Search Results (3,689)

Aging alters cardiac resilience to anesthetic and surgical stress, yet the molecular basis for these effects remain poorly understood. To define age-dependent transcriptional responses, we profiled cardiac gene expression across young adult (3 m), late middle-aged (17 m), and old mice (27 m) following 2 h isoflurane and operative (Iso/Op) exposure. Across all age groups, 24 h after cessation, Iso/Op induced distinct transcriptional signatures relative to the sham, with conserved perturbations in oxidative stress responses, Ca²⁺ handling, hypertrophy-associated signaling, and energy metabolism. In 3 m hearts, transcriptional alterations were characterized by dysregulation of small-molecule catabolism, fatty acid metabolism, endoplasmic reticulum processing, and cytoskeletal organization. In 17 m hearts, lipid metabolic disruption was amplified and accompanied by suppression of muscle system and calcium signaling pathways. In 27 m hearts, Iso/Op robustly activated PPAR and AMPK signaling and fatty acid catabolic programs while downregulating pathways governing contractility, actin organization, and morphogenesis, consistent with age-associated maladaptive metabolic reprogramming. To assess persistence, we analyzed a longitudinal cohort of 20 m mice five weeks after exposure and observed sustained transcriptomic remodeling driven predominantly by isoflurane, including mitochondrial dysfunction and altered expression of genes linked to diabetic cardiomyopathy, extracellular matrix integrity, and neurodegeneration-associated pathways. Together, these data suggest that isoflurane-based perioperative stress can produce age-amplified and durable metabolic and structural cardiac remodeling, implicating impaired lipid utilization and mitochondrial homeostasis as potential mechanisms of long-term cardiovascular vulnerability. Full article

Background: Paediatric pelvic and acetabular fractures are rare and usually the consequence of high-energy trauma, often associated with life-threatening injuries. The majority are managed non-operatively; however, open reduction and internal fixation (ORIF) is indicated in selected, complex, or displaced, acetabular fractures. The modified Stoppa approach is well established in adults, but has been rarely reported in skeletally immature patients, and evidence guiding surgical approach and fixation in children remains limited. Methods: We report the case of an 11-year-old girl who sustained a transverse acetabular fracture following a high-energy trauma. The fracture was treated with ORIF through a modified Stoppa approach. We also performed a systematic review of the literature, focusing on ORIF of acetabular fractures in children. Results: In our patient, ORIF of the acetabular fracture was performed, achieving an anatomical reduction, 10 days after initial damage-control fixation of a concomitant open tibial plateau fracture. Postoperative management consisted of four weeks of non-weight bearing, followed by progressive weight bearing. At six months, she had returned to full daily activities and sports. The review of the literature identified 16 studies (retrospective series and case reports) describing paediatric acetabular fractures treated with ORIF using plates, screws, or flexible nails. In the literature, good to excellent clinical and radiographic outcomes were reported when anatomical reduction and stable fixation were achieved, although growth disturbance and avascular necrosis were described, particularly in cases with delayed reduction or severe triradiate cartilage injury. Conclusions: Our case illustrates the technical feasibility of the modified Stoppa approach in a skeletally immature patient with a complex acetabular fracture, with excellent mid-term outcome. Although it is not contraindicated in paediatric patients, it should be reserved for treating this type of complex fracture. The available literature supports that satisfactory results are reported after ORIF in children, but the heterogeneity and low level of evidence preclude firm recommendations on the optimal approach. Full article

