Search Results (5,100)

The objective was to evaluate the impact of a 3-month comprehensive rehabilitation program on functional outcomes and caregiver burden in a 73-year-old male with end-stage Parkinson’s disease (PD) following pallidotomy. Baseline evaluation included cardiorespiratory, digestive, and neuromusculoskeletal assessments, complemented by a multidomain geriatric assessment: activities of daily living (Barthel Index), cognition (MoCA), nutrition (MNA), mental health (GDS, UCLA Loneliness Scale), sarcopenia (AWGS criteria), frailty (Clinical Frailty Scale), fatigue (FSS), mobility (De Morton Mobility Index), fall risk (Morse Fall Scale), and caregiver burden (Zarit Burden Interview). The patient then underwent a structured 3-month rehabilitation program consisting of strengthening and flexibility training, cardiopulmonary endurance exercise, functional task practice, and psychological and nutritional counseling, with monthly evaluations. At baseline, the patient presented with generalized rigidity, fatigue, low cardiorespiratory endurance, total ADL dependence, malnutrition, sarcopenia, frailty, loneliness, and high caregiver burden, but intact cognition and mood. After rehabilitation, he achieved short distance walking, improved appetite and weight gain, and reduced scores in Zarit Burden, Fatigue Severity Scale, and MNA. Functional independence (Barthel Index) and respiratory capacity (single-breath count) improved, while frailty and sarcopenia remained stable without progression. In advanced PD, comprehensive rehabilitation can yield meaningful gains in mobility, nutrition, and functional independence while alleviating caregiver burden. Frailty and sarcopenia remain strongly associated with disease progression and highlight the need for sustained multidisciplinary care for both patients and caregivers. Full article

Inflammatory bowel disease (IBD) is characterized by chronic and intermittent symptoms, exerting a profound impact on overall health. Although drug therapy and biological agents are primary treatment approaches for IBD, the side effects can affect human health. Thus, it is an urgent need to explore new approaches to counteract the harm caused by IBD. Owing to their natural origin and excellent biosafety, casein peptides are a promising candidate treatment for IBD. This review systematically outlines the structural basis of the intestinal barrier and elucidates the pivotal role of barrier dysfunction in IBD pathogenesis. We further elaborate on the multi-faceted therapeutic mechanisms of casein peptides in IBD, including intestinal barrier repair, immune homeostasis modulation, inflammatory response suppression, and other such pathways. Moreover, we analyze the key challenges of intestinal-barrier-targeted casein peptide therapies in current research and translational practice, and propose future perspectives for overcoming these limitations, thus providing a reference for potential new preventive and therapeutic approaches to IBD. Full article

Background: Malnutrition is highly prevalent in older adults and is associated with functional decline, systemic inflammation, and increased mortality. However, its prognostic role in relation to major adverse cardiovascular events (MACE), particularly when considered alongside established cardiovascular risk scores, remains insufficiently defined in geriatric populations. Methods: This retrospective cohort study included 291 adults aged ≥65 years who underwent a comprehensive geriatric assessment at a geriatric outpatient clinic. Nutritional status was evaluated using the Mini Nutritional Assessment—Short Form (MNA-sf). Cardiovascular risk was estimated using the Framingham Risk Score, SCORE2, SCORE2—Older Persons (SCORE2-OP), and LIFE-CVD (version 1). The primary outcome was the occurrence of MACE, and the secondary outcome was all-cause mortality. Multivariable logistic regression and Cox proportional hazards models were used to identify independent predictors of outcomes. Results: During a mean follow-up of 16.9 ± 4.7 months, 43 participants (14.8%) experienced MACE, and 11 (3.8%) died. Malnutrition or risk of malnutrition (MNA-sf < 12), present in 24.1% of participants, was significantly more frequent among those with MACE and those who died. In multivariable analyses, nutritional status remained a consistent independent predictor of both MACE and mortality, whereas commonly used cardiovascular risk scores showed limited or inconsistent associations with outcomes. Conclusions: In older adults, malnutrition assessed by the MNA-sf is a strong and independent predictor of both major adverse cardiovascular events and all-cause mortality, beyond traditional cardiovascular risk scores. These findings underscore the importance of incorporating nutritional status, together with frailty-related parameters, into cardiovascular risk assessment to improve risk stratification in geriatric care. Full article

