outcome Measures (PROMs), are conceptually promising, but are mainly limited to feasibility or pilot studies. Conclusions: AI is beginning to influence musculoskeletal care, moving beyond pattern recognition toward integrated, patient-centered decision support throughout the perioperative and rehabilitation periods. Its widespread use remains constrained by limited multicenter validation, dataset bias, algorithmic opacity, and immature regulatory and governance frameworks. Future work should prioritize prospective multicenter impact studies, repeatable revalidation of local models, integration of PROM and teleorthopedic data with health learning systems, and adaptation to changing regulatory requirements to enable safe, ethical, effective, and equitable implementation in routine orthopedic practice. Full article

Background: Cerebral palsy (CP) is the most common cause of disability in developmental age, affecting motor and postural skills. With growth, lower-limb orthopedic surgery often becomes necessary. Post-surgical walking rehabilitation programs generally involve conventional therapy with only limited evidence on the use of robot-assisted gait training (RAGT). The aim of the present pilot study is to assess the feasibility and the preliminary functional outcomes of an intensive 3-week rehabilitation of 15 sessions with Lokomat combined with 15 sessions of conventional physiotherapy. Methods: In total, 27 patients with diplegic cerebral palsy who underwent orthopedic surgery were recruited. Outcomes collected: the 6 min walking test (primary outcome), the Gross Motor Function Measure-88, the Gillette Functional Assessment Questionnaire, 3D gait analysis, and spasticity and force metrics of the lower limbs. Paired statistical tests were used to assess pre–post changes. Results: A pre–post statistically significant improvement was observed in gait endurance in the 6MWT (Δ = 28.56 ± 34.28 m; p < 0.001) and in gross motor functional skills. Gait parameters showed some functional and structural improvements, and joint stiffness was reduced in some measures. Conclusions: This combined rehabilitative approach seems to be promising in postoperative patients with CP. Future studies, involving a control group and larger sample size, are needed to generalize our results. Full article

Background/Objectives: A plethora of articles report the effectiveness of many different interventions for managing cerebral palsy (CP), but there are few long-term follow-up studies of children after an intervention designed to improve function in children with CP. This observational mixed-methods study examined the functional gains observed more than one year after toddlers completed a 48-week investigation that included 5 days per week for 12 weeks of occupational and physical therapy using the Perception-Action Approach (P-AA). The aim was to observe whether the functional gains made by the children continued to improve, plateaued, or declined at long-term follow-up. Methods: The sample was 23 children with a mild-to-moderate level of CP (Gross Motor Function Classification System I, II, or III) who completed the original study at least one year prior. The follow-up assessment included quantitative data using the Gross Motor Function Measure-66 (GMFM) and the Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Seventeen of 23 children were evaluated with both instruments. Qualitative data were collected from 14 of the 23 families who completed the PEDI-FS. Those families completed a survey with an open-ended questionnaire that assessed the caregivers’ perspectives about their children’s functioning and the impact of the intervention. Results: Findings from the quantitative data based on prognostic GMFM-66 developmental curves by age for children with CP: seven of the 17 children who had GMFM evaluations showed greater than expected improvement (all 5 with GMFCS II), four met the expected improvement, and six did not. Children with GMFCS II or III maintained their positions relative to the mean on the PEDI-FS mobility subset. Findings from the qualitative data revealed that some parents believed the intervention contributed to the changes in their children’s physical, mental, and social functioning. Many parents indicated that the study helped them overcome financial barriers related to accessing intensive therapies. Most parents reported that their child’s functioning was better than they expected when given the diagnosis of CP. Conclusions: Many months following an intense physical and occupational therapeutic intervention, based on predicted age-appropriate percentiles for motor function, roughly one-third of the children exceeded expectations, and one-third did not meet expectations. Despite the time invested in the intense protocol, caregivers felt the intervention was largely responsible for improvements in their children’s functioning. Full article

