Search Results (6,876)

Background/Objectives: Chronic primary pain (CPP) is a new diagnostic category including chronic pain conditions lacking clinical signs or a clear etiopathogenetic origin. These disorders may share a common neural mechanism known as central sensitization, where nociceptive neurons become hyper-responsive to standard or subthreshold pain stimuli, resulting in pain hyper-sensitivity. In this context, non-invasive brain stimulation (NIBS) appears to be a promising tool for improving CPP symptoms by targeting maladaptive brain activity and connectivity. To date, the effects of NIBS on CPP symptoms remain unexplored. To fill this gap, we conducted a meta-analysis, investigating the effect of NIBS in improving the three core symptoms of CPP, namely pain intensity, emotional distress, and functional disability. Methods: Following PRISMA guidelines, we screened four databases up to February 2025 for English-language, peer-reviewed randomized clinical trials that included CPP patients treated with NIBS and reported pre/post or follow-up scores on validated measures of at least one core symptom. Quality of life was examined as an additional outcome. Results: Fifty-four studies were included, with 1371 participants receiving real stimulation and 1103 sham. Findings highlighted that real stimulation improved CPP symptoms immediately after treatment and at one-month follow-up. Meta-regressions showed that longer CPP duration reduced short-term effects on emotional distress and diminished all outcomes at one-month follow-up. Conclusions: Further research is needed to establish standardized NIBS protocols for CPP management, to investigate the effectiveness at longer follow-up periods, and to test whether combining NIBS with other interventions enhances treatment effectiveness and durability. Full article

Bioelectrical impedance analysis (BIA) is a widely used technique in clinical and research settings because it provides non-invasive estimates of body composition. However, the quality of a measurement depends on more than the perceived accuracy and precision of numbers produced by a BIA device. This review considers BIA through the lens of metrology, defined as the science of measurement. It highlights several key factors that affect measurement quality. These include accuracy, precision, calibration, standardisation, and uncertainty quantification, all of which are essential for meaningful, clinically feasible BIA measurements. Applying prediction equations generated by the device outside their intended context, poor electrode placement, or uncalibrated devices can introduce bias, whereas biological variability can complicate the interpretation of bioimpedance results. The traditional emphasis on using a reference method for validation is considered along with clinical relevance, which is argued to be an equally important benchmark for evaluating measurement utility. We also present best practices and practical guidelines for improving measurement quality, interpretation, and integration into clinical workflows. By adopting a metrological mindset in clinical practice and treating BIA with the same rigour as other diagnostic tools, its utility in areas such as fluid management, nutrition, and preventive health can be further enhanced. Trustworthy decisions depend not only on the data itself but also on how it is measured, interpreted, and used. Full article

Surface-enhanced Raman spectroscopy (SERS) has emerged as a transformative tool in biomedical diagnostics, offering a highly sensitive and non-invasive method for detecting molecular biomarkers at exceptionally low concentrations. This approach takes advantage of the plasmonic characteristics of customized metallic nanostructures that produce intense localized electromagnetic fields via localized surface plasmon resonance and facilitate electron transfer reactions that notoriously enhance the intrinsically weak Raman scattering signals of molecular entities which reside on or next to their surfaces. SERS-based assays have shown remarkable potential in detecting cancer biomarkers, circulating tumor DNA (ctDNA), and proteins at early stages, enabling timely and targeted intervention. Additionally, the combination of SERS with AI-driven data analysis has facilitated real-time diagnostics, enhancing the precision and efficiency of point-of-care testing. Despite its promising capabilities, challenges such as substrate fouling, signal degradation, and the need for better biocompatibility remain. Nevertheless, ongoing research in substrate development, coupled with advances in AI, positions SERS as a leading technology for future diagnostic tools. This paper explores the current state of SERS in biomedical applications, highlighting its potential to revolutionize diagnostics and personalized medicine while addressing the existing limitations and future research directions. Full article

