Search Results (14,966)

Background/Objectives: Adults at high risk of type 2 diabetes frequently show concurrent dyslipidemia, insulin resistance, and central adiposity before overt diabetes develops. We evaluated cardiometabolic responses to standardized whole-grain staple replacement and examined grain-quality patterns in free-living and country-level settings. Methods: This secondary exploratory analysis included 144 participants (48 per group) from a 12-week, three-arm randomized dietary trial. Participants were analyzed according to their randomized assignments to 100 g/day, 50 g/day, or control. Lipid, anthropometric, body composition, and composite cardiometabolic phenotypes were evaluated. Longitudinal and time-weighted cumulative effects were estimated using linear mixed-effects and regression models, with Benjamini–Hochberg false discovery rate (FDR) correction applied within the corresponding multiplicity domains. Complementary analyses included 30,769 NHANES adults without diabetes, including 12,169 with prediabetes, and descriptive country-level data on whole-grain intake, high-FPG-attributable diabetes burden, and cereal supply. Results: Within the extended phenotype panel, HWG versus control time-weighted cumulative effects included triglycerides (β = −0.220, 95% CI −0.397 to −0.043; FDR-adjusted p = 0.047), the atherogenic index of plasma (β = −0.125, −0.191 to −0.060; FDR-adjusted p = 0.002), and the triglyceride–glucose index (β = −0.301, −0.429 to −0.173; FDR-adjusted p < 0.001). Conventional lipid components showed distinct temporal responses. In NHANES, higher whole-grain exposure and more favorable grain-quality ratios were associated with lower adiposity- and insulin resistance-related phenotypes, whereas refined-grain exposure generally showed the opposite pattern. Country-level analyses showed marked heterogeneity in whole-grain intake, diabetes burden, and cereal supply context. Conclusions: Standardized whole-grain staple replacement was associated with short-term changes across several cardiometabolic dimensions in adults at high risk of type 2 diabetes, with the clearest extended-phenotype signals involving triglyceride-related and glucose–triglyceride coupling measures. NHANES identified cross-sectional grain-quality associations in free-living adults; country-level analyses described heterogeneity in whole-grain intake, diabetes burden, and cereal supply context. Full article

Background: Brolucizumab is an intravitreal anti-vascular endothelial growth factor (anti-VEGF) agent developed to improve retinal drying and treatment durability in diabetic eye disease. However, its overall efficacy and safety in diabetic macular edema (DME) and diabetic retinopathy remain uncertain because available trials differ in population, comparator, dosing schedule, and follow-up. Methods: We searched PubMed, Cochrane Library, Scopus, and Web of Science from inception to 25 April 2026. Randomized controlled trials evaluating intravitreal brolucizumab in adults with DME, diabetic retinopathy, or proliferative diabetic retinopathy (PDR) were included. Comparators were aflibercept, panretinal photocoagulation, or other active/conventional treatments. The main efficacy outcomes were change in best-corrected visual acuity (BCVA) and central subfield thickness/central subfield foveal thickness (CST/CSFT). Safety outcomes included ocular, non-ocular, serious ocular, and serious non-ocular adverse events. Random-effects meta-analyses were performed. Results: Five reports representing four phase 3 randomized controlled trials were included, enrolling 2132 participants overall; the four-trial primary 6 mg analyses included 1942 participants. Brolucizumab was not associated with a significant improvement in BCVA compared with control treatment (mean difference [MD], 1.21 letters; 95% confidence interval [CI], −1.12 to 3.54; p = 0.3; I² = 85.1%). However, brolucizumab significantly reduced CST/CSFT (MD −24.45 µm, 95% CI −47.43 to −1.47; p = 0.0370; I² = 78.2%). No statistically significant differences were detected between groups in the assessed safety outcomes, including ocular adverse events (risk ratio [RR], 0.88), non-ocular adverse events (RR 1.00), serious ocular adverse events (RR 0.63), and serious non-ocular adverse events (RR 0.89). Separate analyses of brolucizumab-specific ocular events showed no statistically significant differences for intraocular inflammation (RR 2.35, 95% CI 0.36–15.42), retinal vasculitis (RR 2.10, 95% CI 0.22–20.10), or retinal vascular occlusion (RR 2.13, 95% CI 0.46–9.87); however, estimates were imprecise because of the small number of events. Conclusions: Across the four included trials, brolucizumab was not associated with a statistically significant difference in BCVA compared with control treatment. In the three DME trials, brolucizumab achieved a greater reduction in CST/CSFT. It may be useful for selected DME patients, while its role in PDR requires longer-term evidence. Full article

