Search Results (2,558)

Background/Objectives: Bariatric surgery has emerged as an effective intervention for severe obesity; however, post-operative dizziness remains poorly characterized in the literature. This study aimed to determine the prevalence of dizziness, imbalance, and hearing problems following bariatric surgery and to identify associated risk factors. Methods: A cross-sectional study was conducted among 156 patients who underwent bariatric surgery at multiple centers in Saudi Arabia. Data were collected through structured questionnaires assessing demographic characteristics, surgical details, and post-operative vestibular symptoms. Bivariate and multivariate logistic regression analyses were performed to identify predictors of dizziness. Results: The prevalence of post-operative dizziness was 77.3% (95% CI: 70.0–83.3%), imbalance was 38.0% (95% CI: 30.6–46.0%), and hearing problems were 10.7% (95% CI: 6.7–16.6%). Bivariate logistic regression identified weight loss was significantly associated with dizziness (OR = 1.063, 95% CI: 1.024–1.103, p = 0.001). In the multivariate model, each percentage point increase in weight loss was associated with a 6.1% increased dizziness (adjusted OR = 1.061, 95% CI: 1.017–1.107, p = 0.006). Dizziness was strongly associated with imbalance (chi-square = 14.325, p < 0.001) and falls (chi-square = 7.085, p = 0.008). Conclusions: Vestibular complications, particularly dizziness, are highly prevalent following bariatric surgery and demonstrate a significant dose–response relationship with the magnitude of weight loss. Enhanced awareness and systematic screening for dizziness in post-bariatric patients are warranted. Full article

Background/Objectives: Psychological stress triggers excessive melanin deposition via neuroendocrine pathways, yet targeted interventions for stress-induced hyperpigmentation remain limited. Salidroside (SAL) exhibits established depigmenting effects in UV-induced models and possesses neuroprotective properties. This study investigated SAL’s efficacy in psychological stress-induced hyperpigmentation and elucidated its underlying mechanisms. Methods: B16F10 melanocytes, C57BL/6J mice, zebrafish, and human foreskin organ cultures were subjected to stress factor (Substance P/cortisol) or α-MSH/IBMX stimulation to model psychological stress-induced and canonical cAMP-driven hyperpigmentation, respectively. Melanin content, tyrosinase activity, melanosome maturation (transmission electron microscopy/HMB45 staining), and melanogenic protein/mRNA expression were assessed. Drug Affinity Responsive Target Stability (DARTS) assays, molecular docking, and SEC23A siRNA knockdown were employed to identify and validate SAL’s molecular target and downstream signaling pathways. Results: SAL dose-dependently reduced melanin content, tyrosinase activity, and TYR/TRP-1/DCT expression in SP/Cort-stimulated melanocytes, exhibiting greater potency (200 μM) than in IBMX-induced models (400 μM). SAL reversed SP/Cort-induced hyperpigmentation in human skin explants, zebrafish, and C57BL/6J mice, and normalized melanosome number/maturation. DARTS and molecular docking identified SEC23A as a direct SAL-binding target. SP/Cort specifically upregulated SEC23A, which SAL suppressed. SAL concurrently activated the SEC23A-p-ERK-MITF axis and inhibited the NK1R-p38-MITF axis in the stress model. SEC23A knockdown potentiated SAL’s anti-melanogenic effects specifically in SP/Cort-stimulated cells. Conversely, in IBMX-induced models, SEC23A remained unchanged, and SAL acted via PKA/CREB, PI3K/AKT, and Wnt/β-catenin pathways. Conclusions: SEC23A is a novel core target in psychological stress-induced hyperpigmentation. SAL selectively binds SEC23A to inhibit stress-induced melanogenesis via dual ERK and p38 MAPK signaling axes, demonstrating etiological specificity distinct from canonical cAMP pathway inhibition. Full article