Objectives: The popularity of racket sports has been increasing globally in recent years, with tennis remaining the most played sport worldwide and pickleball gaining popularity in the United States. While many studies have addressed injuries associated with racket sports in adult athletes, minimal data are available focusing on young athletes in pediatric and adolescent populations. This study aimed to review the various injuries associated with racket sports in pediatric and adolescent populations. Methods: Using the PubMed database, we searched for studies completed in the last 10 years that addressed injuries due to racket sports in age groups up to 18 years old, as well as adult studies that included pediatric and adolescent populations. Results: In total, 60 studies met our inclusion criteria, of which 18 were descriptive studies. The most common injuries reported in the studies were lower extremity injuries, specifically knee and ankle injury. Upper extremity injuries were the next most common, specifically shoulder injuries. Most of the studies reported multiple musculoskeletal injuries as opposed to just one. Tennis was found to be the racket sport that caused the highest number of injuries, as well as the most severe injuries. Conclusions: There are few studies on musculoskeletal injuries from racket sports in pediatric and adolescent populations. This review found that tennis had the highest number of studies, and different types and severities of injuries were well-described. Lower extremity overuse injuries were the most common, followed by upper extremity injuries. Eye injuries were less common but serious. Injuries cause pain, time loss in school, and increased healthcare burden, so there is public health relevance to conducting more racket sport studies. There is a significant amount of physical and mental growth occurring during childhood and adolescence; therefore, more kinematic studies and systematic reviews should be conducted pertaining to racket sports, which will hopefully help with injury prevention in these age groups. Full article

Background/Objectives: Holocord astrocytomas are exceptionally rare intramedullary tumors, especially in adults, and often present with extensive longitudinal growth. Because only a small number of cases have been described, management strategies remain insufficiently defined. This report presents an adult patient treated with a staged surgical approach and provides an updated review of the literature. Methods: A 31-year-old male presented with progressive paraparesis, sensory deficits, and sphincter dysfunction. MRI demonstrated an intramedullary tumor extending from T3 to the conus medullaris. The patient underwent a planned two-stage resection with intraoperative neurophysiological monitoring. Histopathological and DNA-methylation analyses were performed. Additionally, a systematic review of previously reported holocord astrocytoma cases was conducted. Results: The two-stage surgical strategy enabled extensive debulking across multiple spinal segments while preserving neurological function. The patient demonstrated marked postoperative improvement, including restoration of sphincter control, improved motor function, and better mobility. Histopathological analyses confirmed a high-grade astrocytoma with piloid features. The literature review identified 28 previously reported cases, including only 5 in adults. Reported neurological outcomes across adult cases are variable, reflecting the heterogeneity and rarity of this tumor entity. Conclusions: Holocord astrocytomas in adults are extremely rare and pose particular diagnostic and therapeutic challenges. This case demonstrates that a carefully planned, staged surgical approach can achieve meaningful neurological recovery, even in patients presenting with severe preoperative deficits. The report expands the limited body of evidence available for adult holocord astrocytomas and may support future management strategies. Full article

One of the challenges post-COVID-19 is reducing the negative impacts on quality of life, performance, and independence in activities of daily living. Assessing functional dependence in adults one year after acute infection can help to understand the long-term consequences, evaluate the impact on quality of life, plan rehabilitation and healthcare, identify the most vulnerable groups, measure the socioeconomic impact, and support public policies and clinical decisions. Objectives: The objectives of this study are as follows: (a) to assess the prevalence of functional dependence in Brazilian adults with COVID-19; (b) to analyze the association between the study variables; and (c) to determine the factors associated with functional dependence. Methods: This was an observational, cross-sectional study with 987 adults (18 to 59 years old) living in the State of Paraná (Brazil) hospitalized for COVID-19 between March and December 2020. Data were collected by telephone 12 months after the acute infection using an instrument to retrieve sociodemographic and health information, and a functional dependence scale to assess dependence before COVID-19 retrospectively (using participant recall information) and at the time of the interview. Data were analyzed using penalized logistic regression after imputing missing data. Data were analyzed using penalized logistic regression after imputing missing data. Results: Functional dependence after COVID-19 was 5.0% and was associated with low levels of education, not having a partner, living with someone, not owning a home, experiencing job changes, requiring care, obesity, smoking, multimorbidity, ICU admission in the acute phase, use of invasive ventilation, or having Long COVID. Individuals who required care or used invasive ventilation support were, respectively, 9.3 and 6.5 times more likely to develop dependence after COVID-19. Despite adjustment for multiple factors, the magnitude of the observed effects warrants cautious interpretation, as unmeasured or residual confounding effects may still be present. Sample recall bias due to collection after 12 months and the presence of the alpha variant without COVID-19 vaccination coverage may limit data generalization. Conclusions: The results highlight the need to emphasize the public health implications of identifying functional dependence. In this vein, it is necessary to implement preventive measures, identify and monitor more vulnerable groups, plan rehabilitation programs, and develop public health policies. Full article

