Search Results (5,171)

Data on menstrual health, energy availability, and injury risk in women undertaking extreme ultra-endurance expeditions remain limited. We conducted a prospective cohort study of the first all-female UK military team competing in a 3000-mile transatlantic rowing race, aiming to characterize menstrual function, low energy availability (LEA) risk, eating disorder (ED) risk, and injury profiles. Four female British Army personnel completed the 46-day race. Menstrual symptoms, injuries, and illnesses were recorded daily, while reproductive, inflammatory, biochemical, and hematological markers were assessed before and after the race. LEA and ED risk were evaluated using the Low Energy Availability in Females Questionnaire and Brief Eating Disorder in Athletes Questionnaire, respectively. Analyses were primarily descriptive. Three athletes experienced amenorrhea during the expedition, including one with previously regular cycles. The fourth reported intermittent abnormal bleeding associated with injury and illness and screened positive for LEA risk before and after the race. Another athlete screened positive for ED risk at both time points. Most biomarkers remained stable post-race, whereas reproductive hormones showed consistent reductions in follicle-stimulating hormone and luteinizing hormone in all four participants, alongside increased oestradiol. These findings, based on a sample of four athletes, suggest that menstrual function may be sensitive to sustained physiological stress in extreme ultra-endurance settings, and support prospective monitoring in female ultra-endurance, military, and expeditionary populations. Full article

Background: Radiation dermatitis (ARD), particularly its most severe form, moist desquamation (MD), is a frequent and distressing complication of external beam radiotherapy (RT) in head and neck (H&N) cancer patients. Standard management often provides limited benefit for healing and symptom control. Silicone-based foam dressings, including Mepilex Lite and Mepilex Ag, may offer atraumatic adherence, moisture balance, and pain reduction. This study evaluated their real-world effectiveness for MD after conventional RT. Methods: Ten H&N cancer patients with clinically confirmed MD post-radiotherapy were prospectively followed until healing. Patients received Mepilex Lite or Mepilex Ag based on exudate level and infection risk, with dressings changed every three days. Patient- and healthcare provider-reported measures were collected throughout follow-up. The primary endpoint was time to MD resolution, defined as healing to grade 1 skin status. Secondary endpoints included changes in symptom burden, dressing tolerability and satisfaction, and adverse events. Results: Median age was 69 years (range 44–78). All wounds healed to grade 1, with a mean time of 8.6 days (SD 3.9). No infections or adverse events occurred. Pain, burning, and interference with daily activity decreased, and most patients reported improved comfort. Conclusions: In this small prospective cohort study, use of Mepilex dressings was associated with rapid healing, good tolerability, and improvement in patient-reported symptoms of acute radiation dermatitis. These findings suggest that Mepilex dressings may be a promising management option and warrant evaluation in larger comparative studies. Full article

