Search Results (3,188)

Peripheral nerve injuries affect over one million individuals annually worldwide due to various causes such as trauma, metabolic disorders, and autoimmune diseases. While autologous nerve grafting remains the gold standard for treating large-gap nerve injuries, its limitations, including limited tissue availability, donor site morbidity, infection risk, and suboptimal functional recovery, have spurred interest in alternative approaches. Among these, allogeneic nerve grafting has emerged as a promising option, offering structural and functional advantages due to the native architecture of donor nerves. However, immune rejection due to histocompatibility antigens remains a significant challenge. Decellularisation protocols utilising mild detergents have shown the most promise in preserving the extracellular matrix’s structural and regenerative properties while mitigating immunogenicity. The study aimed to adapt and validate a decellularisation protocol for human nerves within our tissue bank, adhering to European and national regulatory guidelines. The protocol, based on the cleanroom-compliant method previously developed by our group, was optimised to reduce tissue handling time and ensure regulatory compliance. Decellularised sural nerves were assessed for extracellular matrix preservation and sterility using European (EU) Pharmacopoeia and European Directorate for the Quality of Medicines & HealthCare (EDQM) guidelines. The results demonstrated the feasibility of producing high-quality acellular nerve allografts (ANAs) that are suitable for peripheral nerve repair, paving the way for cost-effective and widely accessible grafting solutions. Full article

Therapeutic phlebotomy remains a key intervention in the management of erythrocytosis and iron overload disorders, particularly polycythemia vera (PV) and hereditary hemochromatosis. Despite its historical origins as an ancient practice, venesection continues to be recommended in international guidelines for the reduction of hematocrit and iron burden, thereby mitigating thrombotic and organ-related complications. However, the evolving landscape of targeted pharmacologic therapies is reshaping the therapeutic paradigm. This review examines the current role of therapeutic phlebotomy, with a particular focus on PV, outlining its physiological rationale, clinical benefits, and well-documented limitations—including iron deficiency, procedural burden, and incomplete hematocrit control between sessions. Comparative insights are provided between phlebotomy and red cell apheresis, highlighting differences in efficacy, tolerability, and accessibility. The emergence of disease-modifying agents—such as interferons, JAK inhibitors, hepcidin mimetics, and epigenetic modulators like givinostat and bomedemstat—promises more sustained hematologic control with the potential to reduce or eliminate the need for repeated phlebotomies. While phlebotomy remains indispensable in early-stage or low-risk PV, its future utility will likely shift toward complementary or bridge therapy in the context of individualized, pharmacologically driven strategies, redefining the role of phlebotomy in the era of precision medicine. Full article

Coriander (Coriandrum sativum L.) has significant value in the food industry due to its unique flavor and health benefits. However, its polyphenol content and antioxidant activity have not been systematically analyzed during storage. This study optimized the extraction process of coriander polyphenols using ultrasound-assisted extraction combined with response surface methodology. The polyphenol composition was systematically identified, and changes in polyphenol content and antioxidant activity during storage were investigated. The optimal process conditions for extracting coriander polyphenols were determined as 40% ethanol concentration, 1:121 g/mL material-to-liquid ratio, 81 °C extraction temperature, and 10 min extraction time. This optimized protocol yielded 16.231 mg GAE/g, a 119.28% increase over conventional methods using the same raw material. Fifty polyphenolic compounds were identified using high-resolution mass spectrometry. The main types of polyphenols identified were quercetin, kaempferol, and hydroxycinnamic acid derivatives. Notably, 41 of these compounds were reported in coriander for the first time. In vitro tests revealed that coriander polyphenols exhibit potent antioxidant properties, with IC₅₀ values of 73.43 μg/mL for DPPH and 82.15 μg/mL for ABTS. Furthermore, the polyphenol content and antioxidant capacity of coriander increased significantly during storage, with total phenolic content rising by 40.5%, DPPH activity by 32.5%, and ABTS activity by 56.5%. Key individual polyphenols showed differential changes: rutin continuously accumulated, while chlorogenic acid and ferulic acid exhibited an initial increase followed by a decrease. This study provides strong technical support for the use of coriander polyphenols in functional foods and medicines. Full article