Background: Intellectual disability limits physical activity, affecting health and quality of life. Efficient tests to assess cardiorespiratory fitness in adapted football are essential. The Six-Minute Walk Test (6MWT) is a widely used benchmark test but can be logistically challenging. Although alternative tests such as the Sit-to-Stand Test (STST), Chester Step Test (CST), and Two-Minute Step Test in Place (2MST) have been validated in other populations, no study has examined their relationship with the 6MWT specifically in football players with intellectual disability, a population with unique physiological and cognitive characteristics. Therefore, this study reports the convergent validity between the 6MWT and these alternative field tests and describes the physiological responses to each test in football players with intellectual disability. Methods: Forty-two adult male football players with intellectual disability (mean age 27.1 ± 5.6 years) completed the 6MWT, STST, CST and 2MSPT. Physiological parameters, including heart rate, oxygen saturation (SpO₂), and systolic and diastolic blood pressure, were recorded before and after each test. Pearson’s correlation coefficients were calculated to assess relationships among tests. Results: Strong, significant correlations were found between the 6MWT and the STST (r = 0.711), CST (r = 0.724), and 2MSPT (r = 0.683) (all p < 0.001). All tests induced expected changes in heart rate, blood pressure and oxygen saturation. Conclusions: The STST, CST and 2MSPT showed strong associations with the 6MWT and may serve as practical, safe and efficient complementary tools for field-based assessment of cardiorespiratory fitness in this population. These findings apply specifically to adult male football players with intellectual disability and should not be generalized to other populations with intellectual disability. Full article

Background: Migraine is a highly prevalent and disabling primary headache disorder frequently accompanied by gastrointestinal symptoms and comorbid gastrointestinal diseases. Increasing evidence suggests that alterations in the gut microbiota and dysregulation of the microbiome–gut–brain axis may contribute to migraine pathophysiology through immune activation, oxidative stress, impaired intestinal barrier function, and neuroinflammatory signaling. Objectives: This narrative review aims to summarize current mechanistic and clinical evidence linking the gut–brain axis to migraine, with a particular focus on the potential roles of probiotics, prebiotics, and postbiotics as adjunctive strategies in migraine management. Methods: A narrative synthesis of experimental, translational, and clinical studies was performed, focusing on microbiome composition, gut barrier integrity, immune and oxidative pathways, and interventional trials evaluating probiotics, prebiotics, synbiotics, and microbiota-derived metabolites in adult and pediatric migraine populations. Results: Migraine has been associated with intestinal dysbiosis, increased gut permeability, and low-grade systemic inflammation. Probiotics, most commonly strains of Lactobacillus and Bifidobacterium, may modulate inflammatory cytokine profiles, enhance tight junction integrity, reduce oxidative stress, and influence neurotransmitter-related pathways along the gut–brain axis. Clinical trials evaluating probiotic supplementation report heterogeneous but promising signals, including reductions in migraine frequency, severity, disability scores, and analgesic use, particularly in chronic migraine and pediatric populations. Emerging evidence also supports a potential role for prebiotics (e.g., inulin-type fructans) and microbiota-derived metabolites such as short-chain fatty acids, although direct clinical data remain limited. Conclusions: Modulation of the microbiome–gut–brain axis represents a biologically plausible adjunct approach in migraine management. While probiotics, prebiotics, and postbiotics show potential benefits with favorable safety profiles, current evidence of their strain-, formulation-, and population-specific characteristics is lacking. Well-powered, placebo-controlled trials with standardized migraine endpoints and integrated microbiome and metabolomic analyses are needed to define responders, optimal interventions, and clinical relevance. Full article

