Search Results (130)

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: Work-related musculoskeletal disorders (WRMSDs) are highly prevalent among construction workers. Ergonomics training and exercise are both used for their management, but the incremental benefit of adding exercise to ergonomics training in this population is unclear. Our aim was to evaluate whether adding a supervised exercise programme to ergonomics training provides additional benefit over ergonomics training alone in construction workers with WRMSDs. Methods: In this single-centre, two-arm randomized controlled trial, 52 male construction workers with musculoskeletal complaints were allocated to an ergonomics training plus exercise group (n = 26) or an ergonomics training alone group (active comparator, n = 26) for 12 weeks. The primary outcome was pain intensity (Visual Analogue Scale—VAS); secondary outcomes were musculoskeletal symptom burden (Extended Nordic Musculoskeletal Questionnaire, NMQ-E), fatigue (Fatigue Severity Scale—FSS), sleep quality (Pittsburgh Sleep Quality Index—PSQI), and occupational burnout (Maslach Burnout Inventory—MBI). The pre-specified primary contrast was the baseline-adjusted between-group difference at 12 weeks (ANCOVA), with a responder analysis as a sensitivity check. Results: Both groups improved significantly from baseline in terms of pain, fatigue, sleep quality, and musculoskeletal symptom burden (all p < 0.001) and in personal accomplishment (p < 0.001); emotional exhaustion and depersonalization were unchanged in both arms. Baseline-adjusted between-group comparisons showed no statistically significant incremental effect of added exercise on pain (adjusted difference −0.34, 95% CI −0.99 to 0.32), fatigue, sleep, symptom burden, or any burnout dimension. The exercise arm showed numerically greater improvements in pain, fatigue, and symptom burden and a higher proportion achieving ≥30% pain relief (96% vs. 77%; odds ratio 7.5), but these differences did not reach statistical significance (p = 0.099). Conclusions: Over a period of 12 weeks, ergonomics training with or without added exercise was associated with significant improvements in musculoskeletal and related outcomes; however, adding exercise to ergonomics training produced no statistically significant incremental benefit. A non-significant trend toward greater pain response with added exercise warrants confirmation in larger, longer trials. Full article

Background/Objectives: Multisensory inputs generate a common gravity-reference frame, but just the otoliths sense the gravity vector. Graviception is frequently assessed by setting a luminous line to the subjective visual vertical (S.V.V.). Population aging and diabetes prevalence, with insufficient physical activity, imply the need to ponder these factors in clinical assessments. This study aimed to assess S.V.V. accuracy/precision in adults with/without diabetes, according to age, physical activity, and general characteristics. Methods: Participants were 262 adults without diabetes (21–80 years old (y.o.)) and 187 adults with diabetes (28–80 y.o.; matched with 187 without diabetes). All participants had no history of otology/vestibular/neurology/autoimmune/orthopedic/severe renal disease or proliferative retinopathy or traumatic injury or balance complaints. After audiology–vestibular evaluations, the International Physical Activity Questionnaire was self-administered and the S.V.V. was estimated during static and on-axis rotation conditions. Results: In participants without diabetes, S.V.V. precision but not S.V.V. accuracy decreased after the age of 50 years, with no further decrease after the age of 70 years (up to 80 y.o.); the main cofactors contributing to the variability on the S.V.V. precision were physical activity and sitting time, with inconsistent contribution from a history of COVID-19 (R = 0.44 static and 0.35 on-axis, p < 0.00001). In participants with diabetes, the major contribution to the S.V.V. precision variability was from diabetes and age (R = 0.33, static and 31 on-axis, p < 0.00001). Conclusions: Apart from aging, the sensorimotor process affected by insufficient physical activity and sedentary behavior includes vestibular decline. The complex pathophysiology of diabetes may account for the contribution from these cofactors. Full article

Tear film instability and dry eye disease (DED) are among the most common postoperative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all disrupt ocular surface homeostasis through mechanisms that include corneal denervation, inflammation, goblet cell loss, and meibomian gland dysfunction. The severity and duration of postoperative dry eye vary substantially according to the surgical procedure performed. This review summarises current evidence on the pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Procedure-specific recovery trajectories are compared to distinguish transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies, including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy, are also reviewed. Understanding these distinct recovery patterns may improve surgical planning, patient counselling, early intervention, visual outcomes, and patient satisfaction. Full article