Background/Objectives: Fatigue is a highly prevalent and burdensome symptom among individuals with Marfan syndrome (MFS), yet its heterogeneity and underlying psychosocial and clinical correlates remain underexplored. This study aimed to identify and characterize distinct fatigue-related profiles in MFS patients using a data-driven cluster analysis approach. Methods: A cross-sectional study was conducted involving 127 patients with MFS from a specialized connective tissue disorder center in Italy. Participants completed self-reported measures of fatigue severity (Fatigue Severity Scale, FSS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and insomnia (Insomnia Severity Index, ISI). The body mass index (BMI) and clinical data were also collected. A t-distributed stochastic neighbor embedding (t-SNE) analysis was performed to reduce dimensionality, followed by hierarchical clustering (Ward’s method), exploring solutions from k = 2 to k = 10. The optimal cluster solution was identified based on silhouette scores and clinical interpretability. Results: Three distinct clusters emerged: (1) a cluster characterized by low fatigue with minimal psychological and sleep-related symptoms (younger patients, lower PHQ-9 and ISI scores), (2) a cluster characterized by moderate fatigue with moderate psychological and sleep-related symptoms (intermediate age, moderate PHQ-9 and ISI scores), and (3) a cluster characterized by high fatigue with elevated psychological and sleep-related symptoms (older patients, higher PHQ-9, ISI, and FSS scores). Significant differences were observed across clusters in age, BMI, depressive symptoms, insomnia severity, and fatigue levels (all p < 0.05). Conclusions: Our findings highlight the heterogeneity of fatigue experiences in MFS and suggest the importance of profiling patients to guide personalized interventions. This approach may inform precision medicine strategies and enhance the quality of life for individuals with this rare disease. Full article

Objectives: To analyze the effect of abdominal aortic aneurysm (AAA) diameter on late complication occurrence and survival in patients following endovascular aneurysm repair (EVAR). Methods: The study was a retrospective cohort analysis with a prospective follow-up of 176 patients diagnosed with unruptured AAA who underwent EVAR from 2016 to 2024. Preoperative computed tomography (CT) images were used to measure maximal aneurysm diameter. Prospective follow-up data were collected post-EVAR at 1 month, 6 months, and annually through clinical evaluations and imaging studies. The mean follow-up duration was 26 months. For statistical purposes, the group was divided into tertiles based on aneurysm size. This study was intentionally focused on aneurysm size as an isolated imaging parameter, and did not incorporate other known predictors of complications, such as neck morphology or device-related variables. As such, key limitations include the single-center design, relatively small sample size, and lack of data on anatomical features beyond maximum diameter. Results: Kaplan–Meier survival analysis demonstrated that patients in the highest tertile of aneurysm size experienced significantly higher rates of long-term adverse outcomes compared to those in the lower two tertiles, both in terms of late complications (log-rank p = 0.049) and all-cause mortality at 36 months (p = 0.022). In multivariate logistic regression, the occurrence of late complications was independently associated with symptomatic presentation (p = 0.003, OR = 3.616, 95% CI: 1.533–8.529) and acute admission (p = 0.033, OR = 0.345, 95% CI: 0.130–0.916). The largest aneurysms were significantly associated with late endoleak (p = 0.041, OR = 5.365, 95% CI: 1.071–26.871). Conclusions: This study demonstrates that AAA size is an independent predictor of both late complications and long-term survival following EVAR. Patients with larger aneurysm diameters experienced significantly higher rates of late complications and reduced overall survival. Full article

Background/Objectives: Natural products with claimed adaptogenic and/or immunomodulatory effects are widely used in traditional medicine systems across Eurasia. These include herbal remedies (e.g., Panax ginseng), fungi (e.g., Ganoderma lucidum), and animal-derived substances (e.g., propolis from Apis mellifera). Despite their popularity, the safety profiles of these products—particularly concerning adverse events (AEs) and serious adverse events (SAEs)—remain insufficiently understood. This study aimed to assess the safety profiles of adaptogenic and immunomodulatory natural products through a scoping review of published human studies and an analysis of individual case safety reports (ICSRs) from the WHO-UMC VigiBase database. Methods: A scoping review was conducted using PubMed (1980–2024) in line with PRISMA-ScR guidelines. Eligible studies included randomized and non-randomized clinical trials and case reports in humans focused on safety outcomes. Data extraction followed the Joanna Briggs Institute (JBI) standardized template. ICSRs from VigiBase were analyzed by product type, AE type and seriousness, and demographic characteristics. The data were further organized to highlight the 15 most frequently reported products and their top five System Organ Classes (SOCs) and Preferred Terms (PTs). Results: The scoping review identified 51 natural products with reported adaptogenic and/or immunomodulatory properties. This included 285 clinical trials and 119 case studies on single-ingredient products and 54 clinical trials and 21 case studies on multi-ingredient preparations. Common AEs included gastrointestinal, dermatological, hepatic, cardiovascular, and immunological reactions. SAEs were rare but reported for Echinacea purpurea, Silybum marianum, and Camellia sinensis. From Vigibase, 45,042 ICSRs were retrieved for 49 natural products: 10,702 for single-ingredient and 34,340 for multi-ingredient products. Among 7856 reports listing a single-ingredient product as the sole suspect, 15.8% were SAEs, including eight fatal cases. However, the causality remained unclear due to insufficient data. Ganoderma lucidum, Viscum album, and Silybum marianum were most frequently associated with SAEs. In multi-ingredient products, propolis was frequently linked to hypersensitivity and skin reactions. Conclusions: This study provides a comprehensive overview of the safety profiles of adaptogenic and immunomodulatory natural products. Variability in product composition, lack of standardization, incomplete reporting in clinical studies, and underreporting in pharmacovigilance databases complicate accurate risk assessment. For multi-ingredient products, attributing specific AEs to specific components remains difficult. Further high-quality clinical research and improved pharmacovigilance are needed, along with clear safety warnings to reduce risks for consumers. Full article

