Search Results (1,588)

This review provides a comprehensive and critical analysis of geopolymers, focusing on structure–property relationships and functionalization strategies for sustainable applications. A structured narrative review methodology was adopted, following PRISMA principles, based on literature retrieved from Web of Science, Scopus, ScienceDirect, and MDPI databases, primarily covering the period 2015–2025. The influence of precursor type, alkaline activators, and Si–Al ratio on reaction kinetics, microstructure, porosity, and mechanical performance is systematically discussed. Functionalization approaches using additives are critically reviewed with respect to durability, fire resistance, photocatalytic activity, and antibacterial performance. The analysis highlights that the geopolymer matrix primarily acts as stable and versatile support, while functional performance is governed by the controlled integration of active particles. Key limitations related to the variability of raw materials, lack of standardization, and long-term durability are identified. Future research directions are outlined, emphasizing the need for standardized processing protocols and the application-oriented design of multifunctional geopolymer systems. Full article

Background: Mammary ductal hyperplasia represents a spectrum of benign proliferative breast lesions, some of which pose elevated risks for malignant transformation into ductal carcinoma in situ and invasive breast cancer. This narrative review explores why only specific types, particularly those with atypia, exhibit higher progression potential, synthesizing epidemiologic, histopathologic, molecular, and environmental insights. Methods: We reviewed key literature from databases, including PubMed, focusing on classification, risk stratification, genetic/epigenetic mechanisms, tumor microenvironment dynamics, and modifiable factors influencing progression. Results: Benign breast lesions are categorized into non-proliferative, proliferative without atypia, and proliferative with atypia, such as atypical ductal hyperplasia and atypical lobular hyperplasia. Atypia represents a morphologic continuum toward low-grade ductal carcinoma in situ, driven by genetic alterations, epigenetic reprogramming, and changes in the tumor microenvironment, including stromal remodeling, immune infiltration, hypoxia-induced angiogenesis, and extracellular matrix degradation. Dietary factors, such as high-fat intake and obesity, exacerbate progression through inflammation, insulin resistance, and adipokine imbalance, while environmental toxins, including endocrine disruptors, pesticides, and ionizing radiation, amplify genomic instability. Conclusions: Understanding differential risks and mechanisms underscores the need for stratified surveillance, biomarker-driven interventions, and lifestyle modifications to mitigate progression. Future research should prioritize molecular profiling for personalized prevention in high-risk hyperplasia. Full article

This article introduces a theoretical framework centered on enhancing creativity through gaming, termed the Game-based Creativity Enhancement Framework (G-CEF). Rooted in experiential learning and game-based learning theories, the framework adopts an input–process–output paradigm: two inputs (personal attributes and game attributes), one process stage (learning situation), and outputs (learning improvements and acquisitions). Personal attributes take the form of conative dispositions and variables common to both creativity and games, which help explain why gaming habits and creativity are linked, particularly outside the laboratory. Six variables are identified and presented: playfulness, imagination, mind-wandering, mindfulness, psychological capital and motives. The second input corresponds to game attributes, which help explain why and how games can help improve creativity. Two forms of game attributes are presented: affordances and game mechanics. Eight types of affordances were identified: degree of flexibility, narrative, tools, environment, content creation, avatar, progression and replayability. Five types of game mechanics were also identified: originality, divergent thinking, convergent thinking, mental flexibility and creative dispositions. The learning situation within games represents a four-step cyclical experiential learning process: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Lastly, the framework details enhancements in creativity due to gaming, supported by a literature review examining the impact of different game types on creativity. Full article