Background: Managing elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the combination of these conditions complicates both standard treatment pathways. Case presentation: We present the case of an 86-year-old woman admitted after a low-energy fall, with a radiologically confirmed unstable pertrochanteric fracture of the right femur (AO/OTA 31-A2). Upon routine electrocardiogram, anterior STEMI with new-onset atrial fibrillation was diagnosed. Although asymptomatic from a cardiac perspective, bedside echocardiography revealed a severely reduced left ventricular ejection fraction of 10%. Urgent coronary angiography demonstrated a critical mid-left anterior descending lesion, successfully treated with rotational atherectomy, intravascular lithotripsy, and stent implantation. She was initiated on DAPT (aspirin + clopidogrel) and anticoagulated with low-molecular-weight heparin. Given the extremely high bleeding risk, surgical intervention for the femoral fracture was deemed unsafe. Instead, conservative management with skeletal traction (6 kg) was employed. Despite optimal supportive care and early rehabilitation, the patient experienced a complicated hospital course, including delirium, hematuria, and lower respiratory tract infection. She passed away 52 days post-admission. Conclusions: This case illustrates the complexity of clinical decision-making in geriatric patients with competing acute conditions. Current evidence on how to proceed in patients requiring both antithrombotic therapy and urgent orthopedic surgery is limited. Multidisciplinary teams must carefully weigh the risks and benefits of both surgical and conservative strategies. Further guidelines addressing such scenarios in elderly patients are urgently needed. Full article

Primary intracranial squamous cell carcinoma (SCC) arising from an epidermoid cyst is an exceptionally rare and aggressive malignancy with a dismal prognosis. Conventional management typically involves gross total resection followed by wide-field radiotherapy; however, this intensive approach is often unfeasible for elderly or frail patients. We present a case of primary intracranial SCC in a 75-year-old woman who presented with rapid cochleovestibular deterioration. Imaging revealed subtle enlargement of a long-standing cerebellopontine angle epidermoid cyst. Subtotal resection was performed to preserve critical neurovascular structures adherent to the infiltrative tumor. Given the patient’s poor performance status and the risk of toxicity from broad-field radiation, adjuvant Gamma Knife radiosurgery (GKS) was selected as a focal salvage modality. Despite the limited surgical margin, the patient has maintained a progression-free status with no radiographic evidence of disease progression for 18 months without neurological decline. This case highlights the diagnostic challenge of malignant transformation disguised by radiologic mimicry and demonstrates that GKS can serve as an effective and tolerable adjuvant strategy. We propose that for high-risk patients precluded from intensive multimodal therapy, focused stereotactic irradiation offers a viable alternative to secure local control while preserving quality of life and systemic immune integrity. Full article

Late-life Alzheimer’s disease (AD) is increasingly defined by biomarkers, yet in adults aged ≥65 years the relationship between amyloid positivity and near-term cognitive decline is often discordant. Amyloid PET robustly detects fibrillar plaque burden, but it incompletely captures dynamic and potentially neurotoxic amyloid processes, particularly soluble assemblies and oligomer-related “activity.” This review rethinks the late-life AD spectrum by integrating four clinical lenses that frequently drive real-world interpretive uncertainty: (1) amyloid PET positivity as a measure of fibrillar plaque presence and magnitude; (2) plasma amyloid-β oligomerization tendency measured by the multimer detection system (MDS-OAβ) as an activity-oriented (i.e., a dynamic readout hypothesized to reflect ongoing processes rather than cumulative lesion burden), process-linked readout that may decouple from plaque burden; (3) postoperative delirium (POD) as a time-anchored stress-test phenotype revealing vulnerability and reduced resilience under systemic insults; and (4) drug-linked biomarker trajectories, contrasting rapid plaque removal by anti-amyloid monoclonal antibodies with observational signals raising the hypothesis that Ginkgo biloba may be associated with oligomer-related biology and, in some contexts, differences in longitudinal amyloid accumulation trajectories in the absence of observed immediate plaque reduction. We propose a pragmatic multi-axis framework—plaque burden, amyloid activity, downstream engagement, and vulnerability/resilience—to contextualize late-life discordances such as PET positivity without decline, PET negativity with elevated MDS-OAβ, delirium-associated decompensation, and clinical change without rapid PET decline. This synthesis highlights testable predictions and prioritizes longitudinal, multi-marker studies to determine whether activity-oriented biomarkers and stress phenotypes can refine late-life risk stratification beyond plaque-centered models. Full article

