Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD.

A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features).

Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories 'Measuring and monitoring' and 'Support and Feedback' were present in all apps. Overall, the most implemented features were 'progress in visual format' (n = 13), 'advice on PA' (n = 14) and 'data in visual format' (n = 10). Only three apps included social features, and two included a web-based version of the app.

The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients' PA levels.

Kidney diseases are among the most prevalent conditions worldwide, impacting over 850 million individuals. They are categorized into acute kidney injury and chronic kidney disease. Current preclinical and clinical trials have demonstrated that endothelin (ET) is linked to the onset and progression of kidney disease. In kidney diseases, pathological conditions such as hyperglycemia, acidosis, insulin resistance, and elevated angiotensin II levels lead to an increase in ET. This elevation activates endothelin receptor type A, resulting in harmful effects like proteinuria and a reduced glomerular filtration rate (GFR). Therefore, to slow the progression of kidney disease, endothelin receptor antagonists (ERAs) have been proposed as promising new therapies. Numerous studies have demonstrated the efficacy of ERAs in significantly reducing proteinuria and improving GFR, thereby slowing the progression of kidney diseases. This review discusses the mechanisms of action of ERAs in treating kidney disease, their efficacy and safety in preclinical and clinical studies, and explores future prospects for ERAs.

Currently, the pathogenesis of depression remains poorly understood, leading to many patients receiving ineffective treatment. Resveratrol has demonstrated beneficial effects in the prevention and treatment of depression. However, it remains unknown whether resveratrol administration can counteract depression-like behaviors by regulating the SIRT1/NF-κB signaling pathway.

Male C57BL/6 mice were randomly assigned to a control group, a depression group, and a resveratrol group. The depression model was established using chronic unpredictable mild stress (CUMS) for 5 weeks. Behavioral tests were conducted to assess depressive-like behaviors. The expression levels of SIRT1 and NF-κB in the hippocampus of mice and BV2 microglial cells were measured. After 5 weeks of modeling, the results indicated that mice in the depression group exhibited significant depressive-like behaviors and inhibited activation of the SIRT1/NF-κB signaling pathway. In contrast, resveratrol administration effectively reversed these changes. Results from in vitro experiments showed that LPS stimulation increased microglial activity and downregulated the SIRT1/NF-κB signaling pathway in microglia; however, resveratrol treatment mitigated these effects.

Our findings suggested that resveratrol can alleviate CUMS-induced depression-like behaviors via the activation of the Sirt1/NF-κB pathway in microglia.

To determine how screening positive for depression preoperatively can affect patient reported outcomes after anterior cruciate ligament reconstruction (ACLR).

Primary ACLR patients between May 2020-September 2022 with a PHQ-2 score prior to their surgery were retrospectively reviewed. Patients older than 13 years of age and with minimum 6-months of follow-up were included for analysis. Patients were categorized as PHQ(+) (PHQ-2 ≥2) or PHQ2(-) (PHQ-2 < 2). Demographics, preoperative and postoperative Patient Reported Outcome Information System (PROMIS) -Physical Function (PF) and Pain Interference (PI) scores, Patient Acceptable Symptomatic State (PASS), surgical clinical outcomes, and complications were collected and compared. Chi-square tests and independent t-tests were used for categorical and continuous variables, respectively.

A total of 127 patients were analyzed, with 32 PHQ2(+) and 95 PHQ2(-). The PHQ2(+) group had a lower proportion responding "yes" to PASS preoperatively (6.5 % vs. 25.3 %, p = 0.03), at 9 months (47.4 % vs. 72.4 %, p = 0.05), and 12 months postoperatively (42.9 % vs 79.5 %, p = 0.009). PHQ2(+) reported worse PROMIS-PI scores preoperatively, at 6 months, and at 9 months. The PHQ2(+) group reported worse PROMIS-PF preoperatively, at 6 months, at and 12 months. The PHQ2(+) group had worse IKDC scores preoperatively at 9 months and at 12 months. Those screening positive for depression also demonstrated a higher incidence of postoperative complications (34.4 % vs. 9.5 %, p = 0.001) and reoperation rates (21.9 % vs. 4.2 %; p = 0.002).

