Search Results (11,158)

Background: Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway represent an effective preventive treatment for chronic migraine, including in patients with multiple prior therapeutic failures. However, a substantial proportion of patients exhibit a suboptimal or delayed response. The role of personality traits in modulating treatment response remains poorly understood. Methods: In this prospective observational study, adults with chronic migraine received anti-CGRP monoclonal antibodies and were followed for 12 months. Monthly headache days (MHDs), monthly acute medication use (MAM), and disability scores (MIDAS and HIT-6) were recorded at baseline and at 3, 6, and 12 months. Responders were defined as patients achieving a ≥50% reduction in monthly headache days (MHDs) compared with baseline. Changes in disability measures were evaluated as secondary clinical outcomes. Personality traits were assessed using the Millon Clinical Multiaxial Inventory-III. Results: Thirty-eight patients were included, of whom 71% had medication overuse headaches. Responder rates increased over time (31.6% at 3 months and 39.5% at 12 months). Histrionic traits (37.5% vs. 6.7%, p = 0.048) and dysthymic features (21.4% vs. 0%, p = 0.046) were significantly more prevalent among non-responders. Conclusions: Histrionic and dysthymic personality features were associated with a lower likelihood of response to anti-CGRP therapy in patients with chronic migraine. Given the exploratory design, limited sample size, and absence of correction for multiple comparisons, these findings should be considered preliminary and hypothesis-generating. Further studies in larger cohorts are needed to confirm these observations. Full article

This exploratory research investigates the perceived educational potential of visual, spatial, and auditory immersions as integral components of innovative healthcare simulation technologies. The study examines user experiences in learning health assessment concepts through purposefully designed 360° immersive virtual reality video (360° IVRV). Utilizing a case-study approach, insights were gathered from four subject-matter experts and four doctoral students regarding the perceived effectiveness of 360° IVRV for instructional activities focused on patient health assessment, commonly known as the Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors, Related symptoms, Treatment, and Severity method (OLD CARTS). The research aimed to enhance the accessibility of learning materials by optimizing 360° IVRV content for personal phones and mobile devices, accommodating both online and traditional instructional formats. Interviews were transcribed and analyzed using qualitative data analysis software, with results categorized into subthemes, themes, and perspectives. The findings highlight the distinct perceived advantages of immersive technologies in advancing teaching methods for nursing practitioners. The discussion addresses concerns related to integrating 360° IVRV simulation technology in nursing education and the limitations of current instructional interventions. Practical implications for future research, design, and development of immersive learning materials and their integration with instructional design elements are emphasized. Full article

Penile squamous cell carcinoma (PSCC) is a rare malignancy with limited therapeutic options in advanced and recurrent diseases. Advanced PSCC is typically managed with multimodal therapy, including neoadjuvant chemotherapy or chemoradiation followed by surgery; however, durable responses remain uncommon, and outcomes after recurrence are poor. Cancer vaccines represent a promising immunotherapeutic strategy, as these treatments induce tumor-specific immunity and heightened immune surveillance against penile cancer cells. While therapeutic cancer vaccines have not yet demonstrated consistent clinical efficacy as monotherapy in PSCC, their integration with complementary immune-modulating approaches, particularly immune checkpoint blockade, represents a rational strategy to enhance antitumor immunity. This review summarizes the rationale for vaccine development in PSCC, with emphasis on HPV-derived antigens, neoantigens, and emerging tumor-associated targets. We examine major vaccine platforms, including viral-vector, peptide-based, nucleic acid, and dendritic cell-based approaches. We also discuss how spatial transcriptomics, single-cell RNA sequencing, artificial intelligence-assisted antigen prediction, and nanotechnology-enhanced delivery systems may support future personalized vaccine development. Overall, therapeutic vaccines remain investigational in PSCC but may become relevant within biomarker-driven, combination-based immunotherapy strategies. Full article

