Search Results (16,968)

Osteoarthritis is a leading cause of lower-limb arthroplasty, and although total hip arthroplasty (THA) and total knee arthroplasty (TKA) reduce pain and improve quality of life, gait impairments often persist after surgery. This study aimed to analyze gait patterns in individuals following THA and TKA using the wearable RunScribe™ sensor system and to examine its sensitivity to short-term changes during rehabilitation. Thirty-seven patients (19 THA, 18 TKA) attending a two-week inpatient rehabilitation program were assessed twice, on the first and final day of rehabilitation. Gait was measured during a 2 min circular walk test, and both global spatiotemporal variables and limb-specific loading-related variables were analyzed. A significant main effect of time was observed for walking speed (p = 0.001, ηp² = 0.284), with improvements of approximately 10% in both groups, as well as for step cadence (p < 0.001, ηp² = 0.429) and contact time (p < 0.001, ηp² = 0.380). Loading-related variables also changed significantly over time, including impact acceleration (p = 0.004, ηp² = 0.226), braking acceleration (p < 0.001, ηp² = 0.419), and rate of force development (p < 0.001, ηp² = 0.412). No statistically significant between-group differences were observed for global gait variables, although participants following THA showed a tendency toward better walking performance (e.g., higher cadence, p = 0.065). These findings suggest that early rehabilitation is associated with measurable improvements in gait after arthroplasty and support the potential of affordable wearable sensors as practical tools for objective gait assessment in clinical settings. Full article

Background and Objectives: Halitosis is a common condition with substantial psychosocial impact, frequently driven by intra-oral biofilm, tongue coating, and reduced salivary clearance. This study compared the short-term effectiveness of standardized counseling alone, probiotic lozenges containing Streptococcus salivarius K12, and a zinc-containing mouthrinse in adults with persistent intra-oral halitosis. Materials and Methods: In this 4-week, parallel-group, randomized pragmatic trial, 117 adults with bothersome halitosis for at least 3 months and baseline organoleptic score ≥ 2 were allocated 1:1:1 to standard care, probiotic lozenges, or zinc mouthrinse. All participants received standardized counseling and tongue cleaning instructions. The primary endpoint was change in volatile sulfur compounds (VSCs) measured by portable sulfide monitoring. Secondary outcomes included organoleptic score, Halitosis Associated Life-Quality Test (HALT), Oral Health Impact Profile-14 (OHIP-14), tongue coating, plaque, and salivary Solobacterium moorei quantified by qPCR. Results: Baseline demographic, clinical, and biochemical characteristics were comparable across groups. All interventions improved outcomes over 4 weeks, but improvements followed a consistent gradient favoring zinc mouthrinse, followed by probiotic lozenges, then standard care. Mean VSC reduction was −12.7 ± 33.9 ppb with standard care, −47.3 ± 42.2 ppb with probiotics, and −78.5 ± 36.3 ppb with zinc mouthrinse (p < 0.001). Organoleptic scores improved by −0.2 ± 0.7, −0.8 ± 0.8, and −1.2 ± 0.8, respectively (p < 0.001). HALT and OHIP-14 scores showed parallel reductions, and moderate/severe halitosis at week 4 remained most frequent in the standard care group (58.9%) and least frequent in the zinc group (20.5%; p = 0.004). Conclusions: Both active adjunctive strategies improved intra-oral halitosis beyond standardized counseling alone, but the zinc-containing mouthrinse produced the greatest short-term benefits across objective, clinician-rated, and patient-reported outcomes. These findings support zinc-based rinses as a practical short-term adjunct for managing persistent intra-oral halitosis in outpatient dental care. Durability after discontinuation and potential relapse beyond 4 weeks were not assessed in this trial. Full article

