Search Results (2,362)

Background/Objectives: Chronic primary pain (CPP) is a new diagnostic category including chronic pain conditions lacking clinical signs or a clear etiopathogenetic origin. These disorders may share a common neural mechanism known as central sensitization, where nociceptive neurons become hyper-responsive to standard or subthreshold pain stimuli, resulting in pain hyper-sensitivity. In this context, non-invasive brain stimulation (NIBS) appears to be a promising tool for improving CPP symptoms by targeting maladaptive brain activity and connectivity. To date, the effects of NIBS on CPP symptoms remain unexplored. To fill this gap, we conducted a meta-analysis, investigating the effect of NIBS in improving the three core symptoms of CPP, namely pain intensity, emotional distress, and functional disability. Methods: Following PRISMA guidelines, we screened four databases up to February 2025 for English-language, peer-reviewed randomized clinical trials that included CPP patients treated with NIBS and reported pre/post or follow-up scores on validated measures of at least one core symptom. Quality of life was examined as an additional outcome. Results: Fifty-four studies were included, with 1371 participants receiving real stimulation and 1103 sham. Findings highlighted that real stimulation improved CPP symptoms immediately after treatment and at one-month follow-up. Meta-regressions showed that longer CPP duration reduced short-term effects on emotional distress and diminished all outcomes at one-month follow-up. Conclusions: Further research is needed to establish standardized NIBS protocols for CPP management, to investigate the effectiveness at longer follow-up periods, and to test whether combining NIBS with other interventions enhances treatment effectiveness and durability. Full article

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

Background: Cancer-related cognitive impairment is a frequent and clinically relevant concern among women with breast cancer, particularly during active oncological treatment, with potential consequences for memory, attention, executive functioning, daily autonomy, emotional well-being, and quality of life. This study aims to evaluate the effectiveness of the Playful Attention and Active Memory intervention (ALMA) on cognitive functioning in women with breast cancer undergoing active oncological treatment. Methods: This single-centre, three-arm, parallel-group randomized controlled trial at the University Healthcare Complex of Salamanca (Spain) will evaluate 63 women with breast cancer undergoing active oncological treatment. Participants will be randomized (1:1:1) into a health education control group, an individual non-tailored cognitive training group, or the ALMA multidimensional group intervention (two 120 min face-to-face sessions/week for four months, combining psychoeducation, targeted cognitive stimulation, and group feedback). Assessments will occur at baseline and post-intervention. The primary outcome is objective global cognitive performance (Montreal Cognitive Assessment). Secondary outcomes include perceived cognitive function, everyday cognition, functional autonomy, anxiety, sleep quality, performance status, and everyday memory failures. Intention-to-treat analysis using linear mixed models will perform prespecified comparisons of ALMA versus both other groups. Expected results: This study is designed to provide evidence on the potential value of a structured, multidimensional cognitive intervention delivered during active breast cancer treatment. By comparing ALMA with both health education and individual cognitive training, the trial may clarify whether the integration of psychoeducation, ecological cognitive stimulation, and group-based support offers additional benefits beyond cognitive practice alone. The inclusion of objective, subjective, and functionally oriented outcomes strengthens the clinical relevance of the protocol and may contribute to the development of more comprehensive supportive care strategies for cancer-related cognitive impairment. Trial registration: This protocol is registered at ClinicalTrials.gov under the identifier NCT07165912. Full article

Transitional waters—such as estuaries, lagoons, deltas, and coastal wetlands—are dynamic environments where freshwater and seawater interact, forming highly productive and biologically diverse ecosystems. Shaped by temperature and salinity gradients, tidal influence, sediment transport, and nutrient-rich conditions, these habitats support diverse ecological functions. Their structural complexity—including seagrass beds, salt marshes, mudflats, and mangroves—provides essential habitats for many fish species. These areas are crucial for fish life cycles, serving as nurseries, spawning grounds, feeding zones, and refuges from predators. Many commercially important species depend on them during early life stages before moving offshore, making them vital for both commercial and recreational fisheries. Beyond food provision, they deliver key ecosystem services, including water purification, coastal protection, and carbon storage. Research on the fish community of the Ria Formosa lagoon in Portugal since the 1980s highlights long-term changes in the fish community and the dominant role of habitat structure and temporal dynamics. Subtidal seagrass beds support higher fish abundance and diversity than unvegetated areas, acting as key nursery habitats and provide important fish provisioning services. Seasonal variation is also central, driven by recruitment pulses of marine migrants in late winter–spring. Recent pressures on this system have been driven by human activity and environmental change. Seagrass loss reduces nursery and feeding areas, while pollution degrades water quality. Overfishing (including illegal fishing), recreational activities, and aquaculture expansion add stress. Climate warming and invasive species such as Caulerpa prolifera, further disrupt ecosystem balance and threaten biodiversity. Sustainable management—such as habitat restoration, protected areas, and integrated policies—is essential to preserve the ecological and economic value of this unique lagoon. Ongoing research, monitoring, habitat restoration, and stakeholder engagement remain critical for ensuring resilience. Full article

