Search Results (243)

Objectives: Clinical decision-support systems are computer-based tools to improve healthcare decision-making. However, their effectiveness depends on being positively perceived and well understood by healthcare professionals. Qualitative research is particularly valuable for exploring related behaviors and attitudes. This study aims to explore experiences of family physicians and nurses concerning the visualization, utility and understanding of the non-valvular atrial fibrillation clinical decision-support system (CDS-NVAF) tool in primary care in Catalonia, Spain. Methods: We performed a qualitative study, taking a pragmatic utilitarian approach, comprising focus groups with healthcare professionals from primary care centers in the intervention arm of the CDS-NVAF tool randomized clinical trial. A thematic content analysis was performed. Results: Thirty-three healthcare professionals participated in three focus groups. We identified three key themes: (1) barriers to tool adherence, encompassing problems related to understanding the CDS-NVAF tool, alert fatigue, and workload; (2) using the CDS-NVAF tool: differences in interpretations of Time in Therapeutic Range (TTR) assessments, and the value of TTR for assessing patient risk; (3) participants’ suggestions: improvements in workflow, technical aspects, and training in non-valvular atrial fibrillation management. Conclusions: Healthcare professionals endorsed a clinical decision-support system for managing oral anticoagulation in non-valvular atrial fibrillation patients in primary care. However, they emphasized the view that the CDS-NVAF requires technical changes related to its visualization and better integration in their workflow, as well as continuing training to reinforce their theoretical and practical knowledge for better TTR interpretation. Full article

Exposure to plant protection products (pesticides) is common among agricultural workers and may represent an underrecognized cause of mucocutaneous disease. We conducted a descriptive cross-sectional survey in agricultural communities in southern Thailand (August–November 2025) to estimate the prevalence, clinical characteristics, and dermatology-specific quality-of-life impact of pesticide-attributed symptoms. Agricultural workers with pesticide use or exposure within the preceding 12 months were recruited via convenience sampling; participants provided consent and completed standardized interviewer-administered questionnaires assessing demographics, pesticide exposure history and application practices, personal protective equipment (PPE) use, self-reported cutaneous and mucosal symptoms (ocular and oral/nasal), and the Dermatology Life Quality Index (DLQI). Of the 354 eligible individuals, 228 participated in the study, and 226 were included in the analyses. The median age was 54 years (interquartile range [IQR], 15), and 82.7% were male. Overall, 14.6% reported pesticide-attributed cutaneous symptoms, 5.3% reported ocular mucosal symptoms, and 0.4% reported oral/nasal mucosal symptoms. Cutaneous manifestations were predominantly symptoms occurring after exposure, with pruritic, erythematous eruptions affecting the arms and hands that typically resolved within 1–7 days after cessation of exposure. Among symptomatic participants, the median DLQI was 0.5 (IQR 3.0); however, DLQI scores were significantly higher among participants who reported pesticide-attributed cutaneous symptoms (p < 0.001) and ocular symptoms (p < 0.001). These findings suggest that pesticide-associated mucocutaneous effects are generally mild yet clinically meaningful, underscoring the need to strengthen PPE training, risk communication, and occupational health surveillance in agricultural settings. Full article