Co-created research outputs are considered the gold standard in research translation projects. It is often a requirement for gaining funding to work with affected community members and partners when working to provide resources or support communities with a lived experience of trauma. However, there is limited literature on combining a co-creation framework and trauma-informed approaches. This paper adds to these studies by describing our project, which combined co-creation with trauma-informed principles to work with potentially vulnerable communities, specifically service families who experience high family mobility (e.g., military and first responder families). The approach taken prioritised safety, trust, transparency, peer support, collaboration, empowerment, and voices of those with lived and living experiences, while also emphasising participant choice to ensure safe engagement and maintain research partner commitment. After many rounds of feedback from those with lived and living experience (over 35 initial co-creation participants), we tested the suitability of the resources on other affected community and research partners. Twelve (additional) participants provided rich feedback that was analysed using inductive thematic analysis. This included the appropriateness of the resources for the age group, the use of children’s narrative story techniques and engagement, increasing caregiver capacity and knowledge, and integration into family, educational and professional settings. We examine here potential strategies to better support this type of research and propose an improved research framework that combines co-creation and a trauma-informed approach. Although complex and time-consuming, this combined approach offers an effective means of developing targeted supports. Further testing, research and refinement with potentially vulnerable populations are needed, and successful implementation may require institutional research systems to adapt to support this approach in the future. Full article

As the rates of type 2 diabetes and obesity have increased globally, the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic steatotic fatty liver disease (NAFLD), has risen concomitantly worldwide. MASLD is now the most common etiology of chronic liver disease and is the leading indication for liver transplantation in the United States. Patients with MASLD have an increased risk of progression to metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis, hepatocellular carcinoma, extrahepatic malignancies, as well as liver- and cardiovascular-related mortality. Diet and lifestyle modifications with a goal of ≥10% total body weight loss—required to reverse steatosis, steatohepatitis, and fibrosis—are often challenging and ineffective. Although novel pharmacotherapies have recently been approved and others are in development, cost, adherence, and adverse effects remain potential limitations. Bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy, is highly efficacious and a cost-effective treatment for obesity and associated medical problems. However, bariatric surgery may be associated with morbidity and mortality. Endoscopic bariatric and metabolic therapy (EBMT) has recently emerged as a promising treatment modality and offers an alternative to surgery. Primary EBMTs include intragastric balloon placement, aspiration therapy, endoscopic sleeve gastroplasty, duodenal mucosal resurfacing, duodenal–jejunal bypass liner, and primary obesity surgery endoluminal (POSE 2.0). Secondary EBMTs include transoral outlet reduction, argon plasma coagulation of the anastomosis, and revisional endoscopic sleeve procedure. We review the recent literature on primary EBMTs and secondary EBMTs for the treatment of obesity and MASLD, the pathophysiologic mechanisms, efficacy, safety, and patient outcomes in MASLD in this narrative review. Full article

Controlled local hyperthermia supports postoperative wound healing in liver surgery by stimulating metabolism, angiogenesis, and immune responses through the induction of heat shock proteins (HSPs) and modulation of Damage-Associated Molecular Patterns (DAMPs). This study evaluates the impact of thermal modulation on immune processes during abdominal wound repair, specifically analyzing the role of HSPs and immune activation pathways. A narrative review of the literature from 2010 to 2025 was conducted to summarize molecular mechanisms regarding temperature, HSP activation, cytokine expression, and DAMPs, excluding studies conducted solely in animal models. The results indicate that precise local hyperthermia in postoperative abdominal wounds activates HSPs as well as inflammasome and Toll-like receptor (TLR) pathways, modulating immune and cytokine responses depending on the type and depth of tissue injury. Consequently, such thermoimmunomodulation stabilizes immune cell functions, optimizes the balance between inflammation and regeneration, and minimizes the risk of postoperative complications to support effective wound healing. Full article

Diabetes mellitus remains a major global health burden, and many patients do not achieve durable glycemic control despite modern pharmacotherapy. This narrative review synthesizes evidence on plant-derived strategies that may complement standard care, focusing on two clinically aligned domains: glucose-lowering medicinal plants and plant-based sugar substitutes that reduce dietary glycemic load. We summarize key mechanistic pathways, including inhibition of α-amylase/α-glucosidase, reduced intestinal glucose entry and absorption kinetics, glucose-dependent insulinotropic effects, improved insulin signaling, suppression of hepatic gluconeogenesis, and microbiota-linked effects. We critically appraise human evidence for selected botanicals (cinnamon, fenugreek, mulberry, gymnema, gynura, rosehip, and Jerusalem artichoke) and plant sweeteners (stevia and monk fruit). Overall, clinical effects are modest and heterogeneous; the most reproducible signals are observed for mulberry leaf in blunting postprandial glucose excursions, and for cinnamon, fenugreek, and gymnema, where meta-analyses suggest modest improvements in glycemic markers. Stevia and monk fruit are best supported as glycemically neutral sucrose substitutes, while inulin-type fructans show small-to-moderate benefits with sustained intake, limited by gastrointestinal tolerability at higher doses. Key gaps include a shortage of long-term randomized trials using standardized preparations and durable endpoints such as glycated hemoglobin. Plant-derived interventions are therefore best positioned as adjuncts within individualized, evidence-based glycemic management. Full article