Background: Visceral Leishmaniasis (VL), a severe systemic parasitic disease caused by Leishmania species, can be complicated by secondary Hemophagocytic Lymphohistiocytosis (HLH). HLH is a life-threatening hyperinflammatory syndrome characterized by excessive immune activation that results in multiorgan dysfunction. The co-occurrence of VL and HLH in adults is a rare but critical diagnostic and therapeutic challenge, often leading to fatal outcomes if treatment is delayed. Case Presentation: We present two cases of adult males (60 and 72 years old) from Greece, an endemic area for L. infantum, who presented with prolonged fever, pancytopenia, hepatosplenomegaly, and impaired liver function. Both patients exhibited extremely elevated ferritin (all > 2000 ng/mL and one > 20,000 ng/mL) and hypertriglyceridemia, fulfilling key laboratory criteria for HLH. Diagnosis was confirmed by the visualization of Leishmania amastigotes in bone marrow aspirates, which also demonstrated features of hemophagocytosis. Case 1, critically ill with acute kidney injury and coagulopathy, required combined treatment with liposomal Amphotericin B and immunoglobulin therapy for HLH. Case 2, who showed rapid and “spectacular improvement” solely after receiving liposomal Amphotericin B, did not require HLH-specific immunosuppression. Conclusions: VL-associated HLH should be considered in adult patients presenting with complex systemic inflammation, fever, and cytopenias, particularly in endemic settings. Our cases illustrate that the prompt initiation of anti-leishmanial therapy with liposomal Amphotericin B can be sufficient to reverse the HLH syndrome by eliminating the infectious trigger. However, intensive immunomodulation may be necessary in patients presenting with critical multi-organ failure. Full article

Background: Polycystic ovary syndrome (PCOS) is commonly associated with psychological disorders, including depression and anxiety. Women with PCOS also tend to experience poorer sleep quality and greater daytime sleepiness than healthy individuals. To the best of our knowledge, no systematic reviews have investigated the impact of probiotic supplementation on mental health and sleep patterns in women with PCOS. Emerging evidence indicates that probiotic therapy may be a promising adjunct for enhancing mental well-being and sleep quality within this population. Objectives: This systematic review aimed to evaluate the effects of probiotic supplementation on depression, anxiety, and sleep quality in adult women with PCOS. Methods: PubMed, Cochrane, and Scopus were searched for randomized controlled trials (RCTs) involving women aged 18–45 years old, with diagnosed PCOS, who received probiotic/synbiotic supplements and enriched foods compared with placebo. Studies had to assess mental health, depressive symptoms, or sleep disorders using validated questionnaires. Five publications met the Population, Intervention, Comparison, and Outcome inclusion criteria (PICO) and were included in the final analysis. Results: Probiotic supplementation was associated with significant improvements in sleep quality (assessed by Pittsburgh Sleep Quality Index, PSQI), depressive symptoms (assessed by Depression, Anxiety and Stress Scale, DASS 21) and some domains of quality of life (measured by Polycystic Ovary Syndrome Health Related Quality of Life Questionnaire, PCOSQ-26). Conclusions: Although probiotic supplementation may benefit mental health and sleep parameters in women with PCOS, this evidence is limited due to the small number of studies, modest sample sizes, and methodological variability. Further research with larger, more rigorous studies is needed to confirm these findings. Full article