Background: Nasal valve dysfunction (NVD) is a common yet underrecognized cause of nasal airway obstruction, with a significant impact on quality of life. Despite its clinical relevance, no universally accepted diagnostic standard exists, and optimal management remains debated. Multiple diagnostic tools and surgical or minimally invasive treatments have been proposed. This systematic review and meta-analysis aimed to evaluate current evidence regarding diagnostic approaches and treatment outcomes in NVD. Methods: A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library was performed for studies published between January 1990 and January 2026, in accordance with PRISMA 2020 guidelines. Randomized controlled trials, non-randomized comparative studies, cohort studies, and case series (≥10 patients) assessing diagnostic methods or therapeutic interventions for NVD were included. Diagnostic data were synthesized narratively. The primary surgical outcome was change in the Nasal Obstruction Symptom Evaluation (NOSE) score. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 tools. Results: Seventy-two primary clinical studies were included (15 diagnostic, 57 treatment-focused). Objective airflow measurements, particularly rhinomanometry and peak nasal inspiratory flow, showed greater reliability than isolated clinical maneuvers. Imaging modalities provided anatomical detail but correlated inconsistently with symptoms. Meta-analysis of 12 studies (n = 1210 patients) suggests that both traditional surgical and minimally invasive interventions can substantially improve nasal breathing, with mean NOSE score reductions of 40–55 points, though heterogeneity precludes direct comparison of their relative effectiveness. Conclusions: Diagnosis of NVD requires a multimodal approach combining clinical assessment, validated symptom scores, and selective objective testing. Surgical and minimally invasive treatments provide substantial symptom improvement when appropriately indicated. Evidence is constrained by the predominance of observational data, emphasizing the need for standardized diagnostics and robust comparative trials. Full article

Background/Objectives: Active surveillance (AS) has become the gold standard for managing men diagnosed with low-risk or favorable intermediate-risk prostate cancer. However, both patients and healthcare providers often face a lack of clear, evidence-based guidance regarding lifestyle choices during this period. This systematic review was designed to determine whether specific lifestyle modifications—including dietary changes, physical activity, weight control, and use of supplements—can tangibly impact oncologic outcomes or improve patient-reported quality of life during surveillance. Methods: The research followed PRISMA protocols, searching PubMed, Cochrane, and Scopus for studies published between 2000 and 2025. The team included diverse methodologies, from randomized controlled trials to qualitative interviews, specifically focusing on men on AS. To ensure high standards, two independent reviewers performed data extraction and quality assessments using CASP tools, and the review was formally registered with PROSPERO. Results: The review synthesized data from over 30 heterogeneous studies. The findings suggest that lifestyle interventions are safe and highly feasible. Physical exercise emerged as the most effective intervention, consistently improving cardiorespiratory fitness and reducing psychological burdens such as fatigue and “PSA anxiety.” While dietary changes and weight loss successfully improved metabolic health markers, they did not show a consistent ability to prevent biopsy upgrading or MRI progression. Similarly, supplements showed only minor, short-term effects on PSA kinetics without providing reproducible oncologic protection. Conclusions: For men undergoing active surveillance, lifestyle interventions may be considered as supportive measures, as they appear feasible and may improve physical fitness, metabolic health, and selected patient-reported outcomes. However, current evidence remains insufficient to demonstrate a consistent effect on biopsy upgrading, MRI progression, or long-term deferral of definitive treatment. Full article