Objective: Glutamic acid decarboxylase 65 (GAD65) antibody-associated epilepsy often presents as chronic focal epilepsy, usually with temporal lobe predominance, marked drug resistance, and inconsistent response to first-line immunotherapy. We assembled a large, harmonized, and literature-derived patient-level cohort to examine whether immunotherapy timing and regimen composition were associated with seizure outcome and to identify clinically meaningful prognostic signals. Methods: We performed a literature-derived patient-level analysis of 375 unique published cases linked to 132 contributory source publications from an audited full-text register of 166 reviewed studies. Descriptive analyses used the whole cohort. Treatment-response analyses assessed seizure outcome at the first evaluable post-immunotherapy assessment and at the last follow-up. Good seizure outcome was defined as seizure freedom and/or ≥50% seizure reduction. The primary timing comparison contrasted early treatment, defined as immunotherapy within 6 months of symptom onset, with late treatment, defined as immunotherapy after more than 12 months; four cases treated in the intermediate >6 to ≤12 month window were retained for descriptive timing summaries but excluded from the primary comparison. Statistical testing used the Fisher exact, Chi-square, Mann–Whitney U, and prespecified clustered logistic sensitivity analyses where appropriate. Results: The pooled phenotype was predominantly female, usually temporal-lobe-based, and frequently drug-resistant, with common autoimmune comorbidity and heterogeneous MRI abnormalities. Among timing-evaluable treated cases, earlier immunotherapy showed a class-specific, exploratory signal rather than a uniform regimen-independent effect. In rituximab/CD20-directed regimens, early treatment was associated with a higher rate of good seizure outcome than late treatment at both the first post-immunotherapy assessment and last follow-up (93.8% vs. 50.0%; risk difference [RD]: 43.8 percentage points; 95% CI: 7.7 to 72.7). A similar pattern was observed in the broader escalation group (94.4% vs. 55.6%; RD: 38.9 percentage points; 95% CI: 6.3 to 68.1). By contrast, steroid-containing regimens showed no clear early-versus-late advantage (84.6% vs. 88.2%; RD: −3.6 percentage points; 95% CI: −18.4 to 20.1). Shorter epilepsy duration before immunotherapy and absence of established drug resistance were the most clinically meaningful favorable baseline features. Significance: In GAD65 antibody-associated epilepsy, the therapeutic window may be most relevant for escalation strategies rather than for steroid-containing first-line regimens. However, these class-specific findings are exploratory and hypothesis-generating. They derive from non-randomized, literature-derived data and may reflect treatment intensity, center practice, publication era, and confounding by indication rather than isolated regimen superiority. Prospective collaborative registries with standardized longitudinal seizure outcome measures are needed to validate these observations. Full article

Background: Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, sleep disturbances, and psychological symptoms. Mindfulness-based approaches are increasingly used as complementary interventions for symptom management. This study aimed to investigate the effectiveness of mindfulness-based yoga (MBY) delivered via telerehabilitation in individuals with fibromyalgia. Methods: This trial included 64 women with fibromyalgia who were randomly assigned to an 8-week mindfulness-based yoga program delivered via telerehabilitation or active control group including walking and physiotherapy modalities. Both groups received patient education at the outset. Assessments were conducted before and after the intervention. Outcome measures included fatigue, anxiety, depression, sleep quality, symptoms associated with central sensitization, kinesiophobia, pain intensity, mindfulness level, impact of fibromyalgia on life, biopsychosocial status, and pain catastrophising. Data were analyzed using mixed-design analysis of variance (ANOVA), with additional t-tests and analysis of covariance (ANCOVA) conducted for post hoc analyses. Results: Compared to the control group, the mindfulness-based yoga (MBY) group showed more pronounced improvements in terms of fatigue, anxiety, symptoms associated with central sensitization, biopsychosocial status, symptom severity, catastrophising about pain, ruminative thoughts about pain, and cognitive dimensions of pain. Although no significant differences were found between groups for other variables, intra-group improvements were observed in the MBY group. Conclusions: It was concluded that the MBY intervention administered via telerehabilitation is a viable complementary approach to traditional treatments in reducing the symptom burden of fibromyalgia. It was thought that the effectiveness of the research could be increased by conducting studies involving long-term follow-up assessments and investigating the integration of different mindfulness-based telerehabilitation interventions into the clinical setting. Full article