Honeybees (Apis mellifera) serve as biological sentinels because their foraging behavior links colony health to environmental conditions. Traditional hive inspections are invasive, observer-dependent, and often detect problems only after symptoms appear. This review synthesizes advances in precision beekeeping, environmental DNA (eDNA) metabarcoding, exposomics, and artificial intelligence to propose the Honeybee-Based Early Warning System (H-BEWS), a unified framework that integrates digital sensors, molecular and chemical monitoring, and ecological data into a predictive early warning system for both colony and ecosystem health. By linking anomalies detected by hive sensors to targeted molecular and chemical analyses, H-BEWS enables proactive interventions and environmental surveillance, supporting a One Health perspective. Unlike previous reviews that focus on individual technologies, H-BEWS emphasizes multi-layered integration, predictive risk assessment, and ecosystem-level insights, providing a novel conceptual framework for early detection of colony stress and environmental hazards. The approach offers practical applications for beekeepers, researchers, and policymakers by converting real-time data into actionable insights and informing management decisions. Challenges include sensor standardization, data integration, AI validation, and equitable access for small-scale beekeepers. Future directions will focus on real-time sequencing, multimodal AI models, digital twin creation, and the development of global surveillance networks. H-BEWS demonstrates how an integrative, multi-layered approach can transform honeybee colonies into living biosensors, providing actionable insights for both apiculture management and ecosystem monitoring. Full article

Endometriosis is a long-term gynecological condition marked by the growth of endometrial-like tissue outside the uterus, which undergoes proliferation, bleeding, and regeneration. This disease is associated with disrupted steroid hormone signaling, notably progesterone (P4) resistance and estradiol (E2) dominance. P4 resistance has been associated with impaired activation of the progesterone receptor (PR) and reduced transcription of P4 target genes, while elevated E2 levels induce estrogen receptor (ER)-mediated signaling, enhancing estrogen-dependent lesion growth. This hormonal imbalance contributes to a pro-inflammatory microenvironment, chronic pelvic pain, infertility, and enhanced neuroangiogenesis. Emerging evidence indicates that the coordinated regulation of neurotrophins and sex hormones promotes nerve fibers and blood vessel growth and invasion within endometriotic lesions. P4 and E2 have been shown to modulate the expression of key neurotrophins, including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). This review presents current evidence on the interplay between neurotrophins and ovarian steroids in endometriosis, with a specific focus on their contribution to neuroangiogenesis and pain pathophysiology. The review includes articles in English containing the Medical Subject Headings (MeSH) terms: “endometriosis”, “neurotrophins”, “nerve growth factor”, “brain-derived neurotrophic factor”, “neuroangiogenesis”, “progesterone”, and “estradiol”, found in the PubMed database published between 2000 and 24 May 2026. This review included a range of original research articles, systematic reviews, meta-analyses, prospective observational studies, case–control studies, and review papers, for a total of 122 articles. Full article

Ventilation is an essential function of life, and one of the first to be replicated by artificial means. Annually, it is estimated that 15 to 20 million patients worldwide are intubated and receive invasive mechanical ventilation (MV). However, MV is a non-physiologic intervention and frequent complications are associated with its use, including extravascular lung liquid, impaired cardiac performance, and alveolar rupture. Research shows that injurious MV can cause or aggravate lung damage and initiate an intense inflammatory response, contributing to multiple organ dysfunction and poor outcomes due to ventilator-induced lung liquid and intense alveolar rupture. In this brief commentary, we postulate that this resulting injury is better characterized with the term “ventilator-induced lung liquid and alveolar rupture”. We will summarize key points for clinical implications, existing challenges, and future perspectives for the management of patients with severe acute hypoxemic respiratory failure. Full article

Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. Objectives: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. Methods: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. Results: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. Conclusions: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice. Full article

One of the most commonly diagnosed malignancies in men worldwide, prostate cancer (PCa) is the subject of much study across various treatment approaches and medical specialties. Currently, 5-year survival rates exceed 90%, and research efforts have increasingly shifted towards approaches that improve quality of life, minimizing the likelihood and severity of morbidities associated with treatment. Focal cryoablation is an approach that has been steadily gaining traction in recent years, both for its reduced risk of morbidity and greater potential for salvage therapy, relative to standard treatment. The goal of this work is to discuss the safety and efficacy of focal cryoablation for prostate cancers and define it in context among other treatment approaches. Publications describing approaches to, results from, and the science behind PCa cryoablation were reviewed and collated, describing the current landscape. Additional comparisons were made against analogous approaches, including radiation, surgical resection, hormone therapy, and other ablation modalities. Currently available literature characterizes prostate cryoablation as an effective and well-tolerated approach for treating primary and recurrent PCa, although the data are limited by heterogeneous evidence, lack of standardized endpoints, and an absence of robust randomized comparisons. Cryoablation for prostate cancer continues to evolve, offering a minimally invasive treatment option for both primary and salvage prostate cancer patients, although additional long-term studies are needed. Full article