Background: Raynaud’s phenomenon (RP) may occur in the pediatric age span, sometimes representing the forerunner of devious underlying conditions. Objective: To investigate the prevalence of vitamin D deficiency in a single-center cohort of children and adolescents with idiopathic RP and evaluate changes in RP severity following cholecalciferol supplementation. Patients and Methods: Sixty-one children and adolescents with RP regularly followed at the pediatric rheumatology unit of our University between 2010 and 2025 were retrospectively evaluated. Clinical, laboratory, and nailfold videocapillaroscopy (NVC) findings were collected at baseline; patients were periodically examined for a mean investigation period of 3 ± 1.6 years. RP severity was assessed using the 2-week Raynaud’s Condition Score (RCS). Patients found to have serum 25-hydroxyvitamin D levels < 20 ng/mL received cholecalciferol supplementation for at least 12 weeks. Results: Nineteen out of 61 patients with RP (31.1% of the cohort) had vitamin D deficiency, while other laboratory parameters including inflammatory markers, complement fractions, liver and renal function tests, lipid profile, and autoimmune panel were non-informative. Univariate analysis demonstrated significant differences between vitamin D-deficient and non-deficient patients in terms of mean RP duration (p = 0.0002), baseline 2-week RCS (p = 0.0001), lupus-like anticoagulant positivity (p < 0.001), NVC pattern (p < 0.001), pain visual analogue scale (VAS) (p = 0.0001), and global quality of life VAS (p = 0.0001). After adjustment for age and sex, baseline 2-week RCS remained significantly associated with vitamin D deficiency. In addition, RCS significantly decreased during follow-up among vitamin D-deficient patients who received supplementation of cholecalciferol. Conclusions: Vitamin D deficiency may be common in pediatric idiopathic RP and pinpoint its severity: our exploratory study supports the routine assessment of vitamin D in children and adolescents with severe forms of RP, warranting prospective randomized controlled trials to determine whether correction of vitamin D deficiency may potentially improve disease severity. Full article

This study assessed the feasibility of a technology-supported high-intensity interval training (HIIT) program for occupational drivers. A multiphase feasibility study incorporating participant feedback was conducted in Flanders, Belgium, including consultation, pilot, and intervention phases. Occupational drivers were randomized to a HIIT group, an active control group (mindfulness program), or a passive control group (no intervention). The 16-week, equipment-free HIIT program consisted of two 15-min sessions per week, delivered via a technology-supported mobile application, preceded by a 2-week baseline. Primary feasibility outcomes included program completion, session adherence, intervention fidelity, adverse events, and participant experiences, while changes in health-related outcomes were assessed as secondary exploratory outcomes using validated questionnaires. During the consultation (n = 11) and pilot (n = 2) phases, participants reported positive attitudes toward the intervention. Key barriers, including scheduling constraints (n = 5) and bicycle transportation (n = 4), informed refinements such as an equipment-free, technology-supported protocol and flexible scheduling. Of the 23 randomized participants across all groups, 16 participants initiated their assigned study protocol, and 10 completed all assessment points and were included in the final analysis. Of the nine participants allocated to the HIIT group, four initiated the intervention (44.4%), and three completed the program (33.3% of those allocated; 75% of those who initiated). Among the three completers, mean session attendance was 80.2%. Session fidelity was well maintained, but exercise-intensity fidelity could not be objectively confirmed. No exercise-related adverse events were reported. Participant feedback indicated generally positive usability but mixed acceptability of the technology-supported HIIT program among the three participants who completed the intervention. Exploratory individual-level changes in health-related outcomes were heterogeneous, with lower mean scores for depression, anxiety, stress, and fatigue. A technology-supported HIIT program was feasible among the small subgroup of occupational drivers who initiated it, with high session attendance. However, considerable pre-initiation attrition and low retention limit its feasibility for the broader target population. Observed health-related outcomes were heterogeneous and should be interpreted descriptively, warranting evaluation in a fully powered randomized controlled trial. Full article