Introduction: Previous research has shown that L-carnosine (β-alanyl-L-histidine) can reduce cognitive decline and improve mental health outcomes, but an updated systematic review of the effects of carnosine alone or in combination with other supplemental nutrients or bioactive compounds on these interconnected outcomes is lacking. Methods: We searched multiple databases from 1 January 2006 to 30 June 2025 for clinical trials evaluating the effects of all forms of carnosine (e.g., L-carnosine, zinc–L-carnosine) alone or in combination with other supplements on cognition, brain structure and function, mood, depression, or quality of life (QOL) outcomes. The Cochrane Risk of Bias (ROB) 2.0 tool was used to assess the ROB in randomized controlled trials (RCTs). When data were sufficient, random-effects meta-analyses were conducted. Strength of evidence (SoE) across studies was rated using the GRADE approach. Results: A total of 13 distinct studies (12 RCTs; 1 single-arm trial) involving healthy adults and patients with psychiatric or neurocognitive disorders were included. Studies were also heterogeneous in carnosine supplement dosage and duration. Overall 58% of included RCTs were rated ‘some concerns’ for ROB. Ten RCTs evaluated cognitive function, seven RCTs and one single-arm trial assessed mood and depression, four RCTs measured QOL, and three RCTs examined brain structure and function. Results from five RCTs found no significant differences in the majority of the cognitive function measures between L-carnosine supplement and placebo, but random-effects meta-analysis of three RCTs from a single research team found that anserine/L-carnosine supplementation significantly improved WMS-LM2 scores (pooled net change = 1.70; 95% CI 0.19, 3.2; I² = 58.3%) but not WMS–Local Memory Immediate Recall (LM1) scores (pooled net change = 0.76; 95% CI −0.18, 1.71; I² = 8.5%). Additionally, meta-analysis results showed that L-carnosine combined with anserine or antioxidant supplementation significantly improved the MMSE score compared to placebo (pooled net change = 0.62; 95% CI 0.23, 1.01), with small statistical heterogeneity (I² = 21.3%). Most of the studies did not show significant effects in a wide range of mood and depression outcome measures or health-related QOL (data cannot be meta-analyzed). Conclusions: A low strength of evidence suggests that L-carnosine supplement combined with anserine or antioxidants can slow cognitive function decline among healthy elderly or patients with probable Alzheimer’s Disease or mild neurocognitive disorder. More high-quality RCTs are needed to verify these findings and to improve the certainty level of this body of evidence. Full article

Background: Post-COVID-19 syndrome (PCS) is associated with impairments in mobility, balance, and physical function, which may reduce quality of life. The 30 s Sit-to-Stand (30STS) and Timed Up and Go (TUG) tests are widely used clinical measures; however, their intra-rater reliability in older adults with PCS has not been established. Reliable outcome measures are essential for clinical assessment and rehabilitation planning. Methods: In this single-center pilot study, nineteen older adults with PCS were recruited as a convenience sample. Participants completed three trials of the 30STS and TUG tests on day one, with the protocol repeated after three days. The 30STS evaluates lower-limb strength and functional performance, while the TUG assesses balance, gait, and fall risk. Intra-class correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC) were calculated. Results: The TUG showed an ICC of 0.995 (95% CI: 0.991–0.998), SEM of 0.48 s, and MDC of 1.33 s. The 30STS showed an ICC of 0.986 (95% CI: 0.973–0.994), SEM of 0.26 repetitions, and MDC of 0.72 repetitions. Conclusions: The TUG and 30STS demonstrate excellent intra-rater reliability and appear to be feasible clinical tools for assessing functional performance in older adults with PCS. However, findings should be interpreted cautiously due to the small, single-center pilot design and single evaluator. Further research is needed to confirm generalizability across broader PCS populations and clinical settings. Full article

Objective: This study aimed to identify clinically modifiable and readily accessible predictors of 30-day mortality in a 10-year candidemia cohort and to assess temporal changes in Candida species distribution. Methods: We retrospectively evaluated 391 hospitalized adults with positive blood cultures for Candida spp. between January 2015 and March 2025. Only the first candidemia episode was included. Demographic characteristics, comorbidities, risk factors, laboratory parameters, antifungal therapy, and outcomes were recorded. Species identification was performed using conventional methods and the VITEK 2 system. Factors associated with 30-day mortality were analyzed using univariate and multivariate logistic regression models. Results: The mean age was 64.5 ± 17.7 years, and 56.3% of patients were male. Most patients (68.8%) were managed in the intensive care unit, and the 30-day mortality rate was 54%. Non-albicans Candida species accounted for 62.7% of isolates, with an increasing trend over time, particularly for Candida glabrata. Fluconazole susceptibility was 79%. In univariate analysis, advanced age, solid tumors, invasive mechanical ventilation, leukocytosis, thrombocytopenia, septic shock, intensive care unit admission, and failure to remove the central venous catheter were associated with mortality. Multivariate analysis identified advanced age, intensive care unit admission, septic shock, failure to remove the central venous catheter, leukocytosis, and thrombocytopenia as independent predictors of 30-day mortality. Conclusions: Candidemia remains a life-threatening infection with high mortality. Central venous catheter management and simple hematological parameters, particularly white blood cell and platelet counts, provide practical tools for early risk stratification. Although the rising prevalence of non-albicans Candida species may require updates in empirical therapy, prompt source control remains essential to improve survival. Full article