The evaluation of stents in coronary computed tomography angiography (CCTA) is still a major topic in cardiovascular imaging. Using Photon-Counting Detector CT (PCCT) may improve the assessment of coronary stents and make on-site CT-FFR analysis feasible for ruling out in-stent restenosis (ISR). In this study, patients with previous coronary stent implantation who underwent CCTA using PCCT and subsequent invasive catheter angiography (ICA) were included. Stent characteristics such as location and length were reported. CT-FFR measurements were taken 1.8 cm before and after the stent, with a value of ≤0.80 defined as hemodynamically significant under respecting the diagnostic accuracy drop in the gray zone between 0.76 and 0.80. Delta CT-FFR with a cut-off value of ≥0.06, indicating hemodynamic significance, was determined. Any ISR and interventional treatment during the following ICA was recorded. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for post-stent CT-FFR and Delta CT-FFR in detecting ISR. Patients were followed up to evaluate the rate of major adverse cardiovascular events (MACE) 6 months after CCTA. A total of 19 patients (5 female, 14 male, median age 69 years) were enrolled in this study. In most cases, coronary stents were located in the proximal LAD with a median stent length of 70.2 mm. Pathological CT-FFR < 0.76 distal to the stent was detected in 6 cases (31.6%), while pathological Delta CT-FFR ≥ 0.06 occurred in 14 cases (73.7%). ICA was performed in three of these patients, with ISR confirmed in two cases. These findings yield sensitivity and NPV of 100% for both post-stent CT-FFR and Delta CT-FFR for excluding ISR with a superior specificity (76.5% vs. 29.4%) and overall diagnostic accuracy (78.9% vs. 36.8%) for post-stent CT-FFR. Two patients reported a myocardial infarction in follow-up; however, neither of them was located in the territory of the stented coronary artery. This study outlines the feasibility of on-site CT-FFR analysis using PCCT in excluding ISR in coronary stents with a high diagnostic accuracy. These findings highlight the need to extend the benefits of CT-FFR analysis for non-invasive assessment of possible ISR regarding personalized risk stratification and therapy planning. Full article

Background/Objectives: The aim of this study was to show a standardized four-step technique that can offer individually personalized full-mouth therapy for each complex dental patient with erosive tooth wear resulting from bulimia nervosa, focusing on the individualized vertical dimension of occlusion (VDO), functional and aesthetic stability, and patient-reported outcomes, including dental symptoms, nutrition, self-perception, and quality of life. Methods: The following steps are proposed for structured full-mouth rehabilitation. Step 1: Intraoral diagnosis via a single computer-aided impression. Step 2: Determination of a new adequate vertical dimension of occlusion and soft tissue prediction. Step 3: Removable sample dentures—prototypes. Step 4: Non-prep/minimal-prep crowns as the long-term provisional/definitive treatment. Results: Nine adults (11% male) with dental erosion caused by bulimia nervosa (78%), gastro-esophageal reflux (11%), and soft drinks (11%) were part of this cohort. The novel digital workflow enabled restoration of an individualized vertical dimension of occlusion, stable occlusion, appropriate centric and eccentric contacts, biomimetic dental anatomy, harmonious tooth proportions, and optimized red–white aesthetics. Dental problems (hypersensitivity, dental pain), nutritional behavior, body perception, and quality of life improved after the full-mouth rehabilitation. Conclusions: The presented digital workflow offers a promising approach for full-mouth rehabilitation in patients with severe dental erosion, particularly associated with bulimia nervosa, enabling structured restoration planning and stepwise evaluation of the vertical dimension of occlusion and functional adaptation. Prospective studies with larger cohorts are needed to confirm long-term clinical outcomes and patient-reported benefits. Full article