Background/Objectives: Fruit, vegetable and berry (FVB) juice powder concentrates are increasingly used to support cardiovascular health. Since they are usually consumed over long periods, this study assessed the metabolic safety of a commercial FVB supplement and its impact on selected biomarkers of systemic oxidative stress and cardiovascular health. Methods: In this open-label, randomized controlled trial, generally healthy older adults were allocated to a control group (n = 16) or an FVB group (n = 18), ingesting six capsules/day. This work reports the pre-specified 6-month timepoint of a 1-year trial. The primary outcome, metabolic safety, was assessed by hepatic, renal, thyroid, lipid and glucose metabolism markers. Exploratory analysis assessed carbonyl proteins, malondialdehyde, and oxidized LDL as markers of systemic oxidative stress, together with homocysteine and blood pressure as markers of cardiovascular health, while plasma vitamin C served as a compliance marker. Results: The FVB concentrate was well tolerated, and no safety-relevant deteriorations were observed in the FVB group. Carbonyl proteins decreased significantly in the FVB group (interaction p = 0.030). Homocysteine remained stable in the FVB group but increased significantly in the control group (interaction p = 0.002). Furthermore, systolic blood pressure decreased significantly (interaction p = 0.036), with a comparable interaction of diastolic blood pressure (p = 0.011), and plasma vitamin C increased significantly in the FVB group (interaction p = 0.004). After adjustment for baseline values, age and BMI, between-group differences persisted for homocysteine and diastolic blood pressure, whereas the differences in systolic blood pressure and carbonyl proteins were attenuated and no longer reached statistical significance. Conclusions: Six months of supplementation with a commercial FVB concentrate was metabolically safe and well tolerated. Since these findings are based on a pre-specified timepoint and a limited number of participants, they are hypothesis-generating rather than confirmatory and require confirmation by the complete trial. Registered at ClinicalTrials.gov (NCT04763291; registered on 21 February 2021). Full article

Catheter ablation is the cornerstone of rhythm control in atrial fibrillation (AF), yet recurrence remains common, and obesity is among the most consistently implicated modifiable risk factors. Weight reduction and metabolic pharmacotherapy are increasingly used in the periprocedural period, but whether they act through a shared pathway has not been systematically examined. This narrative review compares the two approaches and asks whether metabolic agents confer protection beyond weight loss itself. Three observations argue that they do not act identically. First, the benefit of weight reduction is dose-dependent yet contingent on delivery: a structured, physician-led risk-factor program reduced 12-month arrhythmia recurrence (risk ratio 0.53), whereas nurse-led care that improved guideline adherence without structured delivery did not alter the primary endpoint. Second, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with reduced recurrence across BMI strata despite producing only modest weight loss; notably, a randomized trial in patients without cardiovascular or metabolic comorbidity showed no additional benefit, whereas benefit was observed in patients with type 2 diabetes and heart failure. Third, glucagon-like peptide-1 receptor agonists (GLP-1RA) achieve greater weight loss but yield inconsistent recurrence data, and Mendelian randomization suggests their cardiometabolic benefit is largely BMI-mediated, whereas that of SGLT2i is weight-independent. Together, these observations are consistent with a working hypothesis of two partly distinct atrial substrates—an obesity-related substrate responsive to weight reduction, and a metabolic-inflammatory substrate that may respond to SGLT2i predominantly when metabolic comorbidity is present. This framework is hypothesis-generating: it rests on indirect, cross-study comparisons and has not been tested by formal mediation analysis. If confirmed, it would imply that the two interventions are complementary rather than interchangeable. Full article