Background: Upper respiratory tract infections (URTIs), allergic rhinitis (AR), and chronic rhinosinusitis (CRS) are prevalent and burdensome inflammatory disorders. Probiotics may modulate immune responses via gut–respiratory axis signaling, but their clinical efficacy across these conditions remains uncertain and highly heterogeneous. Methods: We conducted a PRISMA-guided systematic review and random-effects meta-analysis of randomized controlled trials (RCTs) evaluating oral or topical probiotics for URTIs, AR, or CRS (MEDLINE, EMBASE, CENTRAL, and Web of Science; inception to July 2025). Disease severity category (acute, subacute, chronic), episode incidence, and duration of illness were extracted alongside symptom scores. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was graded using the GRADE framework. Results: Thirty-two RCTs were included. In URTIs, certain strains [e.g., Lactiplantibacillus plantarum DR7, Lactobacillus rhamnosus GG] reduced symptom duration and antibiotic use; however, the pooled incidence reduction was non-significant (RD = −0.07; 95% CI: −0.23 to 0.09; p = 0.38), with very high heterogeneity (I² = 93.12%), limiting interpretability. In AR, probiotics reduced TNSS and improved quality of life (SMDs −0.72 to −2.30) in individual trials supported by immune marker changes [e.g., increased IL-10, decreased IgE]. In CRS, only two small trials—differing in delivery route (topical vs. oral), CRS phenotype, and publication era (2009 and 2017)—with conflicting effect directions were identified; formal meta-analysis was not performed given insufficient and methodologically heterogeneous data, and CRS findings are reported descriptively only. GRADE certainty ranged from very low (URTI incidence) to low (AR symptoms, URTI illness burden). Conclusions: Probiotic effects appear strain- and condition-specific. URTI pooled incidence data are unreliable due to extreme heterogeneity; individual strains show consistent benefits on illness burden and AR symptoms/quality of life. Evidence for CRS is insufficient for meta-analytic conclusions; findings are reported descriptively pending adequately powered dedicated trials. Strain-targeted RCTs with standardized outcomes, formal GRADE appraisal, and adequate power are needed before clinical recommendations can be made. Full article

Background: Lumbar disc herniation (LDH) is the most common etiological cause of low back pain (LBP). Objective and precise pain evaluation is of significant clinical value. Functional near-infrared spectroscopy (fNIRS) as a noninvasive neuroimaging modality, has been increasingly validated to reflect subjective pain perception through hemodynamic correlates. This study aimed to analyze the fNIRS changes in patients with LDH about to receive Unilateral Biportal Endoscopy and to further explore the feasibility of fNIRS as an objective biomarkers for clinical assessment of LDH. Methods: Resting-state fNIRS data were acquired from 67 preoperative LDH patients and 20 healthy controls (HC). Brain functional maps—including z-standardized fractional amplitude of low-frequency fluctuations (zfALFF) and seed-based functional connectivity (FC)—were extracted and quantified. Group-level comparisons were performed between LDH and HC groups across four predefined regions of interest; additionally, correlation analyses were conducted between fNIRS metrics and clinical assessment scores within the LDH cohort. Results: Compared with HC, LDH patients exhibited significantly altered zfALFF in the medial prefrontal cortex (mPFC): decreased amplitude at channel CH12 (t = −2.031, p = 0.045) and increased amplitude at CH21 (t = 2.462, p = 0.016). Whole-brain FC analysis further revealed widespread changes—particularly between the parietal somatosensory cortex and prefrontal regions. Among all tested FC–clinical indicator associations, 56 reached statistical significance after FDR correction (q < 0.05). VAS_ lumbar and SF-36_SF exhibited the highest number of significant connections. Conclusions: LDH patients with LBP exhibit notable alterations in prefrontal resting-state ALFF and FC between the parietal somatosensory cortex and prefrontal cortex relative to HC. Importantly, these neural alterations exhibit significant associations with both pain severity (VAS) and long-term health-related quality of life (SF-36), thereby strengthening their candidacy as neural correlates meriting prospective validation as objective, mechanism-informed biomarkers for clinical evaluation of lumbar disc herniation (LDH). Moreover, these findings highlight candidate neural targets for future longitudinal studies investigating early prognostic prediction and treatment response monitoring in LDH. Full article

