Search Results (320)

Background: Chronic shoulder pain is a frequent musculoskeletal complaint that significantly affects function, productivity, and quality of life. Mesenchymal stem cell (MSC)-based therapies have emerged as a potential regenerative option due to their anti-inflammatory and tissue-repair properties. This study aims to evaluate the safety and short-term effectiveness of intra-articular injections of umbilical cord-derived MSCs (UC-MSCs) in patients with chronic shoulder pain. Methods: A retrospective pragmatic observational study was conducted at the Regenerative Medicine Institute in Costa Rica. Medical records were reviewed to extract clinical, sociodemographic, and treatment-related variables. The primary outcome was functional improvement measured with the American Shoulder and Elbow Surgeons (ASES) score. Changes between baseline and the 3-month follow-up were analyzed using paired tests, effect size calculations, and regression models to explore predictors of treatment response. Results: Twenty patients met the inclusion criteria. A significant improvement in shoulder function was observed, with a mean ASES increase of 17.17 points, exceeding the minimum clinically important difference of 12. Sixty percent of patients achieved clinically meaningful improvement. Effect size estimates indicated a large magnitude of change. Regression analyses showed that baseline ASES predicted follow-up scores, while higher UC-MSC doses were associated with greater functional improvement. No adverse events were documented during the study period. Conclusions: The study shows that UC-MSC therapy is a safe, minimally invasive, and clinically beneficial option for chronic shoulder pain. These findings support the therapeutic potential of MSCs and highlight the need for larger controlled studies to validate long-term efficacy and optimize treatment protocols. Full article

Chronic hepatitis B remains difficult to cure because viral persistence is maintained within hepatocytes through covalently closed circular DNA and integrated viral sequences that continue to drive antigen production even when viral replication is effectively suppressed. Although current antiviral therapies improve clinical outcomes and slow disease progression, they rarely achieve a durable functional cure, defined as sustained loss of hepatitis B surface antigen (HBsAg), with or without anti-HBs seroconversion. This limitation has shifted attention toward therapeutic strategies that depend on precise and reliable drug delivery to the liver. Several recent reviews have focused on antiviral mechanisms or immune modulation. However, the specific contribution of drug delivery to therapeutic success has not been systematically addressed. This review examines hepatocyte-targeted drug delivery as a central determinant of success for emerging hepatitis B therapies. Rather than cataloging individual therapeutic agents, this review adopts a delivery-centered framework that links viral persistence biology with translational feasibility across therapeutic classes. Recent advances in ligand-mediated hepatocyte targeting have demonstrated consistent liver specificity and clinical feasibility, enabling meaningful reductions in viral transcripts and antigens. At the same time, we discuss why more complex delivery platforms continue to face challenges related to intracellular access, immunogenicity, scalability, and safety during repeated dosing, particularly for strategies intended to act within the nucleus. Translational and clinical considerations, including differences between experimental models and human infection, manufacturing and regulatory constraints, and the demands of long-term treatment, are also addressed. Overall, this review supports a pragmatic path toward functional cure based on rational combination therapies, coordinated delivery strategies, and patient-tailored approaches, with delivery science serving as the critical link between biological insight and durable clinical benefit. Full article

Debates on sustainability have focused mainly on conventional and organic farming. However, little attention has been given to intermediate production approaches with potential benefits for environmental protection, food affordability, and food safety. This study investigated consumers’ acceptance of an intermediate farming method characterized by minimal use of agrochemicals. Using a preference-based grouping approach, 184 Japanese consumers were divided into organic-prone (OA-prone), conventional-prone (CA-prone), and balance-prone groups (χ² test, p < 0.001). The results revealed clear differences in how these groups evaluated and responded to the produce from the intermediate farming method. OA-prone consumers tended to evaluate such produce against the standards associated with organic food and therefore showed more cautious acceptance. In contrast, CA- and balance-prone consumers demonstrated relatively higher acceptance when product safety and taste were assured, reflecting a more pragmatic evaluation based on functional attributes and affordability. These findings suggest that the promotion of environmentally friendly intermediate farming depends more on pragmatic CA- and balance-prone consumers rather than those value-driven organic consumers. By highlighting consumer heterogeneity in the evaluation of such farming systems, this study contributes to a broader understanding of sustainable food consumption and underscores the role of intermediate farming in bridging environmental sustainability and food security. Full article