Transitional waters—such as estuaries, lagoons, deltas, and coastal wetlands—are dynamic environments where freshwater and seawater interact, forming highly productive and biologically diverse ecosystems. Shaped by temperature and salinity gradients, tidal influence, sediment transport, and nutrient-rich conditions, these habitats support diverse ecological functions. Their structural complexity—including seagrass beds, salt marshes, mudflats, and mangroves—provides essential habitats for many fish species. These areas are crucial for fish life cycles, serving as nurseries, spawning grounds, feeding zones, and refuges from predators. Many commercially important species depend on them during early life stages before moving offshore, making them vital for both commercial and recreational fisheries. Beyond food provision, they deliver key ecosystem services, including water purification, coastal protection, and carbon storage. Research on the fish community of the Ria Formosa lagoon in Portugal since the 1980s highlights long-term changes in the fish community and the dominant role of habitat structure and temporal dynamics. Subtidal seagrass beds support higher fish abundance and diversity than unvegetated areas, acting as key nursery habitats and provide important fish provisioning services. Seasonal variation is also central, driven by recruitment pulses of marine migrants in late winter–spring. Recent pressures on this system have been driven by human activity and environmental change. Seagrass loss reduces nursery and feeding areas, while pollution degrades water quality. Overfishing (including illegal fishing), recreational activities, and aquaculture expansion add stress. Climate warming and invasive species such as Caulerpa prolifera, further disrupt ecosystem balance and threaten biodiversity. Sustainable management—such as habitat restoration, protected areas, and integrated policies—is essential to preserve the ecological and economic value of this unique lagoon. Ongoing research, monitoring, habitat restoration, and stakeholder engagement remain critical for ensuring resilience. Full article

Background: The diagnostic value of surface electromyography (sEMG) for identifying muscles affected by myofascial trigger points (TrPs) remains controversial. However, advances in pain neurophysiology and discussions regarding TrPs within the International Classification of Diseases (ICD-11) have renewed interest in objective diagnostic approaches. Objective: To synthesize current evidence on the diagnostic utility of sEMG for detecting TrP-related muscle alterations across different electromyographic signal analysis domains. Methods: A scoping review was conducted following JBI guidance and PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, CINAHL and Cochrane were searched for studies involving adults with symptomatic or asymptomatic TrPs, myofascial pain syndrome, or TrP-related referred pain. Fifteen studies met the inclusion criteria. Analyses included amplitude-, frequency-, time–frequency-, and spatial-domain sEMG parameters. Results: Muscles affected by TrPs showed increased resting electromyographic activity and reduced activation during maximal voluntary contraction in several studies. Frequency domain analyses indicated changes in median frequency and muscle fatigue index, whereas time–frequency analyses suggested redistribution of sEMG signal energy toward lower-frequency components or altered spectral power during experimentally provoked referred pain. Spatial analyses revealed altered activation patterns, although these findings did not consistently correspond with TrP anatomical locations. Overall, the limited number of studies assessing diagnostic sensitivity and specificity prevents firm conclusions. Conclusions: sEMG may be useful as a non-invasive complementary tool for functional assessment and monitoring of TrP-related muscle dysfunction. However, current evidence does not support its use as a standalone diagnostic method. Time–frequency, machine learning-supported and spatial analyses appear promising for future clinical research, but standardized protocols and external validation are required before clinical diagnostic criteria can be proposed. Full article