Background and Clinical Significance: Left ventricular free-wall rupture (LVFWR) is a rare but devastating mechanical complication of acute myocardial infarction (AMI), with reported in-hospital mortality approaching 90% without surgical intervention. Although its incidence has declined in the contemporary primary percutaneous coronary intervention (PCI) era, LVFWR remains an important cause of early post-infarction death, particularly after delayed reperfusion or fibrinolytic therapy. Subacute or contained “oozing” ruptures pose a unique diagnostic challenge because hemodynamic stability and nonspecific symptoms can mask the underlying catastrophe, and standard transthoracic echocardiography may fail to visualize a sealed defect. Contrast-enhanced cardiac computed tomography (CT) has emerged as a valuable adjunct in this setting, enabling early recognition and surgical planning. Case Presentation: We report a case of a 51-year-old male, a heavy smoker, with acute lateral ST-segment elevation myocardial infarction (STEMI) treated with thrombolysis at a referring hospital, followed by percutaneous coronary intervention (PCI) to the obtuse marginal branch. Despite reperfusion, he developed persistent pleuritic chest pain and a small pericardial effusion. Cardiac computed tomography (CT) demonstrated a contained (sealed) lateral-wall oozing-type left ventricular free-wall rupture (LVFWR) with thrombus sealing the defect. A multidisciplinary heart team initially opted for diligent observation with frequent echocardiography. Within the first 24 h, the pericardial effusion increased, and echocardiography showed circumferential effusion with lateral wall thickening and hematoma, prompting emergent sternotomy. Intraoperatively, a large posterolateral infarct with an oozing-type LV free-wall rupture was identified. Surgical repair was performed using interrupted pledgeted sutures, native pericardial patch, BioGlue, and an overlying Teflon patch, with intra-aortic balloon pump (IABP) support. This case demonstrates the complementary diagnostic value of multimodality imaging—echocardiography for serial monitoring of the pericardial effusion and regional wall changes, and cardiac CT for direct characterization of the contained (sealed) defect—and the timely transition from conservative to surgical management in oozing-type rupture. The patient recovered uneventfully and was discharged in stable condition. Conclusions: This case highlights the diagnostic value of multimodality imaging—particularly cardiac CT—in detecting contained (sealed) LVFWR when echocardiography is inconclusive. Early recognition and prompt surgical intervention enabled a successful outcome in this otherwise frequently fatal complication. Full article

α-Synuclein (α-Syn) is a key presynaptic protein, primarily known for its role in the pathogenesis of Parkinson’s disease (PD) and other synucleinopathies, including dementia with Lewy bodies (DLB). Although much of the research has focused on the nigrostriatal dopamine (DA) pathway, there is growing recognition that the accumulation of misfolded α-Syn in the prefrontal cortex (PFC) is a critical driver of non-motor symptoms and cognitive deficits in PD and DLB. This review examines the dual role of α-Syn in the PFC circuitry, initially exploring its regulation of synaptic vesicle (SV) dynamics and recycling to maintain stable neurotransmission. We highlight its contribution to the modulation of glutamatergic (Glu) and GABAergic (γ-aminobutyric acid, GABA) synapses, which ensures the functional excitatory/inhibitory (E/I) balance of prefrontal circuits. Conversely, in PD and DLB, the transition of functional α-Syn monomers to pathological oligomers triggers a cascade of synaptic failures. We analyze how α-Syn aggregation causes pathology in dendritic spines, leads to a progressive reduction in the density of synaptic markers, and impairs cortical plasticity. Synthesizing evidence from neuroimaging studies, post-mortem human cortical samples, and animal models, this review emphasizes the PFC as a vulnerable brain region where α-Syn-mediated synaptic dysfunction translates into cognitive and emotional deficits. Deciphering these early synaptic alterations is essential for developing neuroprotective strategies that preserve cortical function in PD and DLB. Full article

Background/Objectives: The COVID-19 pandemic had a negative effect on early intervention (EI) delivery to children with developmental delays or disabilities. This study aimed to compare school readiness of children who received, or attempted to receive, EI before, during, and after the COVID-19 pandemic stay-at-home order. Methods: A prospective cohort study was conducted with a single state-funded center that delivers federally mandated EI. School readiness assessments were performed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Fisher’s Exact tests, and Kruskal–Wallis ANOVA were performed to compare scores in children who began EI in the three time periods related to the COVID-19 pandemic. Results: A total of 56 children were enrolled in this study, the timing of EI start was available in 43, and 22 were able to complete all assessments. Statistically significant differences were found in WPPSI-IV Verbal Comprehension Index T scores (100 ± 15) across the COVID-19 phases, with the lowest scores arising during the pandemic (76.2 ± 9.3); the highest scores, pre-pandemic (98.0 ± 6.2); and intermediate scores, post-pandemic (81.5 ± 10.1, p < 0.05). Many children exhibited mental health concerns, with 29/56 (52%) being referred to community-based mental health services. Conclusions: In this study, lower scores were reported for markers of school readiness in children who received or attempted to receive EI during the COVID-19 stay-at-home orders compared to those pre- and post-pandemic. High mental health needs were identified, particularly among children with mild–moderate symptoms of autism or those who underwent EI during the COVID-19 stay-at-home orders. Full article