A brief preoperative survey, such as the PHQ-2, can provide prognostic value for patient outcomes after ACLR.

III-Retrospective cohort study.

Responses to treatment for Major Depressive Disorder (MDD) vary widely, complicating clinical decision-making. Various clinical prediction instruments are available to support this process and potentially improve treatment outcomes. However, a systematic review to guide clinicians in choosing among these instruments is lacking.

To provide an overview of statistically evaluated clinical prediction instruments that are currently available for clinicians to assist in their decision-making processes. This review focuses on instruments accessible online or in print.

A systematic search following PRISMA/CHARMS guidelines in Medline, Embase, and PsycINFO databases was conducted from January 1, 2010, to March 1, 2023 (PROSPERO: CRD42021261469). Original studies in English reporting on prediction instruments for adults with MDD, available online or in print, were included. The risk of bias in these studies was evaluated using the Prediction model Risk Of Bias Assessment Tool (PROBAST).

Of the 5879 records screened, 111 full-text records were reviewed for eligibility, resulting in 15 original studies that reported on 16 unique prediction instruments. Most instruments (12 out of 16) were designed for use at the beginning or during treatment, while four specifically assessed outcomes after treatment. All studies had a high risk of bias.

This systematic review provides a comprehensive overview of 16 prediction instruments immediately available for clinicians to support decision-making in depression treatment. For use at treatment initiation, we recommend instruments assessing prior treatments and clinical characteristics, such as the Maudsley Staging Method (MSM) or the Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD).

Treatment-resistant depression (TRD) affects one-third of major depressive disorder (MDD) patients. Previous pharmacogenetic studies suggest genetic variation may influence medication response but findings are heterogeneous. We conducted a comprehensive genetic investigation using proxy TRD phenotypes (TRDp) that mirror the treatment options of MDD from UK Biobank primary care records.

Among 15,125 White British MDD patients, we identified TRDp with medication changes (switching or receiving multiple antidepressants [AD]); augmentation therapy (antipsychotics; mood stabilizers; valproate; lithium); or electroconvulsive therapy (ECT). Hospitalized TRDp patients (HOSP-TRDp) were also identified. We conducted genome-wide association analysis, estimated SNP-heritability (hg2), and assessed the genetic burden for nine psychiatric diseases using polygenic risk scores (PRS).

TRDp patients were more often female, unemployed, less educated, and had higher BMI, with hospitalization rates twice as high as non-TRDp. While no credible risk variants emerged, heritability analysis showed significant genetic influence on TRDp (liability hg2 21-24 %), particularly for HOSP-TRDp (28-31 %). TRDp classified by AD changes and augmentation carried an elevated yet varied polygenic burden for MDD, ADHD, BD, and SCZ. Higher BD PRS increased the likelihood of receiving ECT, lithium, and valproate by 1.27-1.80 fold. Patients in the top 10 % PRS relative to the average had a 12-36 % and 24-51 % higher risk of TRDp and HOSP-TRDp, respectively.

Our findings support a significant polygenic basis for TRD, highlighting genetic and phenotypic distinctions from non-TRD. We demonstrate that different TRDp endpoints are enriched with various spectra of psychiatric genetic liability, offering insights into pharmacogenomics and TRD's complex genetic architecture.

This rapid review assessed evidence to inform policy on the clinical effectiveness and optimal frequency of dental scaling and polishing (S&P) for adults, including those with low incomes eligible for the Canadian Dental Care Plan.