Background/Objectives: Neurofibromatosis type 1 (NF1) is a genetic disorder characterized by various clinical manifestations, including significant neurovascular complications. This review aims to synthesize current knowledge regarding intracranial stenoses and associated vascular abnormalities in patients with NF1, emphasizing the differences between pediatric and adult populations. Methods: A narrative review was conducted, analyzing the existing literature on the epidemiology, clinical manifestations, and management of neurovascular issues related to NF1. Data were collected from a range of studies, including retrospective analyses and case series, focusing on the incidence and outcomes of intracranial vascular abnormalities. Results: The study found that intracranial vasculopathy affects between 0.4% and 6.4% of NF1 patients, with children experiencing higher rates of stenotic lesions. However, vascular issues in adults are less understood, with 3.5% of adult patients presenting vascular abnormalities. The review highlights a significant underdiagnosis of these conditions due to the lack of routine use of magnetic resonance angiography (MRA) in standard evaluations. The management of NF1-related vascular conditions, particularly in adults, remains poorly defined, particularly regarding the efficacy of antithrombotic therapies. Conclusions: The management of neurovascular complications in NF1 requires urgent attention, with a need for standardized screening protocols and further research to elucidate the natural history and optimal treatment strategies for these patients. Enhanced diagnostic practices, including routine neuroimaging, are essential to improve outcomes and reduce the risk of significant vascular events. Full article

This exploratory mixed-methods study examined whether a narrative-driven digital gamification platform, FantasyClass, grounded in the MDA (Mechanics–Dynamics–Aesthetics) framework and Bartle’s player typology (used as a cohort-level design input), was associated with science attitudinal change in preservice primary teachers. The quantitative component employed a one-group pretest–posttest (pre-experimental) within-participant design using a validated 22-item attitudes questionnaire (N = 23), structured across three temporal dimensions: past (retrospective experiences), present (current perceptions), and future (teaching expectations). Significant improvements were observed across all attitudinal dimensions with large effect sizes, most notably in students’ future expectations and confidence to teach science. Exploratory correlation analyses indicated that participants’ perceived motivational value of narrative and immersion elements was moderately associated with Future-dimension attitudinal gains. Qualitative thematic analysis of open-ended responses (n = 15) revealed enhanced motivation, reduced science anxiety, more positive perceptions of physics and chemistry, and strong intentions to adopt game-based and gamified strategies in future teaching practice. Convergence across quantitative and qualitative strands suggests that structurally coherent, player-type-informed narrative gamification may be associated with attitudinal transformation and early professional identity development in STEM teacher education, while recognizing that the design does not permit causal attribution. Full article