Atrial fibrillation (AF) and heart failure (HF) frequently coexist and mutually worsen prognosis, creating a complex clinical scenario in which treatment decisions are increasingly imaging driven. Catheter ablation has emerged as a pivotal rhythm control strategy in selected patients with HF, but careful phenotyping of the atrial and ventricular substrate is essential to balance potential benefits against procedural risk and the likelihood of durable sinus rhythm. In this narrative review, we summarize the role of multimodality imaging across the entire AF care pathway in patients with HF, from candidate selection to intraprocedural guidance and post-ablation follow-up. Ultrasound imaging remains the cornerstone of pre-procedural assessment. Cardiac computed tomography (CCT) refines anatomical characterization of the left atrium, pulmonary veins, and left atrial appendage. Cardiovascular magnetic resonance (CMR) offers comprehensive tissue characterization of atrial and ventricular fibrosis, allowing distinction between atrial primary and atrial secondary AF phenotypes and informing expectations of reverse remodelling. During ablation, intracardiac echocardiography and transesophageal echocardiography optimize transseptal access, catheter navigation, and complication monitoring, and they are particularly relevant with contemporary Pulsed Field Ablation systems. In follow-up, echocardiography, CCT, and CMR are pivotal for quantifying structural reverse remodelling and detecting rare but life-threatening complications such as atrio esophageal fistula and pulmonary vein stenosis. An integrated, multimodality, substrate-based imaging strategy is therefore crucial to personalize rhythm versus rate control decisions and to guide safe, effective ablation in patients with AF and HF. Full article

Background: Telemedicine complements traditional healthcare delivery and may improve access, continuity of care, and patient engagement, particularly in chronic conditions requiring regular follow-up. Video consultation is a widely adopted telemedicine modality and is increasingly integrated into hybrid care models. Methods: This real-world implementation project describes scheduled video consultations embedded in a hybrid care model for children and adolescents with type 1 diabetes using continuous glucose monitoring (CGM) and integrated insulin delivery technologies as part of routine clinical care. A total of 38 families were offered video consultations as part of routine care; 18 adopted the hybrid model. Video consultations were used for routine follow-up, shared review of device data, treatment adjustment, and diabetes education. Family experience was assessed using a voluntary 5-point Likert-scale satisfaction questionnaire. Complete longitudinal CGM data were available for 13 participants, all of whom were established users of the same automated insulin delivery (AID) platform (MiniMed™ 780G (Medtronic MiniMed, Inc. Minneapolis, MN, USA) integrated with Guardian™ 4 (Medtronic MiniMed, Inc. Minneapolis, MN, USA) continuous glucose monitoring). Results: Between 2022 and 2024, 162 video consultations were conducted. Acceptability was high, with 95% (17/18) of respondents reporting high satisfaction (score ≥ 4 on the 5-point Likert scale). 89% (16/18) of families perceived the quality of care as comparable to face-to-face visits for routine follow-up. Families highlighted convenience, reduced travel burden, and flexibility, as well as the value of shared review of CGM and AID system data. Group-level CGM-derived metrics appeared descriptively similar across sequential face-to-face visits and video consultations. Individual patient trajectories showed expected variability but no consistent pattern of deterioration during periods of remote follow-up. Conclusions: Video consultation is a feasible and well-accepted complementary modality within hybrid care models for pediatric type 1 diabetes. When integrated with CGM and automated insulin delivery systems, it supports personalized, data-driven clinical decision-making and continuity of care. Structured implementation and systematic evaluation are essential for sustainable integration into routine practice. Full article