Introduction: Two small, preliminary pilot studies report that 2 weeks of daily tart cherry juice consumption (half of the dose in the morning, half of the dose at night) may increase sleep quantity (assessed via a sleep diary or 1 night of polysomnography) in older adults with insomnia. A study of longer duration, with doses closer to bedtime, and daily objective monitoring of sleep via a wearable device may potentiate the observed impact of tart cherry juice intake on sleep. With the proposed changes to the study protocol, it is paramount to evaluate the study’s feasibility. Methods: The current study is a single-site, randomized, double-blind, cross-over pilot study in 20 older adults with self-reported insomnia. Eligible individuals will be randomly assigned to consume 16 oz. of tart cherry juice/day or placebo juice for 4 weeks each, separated by a 3-week washout period. Information on study feasibility, including recruitment rate, retention rate, safety, compliance, and study practicality, will be collected, as well as pre- and post-arm evaluations of sleep quantity/quality and biomarkers related to melatonin, cortisol, serotonin, and inflammation. Discussion: Identification of a dietary intervention that improves sleep quantity and quality may serve as a novel and feasible approach for older adults who suffer from insomnia. If successful, such a strategy would help mitigate the plethora of health consequences associated with poor sleep. Full article

Background: Childhood vaccination remains one of the most effective public health interventions. Despite consistently high national coverage, vaccine hesitancy persists among parents and may undermine herd immunity. The Parent Attitudes about Childhood Vaccines (PACV) questionnaire provides a validated framework for identifying parental concerns and patterns of hesitancy. Methods: A cross-sectional online survey was conducted in May 2025 using the Croatian version of the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. The study included 1087 parents aged 18–65 years. PACV scores were transformed to a 0–100 scale, with values ≥50 indicating vaccine hesitancy. Associations between PACV scores and parental age and educational level were analysed using non-parametric statistical tests. Results: Most respondents were mothers (87.7%) and aged between 30 and 45 years (71.8%). Approximately one fifth of parents reported postponing vaccination (22.7%), and 19.2% indicated having refused at least one vaccine dose. While 63.7% expressed full acceptance of recommended childhood vaccines, a substantial proportion either refused vaccination (20.8%) or remained undecided (15.5%). Higher educational attainment was significantly associated with lower PACV scores, whereas no significant association was observed with parental age. Conclusions: Although overall vaccination acceptance in Croatia remains high, vaccine hesitancy continues to affect a considerable proportion of parents. Strengthening tailored communication strategies and reinforcing trust-based counselling—particularly within pediatric and community nursing services—may support informed decision-making and improve vaccine confidence. Full article

Galacto-oligosaccharides (GOSs) are well-recognized for their beneficial effects on intestinal health, yet their regulatory impacts on the metabolic dynamics of other intestinal metabolites remain elusive. In this study, 24 male C57BL/6 mice were assigned to three groups: control (CON), low-dose GOS (L-GOS; 500 mg/kg body weight), and high-dose GOS (H-GOS; 800 mg/kg body weight). Following a 4-week intervention, the cecal contents were analyzed to characterize the bacterial community structure and metabolic profiles. Results indicated that GOS supplementation significantly increased the ACE and Chao1 indices of cecal bacteria. Specifically, L-GOS led to notable enrichment of the [Eubacterium] brachy group, Coriobacteriaceae UCG-002, Faecalimonas, and the [Eubacterium] siraeum group, whereas H-GOS significantly increased the abundance of Clostridium, Ruminiclostridium, Thomasclavelia, Adlercreutzia, and Faecalimonas. Metabolomic profiling revealed that L-GOS profoundly reduced levels of phosphatidylethanolamine, phosphatidylcholine and their downstream metabolites, while inhibiting the conversion of sphingolipids to ceramides. The changes in phospholipid derivatives imply enhanced intestinal epithelial integrity, supporting intestinal homeostasis. GOS intervention also decreased phenylacetic acid content. L-GOS increased the 4-hydroxyphenylpyruvic acid content, whereas H-GOS reduced 4-hydroxyphenyllactic acid levels. Notably, H-GOS significantly up-regulated the production of indole-3-acetic acid, a tryptophan-derived microbial metabolite with multiple biological activities. Collectively, these findings provide insights and potential targets for future research on GOS application in intestinal health interventions. Full article