Background: Patient activation is associated with both health outcomes and the utilization of healthcare resources. Since various factors influence activation levels among older ill adults, further exploration of this topic is needed. Specifically, we aim to examine the extent to which changes over time in self-rated symptoms of depression are associated with changes in patient activation and to what extent self-rated health status and satisfaction of basic psychological needs (autonomy, relatedness, and competence) have a mediation effect. Methods: A longitudinal and correlational design was employed in which two hundred and seven participants with heart failure or chronic obstructive pulmonary disease were recruited from two hospitals in the middle of Sweden. The sample used in this study is the same as that used in a randomized controlled trial. A questionnaire was administered at baseline, and at 30-, 90-, and 180 days post-discharge, involving ratings of depression, patient activation, self-rated health, and satisfaction of basic psychological needs (autonomy, relatedness, and competence). As the results from the original study showed no difference between the two randomized groups in patient activation, the analysis in this study was conducted using a combined sample in which the intervention and control groups were merged. For estimation of the direct effects and the components of indirect effects, we employed multilevel modeling using a linear mixed model, and to test mediation, the stand-alone program RMediation was used. Results: Over time, increases in depressive symptoms were associated with reduced patient activation, with this relationship mediated by declines in relatedness and competence. No evidence was found showing that autonomy or self-rated health had a mediation effect. Conclusions: The results indicate that older chronically ill individuals may benefit from interventions targeting psychological mediators to improve and sustain activation. Full article

Background/Objectives: Verb anomia is a common symptom of primary progressive aphasia (PPA), particularly in the logopenic variant (lvPPA). Despite the central role of verbs in sentence construction, interventions specifically targeting verb anomia remain scarce. This study examined the effects of Personalized Observation, Execution and Mental Imagery (POEM) therapy, grounded in evidence that sensorimotor systems are recruited during action verb processing and may support verb retrieval. Methods: A 74-year-old woman with lvPPA completed pre- and post-POEM assessments (linguistic, cognitive, thymic, and motor). POEM consisted of 15 telepractice sessions delivered three times weekly using a systematic procedure with three sensorimotor strategies: action observation, gesture execution, and mental imagery. Results: No significant gains were observed in verb production across naming tasks, spontaneous speech, or functional communication contexts. However, co-verbal gesture use increased in frequency and quality, particularly during the naming of untrained verbs, suggesting that the gesture execution strategy was generalized. A delayed treatment effect was also noted, raising questions regarding the optimal duration of POEM in neurodegenerative conditions. Conclusions: While no statistically significant improvements in verb production were observed, qualitative analyses revealed increased use and quality of co-verbal gestures, suggesting that POEM had a compensatory effect. Future research involving larger cohorts and longer periods could help clarify the benefits of POEM therapy. It would also be relevant to compare in-person and remote delivery formats to evaluate POEM therapy’s robustness and adaptability in different clinical contexts. To conclude, these findings remain preliminary and should be interpreted with caution, particularly given the lack of significant improvement in primary verb production outcomes. Full article

Background and Clinical Significance: Inflammatory myopericardial syndrome is an umbrella term recently introduced by the European Society of Cardiology, which encapsulates the overlap that exists in clinical practice between myocardial and pericardial disease. It has a heterogeneous aetiology and a broad spectrum of severity in terms of its clinical features. Toxoplasma gondii is a rare but recognised infectious cause of myopericarditis and is typically seen in immunocompromised individuals. Case Presentation: We present the case of a young, immunocompetent male, presenting with pleuritic chest pain following a recent flu-like illness. Investigations revealed an acute myocardial injury based on elevated troponin T levels, in the absence of ventricular dysfunction. Toxoplasma immunoserology was consistent with primary toxoplasma infection. The remainder of his viral panel was negative. There was prompt symptom improvement following commencement of treatment with colchicine and a non-steroidal anti-inflammatory agent. Cardiac magnetic resonance imaging post-discharge revealed findings consistent with prior myocarditis. Conclusions: This case is an example of the rare occurrence of toxoplasma myopericarditis in an immunocompetent individual. Cardiac MRI is an invaluable imaging modality used to evaluate myocardial function and tissue characteristics in patients presenting with inflammatory myopericardial syndrome. Full article