This study explores the role of TikTok in shaping emotions and communicative dynamics within the broader context of digital culture. The research is grounded in a theoretical framework that traces the shift from a linear communication model to a participatory and convergent ecosystem, characterized by user-generated content and horizontal interaction. Drawing on the concept of digital affordances, the analysis examines how comments on TikTok serve as a crucial dimension, simultaneously driving the algorithmic visibility of content and fostering the construction of social bonds. The study employs a quantitative, descriptive approach, conducting content analysis across three dimensions (syntactic, semantic, and pragmatic) on a corpus of 4206 comments drawn from four self-help videos by influencers Irene Albacete, Daniel Habif, and Yoroi. Additionally, a structured survey of 336 participants, based on a Likert scale, was administered to assess perceptions and emotions associated with these contents. The findings reveal that comments function as interaction multipliers that amplify algorithmic dissemination, generating opportunities for democratizing visibility while also posing risks of reinforcing echo chambers and cognitive biases. Moreover, TikTok demonstrates a dual emotional impact: while it fosters supportive communities and enhances socioemotional skills, it can also intensify challenges such as anxiety, low self-esteem, and large-scale negative emotional contagion. In conclusion, TikTok emerges as a central arena of contemporary digital experience, where algorithmic logic and user participation coexist within a landscape of tension between inclusion and risk. These findings underscore the need for conscious, critical engagement with digital platforms, as well as the ethical responsibility of algorithmic systems in shaping social and emotional life in the digital era. Full article

Objectives: Addiction disorders remain a major challenge in contemporary psychiatry due to high relapse rates and significant individual and societal burden. Despite advances in addiction neurobiology, current diagnostic frameworks and dominant models offer limited tools for early risk identification and dynamic support of clinical decision-making across the course of treatment. The aim of this narrative review is to introduce the MAC/MAB–RCS model as an integrated conceptual framework for risk stratification and personalized intervention in addiction psychiatry. Methods: The proposed model integrates evidence from four complementary domains: genetic, epigenetic, and stress-axis biomarkers; functional brain network organization; and psychological/psychiatric dimensions relevant to addictive behaviors. These domains are synthesized into a unified conceptual structure designed to capture dynamic regulatory processes underlying addiction vulnerability. Results: At the core of the model lies the Regulatory Control State (RCS), a latent higher-order construct representing an individual’s dynamic regulatory capacity through the integration of cognitive control, emotional regulation, and motivational drive modulation. Disruption of the RCS is conceptualized as a shared transdiagnostic mechanism driving craving escalation, compulsive behavior, and relapse vulnerability, independent of substance class or specific addictive behavior. Conclusions: The MAC/MAB–RCS model aligns with the principles of precision psychiatry by offering a pragmatic, clinically oriented translational framework with potential applicability across clinical settings, bridging neurobiological research and clinical practice. The review discusses its relationship to existing models, potential clinical and systemic applications, key limitations, and priorities for future validation studies. Full article

Background: This research explores the complex relationship between Attention Deficit Hyperactivity Disorder (ADHD) and language skills, focusing on the impact of the disorder on children’s language development. It is designed as a systematic literature review to synthesize and evaluate existing evidence on this topic. Based on the existing literature, ADHD affects multiple dimensions of language, including phonological awareness, pragmatic comprehension, morphosyntactic structure, narrative skills, and written expression. The difficulties that children with ADHD exhibit at the language level are directly related to their deficits in working memory, attention, and organization, which make it challenging for them to acquire and use language at both educational and social levels. Methods: This study followed the PRISMA methodology, with a systematic selection process across four stages (identification, screening, eligibility, and inclusion). During the identification phase, 475 records were identified (450 from database searches and 25 through reference screening). After screening and applying inclusion criteria, 15 studies met all eligibility requirements and were included in the final synthesis. Results: The present research highlighted the important role that occupational therapists and psychologists can play in the language development of children with ADHD. Strategic interventions to alleviate the language difficulties of children with ADHD are designed to enhance phonological awareness, executive function, speech and language, the use of technological tools, and social skills training. Conclusions: The importance of early diagnosis and implementation of holistic, individualized interventions targeting the language, executive, and social difficulties manifested by children with ADHD is considered influential in addressing the barriers to improving language skills as effectively as possible. Full article