A rapid review was conducted according to Cochrane Recommendations for Rapid Reviews. Populations included all adults, adults with periodontitis, and those with inequitable access to dental care. Primary outcomes included gingival inflammation, probing depths, and tooth loss. Secondary outcomes included oral health-related quality of life and economic impact. Four databases were searched for randomized clinical trials, systematic reviews, cohort studies, and practice guidelines. Risk of bias was evaluated using Cochrane Risk of Bias, Newcastle-Ottawa, ROBIS, and AGREE II tools. A qualitative synthesis was planned.

In total, 3,181 references were retrieved: 4 applied to "all adults" and 4 to those with periodontitis. All reports had low risk of bias. One systematic review and one multicenter trial of adults with regular dental care found no clinical benefit regardless of S&P interval; however, patients valued and were willing to pay for regular scaling. One claims-based study reported regular S&P reduced tooth loss, and 2 clinical practice guidelines found a reduced risk of future attachment and tooth loss, lower overall health care costs for diabetes, and reduced costs for and incidence of acute myocardial infarction in those with regular S&P. There were no studies of underserved populations.

For adults with no or early periodontal disease and regular access to dental care, routine S&P may have little clinical benefit but reduces tooth loss and some health care expenses. In patients with periodontitis, scaling intervals tailored to individual risk profile and periodontal status can maintain health. There is no evidence on the impact of routine S&P on patients with barriers accessing care.Knowledge Transfer Statement:In terms of the benefits of routine scaling and polishing in adults, this rapid review found mixed evidence with a high level of certainty due to minimal risk of bias in the appraised studies for "regular dental attenders" and those with a diagnosis of periodontal diseases. Tailored intervals for dental scaling are beneficial for those diagnosed with periodontitis but may not provide the clinical benefits previously expected for adults at low risk. There is no evidence that dental polishing is effective. No evidence was found to support recommendations about the clinical effectiveness of scaling or the most appropriate recall intervals for scaling for low-income Canadians eligible for dental services under the new Canadian Dental Care Plan.

This study aims to develop a novel bioactive resin infiltrant (BRI) to treat white spot lesions (WSLs) of enamel.

BRI was prepared by adding an appropriate amount of high-phosphorus bioactive glass named as PSC (10.8 mol% P2O5-54.2 mol% SiO2-35 mol% CaO) to resin matrix which including 86.5 wt% TEGDMA, 10 wt% HEMA, 0.4 wt% Bis-GMA, 2.6 wt% DMAEMA and 0.5 wt% CQ. The degree of conversion, cytotoxicity, microhardness, elastic modulus, water sorption, and calcium (Ca) and phosphorus (P) ion release of BRI were evaluated. The color change, microhardness, and remineralization of demineralized enamel samples treated with BRI were observed. Icon resin infiltrant (IRI, DMG, Germany) was used as the control.

BRI were proved to be bioactive due to the ability to release Ca and P ions and form hydroxyapatite. The degree of conversion, biocompatibility, and physical properties of BRI were comparable to those of IRI. After application to demineralized enamel, BRI showed similar effects to IRI control group on the color change and penetration depth of enamel. After 28 days of immersion in simulated body fluid (SBF), the microhardness of demineralized enamel treated with BRI is higher than that treated with IRI (P<0.05). PSC particles were observed at the resin-enamel interface after BRI application by scanning electron microscopy (SEM).

The novel bioactive resin infiltrant has the potential to promote remineralization of demineralized enamel and is expected to be used in the treatment of early enamel caries.

Depression is associated with inflammation, and the uric acid to HDL-C cholesterol ratio (UHR) has emerged as a potential marker of increased inflammation; however, the association between UHR and depression is unclear. Therefore, we aimed to explore this association in a sample from the general US population.

We conducted a cross-sectional study of 11,444 participants ≥20 years of age from the 2009-2014 NHANES database. We conducted weighted multivariate logistic regression analyses and restricted cubic spline function (RCS) models exploring the association between UHR and risk of depression, as well as subgroup analyses and tests of interaction.