Introduction: Healthcare institutions and care providers, including medical professionals, were at the forefront of the rapid response to the challenges of the pandemic. As medical professionals across the country actively fought the COVID-19 pandemic, many ethical, social, and legal challenges arose that had not been previously encountered. This study was conducted to determine the ethical challenges and dilemmas faced by medical professionals during the COVID-19 pandemic. Materials and Methods: A descriptive cross-sectional questionnaire-based survey was conducted among the registered medical practitioners in the year 2022. The study setting included health care institutions in India where COVID patients were treated. Results: 558 participants took part in this study. The availability of personal protective equipment was sufficient in 519 (93%) of cases, while 39 (7%) of respondents reported insufficient quantities of personal protective equipment. Overall, 318 (56.99%) respondents were comfortable with their duty patterns, and 435 (77.96%) medical professionals received clear-cut and updated guidelines for practicing safely; 534 (95.70%) completed both doses of vaccines available at that time in India. Conclusions: Indian medical professionals experienced substantial ethical, occupational, and psychological challenges during the COVID-19 pandemic, despite the high availability of protective equipment and vaccination coverage. Resource allocation dilemmas, demanding duty patterns, and psychological distress during quarantine underscore the need for stronger institutional support, clear guidelines, and mental health interventions during future public health crises. Full article

Bisphenol F (BPF) is a chemical compound that has found extensive application in the field of plastics manufacturing. BPF exposure leads to renal dysfunction; however, the mechanism is unclear. This study investigated BPF-induced nephrotoxicity using 50 male Kunming mice divided into five groups: control (C), low-dose (L, 0.5 mg/kg), medium-dose (M, 5 mg/kg), high-dose (H, 50 mg/kg) BPF, and an intervention group receiving 4-phenylbutyric acid (4-PBA) plus BPF. Treatments were administered daily by oral gavage for 28 days. Renal function was assessed via serum creatinine (SCr), while inflammation and fibrosis were evaluated using histology, immunohistochemistry, immunofluorescence, ELISA, qRT-PCR, and Western blotting. Preliminary results suggest that BPF causes structural damage and dysfunction in the mice kidney. Furthermore, BPF-induced renal inflammation and fibrosis, accompanied by the activation of endoplasmic reticulum (ER) stress and the polarization of renal macrophages toward M1 and M2 types. In vitro, BPF (40 µM, 48 h) induced similar effects in Raw264.7 cells, which were mitigated by 4-PBA pretreatment. Finally, 4-PBA intervention confirmed that BPF triggers macrophage polarization via ER stress, leading to inflammation and fibrosis, ultimately causing renal dysfunction in vivo. This study provides new insights into BPF nephrotoxicity and a basis for therapeutic strategies. Full article

Background: Alzheimer’s disease (AD) remains a major public health challenge. Observational associations between dietary patterns and reduced dementia risk have prompted investigations of dietary bioactives (DBs) as cognitive nutraceuticals. Methods: This critical narrative review examines interventional trials for nine prominent DBs relevant to AD: docosahexaenoic acid (DHA), curcumin, resveratrol, epigallocatechin gallate (EGCG), nicotinamide riboside (NR), tricaprilin, vitamin E (α-tocopherol), cannabinoids, and NIC5-15 (D-pinitol). Trials were identified through ClinicalTrials.gov (search date: December 2024) and supplemented by PubMed searches for published results. Data were extracted on trial phase, design, cognitive/functional endpoints, biomarker outcomes, and development status. Findings are synthesized qualitatively; no formal meta-analysis or risk of bias assessment was conducted. Results: None of the nine bioactives demonstrated consistent cognitive efficacy in AD. Phase III trials of DHA, curcumin, and tricaprilin did not meet primary cognitive endpoints. Resveratrol reduced CSF Aβ40 without cognitive benefit. Cannabinoids improved behavioral symptoms but showed no measurable cognitive effects. High-dose vitamin E slowed functional decline, while cognition remained unchanged. In contrast, trials in preclinical or at-risk populations reported preliminary cognitive signals for EGCG and biomarker engagement for NR, suggesting potential for early intervention. Conclusions: Current clinical evidence does not support high-dose DBs supplementation as an effective treatment for AD. Predominantly negative late-phase findings highlight limitations, with potential contributors including limited bioavailability, late intervention, insufficient target engagement, and biological heterogeneity. Future research may benefit from early biomarker-defined populations, optimized formulations, multi-nutrient or dietary approaches, and precision nutrition strategies considering genetic risk and baseline nutrient status. DBs may be better positioned for prevention or early-stage intervention rather than late-stage therapy. Full article