Background/Objectives: Simple frailty assessments, such as the clinical frailty scale (CFS), are prognostic for worse outcomes in older adults with cancer and could support treatment decision-making. This interview study aims to explore clinicians’ experiences of using simple frailty assessments in oncology, including the impacts on patient care and barriers and facilitators to successful implementation. Methods: Semi-structured individual interviews were conducted with clinicians at three UK sites that had implemented CFS screening in lung cancer clinics as part of a national pilot, to explore how frailty assessments are applied and are impacting care. Purposive sampling targeted a range of professionals involved in assessing frailty and making treatment decisions. Recordings were transcribed verbatim and analysed thematically. Results: Ten clinicians participated, and four main themes were identified. ‘Assessing fitness and frailty’ explores the central role of performance status (PS), as well as its limitations, and what frailty assessments add. ‘Scoring and interpreting CFS’ describes the ease and relative yield of CFS use, particularly for patients with ‘borderline’ PS scores (e.g., PS 1–2 or 2–3), and the importance of contextual interpretation. ‘Role of frailty and impacts of assessment’ highlights how frailty assessments can enhance patient-centered care and support, and clinical and shared decision-making, with potential for streamlined care and system-level benefits. ‘Barriers and facilitators to implementation’ are described, including time, culture, guidance, and training, with recommendations provided. Conclusions: Assessing frailty has wide-ranging potential benefits for patients, oncology teams, and the wider system, but barriers must be overcome. Specific recommendations are provided to support the routine implementation of frailty assessments, which is a key step towards the benefits of frailty-informed care being realised at scale. Full article

Background: Enhanced recovery pathways and modern fixation systems have shortened admission after lumbar spine surgery, yet the interplay between implant choice, comorbidity, and early morbidity remains incompletely defined. Methods: We undertook a retrospective, single-center cohort study of lumbar procedures performed at SANADOR Clinical Hospital (Bucharest, Romania) between 1 January 2023 and 31 May 2024. Eighty-six adult patients (64 women, 22 men; mean age 64.9 ± 10.8 years) met the inclusion criteria. Outcomes included length of stay (LOS), early postoperative neurological change (Frankel/American Spinal Injury Association (ASIA) Impairment Scale), and unplanned reoperation within 90 days. Analyses were performed in Python 3.11 (pandas, SciPy, statsmodels) and verified in IBM SPSS 28.0; α = 0.05. Results: Spondylolisthesis was the predominant diagnosis (60.5%), followed by lumbar stenosis (17.4%). Instrumentation was used in 75 cases (87.2%). Median LOS was 3 days (mean 3.8 ± 2.1), and most patients were discharged by postoperative day 4. LOS did not differ by interbody cage status (Mann–Whitney p = 0.459; median 3 vs. 3 days). Early postoperative neurological change occurred in 34.9% but improved or resolved in all cases by discharge; no permanent motor deficits were observed. Unplanned reoperation within 90 days occurred in 17.6%. In multivariable logistic regression for prolonged hospitalization (LOS > 4 days), early postoperative neurological change was associated with increased odds of prolonged LOS (OR 4.45, 95% CI 1.29–15.43; p = 0.018), whereas age showed only a borderline association (OR 1.06 per year, 95% CI 1.00–1.14; p = 0.065). Conclusions: In this single-center retrospective cohort, postoperative hospitalization was generally short. Prolonged LOS was more closely associated with early postoperative neurological change than with baseline comorbidity or interbody cage use. These findings should be interpreted as short-term, context-specific observations from a complex, predominantly instrumented referral cohort. Full article