Pulmonary hypertension (PH) is a progressive, multifactorial syndrome characterized by elevated pulmonary arterial pressure and right heart dysfunction, associated with significant morbidity, impaired quality of life, and poor prognosis. Advances in classification, hemodynamic definitions, and targeted pharmacotherapies have improved understanding and management, yet therapeutic challenges persist across the five World Health Organization groups of PH. Historically, exercise was discouraged due to concerns about adverse hemodynamic effects, but growing evidence has suggested that structured, supervised training is safe and beneficial. Randomized trials and meta-analyses show improvements in six-minute walk distance, peak oxygen uptake, right ventricular function, ventilatory efficiency, and health-related quality of life, with a low incidence of adverse events. Physiological adaptations include favorable cardiac remodeling, enhanced endothelial function, improved skeletal and respiratory muscle performance, and improved neurohormonal activity. Despite this evidence, barriers such as patient fears, limited clinical expertise, and restricted access to specialized rehabilitation programs hinder widespread implementation. Current guidelines recommend supervised exercise as part of pulmonary rehabilitation for patients with stable PH, supporting its role as an adjunct to pharmacotherapy. This descriptive review briefly summarizes the pathophysiology of PH, phenotype-related differences and current therapeutic approaches, and the beneficial adaptations to exercise training, with the aim of informing exercise specialists and supporting safer, more effective integration of exercise-based rehabilitation into patient care. Full article

Background and Objectives: In recent years, frailty has emerged as a prognostic factor in inflammatory bowel diseases (IBD), particularly among patients with active disease. However, evidence regarding its reversibility after treatment optimization remains limited. This study aimed to assess frailty in active IBD and determine whether frailty status improved after 6 months of clinical management and the achievement of clinical remission. Materials and Methods: This prospective, single-center, observational cohort study included adults with active IBD requiring escalation to advanced therapy who achieved clinical remission at the 6-month follow-up. Patients were evaluated at baseline and after 6 months using a modified Fried frailty phenotype. Quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Univariate and multivariate logistic regressions were utilized to identify independent factors associated with frailty improvement. Results: The analysis included 54 patients (61.1% male; 42.6% with Crohn’s disease). At baseline, 20.4% were classified as frail, 72.2% as pre-frail, and 7.4% as robust. Following 6 months of clinical management and the achievement of clinical remission, a 100% resolution of frailty was observed, with the robust cohort expanding to 42.6%. Significant improvements occurred across clinical parameters, including handgrip strength, 400 m walk times, and median SIBDQ scores (increasing from 4.4 to 5.9, p < 0.001) alongside a substantial decline in CES-D scores (p = 0.017). Multivariate logistic regression revealed that severe disease at baseline (aOR = 4.51, 95%CI: 1.26–16.18, p = 0.020), anti-TNF therapy initiation (aOR = 3.69, 95%CI: 1.04–13.18, p = 0.044), and higher baseline CES-D scores (aOR = 1.06, 95%CI: 1.00–1.13, p = 0.038) were independently associated with higher odds of frailty improvement. Conclusions: Among patients who achieved clinical remission, frailty and pre-frailty demonstrate substantial short-term improvement following advanced therapy. Functional and psychological recoveries are associated with successful control of baseline disease severity and systemic inflammation. Full article

Background: Menopause is associated with hormonal changes that may influence cognitive function, psychological health, and quality of life, but data on Middle Eastern populations remain scarce. Methods: A cross-sectional study was conducted among 220 Saudi women (110 perimenopausal, 110 postmenopausal) in Riyadh. Cognitive function was assessed with the MMSE-2; quality of life with SF-36 and MENQOL; and psychological distress with PHQ-4 and PSS-10. Group comparisons used the Mann–Whitney U test; associations with Spearman’s correlation; and multivariable logistic regression adjusted for age, BMI, education, and anxiety. Results: In unadjusted analyses, perimenopausal women had higher MMSE-2 scores (median 30 vs. 29, p = 0.002, r = 0.211). Postmenopausal women reported greater vasomotor symptoms (p < 0.001, r = 0.090) but better emotional well-being (p = 0.038, r = 0.140). After adjustment for age, menopausal status was not a significant predictor of lower cognitive function (OR = 1.28, 95% CI: 0.56–2.92, p = 0.560). Age was the only significant predictor (OR = 1.10, 95% CI: 1.03–1.17, p = 0.003). Conclusions: The unadjusted difference in MMSE-2 scores between perimenopausal and postmenopausal women was small and not independent of age. Age, not menopausal status, was the primary factor associated with cognitive performance. Preventive strategies should target modifiable factors such as physical activity and vasomotor symptom management. Longitudinal studies with domain-specific cognitive tests are needed. Full article