Growing evidence has revealed that gut dysbiosis is associated with the development of anxio-depressive disorders through mechanisms that involve neuroimmune signaling, neurotransmitter changes, and neuroplasticity in the brain. This study investigated the effects of gingerol-enriched ginger (GEG) on specifically anxiety-related neuroinflammation-, neuroimmunity-, neuroplasticity-, neurotransmission-, and neurotoxicity-associated genes in different brain regions, as well as on alterations linked to colonic microflora-driven dysbiosis, in the spinal nerve ligation (SNL) rat model of neuropathic pain (NP). Twenty-seven male rats were assigned to 3 groups: sham, SNL, and SNL-treated with GEG at 200 mg/kg body weight (SNL+200GEG) via oral gavage for 5 weeks. Anxiety-like behavior was assessed on the elevated plus maze (EPM). mRNA expression was assessed by qRT-PCR using respective primers. Correlation between behavioral parameters and colonic microbiome composition was analyzed using the Spearman rank correlation. The SNL+200GEG group demonstrated decreased anxiety-like behavior in the SNL model. Compared to the SNL group, the SNL+200GEG group had increased mRNA expression of NRF2 (amygdala: left), LXRα (amygdala: both sides), and CX3CR1 (amygdala: both sides, hippocampus: right). GEG modulated neuroplasticity as shown by increased gene expression of PGK1 (amygdala: right, hippocampus: both sides), MEK1 (frontal cortex: both sides), LDHA (frontal cortex: both sides), GPM6A (frontal cortex: both sides, amygdala: right, hippocampus: right, and hypothalamus), and GLUT1 (amygdala: right) as well by decreased gene expression of HIF1α (in all brain regions except for the hypothalamus). GEG modulated neurotransmission via clearance of excessive glutamate release as suggested by increased gene expression of SLC1A3 (frontal cortex: both sides, hippocampus: right) and via augmenting mGluR5 signaling as shown by increased gene expression of GRM5 (hippocampus: both sides, hypothalamus) as well as downregulation of KMO, HAAO, GRIN2B, and GRIN2C influencing downstream serotonergic neurotransmission and NMDA receptor-mediated glutamatergic pathways in different brain regions. GEG further alleviated neurotoxicity through downregulated gene expression of SIRT1, KMO, IDO1, and HAAO in different brain regions. Moreover, the increased relative abundance of Bilophila spp., accompanied by decreased time spent in the EPM open arms, suggests that increased Bilophila abundance increases anxiety-like behavior. GEG supplementation mitigated anxiety-like behavior in male rats with NP, at least in part, by reducing SNL-induced inflammatory sequelae-related mRNA gene expression in different brain regions. In addition, there is a positive correlation between the abundance of Bilophila wadsworthia and the degree of anxiety-like behavior. Full article

Background: The five-year survival rate of patients with ovarian cancer remains less than 50%, secondary to chemotherapy resistance. Purpose: This study aims to evaluate the effects of itraconazole as a supplementary treatment with paclitaxel and carboplatin on malignancy response and in preventing the initial development of chemoresistance in chemotherapy-naïve patients with advanced ovarian epithelial cancer. Method: This randomized placebo-controlled double-blind study involved 60 chemotherapy-naïve patients with advanced epithelial ovarian malignancy who were randomized into two arms; the placebo and itraconazole groups. The placebo group received six chemotherapy cycles and four inactive capsules, while the itraconazole group received six chemotherapy cycles and 400 mg oral itraconazole for five days per cycle. Results: Following completion of six chemotherapy cycles and when contrasted with the control arm, the itraconazole arm demonstrated statistically significant improvements in tumor response. The objective response rate was 80% in the itraconazole group compared with 47% in the placebo group (p = 0.015), while the disease control rate was 100% versus 80%, respectively (p = 0.023). The median progression-free survival (PFS), defined as the time point at which 50% of patients experienced disease progression or death, was 13.5 months for the overall study population. PFS was evaluated as a fixed-time endpoint at 18 months following completion of chemotherapy for the overall study population. Progression-free survival was significantly improved in the itraconazole group, with 70% of patients remaining progression-free compared with 26.7% in the placebo group (p = 0.001). Also, the itraconazole group produced significant declines in the serum levels of CA-125 (p = 0.005) and p-glycoprotein (p = 0.042) with significant elevation in VEGFR-2 (p = 0.006) as compared to the control group. Itraconazole was safe and its use was associated with a significant improvement in the quality of life (QOL). Conclusions: Itraconazole could represent a promising add-on therapy to enhance tumor response to chemotherapy in patients with ovarian cancer. Full article

This article examines the evolution of heraldic memory and genealogical consciousness within the Czerny family from the Middle Ages to the 20th century. Focusing on this single lineage makes it possible to trace, in a longue durée perspective, how heraldic narratives emerged, were transformed, and became embedded in family identity. The study employs a mixed methodology combining historical and genealogical analysis of municipal and noble registers, heraldic artefacts, epitaphs, and family archives with critical interpretation of early modern panegyrics and oral traditions. This approach enables reconstruction of both material and symbolic aspects of heraldic memory and its adaptation to changing political and social contexts. The findings reveal three major patterns. First, in the 15th and 16th centuries, the Czerny (Szwarc/Czarny) family consolidated its noble status by linking the Nowina coat of arms to heroic myths, especially after the death of Mikołaj Czerny at Pskov. Second, in the 17th century, Michał Czerny introduced the “Szwarcenberg” element to the surname, signifying aspirations to aristocratic prestige rather than actual heraldic adoption. Third, these narratives persisted in epitaphs, literary texts, and oral tradition into the modern period. The case illustrates how heraldic memory operated as a dynamic instrument of symbolic self-legitimation among the Polish nobility. Full article