Background: Thoracic endovascular aortic repair (TEVAR) has evolved the management of descending thoracic aortic disease, but neurological complications—particularly spinal cord ischemia (SCI), stroke, and postoperative delirium—remain among the most feared adverse events, adversely affecting survival, quality of life, and functional independence. Objectives: The aim of this study was to provide a contemporary narrative synthesis (2000–2025) of the incidence, mechanisms, risk factors, prevention, and management of neurological complications after TEVAR, emphasizing how current evidence supports individualized and risk-adapted strategies for prevention and management. Methods: A narrative, non-systematic search (PubMed/MEDLINE, Scopus, Cochrane Library; 2000–2025) was conducted using terms related to TEVAR, SCI, cerebrovascular events, delirium, and cognitive dysfunction. Priority was given to large registries, cohort studies, and systematic reviews in adult TEVAR populations. Results: Perioperative stroke occurs in ~2–6% of TEVAR cases, with higher rates in arch/zone 0–2 procedures and when the left subclavian artery (LSA) is covered without revascularization. SCI incidence ranges from ~2–9%, influenced by aortic extent and urgency; Vascular Quality Initiative data report SCI in 3.7% of procedures, with markedly reduced 1-year survival. Major SCI risk factors include extensive thoracic coverage, prior aortic repair, vertebral or hypogastric occlusion, emergency presentation, low perioperative mean arterial pressure, anemia, and chronic kidney disease. Postoperative delirium occurs in ~13% of TEVAR-treated type B dissections and correlates with longer hospitalization and early complications. Emerging nomograms for SCI and delirium enable individualized risk stratification. Conclusions: Neurological complications after TEVAR remain clinically significant. Contemporary evidence supports personalized prevention—selective cerebrospinal fluid (CSF) drainage, LSA revascularization, staging, neuromonitoring, and tailored hemodynamic targets—guided by anatomical complexity, comorbidities, collateral network integrity, and prior aortic history. Further research should refine prediction tools, standardize definitions, and evaluate individualized neuroprotective bundles. Full article

Cardiac amyloidosis is an infiltrative cardiomyopathy caused by extracellular deposition of misfolded proteins, most commonly immunoglobulin light chains (AL) or transthyretin (ATTR), with rarer forms occurring less frequently. AL amyloidosis arises from plasma cell-derived light chains and typically follows an aggressive clinical course, whereas ATTR amyloidosis results from misfolded wild-type or variant transthyretin and progresses more indolently. Extracellular vesicles (EVs) have recently been recognized as mediators of amyloid propagation, inflammation, and myocardial remodeling, particularly at later stages of disease. Despite growing evidence, no comprehensive reviews have focused on this relationship. We conducted a structured narrative review (PubMed and Scopus, 2020–2025) following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to synthesize emerging data. EVs act as scaffolds for transthyretin and serum amyloid A aggregation and carry disease-specific protein and RNA cargo detectable in blood and urine. Experimental models also demonstrate EV-mediated transport of serum amyloid A under conditions of cardiac stress, representing a reactive amyloidogenic pathway rather than a common cause of human cardiac amyloidosis. Preclinical studies show regenerative and anti-fibrotic effects of stem-cell-derived EVs, and early clinical trials demonstrate the feasibility of EV-based cardiac therapy. While methodological and translational challenges persist, EVs represent promising diagnostic and therapeutic tools that could transform the precision management of cardiac amyloidosis. Full article

Prader–Willi syndrome (PWS) is a rare imprinting-related neurodevelopmental disorder caused by loss of paternally expressed genes within the chromosome 15q11–q13 region, including SNORD116, MAGEL2, and NDN. It provides a natural model for examining how genomic imprinting disruptions shape neural development and psychiatric vulnerability. This review synthesizes current evidence to clarify the mechanistic pathways linking imprinting defects and epigenetic dysregulation to neuropsychiatric outcomes in PWS. Published studies—including patient-derived induced pluripotent stem cell (iPSC) models, animal knockout systems (e.g., Magel2-null models), transcriptomic and DNA methylation datasets, and human neuroimaging research—were identified through targeted searches of PubMed and Web of Science and integrated narratively rather than through systematic procedures. Across these data sources, deletion-type PWS is primarily associated with impaired neuronal maturation, altered serotonergic signaling, and locus-specific transcriptional dysregulation. Maternal uniparental disomy (mUPD) is characterized by broader epigenetic alterations within the imprinted domain, genome-wide transcriptional effects, dopaminergic pathway alterations, and disrupted prefrontal–limbic connectivity linked to increased psychosis risk. Importantly, available evidence supports substantial phenotypic and mechanistic overlap between PWS subtypes, with genotype–phenotype associations reflecting probabilistic tendencies rather than categorical distinctions. Collectively, convergent findings across molecular, neurochemical, and systems-level studies support a mechanistic continuum extending from imprinting defects to behavioral phenotypes. These insights position PWS as a translational model for understanding how epigenetic dysregulation contributes to psychiatric risk and highlight the need for genotype-informed, mechanistically grounded research to advance biomarker development and targeted therapeutic strategies. Full article