Background: Pain is a multidimensional experience shaped not only by nociceptive input but also by cognitive, emotional, and social processes. In musculoskeletal (MSK) rehabilitation, outcome variability among patients with similar clinical presentations suggests that determinants beyond tissue pathology may influence pain perception and recovery. Contextual factors (CFs)—communication, therapeutic relationship, patient expectations, and environmental cues—are increasingly recognized yet remain inconsistently integrated into routine practice. Objective: To map how CFs are represented in the physiotherapy literature indexed under that terminology, and to identify where empirical evidence in MSK rehabilitation is present and where it is absent. Methods: A narrative review with a systematic search strategy, reported following SANRA, was conducted in PubMed and Scopus, searched on 31 March 2026. Records were screened against predefined eligibility criteria, including publication from 2006 onwards and English language. Two reviewers independently screened records and resolved disagreements by consensus. Methodological quality was appraised using the Cochrane RoB2 tool for randomized controlled trials and an adapted Newcastle–Ottawa Scale for observational and cross-sectional studies. Conceptual publications were not formally appraised. Each publication was classified as direct clinical evidence (Tier A), indirect mechanistic or implementation-level evidence (Tier B), or conceptual contribution (Tier C). Results: Eight publications were included: no source provided direct clinical evidence in a musculoskeletal rehabilitation population (Tier A), five provided indirect mechanistic or implementation-level evidence (Tier B), and three were conceptual contributions (Tier C). The single randomised controlled trial retrieved was conducted in asymptomatic volunteers and was at high risk of bias for the between-group comparisons of all reported outcomes. Findings are organised as contextual domains, mediating mechanisms, and outcomes. No direct clinical evidence was retrieved; claims regarding expectations, therapeutic alliance, non-verbal communication, and the clinical environment rest on indirect or conceptual sources. Conclusions: CFs may contribute to pain and rehabilitation variability through cognitive, emotional, and relational pathways, complementing rather than replacing evidence-based care. The scarcity of direct clinical evidence within the literature indexed under this terminology is itself a finding. Construct-level searches and pragmatic trials are required to clarify the contribution of individual contextual domains. Full article

Background and Objectives: Sarcopenia and frailty are associated with falls, disability, and functional decline in older adults. This review evaluated traditional Chinese mind–body exercise (TCMBE), including Tai Chi and Health Qigong, in adults aged 60 years or older with clinically defined sarcopenia or frailty. Materials and Methods: Randomized controlled trials identified through December 2024 from six English- and Chinese-language databases were synthesized. The analyses included physical performance and secondary outcomes and explored sarcopenia and frailty as study-level subgroups. Results: Twenty-two trials involving 1660 participants were included. TCMBE was associated with a shorter Timed Up and Go Test time (mean difference [MD], −1.17 s; 95% CI, −1.80 to −0.54; p < 0.01; I² = 74%), a higher Short Physical Performance Battery score (MD, 0.99 points; 95% CI, 0.58 to 1.40; p < 0.01; I² = 24%), and greater grip strength (MD, 2.02 kg; 95% CI, 0.58 to 3.47; p = 0.006; I² = 89%). The 6 min walk test estimate was borderline and imprecise (MD, 11.76 m; 95% CI, 0.10 to 23.43; p = 0.05; I² = 0%), and no clear overall effects were observed for gait speed, the 30 s chair stand test, sit-to-stand time, Berg Balance Scale score, muscle mass, depressive symptoms, or quality of life. Several analyses showed substantial heterogeneity, and some subgroup estimates were based on only one or two studies. Conclusions: Low-certainty evidence suggests that TCMBE may produce small improvements in TUGT performance, SPPB scores, and grip strength. Very-low-certainty evidence leaves its effects on gait speed and quality of life uncertain. Risk-of-bias concerns, heterogeneity, imprecision, and uncertain clinical significance limit confidence in the current estimates. The available evidence is insufficient to support routine implementation, and larger, rigorously conducted randomized controlled trials are needed. Full article