Spodoptera frugiperda is a major agricultural pest both in Brazil and worldwide, with widespread resistance to synthetic insecticides. This study evaluated the toxicity and residual activity of toxic bait formulations combining 17 insecticides with the plant-based kairomone attractant Noctovi^® 43SB against S. frugiperda adults. Bioassays were conducted with 48 h-old, food-deprived adults. Toxicity was assessed by incorporating insecticides at 2% concentration into Noctovi^® 43SB. Residual activity was measured by applying toxic baits on cotton leaves and testing at 3, 7, 15, 21, and 30 days after application (DAA). Insecticides based on methomyl, spinetoram, spinosad, indoxacarb, malathion, and zeta-cypermethrin induced over 95% mortality. Methomyl showed the greatest toxicity (LC₅₀ = 322 mg a.i. L⁻¹; LC₉₀ = 1160 mg a.i. L⁻¹). Eleven insecticides maintained residual activity (≥70%) after 30 DAA, except malathion. Overall, toxic bait formulations combining Noctovi^® 43SB with methomyl, spinosad, spinetoram, or indoxacarb proved highly effective, offering both rapid and prolonged control of S. frugiperda adults. These findings highlight attract-and-kill as a promising tool for sustainable management of this pest. Full article

Background/Objectives: RELiZORB immobilized lipase cartridge (ILC) is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. It is cleared by the FDA for pediatric and adult use. Limited data have been published regarding the effect of ILC use on growth in children younger than 5 years of age. Methods: We performed a retrospective evaluation of real-world data extracted from a third-party reimbursement program database. All patients in the program database who initiated ILC use with enteral formula when 1 to 4 years of age between 2019 and 2023 were included. Baseline and follow-up weight, height/length, and body mass index (BMI) data were collected for up to 12 months. Results: A total of 186 patients from 90 clinics in the United States were included. A subset (143 patients) with baseline and follow-up growth measurements was included in the efficacy analysis population; 76% were diagnosed with cystic fibrosis. Mean weight and BMI z-scores improved significantly (0.63 [p < 0.001] and 0.53 [p = 0.006], respectively) from baseline to 12 months after initiation of ILC use. Significant improvement in the mean weight z-score was observed after 3 months. Among people with cystic fibrosis (pwCF) who initiated ILC use when 2 to 4 years of age, those with a BMI ≥ 50th percentile increased from 22% at baseline to 43% after 12 months (p = 0.021). Improvement in weight-for-length was also observed in 1-year-old pwCF. Conclusions: Real-world evidence showed that initiation of ILC use was associated with significant improvements in mean weight and BMI z-scores among young children. Full article

Dental caries remains a major global public health problem characterized by pronounced social inequalities. This study aimed to identify, critically appraise, and synthesize the most recent evidence on the relationship between socioeconomic indicators and dental caries among adults aged 19–60 years, providing an updated systematic review that builds upon our previous reviews from 2012 and 2018. Reported following the PRISMA 2020 guidelines, we conducted a systematic search of eight electronic databases for observational studies published between March 2017 and April 2024 (PROSPERO: CRD42017074434). Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Newcastle–Ottawa Scale. Due to substantial methodological heterogeneity across the 22 included studies, a narrative synthesis was undertaken. The findings demonstrated a strong inverse association between socioeconomic position and caries experience. Lower income, lower educational attainment, and unemployment or employment in manual/unskilled occupations were associated with a higher overall caries experience. Advanced analytical approaches in recent studies, including life-course, reinforced that education and income are key contributors of these oral health inequalities, with persistent social disadvantage conferring the greatest risk. In conclusion, dental caries in adults aged 19–60 years is a social condition reflecting the cumulative effects of socioeconomic inequality across the life course. Addressing adult dental caries requires integrated approaches that combine clinical prevention with social and public policies aimed at reducing structural inequalities. Full article