Cancer-related cognitive impairment (CRCI), also known as chemobrain or chemofog, is characterized by subjective and/or objective changes in attention, executive functions, memory, and processing speed in patients with non-CNS cancers, particularly women with breast cancer. This structured narrative review synthesizes current evidence on mechanisms, neuropsychological assessment, neuroimaging correlates, clinical and demographic risk factors, emerging artificial intelligence and machine learning applications, and non-pharmacological approaches to CRCI in breast cancer. A structured literature search was conducted using PubMed/MEDLINE, PsycInfo, and Clinical Key up to May 2026, with emphasis on studies published between 2023 and 2026. Peer-reviewed English-language studies involving adult breast cancer populations and addressing predefined thematic domains of CRCI were considered. Given the heterogeneity of study designs, assessment tools, interventions, and outcomes, the findings were synthesized narratively. Current evidence supports a multifactorial model of CRCI involving neurobiological, treatment-related, psychological, and behavioral mechanisms. Neuroinflammation, endocrine disruption, oxidative stress, glial alterations, and structural or functional brain changes may contribute to cognitive symptoms; however, the strength of evidence varies, and many findings remain correlational or preclinical. Non-pharmacological interventions, including cognitive training, physical activity, mindfulness-based and psychological approaches, and multimodal digital programs, appear promising as supportive strategies. However, evidence remains heterogeneous, with benefits more consistently reported for patient-reported outcomes, fatigue, emotional distress, and quality of life than for objective neuropsychological performance. CRCI in breast cancer should be approached as a heterogeneous condition requiring early recognition, standardized assessment, and multidisciplinary supportive care. Future research should prioritize longitudinal designs, harmonized endpoints, and a clearer distinction between subjective and objective outcomes. Full article

Brewing generates several by-products with high potential for conversion into food in-gredients, including brewer’s spent grain, brewer’s spent yeast, spent hops, and hot trub. These streams contain dietary fibre, proteins, β-glucans, phenolics, minerals, and others with nutritional and technological value. This review evaluates their suitability for food applications by linking composition, processing routes, techno-functional behaviour, safety, sensory quality, and industrial readiness. A structured literature search covering publications from 2015 to 2026 was conducted in Web of Science, Scopus, PubMed, and Google Scholar to support a critical narrative synthesis of food-relevant applications of brewing by-products. The review shows that brewer’s spent grain is the most suitable by-product for wider food use, mainly in bakery, snacks, pasta, and cereal-based products, due to its high availability and fibre-rich composition. Brewer’s spent yeast is more appropriate for fraction-based applications involving proteins, peptides, β-glucans, and mannoproteins, especially in dairy products, savoury foods, beverages, and encapsula-tion systems. Spent hops and hot trub are less suitable for direct incorporation, but they may be used for selective recovery of phenolic-rich, antioxidant, flavour-active, or pro-tein-containing fractions. The conversion of these materials into food ingredients depends strongly on stabilization, drying, milling, extraction, fermentation, enzymatic treatment, debittering, and fractionation. Main limitations include high moisture content, short shelf-life, microbial spoilage, compositional variability, bitterness, dark colour, high nucleic acid content in yeast-derived fractions, regulatory uncertainty, and limited pilot-scale validation. Overall, brewing by-products can support the development of up-cycled ingredients when processing, safety, sensory quality, and product compatibility are controlled. Future progress requires standardized recovery protocols, stronger quality control, sensory validation, legal assessment, and scale-up studies to support their use in commercial food production. Full article