(1) Background: The safety of antioxidants (AOs) in disposable biodegradable tableware products remains insufficiently understood. (2) Methods: The migration of 20 AOs from 39 disposable biodegradable tableware under multiple usage conditions was investigated by Ultra Performance Liquid Chromatography-Tandem Mass Spectrometry. Their potential exposure risks were evaluated using three risk assessment frameworks (EU, FDA, and Monte Carlo simulation). (3) Results: Ten AOs were detected in 95% ethanol, with Irganox 1010 showing the highest migration (0.29 ± 0.62 mg/kg). Starch-based products exhibited a greater variety and higher migration of AOs compared to PLA-based and fiber-based products. Food simulant type, temperature, and time exerted a more significant effect on AO migration than microwave and ultraviolet treatments. An analysis method for six typical AOs in soybean oil using freezing degreasing was established, which demonstrated good recoveries (77.6–110.3%) and relative standard deviations (1.7–14.7%). Four AOs were detected in soybean oil, with Irganox 1010 showing the highest migration (603.7 × 10⁻³ mg/kg). Utilizing high-percentile conservative exposure scenarios derived from Monte Carlo simulation, Irganox 1010 may pose a health risk to humans under high-dose exposure in soybean oil. (4) Conclusions: This study provides a basis for the safety evaluation of AOs in disposable biodegradable tableware. Full article

Muscle-protein modification plays a critical role in determining the quality, functional properties, and nutritional value of meat and aquatic products. Over recent decades, non-thermal processing technologies including irradiation, cold plasma, high-pressure processing, ultrasound, and electromagnetic fields have been widely explored in muscle foods. This review aims to critically examine modifications of food proteins subjected to non-thermal processing, with a focus on literature within the last five years. The review first introduces the type and theory of physicochemical modifications of food proteins, which includes protein oxidation, changes in net charge, cross-linking and aggregation. Subsequently, characterization methods applicable to food proteins are briefly discussed. Finally, the effects of non-thermal processing on muscle proteins are thoroughly discussed. This review will elucidate the intricate mechanisms of protein modification in muscle-based products, providing a theoretical framework to drive the advancement of innovative non-thermal processing technologies. Full article

Background: Oral frailty is an emerging determinant of late-life disability. While objective functional measures have been proposed as key indicators, their combined role in predicting frailty among physically active older adults remains unclear. Therefore, this study aimed to investigate the association between the presence of oral frailty and lip pressure, bite force, and denture use. Methods: This cross-sectional study included 192 participants aged 60 years or older from Brazil (n = 131) and Portugal (n = 61), all physically active and with ≥20 natural or rehabilitated teeth. Data were collected through a questionnaire on sociodemographic data and the Oral Frailty Index-8. The clinical assessment included lip pressure, bite force, and denture use. Multiple logistic regression identified independent predictors; model fit and discrimination were examined using the Hosmer–Lemeshow test and ROC curve. Results: Participants were mainly female (83.3%), mean age ≈72 years; 76% used dentures and frailty prevalence was ≈49%. Higher lip pressure (OR = 0.986, 95% CI = [0.973–0.999]) and higher bite force (OR = 0.925, 95% CI = [0.885–0.967) were independently protective, whereas denture use (OR = 6.898, 95% CI = [2.994–15.895]) markedly increased oral frailty odds. The model showed good discrimination (AUC 0.779). Conclusions: Even small increases in lip pressure and bite force reduced the likelihood of frailty, while denture use identified individuals at substantially higher risk. These findings highlight orofacial muscle strength and masticatory capacity as core components of oral frailty and support incorporating lip pressure and bite force testing into multidimensional frailty assessment and targeted rehabilitation. Full article