Background and Objectives: Executive functions (EFs) decline with aging, impacting functional independence. While resistance training (RT) is a promising non-pharmacological intervention, the optimal modality and duration for cognitive benefits remain unclear. Flywheel RT (FRT) imposes greater motor control and attentional demands than traditional RT (TRT), potentially enhancing EFs. Objective: To compare the effects of a 36-week FRT versus TRT program on executive function and serum insulin-like growth factor 1 (IGF-1) levels in healthy older women. Methods: This parallel-group randomized controlled trial allocated 64 older women (overall mean age 66.8 ± 4.6 years; FRT group: 68.0 ± 4.8 years; TRT group: 65.5 ± 4.1 years) to either FRT (n = 25) or TRT (n = 21) for two weekly sessions over 36 weeks. Executive function was assessed using the Victoria Stroop Test (inhibitory control), Digit Span Test (working memory), and Trail Making Test (cognitive flexibility). Serum IGF-1 was quantified via chemiluminescence. Intention-to-treat analyses with ANCOVA were performed. Results: After 36 weeks, both groups showed significant within-group improvements in inhibitory control (mean reduction from pre to post: FRT: 15.2 ± 10.4 to 14.8 ± 7.4 s; TRT: 20.4 ± 11.8 to 15.6 ± 7.3 s; p = 0.028, ηp² = 0.38) and working memory (Digit Span Forward: FRT: 6.2 ± 1.7 to 7.9 ± 2.0; TRT: 6.7 ± 1.5 to 8.7 ± 1.8; p < 0.001, ηp² = 0.84). The B/A ratio of the Trail Making Test improved significantly more in the FRT group (73.0 ± 65.2 to 87.5 ± 68.1 s) compared to the TRT group (67.3 ± 54.1 to 137.7 ± 83.6 s; group × time interaction: p = 0.001, ηp² = 0.13). No significant changes in serum IGF-1 concentrations were observed in either group (FRT: 112.9 ± 25.4 to 115.3 ± 21.3 ng/mL; TRT: 104.7 ± 27.5 to 103.0 ± 28.9 ng/mL; p = 0.88, ηp² = 0.002). Adherence was high (only 4 out of 46 participants did not complete all 72 sessions), and no severe adverse events were reported. Conclusions: Flywheel training appears particularly effective for enhancing cognitive flexibility, likely due to its higher cognitive-motor demands. The absence of significant changes in circulating IGF-1 suggests that the observed cognitive benefits may not be mediated by systemic endocrine pathways, although this does not exclude the possibility of local central nervous system adaptations or changes in other neurotrophic factors not assessed in this study. Full article

Dental caries is a biofilm-mediated, non-communicable, multifactorial disease in which the balance between demineralization and remineralization determines whether an initial enamel lesion remains stable, arrests, or progresses toward cavitation. Contemporary caries management prioritizes preservation of tooth structure and emphasizes individualized decisions based on lesion activity, cavitation status, cleansability, radiographic depth, and patient’s caries risk. Resin infiltration has emerged as a microinvasive approach positioned between noninvasive preventive strategies and conventional restorative treatment. This evidence-based narrative review summarizes the current literature on resin infiltration for incipient, non-cavitated proximal carious lesions in permanent teeth, with emphasis on diagnosis, case selection, clinical protocol, and current evidence. A structured search of three databases (PubMed, Embase, and the Cochrane Central Register of Controlled Trials) identified randomized clinical trials, observational clinical studies, systematic reviews, narrative reviews, and relevant in vitro investigations. The strongest clinical evidence supports resin infiltration for non-cavitated proximal lesions in permanent teeth, particularly enamel and selected outer dentin lesions, where long-term studies demonstrate reduced radiographic progression. In vitro studies indicate that lesion penetration, enamel hardness, and surface roughness depend on lesion characteristics, pretreatment, and technique, and help explain the caries-arresting effect. Current evidence shows that resin infiltration should be considered a selective microinvasive option for incipient proximal caries, guided by lesion assessment and patient’s caries risk rather than a universal substitute for prevention or restoration. Full article