Background/Objectives: Chronic psychomotor and cognitive slowing after stroke can persist despite standard rehabilitation, especially in young adults with subcortical injuries. Innovative, integrated interventions are crucial for patients who have reached a plateau in their rehabilitation. We present a case of a 41-year-old male with chronic psychomotor and cognitive slowing following a left lenticulostriate infarction (NIHSS score = 5 at onset), who had plateaued after conventional rehabilitation. Methods: Over 4 weeks the patient underwent 20 sessions of a multimodal approach including high-frequency repetitive transcranial magnetic resonance stimulation over the supplementary motor area and bilateral temporo-parietal junctions and simultaneous computerized cognitive training targeting attention and executive function. Both motor and cognitive assessments, along with quantitative EEG (qEEG) evaluations, were conducted before and after the treatment. Results: At the end of treatment, the patient showed significant clinical improvement: speed and coordination in upper extremities (Finger Tapping Test) increased by 66% (dominant hand) and 74% (non-dominant hand), while finger dexterity (Nine-Hole Peg Test) increased by 25% (dominant hand) and 19% (non-dominant hand). Cognitive scores improved in alertness (58%), visual exploration (25%), and flexibility (24%), while divided attention remained stable. qEEG investigation showed increases in alpha (79%), gamma (33%), and beta (10%) power, with topographic shifts in the stimulated regions. Conclusions: These findings highlight the feasibility of combining targeted rTMS and cognitive training to enhance neuroplasticity in the chronic phase of stroke. Clinical recovery was accompanied by normalized cortical rhythms, suggesting qEEG biomarkers may be useful for tracking treatment response. Multimodal precision neurorehabilitation may offer a path forward for patients with persistent cognitive–motor deficits post-stroke. Full article

Segment regeneration in earthworms is a remarkable example of postembryonic morphogenesis, yet its fidelity and cellular mechanisms remain incompletely understood. The present study investigated posterior segment regeneration in adult specimens of the earthworm model Eisenia andrei from wound closure to the 5th postoperative week using anatomical, histological, and ultrastructural approaches. Rapid wound closure occurred through fusion of the cut edges of the body wall and midgut without direct involvement of coelomocytes. The regeneration blastema consisted of dedifferentiated epithelial and muscle cells, innervated by fibers from the last intact ventral nerve cord ganglion. Coelomocytes accumulated in the last intact segments and were primarily involved in debris clearance. Notably, early regenerating tissues lacked collagen fibers, which appeared only after the third postoperative week and remained sparse until the fifth week, whereas original segments exhibited intense, region-specific collagen deposition. Transmission electron microscopy revealed characteristic cytological changes in distinct stages of body wall regeneration, including muscle dedifferentiation and the emergence of collagen-producing fibroblasts. These findings indicate that early cell migration, proliferation, and orientation in the blastema proceed independently of collagen and that collagen functions as a delayed structural scaffold, supporting tissue integrity without impeding regeneration. Importantly, no scar formation was observed between old and new tissues, resembling scarless fetal wound healing. Overall, we clarified previously controversial cellular mechanisms and propose a new, comprehensive model for the early stages of segment regeneration. Our results highlight that coordinated dedifferentiation, spatiotemporal extracellular remodeling, and delayed collagen deposition underlie effective, scar-free regeneration in earthworms, offering insights into conserved mechanisms of regenerative repair across metazoans and potential strategies for enhancing tissue regeneration in mammals. Full article