Background: The vestibular system has traditionally been interpreted within a reflex-based framework, mainly centered on gaze stabilization, vestibulo-ocular reflex pathways, and peripheral vestibular deficits. This model remains essential, but it is insufficient to explain the full spectrum of postural, perceptual, visual-motion, and self-motion complaints observed in contemporary clinical otoneurology. Objective: This conceptual narrative review examines selected representative works by Kathleen E. Cullen as landmarks in a broader transition from reflex physiology to predictive, multimodal, context-dependent, body-centered self-motion control. Methods: This is not a systematic or bibliometric review. Papers were selected because they mark distinct conceptual steps in Cullen’s work: neural encoding of self-motion, peripheral and central coding strategies, multimodal integration, active versus passive self-motion, reafference suppression, body-centered encoding, proprioceptive prediction, vestibular cerebellar internal models, sensory reweighting, and clinical translation. Synthesis: Angelaki and Cullen’s 2008 synthesis and Cullen’s subsequent work demonstrate that vestibular processing is inherently multimodal from the earliest central stages and that neural representations of self-motion depend on behavioral context. Vestibular nuclei, visual-vestibular networks, and vestibular cerebellar circuits integrate labyrinthine signals with optic flow, proprioceptive, oculomotor, motor, cerebellar, cortical, and contextual information. This architecture enables the brain to distinguish expected from unexpected motion, suppress predictable vestibular reafference during voluntary action, compute internal estimates of body motion, adapt to altered sensory reliability, and reweight sensory inputs according to task demands. Conclusions: The clinical relevance of this trajectory is substantial. Patients may show preserved high-acceleration vestibulo-ocular reflex responses while experiencing persistent instability, visually induced dizziness, defective self-motion perception, or abnormal sustained vestibular processing. Such dissociations are not paradoxical when the vestibular system is understood as a predictive, distributed, body-centered control system. Cullen’s long lesson offers a neurophysiological foundation for a modern vestibular grammar in which clinical findings are interpreted across the reflexive, perceptual, postural, visual-vestibular, sustained, and predictive domains. Full article

Contact lens wear is widely used for vision correction by millions of individuals worldwide; however, it remains associated with a spectrum of ocular complications ranging from mild inflammatory conditions to vision-threatening infections. Common contact lens-related complications are predominantly noninfectious, including contact lens discomfort, dry eye syndromes, and papillary conjunctivitis. These conditions are typically mild and manageable with conservative measures. In contrast, corneal inflammatory conditions, such as contact lens-induced acute red eye and peripheral ulcers, represent an intermediate spectrum and may clinically overlap with early infection, creating diagnostic uncertainty. The most serious complication is microbial keratitis, a vision-threatening infection that remains challenging to recognize in its early stages due to its variable and often subtle presentation. Delayed identification may lead to rapid progression and significant visual morbidity. Patients with contact lens-related complaints often present to frontline settings, where early recognition is essential. Distinguishing benign from infectious conditions can be challenging; a risk-based approach with prompt triage and referral, along with proper lens hygiene and patient education, is key. Full article

Objective: To describe the experience of use of laser photobiomodulation in the management of orofacial neurosensory alterations and its clinical outcomes in a series of cases at a public university clinic in Northeast Brazil. Methods: A retrospective case series study was conducted using secondary data from 125 patients treated at the Biophotonics Center of the Federal University of Bahia between 2003 and 2019, all with a confirmed diagnosis of orofacial neurosensory alterations and who were referred to the service by other primary healthcare units in the municipality. Data collection included sociodemographic characteristics, clinical and dental history, and the main patient complaint. The therapeutic protocol consisted of infrared diode laser application (λ 700–808 nm) in continuous mode, performed every 48 h, totaling 12 individualized sessions per treatment cycle. Sensory evolution was monitored using the inverted Visual Analog Scale (VAS). Patients quantified their perceived sensitivity and discomfort at each session, assigning values from 0 to 10, and monitored symptom progression and treatment response over time. Data were analyzed using descriptive and analytical approaches. The study was approved by the Research Ethics Committee of UFBA (protocol 60327516500005024). Results: Tooth extraction was the most frequently reported etiological factor (60%), with an average of three treatment cycles per patient. At the end of follow-up, 67% of individuals reported changes in symptoms, including partial or complete resolution. Cases associated with orthognathic surgery required more treatment cycles; however, no statistically significant association was observed between the number of cycles and the reported outcomes. Conclusions: Laser photobiomodulation has been employed as a therapeutic approach in the management of orofacial neurosensory alterations in this clinical setting. The findings describe patterns of use and the distribution of patient-reported outcomes. Given the observational design, the results do not allow for causal interpretation or inference regarding treatment effectiveness. Full article