Finite-volume gravity currents frequently encounter bottom obstacles, particularly in underwater environments such as lakes and oceans. However, how obstacle–current interactions reorganize Lagrangian transport pathways and ultimately determine the fate of fluid elements over the full current life cycle remains unclear. Using large-eddy simulations, we focus on a low-volume lock-exchange gravity current impinging on an isolated two-dimensional triangular obstacle. Fluid-element trajectories are tracked from collapse through propagation, obstacle interaction, and final dilution and decay, and are classified using K-means clustering into five transport modes linked to characteristic flow structures. We find that increasing obstacle slenderness strengthens upstream reflection and reduces downstream overflow, thereby shifting the fate of tracer particles from downstream delivery toward upstream retention. In addition, the obstacle standoff distance controls the dynamical state of the current at impact, producing systematic yet non-monotonic changes in the fractional population of the transport modes. This study establishes an explicit correspondence between evolving flow structures and clustered Lagrangian pathways. Comparative cases with varying geometric configuration, density contrast, flow depth, and release volume indicate that the identified transport patterns are reasonably robust. Therefore, the present results provide a fate-oriented predictive framework and theoretical basis for the transport of finite-volume gravity currents near obstacles, with important implications for engineering applications. Full article

The increasing use of pressure-sensitive labels (PSLs), driven by growth in the packaging sector, raises concerns regarding material consumption and end-of-life management under evolving European packaging regulations. This study investigates the biodegradation potential of sustainable PSL facestocks produced from 15% agro-industrial by-products, 40% post-consumer recycled fibers, and 45% virgin wood pulp. Their biodegradation behavior was compared with bio-based polyethylene (PE) facestocks using laboratory-scale aerobic soil burial tests conducted for up to 28 days. Biodegradation was assessed through weight loss measurements, visual evaluation, Fourier transform infrared (FTIR) spectroscopy, and fluorescence analysis. Fiber-based facestocks exhibited significant degradation, reaching approximately 50–55% weight loss after 28 days, accompanied by structural changes in the cellulose matrix and reduced fluorescence intensity. In contrast, bio-based polyethylene facestocks showed negligible weight loss and only minor spectroscopic changes, indicating high stability under the tested conditions. The results demonstrate that fiber-based samples derived from agro-industrial and recycled sources possess substantially higher biodegradation potential than bio-based polymeric alternatives. These findings support the use of fiber-based PSL facestocks in applications requiring improved environmental compatibility. Full article

Background and Objective: Sex differences in the treatment of people with Parkinson’s disease (PwP) with a device-aided therapy (DAT) have been poorly investigated. Our aim was to analyze sex differences in the management and response to a DAT in PwP in daily clinical practice (DCP). Patients and Methods: Data collected in the DATs-PD GETM Spanish Registry until 30 October 2025 were used. This is a descriptive, observational, prospective, and multicenter clinical registry with progressive inclusion of PwP treated with a DAT in DCP conditions in more than 40 centers from Spain. Sex differences in the DAT received and changes in quality of life (QoL), motor symptoms (MS), non-motor symptoms (NMS), and autonomy for activities of daily living (AADL) after 6 months of treatment were analyzed. Results: A total of 618 PD patients (66.9 ± 9.5 years old; 57.6% men) were treated with a DAT. A significant difference was observed in the DAT type according to sex (p = 0.006), with 73.1% of PwP who were treated with deep brain stimulation being men. At the time of DAT indication, women were older, received a higher levodopa equivalent daily dose, and had a worse health-related QoL and AADL. OFF time decreased, whereas MS and NMS burden and health-related QoL improved at 6 months follow-up in both groups (men and women). AADL improved only in men during the OFF state. Conclusion: Sex differences were detected in the use of DATs in PwP. Improvement in OFF time, MS, NMS, and QoL was detected in both groups. Full article