Background/Objectives: In Japan, cancer-related anemia (CRA) is common, and erythropoiesis-stimulating agents (ESAs) are not approved for chemotherapy-induced anemia. Modern intravenous (IV) iron formulations, such as ferric carboxymaltose (FCM) and ferric derisomaltose (FDI), enable high-dose repletion; however, real-world evidence in ESA-free oncology settings remains limited. Methods: This single-center retrospective study included patients with CRA (N = 55) who received high-dose IV iron (FCM or FDI). Iron phenotypes were classified as absolute iron deficiency (ID), functional ID, or non-ID. The primary endpoint was hemoglobin (Hb) change from baseline to approximately 1 month (21–45 days) in the non-transfused patients. Secondary endpoints included responder rate (ΔHb ≥ 1.0 g/dL), transfusion avoidance rate, dosing adequacy relative to Ganzoni-calculated iron deficit, and safety, particularly hypophosphatemia. Results: Among the non-transfused patients, mean Hb increased from 8.76 ± 1.34 g/dL to 9.73 ± 1.75 g/dL (mean ΔHb +0.92 ± 1.44 g/dL; p < 0.001). The responder and transfusion avoidance rates were 48.9% and 81.8%, respectively. Functional ID was most prevalent (52.7%), with clinically meaningful Hb responses. A total of 38.2% achieved approximately 1000 mg dosing. The safety profile was excellent, and no infusion reactions or symptomatic hypophosphatemia was observed (median serum phosphate changed from 3.4 [3.0–3.9] to 3.2 [2.7–3.8] mg/dL). Conclusions: In this real-world Japanese oncology setting where ESAs were not available for chemotherapy-induced anemia, high-dose IV iron monotherapy (FCM or FDI) was well tolerated and was associated with modest short-term Hb increases and a high observed rate of transfusion avoidance within a 21–45-day assessment window. These findings suggest that a proactive, TSAT-guided IV iron therapy approach may be a pragmatic option for selected patients; however, durability beyond 1 month, optimal re-dosing, and generalizability require confirmation in larger, longer prospective studies. Full article

Conservative management of rotator cuff disorders remains challenging, with no comprehensive, evidence-based framework integrating diagnosis, prognosis, rehabilitation, and biological therapies. Existing recommendations usually address isolated components of care, leading to inconsistent treatment strategies. This article proposes a global, pragmatic protocol for the non-surgical management of rotator cuff lesions, from initial assessment to long-term follow-up. Drawing on clinical expertise supported by recent literature, we outline a stepwise approach that begins with a comprehensive diagnostic process that combines history, clinical examination, and targeted imaging. Based on lesion type, associated shoulder or neurogenic conditions, and patient profile, rotator cuff disorders are stratified into three prognostic categories under conservative care: good, borderline, and poor prognosis, highlighting factors that require treatment adaptation or early surgical consideration. Rehabilitation objectives are structured around four domains: (1) inflammation and pain control, (2) mobility and scapular kinematics, (3) strengthening and motor control with tendon-sparing strategies, and (4) preservation or restoration of anatomy. For each prognostic category, we define a monitoring plan integrating clinical reassessment, ultrasound follow-up, and functional milestones, including return-to-play criteria for athletes. This comprehensive narrative review demonstrates that precise diagnosis and individualized rehabilitation can optimize medical follow-up, active strengthening, and complementary or regenerative therapies. Aligning therapeutic decisions with prognostic and functional goals allows clinicians to optimize patient satisfaction and recovery, providing a clear, evidence-informed roadmap for conservative management of rotator cuff disorders. Full article

As food typically accounts for substantially higher resource use and potential environmental impacts than its packaging, packaging-related food wastage must be considered in environmental assessments of food packaging. However, this is not currently performed as standard in Life Cycle Assessment (LCA). This article proposes a conceptual framework as an approach to systematically integrating packaging functionality into LCA by incorporating packaging-related food wastage depending on shelf-life and due to technical emptiability. Based on literature data, a segmented non-linear regression is proposed to estimate shelf-life-dependent food wastage at retail level. Two exponential models provide a consistently decreasing relationship between shelf-life and food wastage, with S = 0.064 for products with ≤30 days shelf-life and S = 0.036 for >30 days shelf-life. These values indicate a satisfactory internal fit within both shelf-life segments. In addition, established experimental procedures for quantifying packaging emptiability are integrated to capture further packaging-related food wastage. The approach yields a pragmatic estimation of packaging-related food wastage that can be operationalized in packaging LCAs. Rather than predicting exact amounts of food wastage, the framework enables a more holistic, function-oriented assessment of food packaging by making environmental trade-offs between packaging design, shelf-life effects and emptiability transparent for screening-level LCA. Full article