Background and Clinical Significance: Many women use pessaries to manage their symptoms of pelvic organ prolapse. Hydroxyquinoline is the active ingredient in gels and ointments that are often used to lubricate a pessary prior to vaginal insertion and to provide antimicrobial effects while the pessary is in situ. Case Presentation: A 74-year-old woman with multiple medication allergies develops vulvovaginal erythema and pruritus after increasing vaginal Trimo-San application frequency for pessary care and maintenance. These symptoms are deemed to be consistent with an allergic reaction to hydroxyquinoline, the active ingredient in Trimo-San. Conclusions: This report highlights the importance of personalized treatment in pessary management. It also demonstrates how personalized medicine can optimize outcomes and improve treatment adherence among individuals with complex medical histories. Full article

Background/Objectives: The aim of this study is to describe fertility preservation (FP) techniques performed over the last 10 years at a tertiary hospital in northern Spain in patients under 18 diagnosed with cancer. Methods: A retrospective medical record review was conducted for patients aged 0 to 18 years diagnosed between January 2014 and December 2023 in the Pediatric Oncology Unit at a university hospital. We evaluated patient characteristics, the timing of FP procedures, and potential risk factors for ovarian insufficiency and early azoospermia. Additionally, we assessed the agreement between two gonadotoxicity risk classifications. Results: In our center, FP is more frequently offered to pubertal patients (12 to 16 years old), prior to treatment in those at high risk of subsequent gonadotoxicity (>80%), and after treatment in those at low risk (<20%). Additionally, the increased provision of FP over the last five years of the study suggests improved clinician uptake of this long-term effect of cancer treatment. Our study found weak agreement between available gonadotoxicity risk classifications, complicating the identification of FP candidates. Long-term follow-up of survivors allowed for the detection of ovarian insufficiency (1.2%) and early azoospermia (0.7%), enabling hormone replacement therapy when necessary. Hematopoietic stem cell transplantation (HSCT) emerged as a predictor of early infertility. Conclusions: Our study highlights the prevalence of gonadotoxicity in pediatric cancer patients at our center and the increasing access to FP techniques. The findings emphasize the importance of personalized medicine, tailored FP strategies based on individual risk, and long-term follow-up to assess fertility status. Full article

Functional mitral regurgitation (FMR) is a common condition with significant prognostic implications, primarily driven by left atrial or ventricular remodeling secondary to ischemic or non-ischemic cardiomyopathies. While guideline-directed medical therapy (GDMT) remains the cornerstone of management, reducing mitral regurgitation severity in up to 40–45% of cases, additional interventions are often necessary. In patients where atrial fibrillation (AF) or ventricular dyssynchrony due to abnormal electrical conduction contributes to disease progression, guideline-directed AF management or cardiac resynchronization therapy plays a pivotal role. For those with persistent moderate to severe MR and unresolved symptoms despite optimal GDMT, percutaneous intervention may be warranted, provided specific clinical and echocardiographic criteria are met. This review highlights a precision-medicine approach to patient selection for transcatheter treatment of functional mitral regurgitation (FMR), emphasizing the integration of clinical characteristics with advanced multimodal imaging, including echocardiography, cardiac magnetic resonance, and computed tomography. In anatomically or clinically complex cases, complementary use of these imaging modalities is essential to ensure accurate phenotyping and procedural planning. Once a suitable candidate for percutaneous intervention has been identified, we provide a detailed overview of current transcatheter strategies, with a focus on device selection tailored to anatomical and pathophysiological features. Finally, we discuss emerging technologies and evolving therapeutic paradigms that are shaping the future of individualized FMR management. Full article