Nickel-rich NMC-811 is a benchmark cathode material for high-energy density lithium-ion batteries due to its high specific capacity (>200 mAh g⁻¹) and operating voltage (~3.8 V). However, its strong surface reactivity toward atmospheric species, particularly moisture and CO₂, poses significant challenges during storage and processing, leading to the formation of LiOH- and Li₂CO₃-rich surface layers. Although the effects of humid air have been widely investigated, a direct comparison between high relative humidity and pure CO₂ exposure remains limited. Here, we systematically examine the morphological, structural, chemical, and electrochemical evolution of commercial NMC-811 electrodes after 5 h exposure to 80% relative humidity or CO₂-saturated atmosphere. Moisture treatment induces substantial surface reconstruction, lattice shrinkage, and increased cation disorder, accompanied by extensive hydroxide and carbonate formation. In contrast, CO₂ exposure mainly modifies the outermost surface layer without significant bulk structural changes. Electrochemical testing reveals that CO₂-treated electrodes display higher initial polarization but quickly recover near-pristine performance, whereas humidity-treated electrodes exhibit persistent kinetic limitations, accelerated capacity fading, and earlier end-of-life. Overall, degradation severity follows the trend: pristine < CO₂ < RH 80%, highlighting the dominant role of moisture in irreversible structural deterioration. Full article

Novel psychoactive substances (NPSs) exhibit extremely strong pharmaco-toxicological activity, often leading to severe adverse effects that pose a serious risk to consumers’ health. Among these, synthetic cannabinoids (SCs) currently represent the majority of drug seizures in Europe. One such compound, AKB-48 (also known as APINACA), was first identified in Japanese herbal smoking blends in 2012. Although it mimics the effects of Δ9-THC, the primary psychoactive component of Cannabis sativa, AKB-48 can induce more severe and potentially life-threatening outcomes. Several in vivo studies investigating the acute administration of AKB-48 have reported profound behavioral, neurological, and neurochemical alterations, including disruptions of neurotransmission across multiple brain regions, thus confirming its neurotoxic potential. Given the recognized vulnerability of the cerebellum to NPS, and its critical role in integrating neural circuits affected by psychostimulant drugs, the present study evaluated the toxic effects of repeated AKB-48 exposure on the cerebellar cortex of adult male and female ICR-CD1^® mice. Particular attention was paid to the modulation of cell death pathways, alongside assessments of sensorimotor responses. The results demonstrate, for the first time, that repeated AKB-48 administration induces significant morphological, immunohistochemical, and ultrastructural changes in both male and female mice. These alterations included pronounced disruption of cerebellar architecture and marked modulation of cell death pathways, further corroborated by TEM-detected ultrastructural damage and a substantial reduction in the basal visual placing response. Overall, the findings provide clear evidence of AKB-48’s sex-independent neurotoxicity, leading to cerebellar alterations that ultimately result in neuroplasticity impairment. Full article

Maintaining hormonal equilibrium is a key determinant of women’s health, particularly during the menopausal transition and postmenopause. The decline in ovarian estrogen and progesterone production influences multiple physiological systems, affecting many aspects like vasomotor stability, bone and cardiovascular health, cognitive function, mood, and metabolic regulation. As a result, many women may experience symptoms that impair daily functioning and increase long-term morbidity. Recent progress in menopausal care emphasizes individualized, evidence-guided treatment, supported by improved diagnostic tools that allow for a more precise assessment of endocrine changes during this life stage. Among the available therapeutic options, transdermal menopausal hormone therapy has gained growing recognition due to its ability to re-establish hormonal levels with fewer systemic effects. By bypassing first-pass hepatic metabolism, this route provides more consistent serum hormone concentrations and may be associated with a lower risk of metabolic and thromboembolic complications compared with oral formulations. This review brings together the physiological basis, clinical indications, and current scientific evidence related to transdermal hormonal therapy during menopause while also highlighting its expanding therapeutic role and integration into personalized treatment strategies. In addition, we discuss recent findings on its pharmacological profile, clinical effectiveness, and emerging perspectives that position this therapeutic option as an increasingly important component of modern menopausal care and women’s health management. Full article