Background: Nocturnal leg cramps (NLCs) are common, especially in older adults, and may cause substantial distress, sleep disturbance, and functional impairment. Despite widespread clinical use of quinine sulfate (QUI), safety concerns limit its use. Pridinol mesylate (PRI), a centrally acting antispasmodic, may offer a promising alternative in clinical practice. Objective: To evaluate the clinical effectiveness and tolerability of PRI versus QUI in patients with NLCs. Methods: We conducted a retrospective, non-interventional, propensity score-matched analysis of anonymized routine data from 1722 adult patients (861 per group) with NLCs from the German Pain e-Registry (GPeR). Patients initiating either PRI or QUI between 2018 and 2023 were included. The primary outcome was a predefined composite responder rate (≥50% reduction in NLC frequency, duration, and affected nights, with no treatment discontinuation due to adverse drug reactions [ADRs] or inefficacy). Secondary outcomes included pain intensity, quality-of-life, disability, and ADR frequency. Results: PRI treatment resulted in a significantly higher responder rate (56.9%) compared to QUI (48.4%, p < 0.001; NNT = 12) due to greater short-term reductions in NLC episodes, duration, and pain intensity. The overall ADR rates were numerically higher with PRI (8.6%) than with QUI (6.7%), but discontinuation rates due to ADRs or inefficacy were comparable between groups and occurred in 3.1/2.6% with PRI/QUI (p = 0.865). Conclusions: In this large, real-world, propensity score-matched analysis, pridinol treatment was associated with a modest short-term advantage over quinine in several efficacy outcomes, while overall tolerability appeared broadly comparable. Given the retrospective, non-interventional design and the limited 4-week observation period, these findings should be interpreted as hypothesis-generating rather than confirmatory. Full article

Background: Obstructive sleep apnea (OSA) is increasingly recognized in chronic inflammatory diseases, yet its prevalence and clinical correlates in psoriatic arthritis (PsA) remain poorly characterized. Objective: The objective of this study was to evaluate OSA prevalence and its relationship with disease activity, functional impairment, and comorbidities in PsA patients. Methods: A cross-sectional analysis of 247 consecutive PsA patients was conducted. OSA diagnosis was determined through medical record review. Disease activity was assessed using cDAPSA and ASDAS-CRP. Functional disability was measured using HAQ-DI and BASFI. Sleep quality (PSQI) and psychological symptoms (HADS) were evaluated. Inflammatory markers included CRP, IL-6, and TNF-α. Multivariable logistic regression identified independent predictors of OSA. Results: OSA prevalence was found to be 8.9% (22/247). OSA+ patients had significantly higher median age (58.0 vs. 54.0 years, p = 0.02), tender joint count (2.0 vs. 1.0, p = 0.002), functional disability (1.1 vs. 0.3, p = 0.001), fatigue (30.5 vs. 38.0, p = 0.04), anxiety (7.5 vs. 5.0, p = 0.03), depression (7.0 vs. 3.0, p = 0.004), and worse sleep quality (11.5 vs. 7.0, p = 0.001). Notably, no significant differences in inflammatory markers (CRP, swollen joints) were found between groups despite substantially higher pain burden in OSA+ patients. Female sex and greater tender joint count emerged as independent predictors of OSA. Conclusions: OSA occurs in ~9% of unselected PsA patients and is independently associated with functional disability, psychological distress, and elevated tender joint counts despite comparable inflammatory markers. This dissociation suggests that OSA drives pain amplification through non-inflammatory mechanisms. These findings support the use of systematic OSA screening in PsA patients with pain or disability disproportionate to inflammatory burden, particularly in those with psychological comorbidities. Full article