UHR was positively associated with depression, especially in participants who drank alcohol (interaction P < 0.05).The prevalence of depression increased by 4 % for each 1-unit increase in UHR (OR = 1.04, 95 % CI = 1.02, 1.07, P = 0.003). After dividing the UHR into quartiles compared with the lowest reference group for UHR, participants in the fourth quartile had a significantly increased risk of depression after full adjustment (OR = 1.36, 95 % CI = 1.03, 1.80, P = 0.033).There was a linear dose-response relationship between the UHR and the risk of depression (P for nonlinear = 0.744).

As this was a cross-sectional study, we could not determine a causal relationship between UHR and depression.

The UHR is positively associated with an increased prevalence of depression among adults in the U.S.

Chronic low back pain (LBP) imposes significant burden on patients, healthcare systems and society. Physical therapy is a cost-effective method for improving pain and disability; however, only a small number of patients (7-13%) with LBP ever receive physical therapy services. Patients report obstacles to accessing physical therapy, such as transportation, provider availability and missed work. Access is especially limited in rural communities, where approximately 40% fewer physical therapists are available per capita than in metropolitan regions. This lack of access likely contributes to the greater rates of LBP-related disability and opioid consumption in rural communities. Innovative methods for improving access to physical therapy for patients with chronic LBP are urgently needed; these can help address differences in health outcomes and mitigate opioid dependence for patients with chronic LBP living in rural communities. Telerehabilitation increases access to physical therapy, which can potentially improve health outcomes for these patients.

This prospective, individually randomised group treatment trial will involve primary care clinics serving rural communities on Maryland's Eastern Shore. We will enroll 434 individuals with chronic LBP. Eligible patients will be randomised to either standardised education for back pain delivered via website or to a risk-informed telerehabilitation. Standardised education will be delivered via a study website containing information consistent with materials provided by primary care providers. Risk-informed telerehabilitation will be delivered by trained physical therapists using a web-based, video-enabled telehealth platform. The primary outcome is LBP-related disability. Secondary outcomes are opioid use, pain intensity, health-related quality of life and LBP-related healthcare use assessed using standard patient-reported outcome measures, participant self-report and medical chart abstraction. Implementation outcomes are acceptability, adoption, feasibility and fidelity of our treatment approach guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and assessed using surveys, semi-structured interviews and key performance metrics.

Ethics approval was obtained from the Johns Hopkins Medicine Institutional Review Boards (IRB), which serves as the single IRB for this trial. Upon completion, study data will be shared in compliance with National Institutes of Health guidelines.

NCT06471920.

Dental caries is a worldwide ailment and universally affects about 500 million children. We investigated the clinical signature of vitamin D receptor (VDR) Taq I rs731236 and Amelogenin gene on X chromosome (AMLEX) rs946252 variants with dental caries susceptibility and severity in Egyptian children. This study enrolled 200 dental caries children aged 6-12 years, subdivided into 100 moderate and 100 severe dental caries subgroups, and 100 caries-free control children age-matched. The gDNA extraction was executed from buccal swabs and the genotyping was accomplished by TaqMan® allelic discrimination assay. Our study depicted a substantial association between mutant (G) allele of VDR Taq I rs731236 variant and dental caries susceptibility under allelic (OR = 1.68, 95 %CI = 1.16-2.4, P = 0.005), codominant (GG versus AA, OR = 2.66, 95 %CI = 1.22-5.59, P = 0.01), dominant (OR = 1.8, 95 %CI = 1.11-2.98, P = 0.02) and recessive (OR = 2.1, 95 %CI = 1-4.3, P = 0.047) models. Additionally, a substantial association between mutant (G) allele of VDR Taq I rs731236 and dental caries severity under allelic (OR = 1.68, 95 %CI = 1.13-2.5, P = 0.01), codominant (GG versus AA, OR = 2.6, 95 %CI = 1.15-5.9, P = 0.03), and dominant (OR = 1.9, 95 %CI = 1.09-3.5, P = 0.04) models. Contrariwise, our findings revealed a substantial reduction in dental caries susceptibility associated with mutant (T) allele of AMLEX rs946252 variant under codominant (CT versus CC, OR = 0.53, 95 %CI = 0.32-0.89, P = 0.02), dominant (OR = 0.51, 95 %CI = 0.31-0.85, P = 0.01) and allelic (OR = 0.64, 95 %CI = 0.44-0.9, P = 0.01) models. In conclusion, our discoveries suggested that the existence of the VDR Taq I rs731236 variant may predispose the dental caries susceptibility and severity, whereas the presence of AMLEX rs946252 variant may protect against dental caries.