Background: Robot-assisted laparoscopic radical prostatectomy (RALP) requires prolonged steep Trendelenburg positioning, which increases intraocular and intracranial pressure. Although transient visual field defects have been documented after RALP using objective perimetric testing, data on patient-reported visual outcomes remain limited. We hypothesized that intraoperative optic nerve sheath diameter (ONSD) measurements and hemodynamic variables would be associated with postoperative patient-reported visual symptoms. Methods: This prospective, single-center observational cohort study enrolled consecutive adult patients undergoing RALP between March and September 2023 at Ospedale Santo Stefano, Prato, Italy. Patients with pre-existing glaucoma, ocular disease, or intracranial hypertension were excluded. Intraoperative ONSD was measured by transorbital ultrasound at three time points: before Trendelenburg (t1), 30 min after Trendelenburg (t2), and at end of Trendelenburg (t3). Postoperative visual symptoms were assessed at ≥1 month follow-up using the validated Catquest-9SF questionnaire. Rasch analysis converted ordinal responses to interval-level measures. Logistic regression explored associations between visual complaints and intraoperative predictors (Rasch scores, lowest mean arterial pressure [MAP], maximum ONSD). Results: Fifty-five patients were enrolled. Six patients (10.9%) reported new subjective visual symptoms at follow-up. Rasch-transformed scores were associated with the presence of these symptoms (coefficient 1.38; p < 0.05). Lowest intraoperative MAP (p = 0.081) and maximum ONSD (p = 0.811) did not reach statistical significance as independent factors. Conclusions: Patient-reported visual symptoms occurred in approximately 11% of patients after RALP. Postoperative Rasch-transformed visual function scores correlated with these complaints. While intraoperative ONSD was not associated with visual outcomes, the potential role of intraoperative hypotension requires further investigation in larger, powered cohorts. Full article

Background and objectives: Acute colicky abdominal pain, involving visceral spasms and inflammatory mechanisms, is a common complaint in everyday medical practice. Despite its widespread use, clinical evidence on the fixed-dose combination of pargeverine 10 mg plus lysine clonixinate 125 mg remains limited. The objective of this study was to describe real-world clinical outcomes, safety, and patient-reported experience associated with this combination in routine practice. Materials and methods: This multicenter, observational, non-comparative, real-world study included adult patients with acute colicky abdominal pain of gastrointestinal, urological, or gynecological origin. Pain intensity was assessed using a visual analog scale (VAS) at baseline and at 5 ± 3 days. Secondary outcomes included time to pain relief, satisfaction with treatment, and safety. Associations between pain reduction and patient-reported outcomes were explored. Results: A total of 202 patients were analyzed. Significant pain reduction was observed across all etiologies (p < 0.001), with median VAS reductions ranging from 6 to 9 points (approximately 70% to 90% from baseline). More than 95% of patients reported early improvement, and sustained relief was maintained in more than 96% throughout the study period, regardless of the pain’s origin. Adverse events were infrequent (3%), mild in intensity (primarily transient gastrointestinal symptoms), and did not lead to treatment discontinuation. Conclusions: In real-world clinical practice, the fixed-dose combination of pargeverine and lysine clonixinate was associated with early and sustained, clinically meaningful pain reduction across multiple forms of acute visceral colicky pain, with a favorable safety and tolerability profile, supporting its relevance as a short-term therapeutic option in mild to severe acute pain. Full article

Visual mental imagery, the ability to generate and manipulate internal visual experiences without direct sensory input, links perception with memory, planning, and higher cognition. In this targeted narrative review, we synthesize neuroimaging and lesion evidence on the brain basis of visual imagery, with a focus on neuroradiological correlates of the ventral and dorsal visual pathways. Unlike prior cognitive neuroscience reviews that primarily emphasize functional mechanisms, this review is neuroradiology-oriented and integrates lesion patterns and white-matter disconnection to support clinico-radiological interpretation of imagery complaints. Using a dual-stream framework, we contrast ventral occipito-temporal systems that preferentially support object imagery (appearance-based features such as form, faces/objects, and color, with texture remaining under-studied) with dorsal occipito-parietal systems that preferentially support spatial imagery (relations, transformations, and navigation). Across studies, imagery recruitment is strongly task- and stage-dependent: ventral regions are most often engaged during object-focused imagery, whereas parietal regions are prominent during spatial transformation tasks, with evidence for interaction between pathways when demands require both content and spatial operations. Structural and clinico-radiological findings indicate that imagery impairment can arise from focal posterior lesions and posterior neurodegenerative syndromes but also from network disruption affecting long-range connections that support top-down access to posterior representations. Finally, emerging work on aphantasia and hyperphantasia supports a network-level view in which imagery vividness relates to how effectively higher-order systems engage visual representations. We conclude that standardized, stream-sensitive tasks and multimodal approaches combining functional and structural imaging with lesion-based evidence are key to discovering clinically actionable biomarkers of imagery dysfunction. Full article