Background/Objectives: Chronic nonspecific neck pain is a common global health problem that diminishes people’s quality of life and functionality. Strengthening and mobility exercises are a fundamental tool in managing this condition. Combined treatment with electrotherapy appears to have promising results; however, the evidence is limited. The aim of this review was to compare the effectiveness of therapeutic exercise combined with electrotherapy versus the McKenzie method alone in improving pain and disability in adults. Methods: A systematic review and meta-analysis of randomized clinical trials was conducted following the PRISMA guidelines. Studies published up to June 2025 were extracted from major scientific databases. High-quality studies evaluating therapeutic exercise with or without electrostimulation and studies evaluating the McKenzie method alone were analyzed, measuring short-term pain and disability through meta-analysis using random-effects models. The risk of bias of the included studies was assessed using the Cochrane Collaboration tool. Results: Seven studies were included (N = 441). The combination of therapeutic exercise with electrotherapy showed a significant reduction in pain (SMD −0.76 [−1.36, −0.16] (p = 0.01; 95% CI)), without additional benefits for disability (SMD −0.94 [−2.08, 0.20] (p = 0.1; 95% CI)) compared to exercise alone. Similarly, the McKenzie method presented statistically significant differences compared to other active interventions in reducing pain (SMD −0.61 [−1.01, −0.21] (p = 0.003; 95% CI)), while no significant differences were found for disability (SMD −0.31 [−1.78, 1.15] (p = 0.67; 95% CI)). Heterogeneity among studies was generally high. The results show short-term effects measured after completion of the intervention. Conclusions: Electrotherapy combined with exercise may provide short-term relief of nonspecific chronic neck pain, although the certainty of evidence is very low. Interferential current plus exercise and isolated McKenzie exercises showed short-term pain improvements, with no consistent benefits for disability. The methodological limitations, heterogeneity, small samples, and short follow-up warrant cautious interpretation. High-quality trials with standardized protocols and longer follow-up are needed. Full article

Background: Adolescents with neurodevelopmental disorders (NDDs), particularly autism spectrum disorder (ASD) and borderline intellectual functioning/intellectual disability (BIF/ID), represent a clinically complex population in psychiatric emergency settings, with unclear contributions to acute psychopathology and suicide risk. Aims: This study examined whether ASD and BIF/ID differentially influence clinical severity, psychopathological profiles, and suicidality in adolescents admitted for psychiatric emergencies, comparing high-functioning ASD, ASD with cognitive impairment, and adolescents without NDDs. Methods: We conducted a retrospective, single-center cohort study including 206 consecutive patients aged 11–17 years admitted to a psychiatric emergency unit between January 2022 and December 2023. Patients were stratified into four groups: ASD (ASD-HF; ASD-BIF/ID), BIF/ID and N-ASD/N-BIF/IDClinical severity, global functioning, psychiatric diagnoses, adverse childhood experiences, emotional dysregulation, and suicidality were assessed using standardized diagnostic and behavioral measures. Group comparisons were performed to identify predictors of suicidality. Results: ASD-BIF/ID patients exhibited the lowest global functioning, whereas ASD-HF adolescents showed functioning comparable to controls. Suicidal ideation and behaviors were significantly more frequent in ASD-HF. BIF/ID was associated with greater behavioral impairment and lower suicidality. Conclusions: ASD and BIF/ID may differentially shape psychiatric emergency presentations. Adolescents with high-functioning ASD showed a higher prevalence of suicidality in this specific clinical context. Limits: This study is limited by its cross-sectional, single-center, and retrospective design, small and uneven subgroup sizes, and assessment tools not specifically validated for autistic or intellectually disabled populations. The high prevalence of bipolar spectrum disorders may reflect referral bias. Despite these limitations, adolescents with high-functioning ASD exhibited elevated suicidality, underscoring the importance of risk assessment adapted to cognitive and diagnostic profiles. Full article