Background/Objectives: Calcinosis cutis universalis is a rare and severe manifestation of dystrophic calcification, most associated with connective tissue diseases such as dermatomyositis, systemic sclerosis, and systemic lupus erythematosus. It is characterized by widespread deposition of calcium salts throughout the soft tissues, leading to pain, recurrent infections, restricted mobility, and significant impairment in daily functioning and quality of life. Management remains challenging due to the absence of standardized treatment guidelines with risks including delayed wound healing and recurrence. Adjunctive therapies may support symptom control in refractory cases. Conclusions: Management of calcinosis cutis universalis requires an individualized, multimodal strategy. Based on available evidence and expert opinion, a stepwise therapeutic decision-making algorithm integrating medical, minimally invasive, and surgical approaches is proposed to guide clinical practice and the variable efficacy of available therapies. This review aims to summarize current therapeutic strategies and to propose a pragmatic approach to clinical decision-making. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar. The review focused primarily on calcinosis cutis universalis and severe or extensive forms of calcinosis cutis, with particular emphasis on surgical management and its integration with medical and minimally invasive treatments. Results: Pharmacological treatments—including bisphosphonates, calcium-channel blockers, tetracyclines, phosphate binders, probenecid, immunomodulatory agents, biologics, colchicine, sodium thiosulfate and JAK inhibitors—show heterogeneous and often partial efficacy, with more favorable responses in early or localized disease. Surgical interventions such as excision, curettage, CO₂ laser ablation, and reconstructive procedures provide meaningful symptomatic relief in selected patients but are associated. Full article

Background: The rapid ageing of the cardiovascular population has profoundly transformed clinical practice, with an increasing proportion of patients presenting advanced age, frailty, multimorbidity, and functional vulnerability. Conventional cardiology models, largely derived from younger and selected populations, often fail to adequately address the complexity of cardiovascular care in older adults. Despite the growing development of cardiogeriatrics, the core competencies required for contemporary geriatric cardiology practice remain insufficiently defined. Methods: This narrative review synthesises evidence from cardiology, geriatrics, heart failure, and the palliative care literature, complemented by clinical expertise in integrated cardiogeriatric care pathways, to identify key competencies relevant to the care of older adults with cardiovascular disease. Results: Four major domains of geriatric cardiology competencies were identified: (1) advanced cardiovascular expertise adapted to ageing physiology, frailty, and multimorbidity; (2) integration of comprehensive geriatric assessment into cardiovascular decision-making; (3) a dedicated cardiogeriatric communication mindset supporting shared decision-making under prognostic uncertainty; and (4) system-based competencies focused on multidisciplinary coordination, care transitions, and therapeutic proportionality. Conclusions: Defining the core competencies of the geriatric cardiologist is essential to addressing the clinical and organisational challenges of an ageing cardiovascular population. This framework provides a pragmatic foundation for clinical practice, education, and future research, supporting integrated cardiogeriatric care models aligned with patient-centred outcomes. Full article

Background/Objectives: War-related mandibular injuries result in extensive soft-tissue damage, severe comminution, and bone loss, and are associated with high rates of infection and delayed healing. No universally accepted management protocol exists for these injuries. External fixation is commonly used in this context, particularly when internal fixation is unavailable or contraindicated. This study aimed to analyze injury patterns, treatment outcomes, and complications of war-related mandibular fractures treated with external fixation as a primary and definitive stabilization method in a resource-limited setting in eastern Democratic Republic of Congo. Methods: A retrospective review was conducted of all patients who sustained war-related mandibular fractures and were treated with external fixation between January 2017 and December 2024 at the Hôpital Provincial Général de Référence de Bukavu. Demographic data, injury characteristics, treatment details, outcomes, and complications were collected. Factors associated with delayed union and fracture-related infection were evaluated using univariate analysis. Results: Ninety-one patients with severe mandibular war injuries were included. High-velocity gunshot wounds accounted for 94.5% of injuries. Clinical evidence of wound infection at admission was present in 29.7% of patients. The mean delay between injury and external fixation was 9.2 ± 6.6 days. Successful bone healing without secondary bone procedures was achieved in 71 patients (78.0%), with a mean healing time of 7.6 ± 3.0 weeks. Delayed bone grafting was required in 20 patients (22.0%), performed at a mean of 77.3 ± 30.5 days after initial fixation. The overall complication rate was 36.3%, with fracture-site infection being the most frequent complication (30.8%). Bone loss at presentation, clinical infection at admission, and the need for bone grafting were significantly associated with fracture-related infection (p < 0.05). Conclusions: War-related mandibular fractures in this series were characterized by severe comminution, bone loss, infection, and delayed presentation. Despite these challenges, external fixation provided acceptable fracture healing and functional outcomes. Small orthopedic external fixators represent a pragmatic and effective treatment option for complex mandibular war injuries in resource-limited settings. Full article