Background: Selenium (Sel) supplementation has been proposed as an antioxidant adjunct in Graves’ orbitopathy (GO), with early randomized evidence suggesting benefits in quality of life (QoL), ocular involvement, and disease progression in mild GO. However, subsequent trials across populations with different Sel status and disease severity have yielded inconsistent findings. This systematic review and meta-analysis of randomized controlled trials (RCTs) reassessed the efficacy of Sel supplementation in GO. Methods: PubMed, Scopus, and the Cochrane Library were searched from inception to 1 May 2026 for RCTs, comparing Sel supplementation with placebo or no Sel supplementation in patients with GO (PROSPERO “CRD420261395074”). Heterogeneity was assessed using I² statistics and Cochran’s Q test. Risk ratios (RRs) were calculated using the Mantel–Haenszel method, and mean differences (MDs) using the Inverse-Variance method. Random-effects models with restricted maximum-likelihood estimation were applied. Results: Five RCTs including 303 patients were analyzed, of whom 165 (56%) received Sel. Sel supplementation was associated with a significant reduction in clinical activity score (MD −1.05; 95% CI −1.61 to −0.48; I² = 52%; p < 0.01). No significant differences were observed in palpebral aperture (MD −0.12; 95% CI −1.22 to 0.98; I² = 58%; p = 0.83), although this anatomical parameter should be interpreted cautiously because it may be influenced by thyroid functional status and hyperthyroidism-related Müller muscle hyperfunction. No significant differences were observed in QoL improvement (RR 1.72; 95% CI 0.43 to 6.92; I² = 86%; p = 0.24) or visual function (MD 6.31; 95% CI −1.40 to 14.03; I² = 45%; p = 0.11). Conclusions: Sel supplementation may improve clinical activity score in patients with Graves’ orbitopathy, but this finding should be interpreted cautiously given the small number of trials, limited sample size, and clinically relevant heterogeneity. Current evidence does not show consistent benefits for palpebral aperture, quality of life, or visual function. Larger RCTs stratified by baseline Sel status and disease severity are needed before firm conclusions can be drawn. Full article

Hydrodynamic cavitation (HC) is an emerging non-thermal technology that is capable of improving the quality and shelf life of fruit juices while retaining heat-sensitive bioactive compounds. This study optimized a mixed-fruit juice (MFJ) blend—60% mandarin, 25% pineapple, and 15% watermelon using a D-optimal mixture design. The MFJ was subjected to HC at varying pressures (4–6 bar) and times (40–60 min) and compared to thermal treatment (90 °C for 30 s). The optimized predicted HC treatment (5 bar/52 min) effectively maintained pH, titratable acidity, and TSS. Notably, HC at 6 bar for 60 min reduced the sedimentation index by 2% and lowered viscosity to 3.56 cP. Compared to thermal processing, the optimized HC-treated sample demonstrated superior nutrient retention, preserving 82.29% of vitamin C, 93.50% of total phenolics, 87.43% of flavonoids, and 61.67% of antioxidant activity. Microbial safety was also improved, achieving a 1.35 log CFU/mL reduction in total plate count and 47.96% peroxidase inactivation. While sensory evaluation showed slightly lower acceptability for HC-treated juice (6.36) versus the control (7.14), it significantly outperformed thermal treatment (3.83). Furthermore, the cavitated sample demonstrated superior bioactive retention after 14 days of storage at 4 °C, with total phenolic content retained at 31.55 ± 0.9 mg GAE/100 mL. The findings suggest that hydrodynamic cavitation can be considered a promising non-thermal processing technology for improving physicochemical stability, preserving bioactive compounds, and extending the shelf life of functional fruit beverages. This underscores HC’s potential as a viable, high-quality alternative to traditional pasteurization in the beverage industry. Full article

Advances in screening, surgical techniques, perioperative care, and multimodality treatment have progressively expanded the population of long-term survivors with early-stage non-small cell lung cancer (NSCLC). However, disease-free survival does not necessarily correspond to complete functional recovery after curative-intent treatment. Many patients continue to experience persistent fatigue, dyspnea, reduced physical activity, impaired exercise tolerance, muscle loss, and deterioration in health-related quality of life despite adequate oncologic control. This narrative review discusses functional recovery as a survivorship endpoint in early-stage NSCLC, focusing on recovery trajectories, physiologic vulnerability, frailty, sarcopenia, rehabilitation, symptom burden, and emerging biologic frameworks such as allostatic load. Increasing evidence suggests that survivorship after NSCLC should not be interpreted exclusively according to recurrence or survival metrics, but also according to the ability to recover physiologic reserve, autonomy, and daily functioning after treatment. Functional recovery appears heterogeneous and influenced by multiple interacting factors, including baseline reserve, systemic inflammation, physical inactivity, behavioral adaptation, and cumulative stress burden. Rehabilitation strategies, structured symptom surveillance, and patient-reported outcomes may help identify vulnerable patients and improve long-term survivorship trajectories. Future survivorship models should probably integrate oncologic outcomes with longitudinal functional assessment to better characterize recovery patterns after treatment. Full article