Introduction: Vaccination against COVID-19 has been crucial in controlling the pandemic. While side effects are typically mild, rare neurological complications have been reported. This is a case series of ten patients who reported of persistent fasciculations after COVID-19 vaccination. Methods: We describe the clinical presentation and diagnostic work-up of ten patients with new-onset fasciculations in temporal proximity to COVID-19 vaccination. Patients with prior SARS-CoV-2 infection or known alternative causes of fasciculations were excluded. Routine clinical data, including neurological examination, laboratory results, and electrophysiology (electromyography and nerve conduction studies), were analyzed. Results: Ten patients (5 male, 5 female; mean age 42.4 years) reported fasciculations beginning within 6 h to 13 days post-vaccination and persisting for 2–12 months at the time of presentation. Fasciculations were accompanied by additional symptoms such as paresthesia and fatigue. Laboratory results were mostly unremarkable; two patients had positive myositis antibodies without clinical correlates. Electrophysiology was unremarkable in six patients, while fasciculation potentials were detected in four patients. Nine were diagnosed with probable benign fasciculation syndrome (BFS), and one met diagnostic criteria for amyotrophic lateral sclerosis (ALS). Discussion: In this small, retrospective case series, most cases of post-vaccination fasciculations were benign and compatible with BFS. Whether BFS onset was causally linked to vaccination or due to a nocebo effect remains unclear. One patient was diagnosed with ALS, though a causal link remains speculative given the study’s limitations and rarity of similar reports. Larger, prospective studies are needed to validate these observations and explore underlying pathophysiological mechanisms. Full article

Background: Sublingual immunotherapy (SLIT) is an effective treatment for house dust mite (HDM)-induced allergic rhinitis (AR); however, the significance of qualitative changes in specific IgE (sIgE) remains unclear. This study evaluated post-treatment changes in sIgE reactivity and compared the performance of three immunoassays. Methods: In this prospective study, monosensitized patients with HDM-induced AR were identified using skin prick testing and followed for 12 months after SLIT. Serum sIgE levels were assessed at baseline and after treatment using immunoblot, chemiluminescent immunoassay (CLIA), and ImmunoCAP as the reference method. Qualitative changes in sIgE reactivity were analyzed. Clinical response was assessed using the total nasal symptom score (TNSS), and total IgE (tIgE) levels were measured. Results: At baseline, HDM-sIgE reactivity was detected in 85.7%, 82.1%, and 92.9% of patients by immunoblot, CLIA, and ImmunoCAP, respectively. Following SLIT, a significant qualitative conversion to non-reactive status was observed across all assays (p < 0.001). Conversion rates were 94.0% for immunoblot, 83.3% for CLIA, and 100.0% for ImmunoCAP. Significant improvements in TNSS and reductions in tIgE were also observed. Conclusions: SLIT induces a marked qualitative reduction in HDM-sIgE reactivity, with complete serological conversion detected by ImmunoCAP. Although the immunoassays showed comparable rates of HDM-sIgE detection, their agreement in classifying individual patients differed, indicating variability in assay performance. Qualitative assessment of sIgE may provide a clinically meaningful approach for monitoring immunotherapy response. Full article