To address the limitations of static and coarse-grained analysis in mining online tourism reviews, this study proposes a gated attention-based multi-model fusion framework for dynamic topic evolution and complaint-driven latent issue pattern mining. Using 300,000 reviews from Ctrip and Meituan, we fuse global semantics from Sentence-BERT with attention (SBERT-Attention), local features from Bidirectional Encoder Representations from Transformers–Text Convolutional Neural Network (BERT-TextCNN), and topic distributions from the Biterm Topic Model (BTM) via a learnable gating mechanism. The fused model achieves an F1-score of 92.3% in review classification. We partition the corpus quarterly and apply Uniform Manifold Approximation and Projection (UMAP) followed by K-means++ clustering to the fused vectors, yielding interpretable topics, including Scenery, Transportation, Amenities, Management, Culture, and Value for Money, and enabling dynamic topic discovery over time. River map visualizations and negative review analysis reveal seasonal evolution patterns and recurring complaint patterns associated with specific topics. The framework enables dynamic, interpretable semantic mining, advancing intelligent processing of short-text user content and offering a generalizable approach for temporal knowledge discovery in smart tourism and beyond. Full article

Background: The Temporomandibular Joint Ankylosis Quality of Life Questionnaire (TMJAQoL) is a disease-specific instrument designed to assess quality of life in patients with temporomandibular joint (TMJ) ankylosis. No validated Turkish version of this scale existed prior to this study. The aim of this study was to translate, culturally adapt, and evaluate the Turkish version of the TMJAQoL (TMJAQoL-TR) in patients with severe temporomandibular disorders, including a predefined ankylosis subgroup. Materials and Methods: A total of 120 patients with temporomandibular complaints were included. Test–retest reliability was evaluated in a clinically stable subsample of 72 participants with a one-week interval. Following forward–backward translation and cultural adaptation procedures, the TMJAQoL-TR was administered together with the Oral Health Impact Profile Short Form-14 (OHIP-14), the Short Form-36 (SF-36), and Visual Analog Scale (VAS) pain scores. Reliability was assessed using Cronbach’s α, item-level Weighted Cohen’s Kappa, and test–retest Intraclass Correlation Coefficients (ICC), supported by measurement error indices (Standard Error of Measurement [SEM] and Minimal Detectable Change at 95% confidence [MDC₉₅]). Construct validity was examined using Spearman correlation coefficients. Structural validity was investigated through exploratory factor analysis, followed by a confirmatory structural model in AMOS to evaluate preliminary model consistency. Floor and ceiling effects were analyzed using the 15% criterion. Results: The TMJAQoL-TR demonstrated excellent internal consistency (Cronbach’s α = 0.879) and very high test–retest reliability (ICC = 0.995; 95% CI: 0.992–0.997). Strong correlations were observed with OHIP-14 (r = 0.772, p < 0.01), and moderate correlations with VAS pain scores (r = 0.312, p < 0.01). No significant floor or ceiling effects were detected. A weak but significant negative correlation with the SF-36 physical role subscale suggests that TMJ-related quality of life impairment is associated with role limitations in daily activities, although the magnitude of this association was modest. Exploratory factor analysis supported a clinically coherent two-factor structure, and the AMOS structural model demonstrated acceptable consistency with this framework. Conclusions: The TMJAQoL-TR appears to be a valid and reliable instrument for assessing quality of life in patients with severe TMJ-related functional limitations. Findings from the ankylosis subgroup support potential applicability within the instrument’s original target population; however, further validation in larger ankylosis-specific samples is warranted. Full article