Background: Quality of life (QoL) after spinal cord injury (SCI) is influenced by psychosocial factors, yet less is known about how these factors are examined across national contexts. Objective: This scoping review mapped studies examining depression, employment, and social participation in relation to QoL or health-related QoL (HRQoL) among individuals with SCI in the United States and South Korea. Methods: Following PRISMA-ScR guidelines, five databases were searched for peer-reviewed English- and Korean-language studies published between 2007 and 2025. Results: Sixteen studies were included: nine from South Korea and seven from the United States. Depression and psychological distress were associated with lower QoL/HRQoL in both countries, although South Korean studies more often examined depression with stress and functional concerns, whereas U.S. studies situated depression within participation, spirituality, and youth psychosocial functioning. Employment was linked to QoL/HRQoL in both contexts, with South Korean studies emphasizing economic activity, vocational rehabilitation, and financial strain, and U.S. studies emphasizing employment status and vocational outcomes. Social participation was important in both countries, but South Korean studies focused more on community transition, functional independence, and social attitudes, whereas U.S. studies emphasized participation contexts, accessibility, and social relationships. Conclusions: Across the three domains, depression, employment, and social participation emerged as recurring psychosocial domains associated with QoL/HRQoL after SCI in both countries. These differences suggest that psychosocial adaptation after SCI should be understood within cultural and rehabilitation contexts. Full article

The main causes of lemon fruit senescence and deterioration are fungal diseases and postharvest quality loss. Edible coatings have been proposed to delay quality loss in fresh produce by reducing moisture loss and helping preserve external appearance. Natural functional coatings are increasingly being investigated as potential alternatives to synthetic waxes and preservatives due to environmental and consumer safety concerns. The effect of a natural edible coating based on Opuntia ficus-indica mucilage on extending the shelf-life of lemons during cold storage was investigated. Lemon fruits were treated with the mucilage-based edible coating and subsequently stored under controlled cold conditions. Coated and uncoated lemon fruits were evaluated for their physicochemical properties, including weight loss, total soluble solids, pH, titratable acidity, color, and microbiological analysis, as well as total polyphenol content and antioxidant activity, over a 60-day storage period at 5 ± 0.5 °C and 95% relative humidity. The results showed that the mucilage-based coating improved lemon fruit storage performance, effectively preserving key physicochemical and microbiological parameters over 60 days of cold storage (p ≤ 0.05). In particular, the treatment maintained fruit firmness, reduced weight loss (up to 45%), increased juice content (up to 1.8-fold), and delayed microbial decay compared to control samples. Coated fruits also exhibited higher total polyphenolic content and antioxidant activity than control samples at the end of storage. In addition, using mucilage extracted from cactus pear cladode waste provides a sustainable way to add value to the product, with promising industrial applications as an alternative to synthetic fruit coatings. Full article

Introduction: Population aging is a growing and challenging phenomenon, primarily due to its association with functional decline and sarcopenia, which increase the risk of falls. These events have significant impacts on public health and the quality of life of older adults. Regular physical activity has shown benefits in reducing falls and their consequences, with systemic vibratory therapy (SVT) emerging as a promising strategy to mitigate these adverse outcomes. However, evidence on the actual effectiveness of this therapeutic approach remains limited, as does clarity regarding optimal body position, protocol parameters, and equipment when combined with physical activity programs. Objectives: To compare the effect of systemic vibratory therapy (SVT) associated with a physical activity program on the perception of fear of falling in older adults (M01.060.116.100). As secondary outcomes, the study will assess functional physical conditioning, electromyographic activity, muscular synergy, and center of pressure oscillation in this population. Methods: A randomized controlled clinical trial with blinded outcome assessors and blinded statistical analysis will be conducted with 192 older adults participating in the UNATI/UNISUAM program. Participants will be allocated into three groups: (A) usual physical activity; (B) usual physical activity + SVT in a semi-squat position; and (C) usual physical activity + SVT in a seated position. Assessments will include sociodemographic data, concern about falling assessed using the Falls Efficacy Scale-International (FES-I), physical performance (2 min stationary march test), surface electromyography of the tibialis anterior and medial gastrocnemius muscles, along with posturography using a force platform. Results: This study will provide information on outcomes related to fall risk, balance, physical fitness, and neuromuscular variables in older adults undergoing two distinct SVT protocols. Clinical Trials Registration: Brazilian Registry of Clinical Trials RBR-68pry5j. Registered on 8 December 2025. Full article