Oxygen therapy is one of the most widely used interventions in critical care, yet it remains poorly individualized. Recent trials and meta-analysis suggest no mortality difference between conservative and liberal oxygen strategies, reinforcing the perception that dose does not matter within usual ranges. From this perspective, we argue that this apparent neutrality may largely reflect methodological and conceptual limitations, although true clinical equivalence in some patient populations remains plausible and cannot be excluded based on current evidence. Heterogeneous populations, overlapping oxygenation targets, and the absence of exposure metrics (time in hyperoxia, time in hypoxemia, and cumulative partial pressure of arterial oxygen/peripheral oxygen saturation curves) dilute phenotype-specific signals and force distinct physiological responses into a single pooled estimate. We propose a conceptual model in which oxygen behaves as a dose-dependent, time-dependent drug with phenotype-specific therapeutic windows, particularly in chronic hypercapnia, traumatic brain injury, sepsis, and early versus late acute respiratory distress syndrome. Building on this model, we outline a methodological agenda for precision oxygen trials: defining interventions by actual exposure, pre-specifying pathophysiological subgroups, adopting patient-centered core outcome sets, and using adaptive, target-range designs and individual patient data meta-analyses. For contemporary guidelines and research, the key question is no longer whether conservative or liberal oxygen therapy is superior on average, but how to match the right oxygenation range to the right intensive care unit phenotype at the right time. Moving from population-averaged comparisons to exposure-aware, phenotype-oriented strategies is essential if oxygen therapy is to become a truly precision intervention in critical care. Full article

Postprandial hyperglycemia represents a critical therapeutic target in type 2 diabetes mellitus (T2DM), requiring interventions that simultaneously address glycemic dysregulation and oxidative stress. This study evaluated the anti-hyperglycemic and antioxidant properties of Sclerocarya birrea leaf crude extract (CE) and biosynthesized silver nanoparticles (AgNPs). Phytochemical screening, nanoparticle characterization (UV–Vis, XRD, TEM, SEM, DLS, FTIR), enzyme inhibition assays (α-amylase, α-glucosidase, DPP-IV), glucose dynamics in Caco-2 cells, and antioxidant assays (DPPH, total antioxidant capacity, H₂O₂ cytoprotection) were performed. Phytochemical analysis identified flavonoids, tannins, alkaloids, and terpenoids as major constituents of Sclerocarya birrea leaf extract. AgNPs exhibited spherical morphology (36.8 ± 8.6 nm, n = 100 particles analyzed), face-centered cubic crystallinity (crystallite size: 32.1 nm), and characteristic surface plasmon resonance at 451 nm. Both formulations inhibited α-amylase (CE IC₅₀: 14 µg/mL; AgNPs IC₅₀: 14.07 µg/mL, n = 3) and α-glucosidase (CE IC₅₀: 15.96 µg/mL; AgNPs IC₅₀: 15.82 µg/mL, n = 3), showing substantial inhibition, though less potent than acarbose. Uniquely, AgNPs demonstrated selective DPP-IV inhibition (IC₅₀: 220.5 µg/mL, n = 3, p < 0.001 vs. CE), completely absent in CE. In antioxidant assays, DPPH scavenging potency was comparable between formulations (CE IC₅₀: 23.45 µg/mL; AgNPs IC₅₀: 22.26 µg/mL, n = 3), while CE achieved higher maximal scavenging at the tested concentrations. Conversely, AgNPs provided superior intracellular cytoprotection against H₂O₂-induced oxidative stress in kidney cells (80.2 ± 2.1% viability at 76 µg/mL vs. CE 69.8 ± 3.4% at 190 µg/mL, n = 3, p < 0.001), representing a 2.5-fold dose advantage. Neither formulation significantly altered glucose uptake or SGLT1 expression in intestinal epithelial cells (p > 0.05, two-way ANOVA, n = 3). These findings establish S. birrea-based formulations, particularly AgNPs, as promising multifunctional candidates for managing postprandial hyperglycemia and oxidative complications in T2DM. They also highlight nanotechnology-enhanced phytomedicine as an innovative therapeutic strategy. Full article