The purpose of this study was to verify the influence of three different seat inclinations for work as measured by comfort and changes in vertebral curvatures for the position of work.

The kinematic analysis was recorded at the vertebral levels of T5, T10, L3 and S2 to measure the lumbar and thoracic-lumbar angles. The seat allowed adjustments of the angles (0o, 15o and 30o) and the Likert scale was used to assess the subjects' level of comfort. Each data collection session was performed in a 60-min period. The statistical analysis compared groups through multivariate analysis of variance considering the factors: gender, seat angles and instant. As dependent variable, the comfort level, spine angles were considered.

We included 32 healthy subjects with aged 18-25 years. Male present bigger thoracic-lumbar angles and smaller lumbar angles. Male present more comfort levels. The seat inclination at 30° causes less thoracic-lumbar angle and less comfort, whereas the seat angle at 0o causes less lumbar angle. There are several and frequent variations in the spine curvatures along a 60-min period and, after 27 min in sitting posture there was a gradual decrease in the comfort level, independent on the angle of seat inclination.

The best inclination of the seat was that maybe it is between 0° and 15°, since the results show that in both analysis, the thoracic-lumbar and lumbar angles, and, comfort level, the inclination of 30° seems to be inadequate.

Low back pain affects individuals and society, straining Emergency Departments (EDs) and prolonging wait times. While personal factors influence ED visits, third-party advice's role is underexplored. Limited guidance for healthcare professionals emphasises the need for effective back pain management to ease system strain and improve patient outcomes. This study examines motivations for ED visits due to low back pain.

This research utilised secondary analysis of qualitative data from a previous multisite study, adopting a subtle realist approach. From August to December 2021, 47 patients (26 M:21 F, aged 23-79) with back pain were sampled from four English EDs (2 Northern, 2 Southern) to capture diversity in sociodemographic and LBP characteristics. Eight patients had previously visited the ED for this back pain episode. During the pandemic, semi-structured interviews were conducted online, audio-recorded, transcribed, and analysed thematically. Three key themes influenced decisions to attend ED: Healthcare professionals, trusted others, and individuals. Healthcare professionals often dictated choices, making participants feel powerless. Trusted others offered varying support, acting as allies. Individuals wrestled with anxiety about pain severity and uncertainty regarding LBP.

This study emphasises the need for healthcare professionals to offer clear guidance on when individuals and their caregivers should visit the ED for back pain. Findings show that pain-related worries significantly drive ED visits, misaligning with practice guidelines. Healthcare providers must consider these issues when creating strategies to manage low back pain patients and optimise ED resources.

The study of severe mental conditions has primarily remained under the purview of basic and clinical research. Although global epidemiological data indicate that immigrant groups are at higher risk of these conditions, U.S. data are lacking. Qualitative studies can be an important first step to bring attention to understudied phenomena.

This manuscript describes strategies used to conduct semi-structured, in-depth individual interviews on experiences and perceptions of severe mental conditions among South Asian individuals with psychiatric diagnoses (n=21), family members (n=11), and clinicians (n=4) in New York City. These strategies were synthesized from the team's internal notes of adaptations during the study design and data collection, weekly debrief meetings during data analysis, and brainstorm sessions for this manuscript.