Deep unconventional oil and gas reservoirs are critical to hydrocarbon exploration and development in China. However, their complex geological and petrophysical features, including high temperature, high pressure, high salinity, multiple pressure systems, and intricate pore–fracture structures, make them highly susceptible to formation damage during drilling, completion, stimulation, and production. Effective reservoir protection is therefore essential for minimizing damage and improving development efficiency. This paper systematically reviews recent advances in reservoir protection for deep unconventional reservoirs, with a focus on evaluation methods and protective materials. Laboratory evaluation methods, including permeability recovery, nuclear magnetic resonance, pressure decay, and spontaneous imbibition, together with field-based approaches such as well testing and production decline analysis, are summarized and assessed for their applicability to complex damage characterization. Major damage mechanisms, including liquid-phase trapping, solid invasion, sensitivity damage, stress sensitivity, and wettability alteration, are analyzed with emphasis on working fluid–reservoir interactions under multi-field coupling conditions. Recent progress in protective materials is also reviewed, covering polymer-based materials such as gel sealing agents, delayed-swelling hydrogels, water-/oil-soluble temporary plugging agents, and film-forming polymers, as well as ultrafine CaCO₃ and fiber-based materials. In addition, related protection technologies, including temporary plugging, film-forming fluid-loss control, underbalanced drilling, and low-damage completion fluids, are discussed. Existing models developed for conventional sandstone reservoirs are insufficient for deep unconventional systems. Future research should prioritize integrated evaluation and protection methods tailored to deep tight, shale, and fractured–vuggy carbonate reservoirs. This review provides a basis for understanding complex damage mechanisms, developing functional protective materials, and advancing integrated reservoir protection technologies for the efficient development of deep unconventional resources. Full article

Modern prosthetic dentistry has been significantly reshaped by adhesive dentistry, CAD/CAM technologies, and advanced ceramic materials, leading to the development of minimally invasive all-ceramic restorative approaches. However, the longevity of the adhesive interface is fundamental to the long-term effectiveness of these restorations. With a focus on bond durability and clinical performance, this narrative review aims to evaluate modern adhesive strategies, tooth preparation requirements, and cementation techniques in all-ceramic minimally invasive restorations. Methods: A narrative review of the literature was performed using Google Scholar, Web of Science, and PubMed/MEDLINE databases. Publications from 2000 to 2026 were analysed. In vitro research, narrative reviews, and systematic reviews related to adhesive systems, resin cements, CAD/CAM materials, and minimally invasive prosthodontic principles were the core subjects of the research. Results: The findings indicate that material selection, surface conditioning techniques, and cementation methods have a significant impact on the clinical effectiveness of all-ceramic restorations. Retention and marginal sealing are greatly enhanced by resin-based adhesive systems. Nevertheless, hydrolytic degradation, procedure sensitivity, and substrate-related factors remain a challenge to the adhesive interface. Advances in CAD/CAM and ultra-conservative designs, like occlusal veneers and partial-coverage restorations, have increased treatment alternatives while ensuring acceptable functional and aesthetic results. Conclusions: Minimally invasive all-ceramic restorations represent a conservative and clinically effective treatment approach in modern prosthodontics. Their long-term performance is primarily dependent on adhesive interface stability and adherence to evidence-based clinical protocols. Continued developments in adhesive materials and ceramic systems are expected to improve bond durability and broaden clinical indications. Full article

The subtropical and tropical islands of East Asia host a unique and highly endemic aquatic insect fauna threatened by a variety of anthropogenic stressors (e.g., invasive species, habitat fragmentation, pollution, and climate change). This review synthesizes the impacts of these stressors on aquatic insect diversity across this region based on 206 articles published over the past 40 years (1985–2025) to evaluate the impacts of these stressors on insular aquatic insect diversity. The islands of East Asia include all or parts of China, Japan, Taiwan, and South Korea. The annual number of publications demonstrates a steady upward trend over time and has been accelerating in the last decade. Our systematic analysis reveals a large geographic disparity. Research is heavily concentrated on major islands, with Honshu Island (42%) and Taiwan Island (24%) accounting for two-thirds of the total literature, while small islands (<10,000 km²) comprise only 20%. Furthermore, current research tends to focus on independent impacts of single stressors, largely overlooking the complex additive, synergistic, or antagonistic interactions that characterize stressors on these fragile ecosystems. These research gaps, compounded by a lack of long-term monitoring data (i.e., only ~22% of the studies span more than 3 years), hinder efforts to distinguish natural inter-annual variability from anthropogenic shifts. The extinction of cryptic or endemic species may occur before these species are identified and described. In addition, the disentanglement of these interactive impacts on aquatic insect communities in East Asian islands is critical for predicting ecosystem responses to further local and global changes. Identification of non-linear ecological tipping points through these long-term monitoring networks, coupled with proactive, science-guided habitat restoration, is essential to mitigate imminent extinctions and to rebuild the functional integrity of these imperiled freshwater ecosystems. Full article