Sarcopenia, characterized by the progressive loss of skeletal muscle mass, strength, and function, represents a major public health challenge in aging populations. This condition affects approximately 10–16% of community-dwelling older adults and is associated with increased risks of falls, frailty, functional decline, and mortality. The pathogenesis of sarcopenia involves chronic low-grade inflammation (inflammaging), oxidative stress, mitochondrial dysfunction, and anabolic resistance. Omega-3 polyunsaturated fatty acids (PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have emerged as promising nutritional interventions due to their anti-inflammatory properties and potential anabolic effects on skeletal muscle. This comprehensive review evaluates the current evidence on omega-3 PUFA supplementation for the attenuation and management of sarcopenia. Mechanistically, omega-3 PUFAs appear to enhance muscle protein synthesis through activation of the mTOR-p70S6K signaling pathway, reduce inflammation via specialized pro-resolving mediators (SPMs), improve mitochondrial bioenergetics, and attenuate muscle disuse atrophy. Clinical trials demonstrate that omega-3 supplementation, particularly at doses exceeding 2 g/day of combined EPA and DHA, can increase thigh muscle volume, handgrip strength, and one-repetition maximum strength in older adults. When combined with resistance exercise training, the benefits appear more pronounced, especially in women. However, heterogeneity in study designs, intervention durations, dosages, and outcome measures has produced some conflicting results. Large-scale trials, such as the MAPT study, have shown null findings for long-term supplementation alone, suggesting that omega-3s may be most effective as part of multimodal interventions. The evidence also supports benefits in clinical populations at risk for muscle wasting, including cancer patients experiencing cachexia and individuals with neuromuscular disorders. Future research should focus on identifying optimal dosing strategies, understanding sex-specific responses, and elucidating the mechanisms underlying the synergistic effects of omega-3s with exercise. Overall, omega-3 PUFA supplementation represents a safe, accessible, and potentially effective nutritional strategy for attenuating muscle decline in aging and clinical populations, though its benefits appear most pronounced when combined with resistance exercise as part of a multimodal approach. Full article

Non-operating room anesthesia (NORA) has emerged as one of the fastest-growing domains of modern anesthetic practice. Increasing procedural complexity and an aging, comorbid patient population demand analgesic strategies that enhance safety, comfort, and procedural success while minimizing physiological disturbance. Although systemic opioids and sedatives remain commonly used in NORA settings, their dose-dependent adverse effects may compromise patient safety and delay recovery, particularly in environments with limited postprocedural monitoring. Ultrasound-guided fascial plane blocks (FPBs) have therefore gained prominence as key components of opioid-sparing and opioid-free anesthetic strategies. By providing targeted regional analgesia with preserved hemodynamic stability, FPBs reduce systemic analgesic requirements and opioid-related side effects while improving patient comfort. This review summarizes the anatomical basis, proposed mechanisms of action, and current clinical evidence supporting the use of thoracic and abdominal fascial plane blocks in NORA settings, with particular emphasis on interventional cardiology and interventional radiology procedures. The expanding role of FPBs suggests that these techniques may become integral elements of standard analgesic protocols in contemporary non-operating room anesthesia practice. Full article