The main results of the study are reported elsewhere. This section focuses on lessons learned to improve immigrant participant interest and engagement, including the strengths and limitations of the healthcare setting; recruitment by a multilingual South Asian psychiatrist; interviews by non-clinical South Asian researchers selected for a variety of ages, genders, and languages; and the interview process and content.

Overall, these strategies show the feasibility of non-clinical researchers to collect high-quality data about severe mental conditions among immigrant communities, noting that the details of specific strategies and results will be particular to each immigrant community. Public health research on severe mental conditions is essential to understand and address the experiences of severe mental conditions among immigrant communities in the U.S.

This study aims to understand the utility of a stepwise technology-based audiometry with rapid results (STARR) school screening protocol.

A prospective cohort study.

Six elementary schools in a single school district in Minnesota.

Students at 6 elementary schools in Minnesota participated in the STARR protocol and underwent initial technology-based hearing screening, followed by additional comprehensive automated audiometry with insert earphones and point-of-care otoscopy if they were referred. Results were reviewed by an otolaryngologist remotely, and parents received treatment recommendations based on these findings.

A total of 454 (81% of eligible) students were screened and 27 students (5.9%) referred. On average, the initial screening took 55 seconds (standard deviation [SD] = 22) for those who passed and 116 seconds (SD = 55) for those who were referred. Comprehensive audiometry screening took 163 seconds (SD = 27) for those who passed and 252 seconds (SD = 100) for those who referred. A team of 6 screeners could screen a class of 30 students in 30 minutes. The total number of nursing encounters required to ensure a student saw a provider after a referral was reduced using the STARR protocol (2.47 encounters per referral) compared to traditional audiometric screening (3.39 encounters per referral) (P < .01).

The STARR protocol is a feasible and efficient method of screening in public schools that can reduce false referral rate, provide parents with more information at the point of referral, and reduce nursing burden.

Technology-based hearing screenings should be considered in school settings as a means to provide more patient and family-centered hearing health care. Further research is necessary to understand how the STARR protocol influences loss to follow-up rates after failed hearing screening.

Physical activity (PA) is recommended as a primary treatment to reduce pain and improve function in chronic low back pain (cLBP). However, adherence to PA guidelines and the limitation of sedentary behavior (SB) remain challenging for cLBP patients. While some studies focus on PA promotion, past results are mixed, and the role of SB has not been thoroughly investigated. This observational study aims to assess changes in PA and SB levels among cLBP patients participating in a rehabilitation program (RP) and explore related changes in both explicit and implicit motivational factors. Patients wore an accelerometer for 1 week before the RP (T1) and 3 months afterward (T4) to measure PA and SB. At the start (T2) and at the end (T4) of the RP, we measured motivation, including implicit attitudes, toward these two behaviors. Between T1 and T4 ( n  = 33), the results show a significant decrease in SB. Between T2 and T3 ( n  = 62), all motivational variables were significantly more in favor of an active lifestyle, but implicit attitudes did not significantly change. This study shows that an RP can transform behavior determinants and reduce SB but is less efficient to increase PA levels. It also emphasizes the need to work with patients to enhance adherence and objectively measure behaviors in the future.

The aim has been to translate and cross-culturally adapt the Exercise Adherence Rating Scale (EARS) for Mexican Spanish speaking population with non-specific chronic low back pain and assess its psychometric properties.

The study had two phases: translation and cultural adaptation, followed by psychometric validation. Reliability was assessed with internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient); validity with construct validity (Spearman's correlation) and factor analysis; sensitivity to change with effect size and standardized response mean difference; feasibility by completion time in seconds; and ceiling/floor effects were calculated.