Background: Ocular candidiasis is a serious metastatic complication of candidemia that may lead to irreversible visual impairment. Although recent meta-analyses suggest an overall prevalence of approximately 10%, real-world data from Southeast Asia remain limited. Regional differences in Candida species distribution, antifungal resistance patterns, and health-care resources may influence both the incidence of ocular candidiasis and the utilization of ophthalmic evaluation in routine practice. Methods: We conducted a retrospective cohort study of patients aged ≥15 years with candidemia at a 900-bed tertiary-care university hospital in southern Thailand between January 2014 and August 2025. Only the first episode of candidemia per patient was included. Ophthalmic evaluation was defined as a dilated funduscopic examination performed by an ophthalmologist within 4 weeks of candidemia onset. Ocular candidiasis was classified as Candida chorioretinitis or Candida endophthalmitis according to established definitions. Multivariable logistic regression was used to identify factors independently associated with receipt of ophthalmic evaluation. Results: Among 337 patients with candidemia, 67 (19.9%) underwent ophthalmic evaluation. Ocular candidiasis was diagnosed in 9 of 67 evaluated patients (13.4%), corresponding to an overall incidence of 2.7% in the entire cohort. Five patients (7.5%) had Candida chorioretinitis and four (6.0%) had Candida endophthalmitis, including two concordant and two discordant cases. Visual symptoms were assessable in 35 patients, among whom only 4 (11.4%) reported visual complaints; most patients with ocular candidiasis were asymptomatic at diagnosis. Candida albicans and Candida tropicalis accounted for 55.6% and 44.4% of ocular candidiasis cases, respectively, and bilateral ocular involvement was observed in 77.8%. Ophthalmic findings led to modification of antifungal therapy in 7 of 9 patients with ocular candidiasis (77.8%), most commonly through addition or switching to an azole-based regimen and/or prolongation of treatment duration. In multivariable analysis, vasopressor use at candidemia onset was independently associated with a lower likelihood of ophthalmic evaluation, whereas early infectious diseases consultation was independently associated with increased odds of receiving ophthalmic evaluation. Conclusions: In this Southeast Asian cohort, ophthalmic evaluation was infrequently performed but yielded clinically actionable findings and frequently altered antifungal management. The observed incidence of ocular candidiasis among examined patients was higher than that reported in Western countries. Underutilization of an ophthalmic evaluation appears to reflect illness severity and care pathway factors rather than low disease burden, suggesting that the true incidence of ocular candidiasis may be underestimated. Integrating ophthalmic evaluation into standardized candidemia care pathways may improve detection of ocular involvement, particularly in resource-limited settings. Full article

Background and Clinical Significance: CEUS enhances the visualization of vascular patterns within liver lesions, enabling differentiation between benign and malignant lesions, including hemangiomas, focal nodular hyperplasia, and hepatocellular carcinoma, with high accuracy. Lymphangiomas are rare benign lymphatic-system tumors, with intra-abdominal lymphangiomas accounting for approximately 5% of cases, most of which occur in the pediatric population. Intra-abdominal lymphangiomas commonly occur in multiple localizations due to lymphangiomatosis, but solitary lymphangiomas in adults are rare and easy to be misdiagnosed due to asymptomatic cases or non-specific symptoms. Case Presentation: A 65-year-old male with a history of left nephroadrenalectomy due to clear renal-cell carcinoma and paraaortic lymphadenectomy (staging pT3bN0M0V1R0) presented for a routine contrast-enhanced abdominal computer tomography examination. The scan showed several hypervascular structures that accumulate contrast in the arterial phase in the right liver lobe. Three years later, the patient developed complaints of abdominal pain and night sweats. Multiple MRI and CT examinations were performed, followed by a CEUS and a liver-core biopsy, which supported the diagnosis of hepatic lymphangioma. Conclusions: CEUS may be a more valuable evaluation method for follow-up examination than repeating CT and MRI scans. The real-time diagnostic possibility and tissue-perfusion data provide more profound information about the lesion of interest. Thus, it can be used as a primary diagnostic tool when a biopsy is performed. Although this method is relatively new, it can be applied in clinical settings with great value, and it saves time and resources. Full article

Background: Building on the validation of the Your Memory test for mild cognitive impairment in English speakers, this study adapted and validated the Memory Test for Mild Cognitive Impairment (TYM-MCI) for older Spanish-speaking adults, highlighting its potential utility for the early detection of amnestic mild cognitive impairment and cognitive profiles associated with increased risk of dementia. Methods: A total of 151 independently functioning adults aged 60 or older (Barthel Index 9–10) completed the TYM-MCI, the Addenbrooke’s Cognitive Examination-Revised (ACE-R-Ch), the Mini-Mental State Examination, and the original TYM. Analyses included ROC curves, correlation matrices, and principal component analysis (PCA). Results: The TYM-MCI exhibited strong psychometric properties (Cronbach’s α = 0.832; sensitivity = 81.7%; specificity = 47.8%). The optimal cut-off score was ≥24.5/30. Scores between 19 and 24.5 suggested probable mild cognitive impairment (MCI). Conclusions: The episodic memory components of this test are key cognitive features relevant to the modification and monitoring of early cognitive decline and are straightforward to administer. Notably, the TYM-MCI specifically assesses both visual and verbal episodic memory. It can be used alongside other assessments, such as the ACE-R or MMSE, to support the clinical evaluation of cognitive functioning in older adults. Clinically, it provides an early assessment and follow-up in individuals presenting with memory complaints, contributing to timely clinical decision-making in the context of cognitive decline. Full article