Biomarker-based guided delivery of drugs is an emerging paradigm of precision medicine in which targeted therapeutic intervention is administered on the basis of certain biological markers in order to achieve maximal dosing, targeting, and time optimization. By utilizing quantifiable physiological or molecular signatures like the expression of transporters, enzymatic activities, metabolite levels, or disease-specific markers to tie in the correlation of drug disposition, these systems provide individualized intervention with optimized efficacy and safety. Oral administration of drugs is still the best route in patient compliance; however, several drugs are handicapped by suboptimal bioavailability secondary to poor solubility, limited permeability, efflux transporter participation, and enzymatic first-pass degradation. These result in variable therapeutic results in patient populations. Biomarker guidance in oral drug delivery provides a potent strategy for overcoming such challenges through site-specific release, real-time dose optimization, and adjustment of absorption pathways. Recent developments include pH-controlled formulations for gut-specific targeting, enzyme-activated nanocarriers, glucose-starved responsive devices for metabolic disease, and biomarker-driven transporters for permeability enhancement. Preclinical and early-phase clinical studies hold promising prospects for applications in oncology, infectious disease, inflammatory bowel disease, and metabolic disease. While promising momentum exists, transition to routine use in the clinic awaits rigorous biomarker validation, scalability in manufacture, and regulations harmonization. On the horizon, the integration of biomarker-guided oral drug delivery with nanotechnology, artificial intelligence, machine learning, and wearable biosensors holds promise for revolutionizing oral therapy into very personalized, responsive, and efficient treatment methods. Full article

Background: Irritable Bowel Syndrome (IBS) exerts a profound burden on Health-Related Quality of Life (HRQoL) and psychosocial well-being. While lifestyle changes are recommended, the dose–response relationship between physical activity (PA) intensities, symptom severity, and body image remains unclear. This study analyzed the interrelationships between PA intensities, symptom severity, body image satisfaction, and HRQoL in IBS patients. Methods: A cross-sectional study was conducted with 40 adult patients (60% female; 32.53 ± 12.54 years) diagnosed via Rome III/IV criteria. Validated instruments were used to assess PA (IPAQ-SF), sedentary behavior (SBQ), HRQoL (IBS-QoL), symptom severity (IBS-SSS), and body image (BIS). Data were analyzed using Quantile Regression, Robust Linear Regression, and Causal Mediation Analysis. Results: Participants reported moderate symptom severity (210.1 ± 79.2) and high sedentary time (511.1 ± 265.0 min/day). Quantile Regression showed no statistically significant associations between PA intensities and clinical severity (all p ≥ 0.289). PA did not moderate the negative relationship between pain and HRQoL (p = 0.738). However, symptom severity was a significant predictor of body dissatisfaction (β = 0.36, p < 0.001). A sexual dimorphism was observed, as women exhibited higher baseline dissatisfaction and greater sensitivity to symptom worsening than men (β = −0.50, p = 0.004). Conclusions: Symptom severity is strongly associated with body dissatisfaction in IBS, particularly among women, independent of nutritional status. While PA did not directly mitigate symptoms in this cohort, the significant relationship with body image underscores the need for clinical interventions to integrate psychosocial support to address perceptual vulnerability. Full article

Dietary fiber (DF) has a profound influence on human health mainly by modulating the gut microbiota. This review provides an overview of DF derived from cereals, legumes, fruits, vegetables, fungi, and seaweeds, specifically addressing the relationship between microbial utilization and source-specific structural characteristics (such as linking patterns, conformation, solubility, and fermentability). Due to these structural properties, different DFs display selective microbial responses that favor fermentation and the production of short-chain fatty acids (SCFAs). These microbial responses and fermentation-derived metabolites associated with DF intake may contribute to reduced risk of obesity, diabetes, inflammatory bowel disease, and other chronic disorders. This review does not address the trial heterogeneity, dose response, safety, and conflicting evidence, and much of the available evidence is largely observational and heterogeneous. Future studies should focus on dose–response trials of defined DF structures with standardized microbiome and metabolomic endpoints, including validation in human interventions. This review summarizes the DF source and structure, selective changes in the microbiota across various study types, including in vitro, animal models, and human studies, and how these relate to overall health. Full article