Background: Severe hypertriglyceridemia (SHTG) in children is a rare but clinically significant disorder associated with recurrent acute pancreatitis and substantial morbidity. Early identification and prompt management are essential to prevent pancreatic and systemic complications. Methods: We report the case of an 11-year-old female with a history of xanthogranulomatous pancreatitis who presented with extreme hypertriglyceridemia, with fasting triglyceride levels exceeding 4000 mg/dL. Results: The patient was treated acutely with continuous intravenous aspart insulin (0.1 U/kg/hour) and adjusted 10% glucose infusion, with hourly glucose and potassium monitoring, leading to a rapid and marked reduction in triglyceride levels—55% reduction within the first 24 h, 76% at 48 h, and 82% after 96 h of treatment. No hypoglycemia or other adverse effects were observed. Nutritional management included a low–long-chain triglyceride (LCT) diet enriched with medium-chain triglycerides (MCTs) and omega-3 fatty acids, providing essential calories while minimizing chylomicron production. Over a 12-month follow-up, the patient remained asymptomatic, with sustained lipid normalization and no recurrence of pancreatitis. Conclusions: This case underscores the therapeutic value of combining pharmacologic and dietary strategies in pediatric SHTG. Evidence from pediatric and adult studies supports the role of insulin infusion for acute triglyceride lowering and MCT-based nutritional therapy for long-term control. Our findings highlight the need for early, individualized, and multidisciplinary management and emphasize the potential future role of emerging targeted therapies in addressing refractory pediatric hypertriglyceridemia. Full article

Background/Objectives: Sarcopenia is an age-related decline in muscle mass and strength, reducing mobility and functional independence and increasing the risk of falls. Non-pharmacological interventions remain the most effective strategies to prevent or delay its progression, with exercise recognized as the primary approach. Virtual reality (VR)-based training has recently emerged as a promising tool to promote physical activity; however, its application among the oldest-old individuals remains underexplored. This is a randomized controlled pilot study to evaluate the effects of VR-based intervention using the game “Beat Saber” on muscle strength and selected physical performance indicators related to sarcopenia risk in older adults. Methods: Thirty-eight residents (mean age: 87.2) of a long-term care facility were randomly assigned to either a VR group or a control group. The VR group participated in 12 supervised VR-based training sessions of 20 min per session, three times per week for four weeks. Handgrip strength, the arm curl test, 30-s chair stand, a 2-min step-in-place test, and an 8-foot up-and-go test were assessed before and after the intervention. Results: Linear mixed-model analyses revealed significant group-by-time interactions for upper- and lower-limb strength (handgrip, arm curl, chair stand; p < 0.05), favoring the VR group. Agility and endurance (8-foot up-and-go, 2-min step-in-place) showed no significant interactions. In the VR group, the 30-s chair stand performance correlated positively with the arm curl and the 2-min step-in-place tests results, while handgrip strength correlated with the arm curl performance. In the control group, the 30-s chair stand test results correlated strongly with the 8-foot up-and-go and 2-min step-in-place tests, but no significant correlations were found for handgrip strength. Conclusions: The findings indicate short-term functional benefits of VR exercise among the oldest-old adults. VR-based training appears to be an effective and well-tolerated method to enhance physical performance in individuals aged 80 and older and may represent a valuable strategy for improving functional performance indicators associated with sarcopenia risk in adults aged 80 years and older. Full article

Background: The Ross procedure provides excellent outcomes in young adults requiring aortic valve replacement, with lower rates of infective endocarditis (IE) compared to prosthetic valves. Early postoperative IE of the autograft is exceptionally rare, with only isolated cases reported in major registries. Case Summary: We report a 40-year-old man with bicuspid aortic valve and a history of two previous episodes of native valve endocarditis who underwent Ross procedure with Ozaki modification. Ten days postoperatively, he developed fever and was diagnosed with early autograft IE with perivalvular abscess formation. Despite negative blood cultures (due to prior antibiotic administration), clinical findings met modified Duke criteria for possible IE. Imaging revealed perivalvular abscess with subsequent pseudoaneurysm development, while the autograft leaflets remained functional. The patient was successfully treated with 6-week combination antibiotic therapy without requiring surgical reintervention. After one year of follow-up, he remains asymptomatic with stable pseudoaneurysm size and preserved valvular function. Conclusions: Early IE following Ross procedure, though rare, should be considered in patients presenting with postoperative fever. This case demonstrates that conservative management with appropriate antibiotic therapy can be successful even with perivalvular complications, provided there is hemodynamic stability and close multidisciplinary monitoring. Long-term surveillance remains essential given the persistent structural abnormalities. Full article