Background: Subjective cognitive complaints (SCCs) are common in middle-aged and older adults and may reflect early cognitive changes, alongside alterations in stress, mood, sleep, and quality of life. N-PEP-12 is a peptide-based nutritional supplement with potential neuroprotective effects, but evidence of its benefits in healthy adults with SCCs remains limited. Objective: To evaluate the effects of N-PEP-12 supplementation on attention, cognitive function, and mental wellbeing in healthy middle-aged and older adults with SCCs. Methods: In this prospective, randomized, double-blind, placebo-controlled trial, 276 participants aged 50–75 years with SCCs and no clinically significant cognitive impairment were randomized to placebo, N-PEP-12 45 mg, or N-PEP-12 90 mg. Assessments were performed at baseline and after 30, 90, and 180 days. Primary outcomes included Test of Attentional Performance measures. Secondary outcomes included WAIS-IV Digit Span Forward and Backward, perceived stress, mood, sleep quality, and EQ-5D-5L visual analog scale. Results: Across the three primary attention outcomes analyzed jointly in a multivariate repeated-measures model, there was a significant group-by-visit interaction (p = 0.003) and a significant effect of visit (p < 0.001), without a significant main effect of treatment arm (p = 0.133), indicating a time-dependent treatment effect. This result was obtained in a sensitivity analysis population in which missing values were imputed under assumptions least favorable to the active arms. In exploratory endpoint-specific comparisons at 90 days, both N-PEP-12 groups showed greater improvements than placebo in alertness, attention omissions and memory omissions, and Digit Span Forward and Backward scores also improved. In a subsequent uncontrolled extension phase, in which all participants received active treatment, participants initially assigned to placebo showed comparable improvements after switching to N-PEP-12 90 mg. These observations are exploratory. Adverse events were infrequent and similarly distributed across groups. Conclusions: N-PEP-12 supplementation was associated with improvements in attention, working memory, and mental wellbeing in healthy middle-aged and older adults with subjective cognitive complaints. These findings support further investigation of N-PEP-12 as a nutritional intervention for early subjective cognitive changes associated with aging. Full article

Background/Objectives: Male hypogonadism affects 35–50% of men with type 2 diabetes mellitus (T2DM) and obesity. The relationship between testosterone deficiency and response to incretin-based therapies (GLP-1 and GIP receptor agonists) remains incompletely understood. This systematic literature review, conducted following PRISMA 2020 guidelines, examines whether male hypogonadism represents a risk factor for poor response to incretin therapy or, conversely, whether these agents offer therapeutic benefits for this population. Methods: A comprehensive systematic literature search was conducted on 31 December 2024, across PubMed/MEDLINE, Scopus, and Web of Science using three search domains: (1) hypogonadism and incretin therapy response; (2) testosterone deficiency and GLP-1/GIP receptor agonists; (3) incretin response and testosterone. Eligibility criteria included human studies (randomized controlled trials [RCTs], observational studies, cohort studies, cross-sectional studies, systematic reviews, and meta-analyses) in adult men reporting testosterone levels and/or incretin response. Animal studies, pediatric populations, case reports with n < 5, editorials, and letters without data were excluded. Study selection followed PRISMA 2020 guidelines with independent dual screening. Risk of bias was assessed using the Cochrane Risk-of-Bias 2.0 tool (ROB2) for RCTs, the Newcastle–Ottawa Scale (NOS) for observational studies, and AMSTAR-2 for systematic reviews and meta-analyses. Due to substantial heterogeneity in study designs, populations, interventions, and outcome measures, a meta-analysis was not feasible; therefore, a narrative synthesis was performed. Results: From 326 records identified, 29 studies were included after deduplication and screening (primary studies: 14; systematic reviews/meta-analyses: five; narrative reviews/expert opinion: 10). Risk-of-bias assessment revealed moderate-to-high overall risk: RCTs had small sample sizes (n = 12–42) and short follow-up (12–24 weeks), raising concerns about statistical power; observational studies were of fair-to-good quality (NOS 4–7 stars) but subject to confounding; and systematic reviews were of low-to-moderate confidence (AMSTAR-2). Primary evidence from RCTs and observational studies demonstrates that GLP-1 receptor agonists (GLP-1RAs)—particularly semaglutide and liraglutide—and the dual GIP/GLP-1 receptor agonist tirzepatide significantly increase total testosterone levels in men with obesity-related functional hypogonadism (mean increase 2.5–5.2 nmol/L). This effect is largely mediated by weight loss and improvement of insulin resistance rather than direct androgenic action. Evidence regarding whether baseline hypogonadism impairs glycemic or weight-loss response to incretin therapy is limited and indirect; no adequately powered comparative trials stratified by baseline testosterone status were identified. Conclusions: Incretin-based therapies, particularly GLP-1 receptor agonists and the dual GIP/GLP-1 receptor agonist tirzepatide, appear to improve testosterone levels in men with obesity-related functional hypogonadism, an effect that is largely mediated by weight loss and improvement of insulin resistance rather than a direct androgenic action. However, direct comparative evidence between hypogonadal and eugonadal men regarding glycemic or weight-loss response to incretin therapy remains insufficient to draw firm conclusions. The hypothesis that male hypogonadism does not impair incretin therapy response is biologically plausible but is currently supported only by indirect evidence. Prospective, adequately powered trials stratified by baseline testosterone status are needed to resolve this question. Full article