Background: Teledentistry constitutes a key component of digital health, enabling remote oral healthcare delivery through information and communication technologies (ICT). The COVID-19 pandemic accelerated its global adoption; however, data regarding its implementation within Romanian dental practice remain limited. Understanding usage patterns, perceived benefits, and implementation barriers is essential for effective integration. Objectives: This study examined the adoption of teledentistry among dental practitioners in Sibiu County, Romania, identified its main applications, assessed professional perceptions, and explored barriers and their interrelations using association rule mining (ARM). Methods: A cross-sectional online survey was distributed in 2025 to all 630 registered dentists in Sibiu County. The questionnaire collected demographic data, usage patterns, perceived benefits, and barriers. A total of 197 valid responses were obtained (response rate: 31.2%). Descriptive statistics, Chi-square tests, and ARM were used to identify associations between usage contexts and recorded obstacles. Results: Overall, 44.6% of respondents reported using teledentistry tools, primarily for interdisciplinary consultations (29.4%), postoperative counseling (26.4%), and treatment monitoring (25.3%). The most frequently cited barriers were the inability to perform direct clinical examinations (71.5%), practitioner reluctance (37.1%), insufficient infrastructure (29.9%), and the lack of a clear legislative framework (27.4%). ARM revealed frequent co-occurrence patterns among these barriers. Practitioners with prior experience in teledentistry reported significantly higher perceived utility (58% vs. 22.1%) and greater interest in training (58% vs. 38.5%, p < 0.05). Conclusions: Teledentistry shows moderate but increasing adoption among Romanian dentists. Addressing current barriers, through legislative clarification, infrastructure development, targeted professional training, and public education, is essential for achieving sustainable integration into modern dental practice. Full article

Background/Objectives: A fermented lingonberry juice spray (FLJ spray) was developed from lingonberry (Vaccinium vitis idaea L.) juice as a natural adjunct for oral health. It has a low sugar content and contains naturally occurring phenolic compounds to decrease oral microbial burden, inflammation, and dry mouth symptoms. This human intervention single-arm pilot study examined the oral effects of fermented lingonberry spray (FLJ spray) treatment, used for a period of 30 days. Methods: Eleven adult patients were recruited from a private dental clinic in Tampere, Finland. Traditional clinical oral examinations, periodontal status, and samples were collected at baseline, two weeks, and four weeks. Bleeding on probing (BOP), visible plaque index (VPI), and probing pocket depths (PPD) were examined, and active-matrix metalloproteinase-8 (aMMP-8) mouthrinse assays (cut off 20 ng/mL) were conducted. Additionally, stimulated and resting saliva, pH, and buffering capacity were assessed. A questionnaire assessing dry mouth symptoms was also recorded. Results: The effect of FLJ spray on clinical variables during the study period was analyzed by repeated measures ANOVA. Use of the Lingora^® spray reduced the assessed periodontal indices BOP (p < 0.05), VPI (p < 0.001), PPD ≥ 6 mm (p = 0.136), and aMMP-8 (p = 0.084). No adverse or contrary effects on the parameters were observed during the study. Conclusions: The use of FLJ spray improved periodontal status and reduced plaque burden and signs of inflammation, such as BOP and collagenolytic aMMP-8 levels. This pilot study suggests that FLJ spray is safe and appeared to be beneficial for use in addition to oral home care. Full article