Objective: This study aims to evaluate obstetric and neonatal outcomes in pregnancies complicated by RDs and to identify hemogram-derived biomarkers associated with adverse perinatal events. Methods: This retrospective cohort study analyzed 360 pregnancies in individuals diagnosed with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), ankylosing spondylitis (AS), Sjögren’s disease, sarcoidosis, undifferentiated connective tissue disease (UCTD), and other autoimmune conditions, followed up at the Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, between 2013 and 2018. Data on disease activity, maternal complications, neonatal outcomes, and inflammatory markers were extracted from electronic medical records. Results: Patients with SSc had the highest rates of preterm birth (57.1%) and fetal growth restriction (FGR) (42.9%), whereas those with SLE (50%) and AS (25%) exhibited the highest disease flare rates. Neonates born to mothers with SSc, SLE, and Sjögren’s disease had significantly lower Apgar scores, suggesting increased neonatal distress. NICU admission was associated with elevated neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR), with higher NLR and ELR also predicting spontaneous abortion. Monocyte-to-lymphocyte ratio (MLR) and ELR demonstrated the highest predictive value for composite adverse perinatal outcomes. Additionally, RA patients experiencing disease flares had an 87.5% cesarean section (CS) rate, significantly exceeding the general population rate. Conclusions: This study underscores the increased risk of preterm birth, FGR, and neonatal complications in RD pregnancies, particularly in SSc and SLE patients. The findings suggest that early risk assessment using hemogram-based inflammatory markers may improve perinatal management and patient stratification. Full article

This study presents a comprehensive valorization of Juniperus communis L., a plant known for its culinary and therapeutic applications. Juniper berries are rich in antioxidant compounds such as polyphenols and ascorbic acid, while their kernels contain volatile terpenes with notable pharmaceutical properties. We optimized extraction parameters through stirring extraction (1:20 g/mL solid-to-solvent ratio, 55% v/v aqueous ethanol, 80 °C, 30 min) and response surface methodology via a Box–Behnken design. The optimal conditions—55% v/v aqueous ethanol at 80 °C for 30 min—yielded a high polyphenol content of 55.11 ± 1.54 mg GAE/g of defatted dry weight. Antioxidant capacity was confirmed through ferric-reducing and radical-scavenging assays, and 11 individual polyphenols (totaling 5.41 ± 0.27 mg/g) were quantified using a validated HPLC-DAD method. Additionally, this study identified several bioactive compounds in juniper berry raw kernel oil, which exhibited a high oleic acid content (58.75 ± 2.76%)—a nutritionally valuable fatty acid contributing to the oil’s strong radical-scavenging activity (399.83 ± 34.18 µmol Trolox equivalents/kg oil). GC–MS analysis revealed 58 volatile compounds, underscoring the terpene-rich profile of the oil and its influence on antioxidant potential and aroma. These findings underscore the dual valorization of juniper berry fruit and kernel for both medicinal and food industries. The aromatic kernel oil and polyphenol-rich extracts offer natural alternatives to synthetic antioxidants, with added benefits of flavor enhancement and promotion of health. Full article

Genome instability in induced pluripotent stem cells (IPSC) poses a significant challenge for their use in research and medicine. Cataloging and precisely describing all the identified aberrations that arise during cell reprogramming, expansion, and differentiation is essential for improving approaches to instability prevention and ensuring genetic quality control. We report the karyotypic analysis of 65 cell lines derived from skin fibroblasts, urinal sediment, and peripheral blood mononuclear cells of 33 individuals, 82% of whom suffer from monogenic genetic disorders not associated with genetic instability. Trisomy of chromosomes 20 and 8 was revealed recurrently, while the 1q arm was the most frequently affected region involved in interstitial duplications and unbalanced translocations with chromosomes 15 and 18. The localization of rearrangement breakpoints identified by SNP arrays within the large DCC gene and histone gene clusters links genetic instability in IPSCs to replication-stress-induced chromosome breakage at common and early replicating fragile sites. Full article