Glioblastoma multiforme (GBM), isocitrate dehydrogenase (IDH)-wildtype, is the most aggressive primary malignant tumor of the central nervous system, characterized by poor prognosis and high recurrence rates despite standard multimodal treatment. This study investigates the molecular response of glioblastoma cells to 5-aminolevulinic acid (5-ALA)-based photodynamic therapy (PDT), focusing on gene expression changes associated with apoptosis, ferroptosis, and oxidative stress. Human glioblastoma T98G cells were treated with 5-ALA followed by light irradiation, and gene expression was analyzed using RT-qPCR. PDT induced moderate upregulation of pro-apoptotic genes (BAX, CASP3, FAS) alongside increased expression of the anti-apoptotic gene BCL2, indicating simultaneous activation of cell death and survival pathways. Ferroptosis-related genes showed mixed responses, with slight upregulation of ACSL4 and downregulation of GPX4, suggesting increased susceptibility to lipid peroxidation. The most significant change was observed in GCH1 expression, reflecting activation of oxidative stress response mechanisms. However, none of the observed changes reached statistical significance, likely due to the limited sample size. These findings demonstrate that PDT induces a complex and dual biological response in glioblastoma cells, involving both cytotoxic and adaptive mechanisms. This may limit therapeutic efficacy and contribute to treatment resistance. The results support the rationale for combining PDT with targeted molecular therapies aimed at inhibiting antioxidant defenses and anti-apoptotic pathways. Additionally, personalized therapeutic strategies based on tumor molecular profiles may enhance treatment outcomes. Further studies with larger sample sizes and functional validation are required to confirm these preliminary observations. Full article

Nanotechnology has become an important platform in the fields of gene therapy and genome editing, providing delivery strategies that address persistent therapeutic challenges by improving the precision, efficiency, and safety of genetic modifications. This review highlights the central role of nanomaterials in overcoming persistent barriers to genetic interventions, including inefficient delivery, instability of genetic cargo, and off-target effects. Specifically, we emphasize the combined use of nanomaterials with clustered regularly interspaced short palindromic repeats and CRISPR-associated proteins (CRISPR-Cas) systems, which can improve editing specificity and therapeutic efficacy. Beyond the classical CRISPR/Cas9 platform, this review also discusses next-generation modalities such as base editors, Cas13, prime editing, and the recently described Tandem Interspaced Guide RNA and TIGR-associated protein (TIGR-Tas) system, while considering their therapeutic potential and distinct delivery challenges. By using nanomaterials, the stability and intracellular delivery of genome-editing systems are improved, enabling more effective treatments for genetic disorders and acquired diseases such as cancer and infectious diseases. In addition, nanocarriers provide controlled release, protection from degradation, and better biocompatibility, thereby improving the safety and reliability of gene-editing therapies. Despite these advances, important translational challenges remain, including immunotoxicity, large-scale manufacturing, and regulatory integration. Overall, the continued convergence of nanotechnology and genome engineering may support the development of personalized medicine strategies that adapt genetic engineering tools for patient-specific applications. Full article

Background/Objectives: Gastrointestinal (GI) symptoms, including abdominal pain, bloating, altered stool pattern, dyschezia, and nausea, are frequent in women with endometriosis and may persist despite conventional gynecological treatment. The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP) diet is an established dietary intervention for irritable bowel syndrome. Its endometriosis-specific evidence base remains limited. This systematic review evaluated clinical evidence on the low-FODMAP diet or structured FODMAP restriction for GI symptoms in women with endometriosis. Methods: This systematic review was prospectively registered in PROSPERO (CRD420261388786) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed/MEDLINE, EBSCOhost, and BASE were searched from inception to 30 April 2026. Eligible reports were clinical studies investigating low-FODMAP diet or structured FODMAP restriction in women with confirmed, clinically diagnosed, imaging-based, or medically reported endometriosis and extractable GI or related clinical outcomes. Risk of bias was assessed with design-specific tools. Due to substantial heterogeneity across studies in design, comparators, and outcome measures, a narrative synthesis was performed. Results: Five clinical reports met the inclusion criteria: one randomized controlled crossover feeding trial, two prospective non-randomized studies, one retrospective audit of prospectively collected clinic data, and one case report. The randomized trial showed greater GI response during a 28-day low-FODMAP feeding period than during a nutritionally matched control diet. Prospective studies reported improvements in selected GI symptoms, constipation, pain, and quality-of-life domains, but interpretation was limited by non-randomized allocation, attrition, and mixed or pooled diet comparisons. The retrospective audit and case report supported clinical plausibility but were hypothesis-generating. Conclusions: The five available studies, though limited in number and design, indicate that a low-FODMAP diet can reduce GI symptoms in women with endometriosis, particularly those with abdominal pain, bloating, constipation, or IBS-like symptoms. Currently, the low-FODMAP diet should be viewed as a potentially useful, dietitian-guided GI symptom intervention for selected patients. Future trials should define responder profiles, assess long-term tolerability and nutritional safety, and determine the added value of reintroduction and personalization beyond short-term restriction. Full article