Introduction/Objective: Dental extractions are among the most common oral surgical procedures worldwide, with postoperative pain representing a significant clinical concern. Cannabidiol (CBD), a non-intoxicating phytocannabinoid with analgesic and anti-inflammatory properties, has recently gained attention as a potential adjunct for managing acute dental pain. To explore its clinical utility to generate preliminary feasibility, we conducted the Simple Tooth Extraction with Analgesic Phytocannabinoid (SWAP) pilot trial to evaluate the preliminary efficacy and safety of oral CBD at two concentrations (17 mg/mL and 37 mg/mL) compared with placebo and standard ibuprofen/acetaminophen therapy following simple extractions. Materials and Methods: Eight adults were randomized equally to four arms (n = 2 per arm) CBD 17 mg/mL, CBD 37 mg/mL, placebo, or treatment-as-usual (TAU; ibuprofen/acetaminophen). CBD/placebo groups received 0.5 mL every 4–6 h as needed for 7 days, while TAU followed the non-opioid regimen. The primary endpoint was pain intensity (0–10 Numeric Rating Scale) captured via ecological momentary assessment (EMA) over 72 h. Secondary endpoints included worst pain, rescue medication use, adherence, tolerability, and qualitative feedback. Results: All participants completed follow-up with >75% EMA adherence. Because of the very small sample (n = 8), results are descriptive only. Baseline imbalance was observed; the CBD 17 mg/mL group reported substantially lower pre-extraction pain than other groups, limiting interpretability. Pain trajectories diverged by group: CBD 37 mg/mL showed the lowest ratings, paralleling TAU; CBD 17 mg/mL and placebo showed limited efficacy. Conclusions: This pilot suggests that higher-concentration CBD (37 mg/mL) may provide analgesia comparable to standard non-opioid therapy. Within this small feasibility cohort, higher-concentration CBD (37 mg/mL) appeared to produce pain patterns qualitatively similar to standard non-opioid therapy. Findings should be interpreted as exploratory only. A fully powered randomized trial incorporating biomarker endpoints and a taste-matched placebo is warranted. Full article

Background/Objectives: Protein-energy wasting (PEW) affects up to 75% of hemodialysis (HD) patients, yet adherence to oral nutritional supplements (ONSs) remains poorly understood. This study evaluated ONS adherence patterns, associated socio-demographic and psychological factors, and clinical outcomes over 24 months in chronic HD patients. Methods: A 24-month prospective study was conducted in 101 HD patients. Adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), and depressive symptoms with the Beck Depression Inventory (BDI). Nutritional status was evaluated using the Malnutrition–Inflammation Score (MIS) and anthropometric measurements. Laboratory markers were obtained. Individualized nutritional education was provided at each visit. Results: Regular ONS use was reported in 50.5% of patients. High adherence (MMAS-4 = 0) was observed in 36.6% of the cohort. Forgetfulness (45.3%) and adverse effects (34.4%) were the most common obstacles. Adherence was significantly associated with sex (p = 0.007), with men more frequently demonstrating low adherence. Education level showed a weak, but significant positive correlation with MMAS-4 score (Spearman’s ρ = 0.25, p = 0.018), indicating slightly lower adherence among more educated patients. MMAS-4 and BDI scores were positively correlated (Spearman’s ρ = 0.25, p = 0.04), indicating that greater depressive symptom burden was associated with lower adherence. Regular ONS users demonstrated improved nutritional status (lower MIS; 9 vs. 7, p < 0.001), higher hemoglobin (106 vs. 114 g/L, p = 0.03), and increased mid-upper arm circumference (MUAC; 26 vs. 28 cm, p = 0.02). Lean tissue mass was preserved over time (p = 0.009). However, individualized education had limited effect on patients with initially low adherence. Individualized nutritional education was associated with improved acceptance and implementation of recommendations. Over two years of follow-up, nutritional education was associated with preserved lean and fat tissue index (LTI, p = 0.009; FTI, p = 0.08), reductions in interdialytic weight gain, and significant improvements in MUAC, waist circumference, and scapular skinfold thickness (p = 0.03; p < 0.001; p = 0.02). Prealbumin and hemoglobin levels also increased significantly (p = 0.02; p = 0.04). However, education alone was insufficient for certain subgroups, particularly older patients and those initially classified as non-adherent. During follow-up, 17 patients died. Lower MUAC (OR = 2.97, 95% CI: 1.45–6.08) and triceps skinfold thickness (OR = 1.37, 95% CI: 1.12–1.68) were the strongest independent predictors of mortality. Conclusions: Adherence to ONSs remains suboptimal in HD patients. Individualized nutritional education was associated with improved adherence and nutritional status in some subgroups but may be insufficient in older or initially non-adherent patients. Simple anthropometric markers are strong mortality predictors and may offer practical value for routine monitoring. Full article