Intestinal fungal overgrowth (IFO) is an increasingly recognized yet underexplored component of gut dysbiosis with potential implications for gastrointestinal and systemic disease. While bacterial microbiota have historically garnered research attention, recent advances in sequencing technologies have highlighted the importance of the gut mycobiome in maintaining intestinal homeostasis. Disruption of fungal–bacterial balance, particularly involving Candida albicans, C. tropicalis, and C. glabrata, may contribute to symptom generation through immune activation, epithelial barrier dysfunction, biofilm formation, and the production of toxic metabolites such as acetaldehyde and candidalysin. Emerging clinical evidence suggests that IFO is associated with persistent gastrointestinal symptoms, including bloating, abdominal discomfort, and altered bowel habits, particularly in patients who do not respond to conventional therapies targeting bacterial overgrowth. Furthermore, fungal dysbiosis involving Malassezia restricta and Saccharomyces cerevisiae has been associated with inflammatory bowel disease, metabolic disorders, and systemic immune dysregulation; however, the nature and directionality of these relationships remain incompletely understood. Despite increasing recognition, the diagnosis of IFO remains challenging due to a lack of standardized criteria and validated non-invasive tools. Therapeutic strategies, including antifungal agents such as fluconazole and nystatin, as well as microbiome-targeted interventions, show promise but require further validation. This review provides a comprehensive synthesis of current evidence regarding the epidemiology, pathophysiology, clinical manifestations, diagnostic challenges, and therapeutic implications of IFO, with particular emphasis on species-specific mechanisms. Recognition of the intestinal mycobiome as a potentially important component of gut health may provide new perspectives for understanding gastrointestinal disorders and inform future precision medicine approaches. Full article

Background: Cancer pain affects approximately 44.5% of all patients with malignancy and up to 55–65% of those with advanced or metastatic disease; a substantial proportion remain inadequately controlled with conventional pharmacological approaches alone. Peripheral nerve stimulation (PNS), a minimally invasive neuromodulatory strategy, has emerged as a potential opioid-sparing analgesic option for the perioperative management of oncologic surgical patients. Objectives: This narrative review synthesizes current evidence on the application, mechanisms, clinical efficacy, safety, and integration of temporary and permanent PNS systems in cancer patients, with specific focus on cancer-specific pain syndromes, key clinical studies, opioid-sparing immunological implications, evidence quality, and directions for future research. Methods: As a narrative review, this work was structured in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) to ensure methodological transparency. A focused, non-systematic literature search of PubMed/MEDLINE, Embase, and the Cochrane Library was performed from database inception through March 2026, supplemented by hand-searching of reference lists and targeted retrieval of clinical practice guidelines. Sources were selected on the basis of relevance to PNS or closely analogous peripheral neurostimulation modalities in oncologic, perioperative, or chronic pain contexts. Evidence was synthesized narratively, with each cited study graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence framework to enable transparent calibration of confidence. Results: Available preliminary and largely extrapolated evidence supports PNS as a promising but not yet established useful adjunct in oncologic perioperative care; because cancer-specific data rest substantially on a single pilot study (n = 12), one retrospective review (n = 15), and extrapolation from non-cancer populations, these conclusions should be regarded as hypothesis-generating. Randomized controlled trial data from non-cancer cohorts demonstrate opioid consumption reductions of approximately 80–90% in the PAINfRE trial, while the post-amputation trial demonstrated ≥50% pain-relief responder rates and reductions in pain interference, with clinically meaningful improvements in pain and function. Oncologic-specific pilot and retrospective evidence confirms feasibility and a 58–67% success rate across diverse cancer pain subtypes. Conclusions: The opioid-sparing properties of PNS carry additional biological plausibility for preserving perioperative antitumor immune function. High-quality prospective trials specifically designed for oncologic surgical populations remain needed to establish evidence-based recommendations. Full article