Background: While surgery and radiotherapy are the standard of care for patients with cervical cancer (CC), debate persists regarding the choice of whether treatment should consist of surgery followed by radiotherapy or initial direct radical radiotherapy. The present study was therefore devised to compare real-world clinical outcomes and economic assessments associated with these different treatment approaches. Methods: Six tertiary medical centers retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage I-IVA CC who underwent surgery followed by radiotherapy (surgery–radiotherapy group) or radical radiotherapy (radiotherapy group) between 2015 and 2023 in China. The progression-free and overall survival (PFS and OS) of these patients were compared using Kaplan–Meier and propensity-score-weighted proportional risk models. Economic analyses were also conducted based on patient follow-up for up to 8 years from the start of treatment. Results: A total of 980 patients receiving surgery–radiotherapy and radiotherapy were identified for matching. Propensity score weighting revealed no significant statistical differences in PFS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.44–1.28; p = 0.29) and OS (HR, 0.49; 95% CI, 0.20–1.21; p = 0.12) when comparing these groups. Subgroup analysis found differences in PFS (HR, 0.17; 95% CI, 0.04–0.77; p = 0.02) among adenocarcinoma. Economic analyses revealed that the incremental cost-effectiveness ratio of the surgery–radiotherapy group versus the radiotherapy group was $40,831/quality-adjusted life-year (QALY), which is higher than the Chinese willingness-to-pay threshold of $35,841/QALY. Conclusions: Survival outcomes were similar for patients with CC who underwent surgery–radiotherapy and radiotherapy. Further, radical radiotherapy may be cost-effective for such patients considering economic factors in China. Full article

The study first demonstrated that burdock fructooligosaccharide (BFO) could inhibit peel browning in green banana, with 0.5% BFO treatment showing the most significant suppression of peel browning during low-temperature storage (7 ± 1 °C). The results revealed that 0.5% BFO treatment effectively restrained the increase in electrolyte leakage and malondialdehyde (MDA) content and maintained cell membrane integrity. Furthermore, BFO treatment enhanced total phenolic content and antioxidant capacity, alleviated oxidative damage, and better preserved the external quality of banana peel. Simultaneously, BFO treatment markedly inhibited both the activities of chlorophyll-degrading enzymes and their relative gene expression levels in banana peel, thereby maintaining higher chlorophyll content. This research provided a new insight into the mechanism of inhibiting peel browning for low-temperature storage preservation of banana. Full article

To investigate the effect of phenolic hydroxyl group number on the interaction between catechins and a plant-derived protein carrier, four catechins with varying hydroxyl numbers—epicatechin (EC), epicatechin gallate (ECG), epigallocatechin (EGC), and epigallocatechin gallate (EGCG)—were investigated. The new plant-derived edible dock protein (EDP) was selected as a carrier matrix. EDP, when employed as a protein delivery carrier, possessed a hydrophobic amino acid content of 45%. This structural feature enabled it to provide more hydrophobic cavities for small molecule compounds, thereby facilitating better binding with them. The results indicated that the order of loading capacity of catechins within EDP was EGCG (9.7%) > ECG (9.1%) > EGC (8.8%) > EC (7.1%). This sequence was consistent with the number of hydroxyl groups in catechin: EGCG (8) > ECG (7) > EGC (6) > EC (5). Among the four catechins, EGCG had the highest binding constant (Ka = 2.6 × 10³ L/mol), leading to the largest quenching of EDP. During self-assembly, hydrogen bonding, hydrophobic and electrostatic interactions were the main driving forces, and the interaction between EGCG and EDP was the strongest. This study indicated that the hydroxyl group number of polyphenolic compounds can determine its binding affinity with proteins. Full article

This narrative review aims to analyze sex-specific differences in oral health, examine hormonal influences in women during puberty, pregnancy, and menopause, and compare oral health behaviors between men and women. Articles were selected based on: (1) sex-specific aspects of oral diseases, (2) hormonal influences on oral health, (3) comparative analyses between sexes, and (4) sex-disaggregated data on oral disease prevalence. Women experience hormonal vulnerabilities with estrogen deficiency causing xerostomia, mucosal atrophy, and increased caries susceptibility, showing parallels between oral and vaginal mucosa. Men demonstrate higher periodontitis prevalence (57% vs. 38%), utilize preventive services one-third less frequently, and show higher smoking rates (67% vs. 42%) and traumatic dental injuries (2:1 ratio). Women maintain better oral hygiene and treatment adherence. Sex-specific factors affecting both sexes remain unconsidered in dental practice. Women need targeted interventions during hormonal transitions, while men require improved preventive care engagement. Future research integrating sex-specific considerations is required to enable personalized oral health approaches for both sexes. Full article