In this randomized clinical trial, we compared the effects of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and topical clobetasol on the salivary antioxidant profile in patients with oral lichen planus (OLP) and explored their relationships with clinical outcomes. Ninety adults with OLP were randomly allocated to ALA-PDT (five weekly sessions) or clobetasol (twice daily for 14 days). Unstimulated whole saliva was collected at baseline (T0), immediately after treatment (T1), and at 3 (T3) and 6 months (T6). The activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (Px) and reduced glutathione (GSH) were determined, and nonparametric statistics were applied, including Friedman tests with Dunn’s post hoc comparisons and Spearman’s rank correlations. Both therapies induced an early decline in CAT, Px and GSH at T1, followed by partial recovery at later time points. SOD activity changed significantly over time in the clobetasol group, but not in the PDT arm. At T6, Px and GSH remained below baseline in both groups despite improvement from the immediate post-treatment nadir. No significant between-group differences were observed at individual time points, although GSH at T6 showed a non-significant trend favoring PDT. Exploratory analyses revealed modest, treatment-dependent associations between salivary antioxidant activity and lesion size, as well as between the former and pain intensity. Overall, ALA-PDT and topical clobetasol both modulated the salivary redox profile, primarily through short-term depletion of enzymatic and non-enzymatic antioxidants with incomplete recovery over 6 months, and no clear redox superiority of one modality over the other was demonstrated. These findings are hypothesis-generating and underscore the need for larger, longer-term studies with broader redox panels and more advanced between-group analyses. Full article

Introduction: Pediatric lower-lip dog bite injuries are challenging due to contamination, tissue loss, and the need to maintain function, appearance, and psychological well-being. This single case describes immediate definitive closure using sharp debridement with adjunct polyhexanide (PHMB), a full-thickness skin graft (FTSG), and a polyurethane (PU) compression foam bolster. Methods: A 10-year-old boy with a severe contaminated lower-lip defect underwent debridement and 0.04% PHMB irrigation. An upper-arm FTSG was inset and compressed with a suture-anchored PU dressing. Topical PHMB gel was used perioperatively and for seven days after bolster removal. Oral antibiotics were given for five days. The patient was discharged eight days after the injury with detailed wound care instructions. Results: Immediate definitive closure was achieved with complete graft survival and no infection, necrosis, unplanned early dressing changes, or reoperations. At 12 months, oral competence, speech, lip mobility, and contour were preserved. However, mild residual esthetic differences remained (dyschromia, shallow border indentation, vellus hairs on the graft). Conclusion: In this single descriptive case, primary closure of a lower-lip injury with the combined intervention was associated with an uncomplicated functional course and manageable esthetic trade-offs at 12 months. These observations are descriptive; comparative studies with standardized functional, esthetic, and psychosocial measures are needed. Full article

Background/Objectives: Exogenous ketone supplements elevate circulating ketones without carbohydrate restriction, but their long-term hepatic safety remains unclear. This study evaluated the formulation-dependent impact of chronic ketone supplementation on liver histopathology, inflammatory signaling, and systemic biomarkers in rats. Methods: Male Sprague-Dawley rats were orally administered 1,3-butanediol (BD), medium-chain triglycerides (MCTs), ketone ester (KE), ketone electrolytes/salts (KSs), or a ketone salt–MCT combination (KSMCT) for 4 weeks. In a separate arm, animals received standard diet (SD), or SD supplemented with low-dose KE (LKE) or high-dose KE (HKE), for 83 days. Liver structure was assessed by hematoxylin and eosin staining with quantification of red blood cell density and lipid accumulation. Inflammatory and metabolic responses were evaluated by TNF-α and arginase immunohistochemistry. Serum biochemistry included glucose, proteins, electrolytes, and liver and kidney function markers. Results: BD and KE induced macrovesicular steatosis, vascular congestion, and elevated TNF-α and arginase expression, consistent with hepatic stress. MCT caused moderate hepatocellular ballooning and lipid deposition, whereas KS preserved near-normal hepatic morphology. KSMCT produced intermediate effects, reducing lipid accumulation and TNF-α compared with MCT or KE alone. KE supplementation caused dose-dependent reductions in globulin and elevations in creatinine, while HKE reduced sodium and glucose levels. Conclusions: Chronic hepatic responses to exogenous ketones are highly formulation dependent. KS demonstrated the most favorable safety profile under the tested conditions, maintaining normal hepatic structure, while BD and KE elicited adverse changes. Formulation choice is critical for the safe long-term use of exogenous ketones. Full article