Background: The growing challenge of multimorbidity for healthcare systems worldwide demands a dual prevention framework, targeting both primary and secondary prevention. Multimorbidity–multibehaviours can provide such a theoretical and clinical framework to explore new aetiological evidence for multimorbidity risk. While the role of single health risk behaviours, such as smoking, nutrition, alcohol, and physical activity (SNAP), in chronic disease prevention is well-documented, their synergistic effect on multimorbidity has received relatively little attention. Methods: Using retrospective observational data from electronic health records of 21,079 patients from a convenience sample of three general practices in Staffordshire, UK (2015–2018), we examined the association between SNAP-multibehaviours and multimorbidity risk, defined as follows: MM2+ (≥2 morbidities), MM3+ (≥3 morbidities), and complex multimorbidity (accumulated morbidities affecting ≥3 body systems). Multiple logistic regression models, stratified by sex and adjusted for age and area, were applied to analyse the associations between both combined and accumulative SNAP-health risk behaviours (HRBs) and all multimorbidity operational definitions. Results: A dose–response association was observed, indicating increased multimorbidity risk with greater accumulation of SNAP-HRBs. Additionally, sex-specific patterns were identified, which varied according to the operational definitions of multimorbidity. These findings underscored both the clinical significance of the identified outcomes for promoting tailored multimorbidity guidelines and the need for further sex-sensitive research. Conclusion: These findings support the importance of transcending traditional silos in healthcare and public health research by integrating preventive and curative medicines under a multimorbidity–multibehaviour framework. Embracing the complexity of coexisting morbidities and health risk behaviours, healthcare systems can move beyond disease-specific and behaviour-specific paradigms. This approach has the potential to enhance clinical outcomes and to address the complex needs of individuals with multimorbidity in real-world healthcare settings. Full article

Composite materials have been increasingly used in various branches of industry, transport, construction, and medicine—as well as in other sectors of the economy and science—in recent decades. A significant advancement in the improvement of composite material characteristics has been achieved through the use of nanoparticles, which substantially enhance the properties of the base material, whether it is the matrix or the reinforcing phase in hybrid composites. The broad application of polymers and polymer composites in many areas of engineering has had a significant impact on reducing friction and wear, improving the thermal characteristics of individual components and entire technical systems, enhancing electrical conductivity, reducing the specific weight of components, lowering noise and vibration levels, and ultimately decreasing fuel consumption, production costs, and the costs of operation and maintenance of technical systems. This paper explores the potential applications of polymer composites in various assemblies and components of conventional vehicles, as well as in hybrid and electric vehicles. Furthermore, their use in medicine and the defense industry is examined—fields in which some authors believe composites were first pioneered. Finally, aviation represents an indispensable domain for the application of such materials, presenting unique exploitation boundary conditions, including dynamic environmental changes such as variations in temperature, pressure, velocity, and direction, as well as the need for high levels of protection. Future research can be unequivocally focused on the structural and technological advancement of polymer composites, specifically through optimization aimed at reducing waste and lowering production costs. Full article

Background/Objectives: Radiology often presents communication challenges due to its technical complexity, particularly for patients, trainees, and non-specialist clinicians. This study aims to evaluate the effectiveness of RadioBot, an AI-powered chatbot developed on the Botpress platform, in enhancing radiological communication through natural language processing (NLP). Methods: RadioBot was designed to provide context-sensitive responses based on guidelines from the American College of Radiology (ACR) and the Radiological Society of North America (RSNA). It addresses queries related to imaging indications, contraindications, preparation, and post-procedural care. A structured evaluation was conducted with twelve participants—patients, residents, and radiologists—who assessed the chatbot using a standardized quality and satisfaction scale. Results: The chatbot received high satisfaction scores, particularly from patients (mean = 4.425) and residents (mean = 4.250), while radiologists provided more critical feedback (mean = 3.775). Users appreciated the system’s clarity, accessibility, and its role in reducing informational bottlenecks. The perceived usefulness of the chatbot inversely correlated with the user’s level of expertise, serving as an educational tool for novices and a time-saving reference for experts. Conclusions: RadioBot demonstrates strong potential in improving radiological communication and supporting clinical workflows, especially with patients where it plays an important role in personalized medicine by framing radiology data within each individual’s cognitive and emotional context, which improves understanding and reduces associated diagnostic anxiety. Despite limitations such as occasional contextual incoherence and limited multimodal capabilities, the system effectively disseminates radiological knowledge. Future developments should focus on enhancing personalization based on user specialization and exploring alternative platforms to optimize performance and user experience. Full article