Glucagon-like peptide (GLP)-1 receptor agonists (GLP-1RAs) (including medications that contain GLP-1 and other RAs), hereafter referred to as GLP-1 medicines, have significantly advanced the management of metabolic disease and weight management. Obesity is highly prevalent among cancer survivors at the time of diagnosis, and cancer treatments are associated with subsequent changes in weight, either gain or loss. Research has shown that obesity can adversely affect cancer treatment outcomes and survivorship, leading researchers to investigate the potential integration of GLP-1 medicines into oncology care. There is growing interest in understanding the effects of GLP-1 medicines on weight loss and cancer-related outcomes among individuals with obesity who are taking anticancer therapies, as well as individuals treated for cancer in the past who are long-term survivors. This review examines the literature to characterize what is known about GLP-1 medicine use among cancer survivors. The current literature, though limited and largely retrospective, suggests that GLP-1 medicines may contribute to weight loss among cancer survivors, with outcomes varying by cancer stage and type of anticancer therapy. It is important for healthcare providers to consider the potential negative impact of these GLP-1 medications on their patients, especially those with cancer cachexia or sarcopenic obesity, as well as those undergoing anticancer treatments that often lead to weight loss. While there is preclinical evidence suggesting that there are weight-loss independent effects that may be beneficial to individuals with cancer, use of GLP-1 medicines in patients of normal weight for reasons other than treatment of type 2 diabetes should be initiated with caution. On the positive side, these agents may help mitigate therapy-related toxicities, such as cardiotoxicity, with the potential to enhance survivorship outcomes. Unfortunately, there is a notable lack of well-designed randomized controlled trials evaluating the effects of GLP-1 medicines on weight loss, clinical endpoints, and cancer-related outcomes. Advancing the field requires a focus on elucidating the interactions between GLP-1 medicines and anticancer therapies, particularly their impact on treatment efficacy, nutritional status, and overall patient outcomes, both during treatment and in the long term. Full article

This exploratory randomized trial evaluated an eight-week combined isometric and elastic-resistance program in community-dwelling women aged 70 years or older. Forty-nine participants were randomized to exercise (EG; n = 24) or control (CG; n = 25). Twenty-two EG participants completed the intervention and follow-up; two had no post-intervention measurements because of scheduling conflicts. All randomized participants were included in the intention-to-treat analysis using 50 data sets generated by predictive mean matching and baseline-adjusted analysis of covariance. Compared with the CG, the EG showed lower body weight (adjusted mean difference [AMD], −0.45 kg), BMI (−0.19 kg/m²), 4 m gait time (−0.96 s), and five-repetition chair-stand time (−1.60 s), and higher skeletal muscle mass (0.38 kg), calf circumference (0.80 cm), and handgrip strength (1.01 kg). The corresponding primary 95% confidence intervals excluded zero, although the skeletal-muscle-mass interval narrowly included zero under conservative imputation. Differences in body fat percentage (−0.33 percentage points; 95% CI, −1.24 to 0.58) and tandem-stance time (0.79 s; 95% CI, −0.42 to 2.00) were inconclusive. These preliminary findings suggest that the program may improve selected body-composition and functional outcomes. Larger prospectively powered trials are required to confirm their magnitude, clinical relevance, and durability. Full article

Background: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. Results: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0–167.5] μg vs. 280.0 [IQR, 192.5–327.5] μg; p < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. Conclusions: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity. Full article