Background: Left ventricular thrombus (LVT) remains a well-recognized complication following myocardial infarction (MI). Whilst vitamin K antagonists (VKAs) have traditionally been the cornerstone of management, direct oral anticoagulants (DOACs) have been increasingly utilized despite limited data to support this. We sought to perform an up-to-date meta-analysis of all randomized controlled trials (RCTs) comparing DOACs to VKAs for LVT resolution. Methods: A systematic search of major scientific databases was performed to identify RCTs published until May 2025. The primary efficacy endpoint was complete LVT resolution at 3 months. The risk ratio (RR) and 95% confidence intervals (CIs) of the individual RCTs were pooled via the inverse-variance method and random-effects model. Results: Seven RCTs involving 554 patients with a mean age of 54 years were included in the meta-analysis. At 3 months, there was no difference in the rate of LVT resolution between those in the DOAC arm and the warfarin arm (86% vs. 81%, RR 1.01 [95%CI 0.93–1.10], p = 0.76). There was low heterogeneity at I² = 15%. There was no difference in major or clinically significant bleeding or in the composite of stroke or thromboembolic complications, although the 95%CIs were wide. Conclusions: DOACs appear to be comparable to warfarin in achieving LVT resolution at 3 months. These findings support the consideration of DOACs as alternatives to VKAs in selected patients for LVT resolution. Further adequately powered trials and head-to-head comparisons between DOACs are required to confirm their safety. Full article

Anxiety disorders are closely associated with oxidative stress-mediated neuronal damage, mitochondrial dysfunction, and apoptosis. In this study, we investigated the neuroprotective effects of Lactiplantibacillus plantarum HY7715 in a mouse model of restraint stress-induced anxiety, and in neuronal cell models (HT-22 mouse hippocampal neuroblast cell and SH-SY5Y human neuroblastoma cells). Oral administration of HY7715 (1 × 10⁹ CFU/kg/day) alleviated anxiety-like behaviors significantly, as shown by increased central exploration in the open field test and prolonged open-arm activity in the elevated plus maze. HY7715 reduced serum norepinephrine levels elevated by stress, and restored hippocampal expression of brain-derived neurotrophic factor, while suppressing pro-inflammatory (NF-κB, IL-6) and pro-apoptotic (BAX, caspase-3) markers. It also increased expression of mitochondrial regulatory genes (SIRT1, mTOR), and decreased that of cytochrome c, in brain tissue. Histological analysis revealed that HY7715 preserved neuronal integrity in the CA1 and CA3 hippocampal regions. In vitro, HY7715 attenuated oxidative stress-induced cytotoxicity, decreased intracellular ROS accumulation, maintained mitochondrial activity, and inhibited apoptosis of both neuronal cell types, showing greater efficacy than the strain type L. plantarum KCTC3108. These findings suggest that HY7715 exerts neuroprotective effects by modulating oxidative stress/apoptosis/mitochondrial pathways, and highlight its potential as a psychobiotic for stress-related neuropsychiatric disorders. Full article

Background: Nicotinamide mononucleotide (NMN) has gained attention as an anti-aging compound due to its ability to replenish NAD⁺ levels, which typically decline with age and stress. While improvements in skin conditions have been reported, clinical studies on human hair remain lacking. In this study, we evaluated the effects of NMN supplementation on hair conditions in middle-aged women and explored its association with quality-of-life (QOL) factors such as fatigue. Methods: Torula yeast-fermented NMN was evaluated in this clinical trial. A single-arm, pre-post intervention study was conducted involving 15 healthy Japanese women aged between 40 and 50 years who orally consumed NMN for 12 weeks. Hair growth cycles and hair shaft diameters were assessed using TrichoScan (TrichoGrabV3B) analysis and scanning electron microscopy (SEM). Hair metabolites and hormone levels were also measured. Subjective indices, including fatigue and hair texture, were evaluated using a visual analog scale (VAS) questionnaire. Results: Following NMN supplementation, anagen hair elongation density (hairs/cm²) significantly increased from 55.9 to 87.7 (p = 0.03). Hair diameter (µm) also significantly increased from 75.3 to 78.8 (p < 0.01), with improvements in hair cuticle condition. Metabolomic analyses revealed significant changes in amino acids and energy metabolism-related compounds. No marked changes were observed in hair hormone concentrations. The VAS questionnaire indicated improvements in subjective hair characteristics such as elasticity, gloss, and volume, as well as reductions in fatigue and perceived hair loss, suggesting enhanced QOL. Conclusions: Oral supplementation with NMN may be a beneficial strategy for promoting hair growth and improvement in hair cuticle condition in middle-aged women, thus potentially enhancing overall hair care and quality of life. Full article