Background/Objectives: While traditional transcriptomics and single-cell RNA sequencing can reveal differences in cell type and gene expression, they cannot provide spatial information within tissues. Spatial transcriptomics (ST), as an emerging technology in recent years, has achieved significant progress in resolving gene expression along the spatial dimension. This technology quantifies gene expression at defined spatial coordinates and describes the spatial distribution of transcripts and the co-localization patterns between cells within intact tissue, allowing for an integrated analysis of molecular and spatial information. This review aims to systematically trace the development of ST and highlight its application value in breast cancer research. Methods: We systematically reviewed the recent literature on ST platforms, on combined analyses of single-cell RNA sequencing (scRNA-seq) and ST, and on integrated spatial multi-omics in breast cancer. Key topics include tumor microenvironment organization, intra-tumor heterogeneity, the spatial distribution of immune cells, cancer-associated fibroblast function, treatment-response prediction, and personalized-treatment strategy development. Results: ST can characterize the spatial organization of interactions between breast cancer cells and the tumor microenvironment, describe the spatial dimensions of tumor heterogeneity, and provide multi-dimensional information that may support refined subtype classification and prognostic assessment. Existing studies indicate that ST shows significant potential to inform personalized treatment strategies, but the technology also faces bottlenecks in data integration, spatial resolution, standardization, and the need for functional validation. Conclusions: ST provides an important tool for an in-depth description of the complex spatial organization within breast cancer tumors. When integrated with functional perturbation, longitudinal cohorts, and orthogonal omics, it has the potential to ultimately improve clinical outcomes for breast cancer patients. Full article

Background: Epilepsy is a complex neurological disorder in which growing evidence supports a significant role for the microbiota–gut–brain axis (MGBA) in modulating neuroinflammation, neuronal excitability, and treatment responsiveness. Beyond their traditional role in inducing ketosis, dietary therapies may influence epilepsy by modulating gut microbial ecology, intestinal barrier integrity, immune signaling, and microbiota-derived metabolites. Methods: This narrative review critically examines current clinical and experimental evidence regarding the relationship between epilepsy, gut microbiota, and dietary interventions. Particular attention was given to ketogenic dietary therapies, the Modified Atkins Diet (MAD), low-glycemic-index treatment (LGIT), Mediterranean dietary patterns, restrictive diets, and microbiota-targeted supplementation, including probiotics, prebiotics, and postbiotics. Results: Available evidence suggests that patients with epilepsy exhibit alterations in gut microbial composition associated with impaired short-chain fatty acid production, intestinal inflammation, and altered neuroimmune regulation. Ketogenic and microbiota-supportive dietary approaches may modulate these pathways beyond ketosis alone, potentially contributing to seizure reduction through integrated metabolic, inflammatory, and microbial mechanisms. Emerging evidence also supports a role for probiotics, prebiotics, and postbiotics in modulating gut–brain communication and neuroinflammatory signaling, although current clinical data remain limited. Conclusions: Dietary therapies in epilepsy should no longer be viewed exclusively as metabolic interventions aimed at inducing ketosis, but rather as potential modulators of the microbiota–gut–brain axis and neuroimmune homeostasis. While further mechanistic and clinical studies are needed, microbiota-targeted nutritional approaches may represent valuable complementary strategies to be integrated alongside conventional antiseizure therapies within more personalized models of epilepsy management. Full article