Social sustainability has become a central concern in development-induced resettlement, yet little is known about how social integration and community relations are sustained over long time horizons. Drawing on a retrospective longitudinal ethnographic reconstruction spanning 21 years (2004–2025) of Three Gorges Dam resettlers relocated to rural Anhui, China, this paper examines the co-evolution of group boundaries, interaction strategies, and social networks between migrants and local residents. Using group boundary theory, we identify three sequential phases of interaction: initial boundary demarcation and social distancing, subsequent bridge-building through economic cooperation and relational ingratiation, and a later stage of pragmatic, transactional engagement. We show that the gradual erosion of migrant–local boundaries is driven by economic interdependence, cultural adaptation, individualization, and rural out-migration. Rather than resulting in deep social fusion, long-term integration stabilizes in a form of “thin integration,” characterized by low-density but sustainable social ties, institutionalized conflict resolution, and routine coexistence. This study conceptualizes social integration as a dynamic process of social sustainability, demonstrating how resettled communities maintain social order and functional cohesion amid structural change. The findings contribute to debates on sustainable rural development, forced migration, and the long-term governance of resettlement communities. Full article

Considering the high prevalence of adolescent depression and anxiety, the profound functional consequences of untreated early psychosis and suicide being the number one cause of death in Australia among 15–19-year-olds, ensuring that teachers are literate about these disorders should be a high priority. Teachers’ disorder-specific literacy is a pragmatic response to healthcare system constraints. This scoping review aimed to map the evidence of teacher mental health literacy training programs, specifically for depression, anxiety, early psychosis and suicide risk. PRISMA-ScR guidelines were followed. Included studies were published in English between 2000 and 2024, focused on teachers working with students in Year 7–12 and measured teachers’ knowledge of depression, anxiety, psychosis or suicide risk. Studies were appraised for quality. Eighteen studies met the inclusion criteria. Nine evaluated knowledge of student depression, five evaluated knowledge of anxiety and five evaluated knowledge of psychosis, while nine studies focused on suicide risk. Providing disorder-specific training and evaluation, rather than general mental health literacy training, is recommended for future research. When healthcare systems lack the capacity to provide care for ill adolescents, schools often function as frontline sites for recognition and triage. Disorder-specific literacy is recommended for teachers so they can manage their real-world, health-system compensation role. Full article

This study examines how Association of Southeast Asian Nations (ASEAN) is framed in Chinese, Japanese, and South Korean English-language mainstream media during four high-salience geopolitical events (2023–2025). Methodologically, it employs a qualitative comparative framing and discourse analysis of 28 systematically selected news articles from leading outlets in each media system, coded using Entman’s four framing functions (problem definition, causal attribution, moral evaluation, and treatment recommendation) and supplemented by representational logics and explicitly stated platform-governance indicators. Drawing on framing theory, representation, platform governance, and critical geopolitics, the analysis finds that ASEAN is portrayed not as an autonomous actor but as a flexible signifier within nationally inflected narratives. Chinese media emphasize regional cooperation and developmental connectivity, Japanese outlets foreground liberal-normative order and security alignment, and South Korean coverage prioritizes technocratic and pragmatic partnership. The study argues that ASEAN’s mediated visibility is shaped by recurring editorial framing patterns and, where explicitly invoked, by infrastructural and platform-related cues, revealing ongoing narrative contestation over regional power and legitimacy in East Asia. Full article