Background/Objectives: Stroke is a leading cause of long-term disability, and predicting functional outcome at discharge, such as the modified Rankin Scale (mRS), is important for guiding treatment and rehabilitation. Many existing approaches depend on advanced imaging or complex corticospinal tract (CST) segmentation from multi-shell diffusion MRI, limiting clinical feasibility. Automated lesion segmentation is also challenging due to lesion heterogeneity and MRI variability. This study proposes a clinically feasible multimodal MRI pipeline based on routine imaging. Methods: Lesion segmentation models were trained and evaluated on the ISLES 2022 dataset (250 training, 150 test cases). Zero-shot external evaluation was performed on 149 cases from ISLES 2024 using standard MRI sequences only. An ensemble of deep learning models (SEALS, NVAUTO, FACTORIZER) was evaluated on ISLES 2022, while SEALS alone was used for external testing. CST segmentation was performed using TractSeg on single-shell diffusion-weighted imaging. Imaging biomarkers included lesion volume, shape, ADC-based texture features, CST integrity, and lesion–CST overlap. These features were used to train machine learning models for binary mRS prediction at discharge. Results: The ensemble achieved a Dice score of 0.82 on ISLES 2022, while zero-shot evaluation on ISLES 2024 achieved 0.57. In exploratory analysis, CatBoost achieved the highest point estimates (accuracy 0.88, F1-score 0.87, ROC-AUC 0.83). Key predictors included lesion–CST overlap, lesion volume, surface area, dissimilarity, and contrast. Conclusions: This exploratory study demonstrates the feasibility of combining automated lesion segmentation with anatomically informed biomarkers using routine clinical MRI, supporting interpretable stroke outcome modelling and motivating future large-scale validation. Full article

Older adults with disabilities face compounded vulnerabilities due to both functional limitations and socioeconomic disadvantage. In South Korea, where public welfare systems remain fragmented and cultural values emphasize independence and productivity, understanding the mechanisms linking socioeconomic status (SES) to health outcomes is critical. This study investigates whether reserve capacity mediates the relationship between SES and self-rated health (SRH) in older adults with disabilities. Data were drawn from the supplementary survey on people with disabilities in the 18th wave (2023) of the Korea Welfare Panel Study (KWePS). The analytic sample included older adults aged 65 and above with registered disabilities. A multiple mediation analysis was conducted using Model 4 of the PROCESS macro in SPSS to examine whether three dimensions of reserve capacity—intrapsychic resources (self-esteem), interpersonal resources (social support satisfaction), and tangible resources (use of public disability services)—mediated the relationship between SES and SRH. Demographic and health-related covariates were statistically controlled. The results are as follows: The direct effect of SES on SRH was not significant; however, significant indirect effects were found through all three mediators. Higher SES was positively associated with intrapsychic and interpersonal resources and negatively associated with tangible resource use. Among the mediators, interpersonal resources had the strongest positive effect on SRH, while tangible resources showed a negative association—possibly due to compensatory activation or increased disease awareness among service users. The findings highlight the importance of psychosocial and relational resources in shaping perceived health among disabled older adults in Korea. Policy interventions should move beyond material assistance and focus on strengthening social networks and psychological resilience to reduce health disparities in this population. Full article

Spinal cord injury (SCI) is a devastating neurological disorder that can result in permanent disability and reduced quality of life, characterized by heterogeneous injury mechanisms and limited tools for accurate early diagnosis and prognostic stratification. The clinical course of SCI is driven not only by the initial mechanical insult but also by complex secondary injury cascades involving neuroinflammation, axonal degeneration, demyelination, and maladaptive repair responses. Current diagnostic and prognostic approaches, which rely largely on neurological examination and imaging, provide limited insight into these dynamic molecular processes. In this context, extracellular vesicles (EVs) have emerged as a biologically compelling source of biomarkers for SCI. EVs are released by neurons, glial cells, endothelial cells, and immune cells and carry molecular cargo that reflects cellular stress, injury severity, and endogenous repair activity. Increasing evidence indicates that EV-associated proteins and regulatory microRNAs (miRNAs) encode injury-specific signatures related to neuronal and glial damage, inflammatory signaling, metabolic stress, and functional recovery potential. In this review, we summarize the current knowledge on EV biology in SCI and discuss emerging evidence supporting EV-derived proteins and miRNAs as promising tools for refining diagnosis and prognosis. Our aim is not only to consolidate established findings but also to highlight EV-based molecular signatures as a developing framework for precision biomarker discovery in SCI. Full article