The new therapeutic options now available for patients with hepatocellular carcinoma (HCC) have made their assessment more complex, especially due to the different stages of liver cirrhosis typically associated with this tumor. The management of the disease therefore requires an interdisciplinary approach aimed at identifying the most appropriate treatment based on the risk–benefit profile and residual liver function, as well as in relation to the patient’s age and potential for a full or partial recovery, risk of complications, and cancer recurrence. Another factor to be carefully considered in patients with hepatocellular carcinoma is the frequent comorbidities and the associated socio-health variables (substance abuse, addictions, unfavorable economic or family circumstances), which can impact patient management or the possibilities for long-term monitoring, thus influencing the choice of the most appropriate therapeutic pathway. The healthcare services offered in the Province of Salerno (Campania Region, Southern Italy) to ensure all possible diagnostic and therapeutic options for these patients can be difficult to access due to the territorial extension of the Local Health Authority, characterized by clinics and hospitals located in distant locations, as well as the potential fragmentation of expertise between the University Hospital and ambulatorial facilities or small hospitals. An interdisciplinary consensus conference on the management of patients with HCC has been set with the aim of involving clinicians and surgeons working in healthcare facilities located in Salerno and its Province for the optimal care and effective management of these patients, taking into account all the clinical characteristics of the disease and individual health needs or expectations, from the perspective of personalized medicine. Full article

Background: Driven by Vision 2030, Saudi Arabia is rapidly integrating Artificial Intelligence into its healthcare ecosystem. This study investigates the patterns, predictors, and sociodemographic determinants of AI reliance and dependence in healthcare decision making, focusing on how trust influences the shift toward personalized digital diagnosis. Methods: A cross-sectional study was conducted with 627 adults in Saudi Arabia using convenience sampling. Data collected via online questionnaires were analyzed using JMP student edition version 18 software to evaluate user interaction with symptom checkers, wearables, and generative AI. A multidimensional framework assessed how trust and dependence influence health-seeking behaviors. Results: The findings reveal high AI engagement, with 63.7% of respondents using AI tools weekly. Conversational AI and LLMs are the dominant interfaces (92.2%), primarily serving as “gatekeepers” for personalized diagnosis (71.6%) and treatment suggestions (76.9%) before formal consultations. While gender significantly impacts reliance (p = 0.0037), trust was identified as the only significant predictor of overall engagement (p < 0.0001). Notably, age, education, and income had no statistical impact (p > 0.05), indicating uniform adoption across groups. Conclusions: For surveyed cohorts, trust is the primary determinant of AI reliance, overriding traditional demographic factors. Fostering user trust is essential for the successful implementation of AI-driven personalized healthcare solutions. Full article

Transcranial magnetic stimulation-electroencephalography (TMS–EEG) biomarkers have recently become available as a means to obtain new understanding of the causal chains of neuronal signaling in the brain. This is a key piece in the puzzle of how the brain is organized and how it works. Using dMRI tractography, we can map the circuit beneath a chosen cortical target; TMS can then stimulate it, and EEG records responses that reflect—and may even be caused by—activity in that structural circuit. The chain of events after stimulus delivery can be observed and quantified using current neuroimaging and TMS–EEG technology, a matter of tremendous relevance on how to approach novel therapeutic approaches in clinical conditions. Herein, we elaborate upon a perspective of how groundbreaking multi-locus TMS (mTMS) technology associated with EEG and multimodal neuroimaging can be applied to modulate the flow dynamics of the glymphatic system (GS). The enhancement of the GS waste clearance functionality has been shown to improve significantly symptom severity in neurodegenerative disorders such as Alzheimer’s (AD) and Parkinson’s disease (PD) or long COVID. In this perspective paper, we consider that next-generation therapeutics using versatile technologies such as noninvasive neuromodulation and neuroimaging will provide important benefits in public health and in how society can address the management of these difficult-to-deal-with ailments more effectively. Full article