Background: Influencer marketing has become one of the most effective strategies in digital communication due to its capacity to generate trust, credibility and endorsement within segmented online communities. Within the tourism sector, travel influencers have been progressively integrated as key agents in destination and brand promotion, contributing to both the construction of tourism-related perceptions and travel decision-making. This study aims to analyse how travel influencers communicate and promote tourist destinations, focusing on their profiles, content formats, commercial transparency and audience engagement. Methods: The research is based on a quantitative content analysis of publications by leading Spanish travel influencers identified through the Forbes Best Content Creators 2025 ranking. The observation period covered March to July 2025. Analysis was structured around four analytical blocks comprising 17 variables related to influencer profile, format and content, commercial transparency and ethics, and interaction. Results: The results reveal consistent behavioural patterns associated with gender, destination type and narrative style. Male influencers are more frequently linked to adventure-oriented storytelling and natural landscapes, whereas female influencers tend to emphasise urban and cultural experiences. Short-form video emerges as the dominant format, generating higher interaction levels, while engagement proves to be a more informative indicator of effectiveness than follower count. Conclusions: The findings underscore the importance of prioritising specialisation, narrative coherence, authenticity and transparency when integrating influencers into their communication strategies. Full article

Background/Objectives: In recent years, improvements and innovative treatments in pediatric cancer have significantly increased survival rates, but challenges in both cognitive and psychosocial development in children remain significant. This review applies a comprehensive framework to evaluate psychosocial interventions in pediatric populations, offering novel insights into intervention strategies and their effectiveness across diverse contexts. Methods: A systematic search was conducted in the PubMed, Scopus, PsycINFO, and Web of Science databases for the period 2000–2024. Controlled studies, systematic reviews, and qualitative studies examining psychosocial interventions for children and adolescents with cancer or survivors were included. Quality assessment was performed using the RoB2 tool, and data were analyzed using narrative synthesis by age group and type of intervention. Results: Studies have shown that developmentally targeted interventions, such as therapeutic play, cognitive–behavioral therapy, and school reintegration programs, improve emotional regulation, cognitive functioning, and social adjustment in children with cancer. However, the heterogeneity of the samples and the variety of measurements limit the generalizability of the results. Conclusions: Integrating a developmental perspective into the design of psychosocial interventions can enhance their effectiveness and sustainability in pediatric oncology. Future research should focus on long-term, culturally sensitive programs and their implementation in clinical practice. Full article

Background/Objectives: Systemic sclerosis (SSc) is a rare autoimmune disease characterized by chronic inflammation, microvascular injury, and fibrosis of the skin and internal organs. Although there are therapies, there is a need for treatments targeting early pathogenic mechanisms. Type I interferons (IFN-I) are key mediators linking immune dysregulation to vascular and fibrotic damage in SSc. This review summarizes the current evidence supporting IFN-I blockade with anifrolumab as a novel therapeutic strategy. Methods: A narrative review of preclinical, translational, and emerging clinical studies was conducted to evaluate the role of IFN-I signaling in SSc and the therapeutic potential of anifrolumab. Particular focus was placed on the IFN signature, upregulation of interferon-stimulated genes (ISGs), and the association with disease activity and organ involvement. Results: Anifrolumab, a fully human monoclonal antibody targeting the IFN-I receptor subunit 1 (IFNAR1), inhibits the signaling of all IFN-I isoforms, suppressing downstream JAK–STAT activation and ISG expression. Mechanistic data suggest that IFNAR blockade modulates vascular injury, immune activation, and fibrosis. Early findings and ongoing trials indicate potential benefits, particularly in patients with a high IFN signature or rapidly progressive cutaneous and cardiac disease. Conclusions: The current evidence supports IFN-I pathway inhibition as a promising approach in SSc. Ongoing trials will help to determine the clinical efficacy, safety, and optimal patient selection for anifrolumab in this rare but severe disease. Full article