Prolonged endurance exercise performed in hot ambient conditions is associated with an increased prevalence of performance-limiting gastrointestinal perturbations. This study aimed to examine the associations between biomarkers of exercise-induced gastrointestinal syndrome (EIGS) and exercise-associated gastrointestinal symptoms (Ex-GIS) under exertional heat stress (EHS). Fifty-six non-heat acclimated endurance-trained individuals completed 2 h of steady state running at 60% maximal oxygen uptake ($\stackrel{.}{V}{\mathrm{O}}_{2\max }$) with an ambient temperature of 35.1 °C and relative humidity 29.4%. Venous blood samples were collected immediately pre- and post-exercise to quantify plasma concentrations of gastrointestinal epithelial injury and systemic inflammatory biomarkers, whilst gastrointestinal symptoms were recorded at regular intervals throughout the exercise protocol. Spearman’s rank correlation identified moderately significant relationships between interleukin-6 (IL-6) with defecation-bloody stools; interleukin-10 (IL-10) with upper abdominal pain; and IL-10, IL-1 receptor antagonist (IL-1ra), and systemic inflammatory response (SIR) profile with flatulence. Simple linear regression demonstrated that IL-6 explained a small but significant proportion of the variance defecation-bloody stool (adjusted R² = 0.094, p = 0.024); whilst variance in flatulence was independently explained by IL-10 (adjusted R² = 0.138, p = 0.025), IL-1ra (adjusted R² = 0.122, p = 0.033), and SIR-Profile (adjusted R² = 0.112, p = 0.040). These findings suggest that Ex-GIS development is multifactorial in aetiology and pathophysiology, and that symptom reporting alone likely underestimates perturbations to the gastrointestinal tract during EHS. Full article

Breast cancer is the most prevalent malignancy among women. The disease and its treatments often lead to physical and psychosocial impairments, compromising quality of life. While exercise and music-based interventions have individually demonstrated benefits on these symptoms, the advantages of their combination remain unexplored. This study evaluates whether a concurrent exercise program, including aerobic and strength training performed while listening to music based on individual preferences, is more effective than the same exercise program without music in improving self-esteem, body image, cancer-related fatigue, physical function (upper and lower limb strength and cardiorespiratory endurance), quality of life, sleep quality, and intolerance of uncertainty in female breast cancer survivors. A single-blind, two-arm, parallel-group, randomized controlled trial will be conducted including 42 women who completed primary treatment for stage 0–III breast cancer at least six months before enrollment. Participants will be randomly assigned to a music-listening concurrent exercise training group (MLTG), or a no music exercise training group (NMLTG), both performing the same 8-week exercise program. The primary outcome will be self-esteem (Rosenberg Self-Esteem Scale). Secondary outcomes include body image, fatigue, upper and lower limb strength, cardiovascular endurance, quality of life, sleep quality, and intolerance of uncertainty. Measurements will be collected using validated and reliable questionnaires and standardized functional tests at baseline, post-intervention, and at 6 months. Data will be analyzed under the intention-to-treat principle. Music listening, particularly when based on individual preferences and synchronized with movement, may enhance mood and exercise performance while modulating reward-related neural pathways. This trial will provide new evidence on a feasible and low-cost strategy to enhance supportive care and physical and psychosocial outcomes in breast cancer survivors. ClinicalTrials.gov (NCT07045961). Ethics Committee code: 2025-0855. Full article

Exercise-induced fatigue is a common phenomenon after intense exercise or labor, which significantly affects an individual’s exercise performance and physical and mental health. Its timely recovery is crucial for enhancing exercise capacity and preventing injuries. Acupuncture, as a “simple, convenient, inexpensive, and effective” non-pharmaceutical therapy in traditional Chinese medicine, has shown potential unique advantages in the prevention and treatment of exercise-induced fatigue. This narrative review summarizes the recent research progress, with core mechanisms including the inhibition of oxidative stress and inflammation, regulation of energy metabolism, and improvement of central nervous system function, which are mainly verified by preclinical animal studies and partially supported by small-sample clinical trials. The application effects are reflected in the fact that pre-acupuncture before fatigue can enhance anti-fatigue reserves, and post-fatigue treatment can alleviate symptoms and promote recovery, with human evidence limited to small-scale clinical observations. In conclusion, acupuncture has potential therapeutic effects on the prevention and treatment of exercise-induced fatigue, providing a theoretical and practical reference for clinical application. Full article