A total of 161 subjects were included. Cronbach's alpha (0.93; 95% CI 0.92-0.95) indicated good internal consistency, and intraclass correlation (0.95; 95% CI: 0.89-0.97) showed excellent test-retest reliability. Weak correlations between the EARS vs. the Visual Analogue Pain Rating Scale and the Roland Morris Disability Questionnaire were found (r = -0.29 and r = 0.00 respectively). All effect size values indicated that the scale presented a significant sensitivity to change. The average time to complete the EARS-Mx was 219 s. No ceiling or floor effect was detected.

The EARS-Mx showed semantic, conceptual, idiomatic, content and operational equivalence with respect to the original scale, and appropriate metric properties of reliability, validity, sensitivity to change and feasibility.

Intervertebral disc degeneration (IVDD) is a prevalent condition leading to low back pain. Endoplasmic reticulum stress (ERS) is strongly linked to IVDD progression, although the underlying mechanisms remain unclear. In this study, we investigated the effects of NOXA on ERS-induced IVDD. Primary nucleus pulposus cells (NPCs) were stimulated with Thapsigargin to mimic the ERS microenvironment in IVDD. Western blot analysis, PCR, immunofluorescence, and immunohistochemistry assay were performed to measure the expression levels of PERK, NOXA, and cell apoptosis- and extracellular-matrix-degradation-relevant proteins. JC-1 fluorescent probes, terminal deoxynucleotidyl transferase dUTP nick end labeling staining, and flow cytometry were used to measure mitochondrial function and apoptosis in NPCs under ERS conditions. Magnetic resonance imaging, Safranin O staining, alcian blue staining, and immunohistochemistry were performed to estimate the effects of NOXA knockdown on acupuncture-mediated IVDD in rats at both imaging and histological levels. The results showed that ERS induced and activated the PERK pathway during IVDD development. Mechanically, ERS induced NPC apoptosis and ECM degradation by upregulating PERK expression and activating NOXA expression. The genetic overexpression of NOXA inhibited cell proliferation and increased apoptosis, whereas its knockdown decreased MCL-1 expression and alleviated IVDD degeneration in human NPCs and rat models. NOXA plays a crucial role in the PERK/NOXA/MCL-1 axis, mediating the link between ERS and IVDD. Targeting NOXA expression may be an effective method for treating IVDD, laying the foundation for future research on molecular mechanisms and the development of new therapies.

Genetic factors contribute to weight gain, but how these effects change over adulthood is still unknown. We studied the impact of genetics on BMI change from young adulthood to old age and its relationship with BMI in early young adulthood.

Data from 16 longitudinal twin cohorts, including 111,370 adults (56% women) and 55,657 complete twin pairs (42% monozygotic), were pooled. The data were divided into three stages (young adulthood-early middle age, late middle age, and old age). BMI change was calculated using linear mixed effects and delta slope methods. Genetic and environmental contributions to these changes and their correlations with baseline BMI were estimated through structural equation modeling.

The average BMI increase per year was 0.18 kg/m² in men and 0.15 kg/m² in women during young adulthood-early middle age (18-50 years), decreasing to ≤0.07 kg/m² at older ages. Genetic effects contributed to BMI change during young adulthood-early middle age (men a²=0.29; women a²=0.26) and less so in late middle age (51-64 years) (men a²=0.05; women a²= 0.16) and old age (>65 years) (men a²=0.13; women a²= 0.18). Most variation was explained by non-shared environmental effects. In men, greater BMI during early young adulthood (18-30 years) was associated with lower BMI change later in life (r= -0.22 to -0.13), and the association was driven by genetic (r A =-0.27) and non-shared environmental (r E =-0.22 to -0.14) factors. In contrast, the association was positive in women (r=0.05-0.28) and was explained by genetic factors (r A =0.27- 0.51).

Genetics influence BMI change across adulthood, with their impact varying by age and sex. Environmental factors are the main drivers of adult BMI change, highlighting the role of modifiable factors in long-term weight regulation.

Insomnia represents a common sleep disorder in major depressive disorder (MDD) that is associated with unfavourable treatment outcomes. Yet, it is unknown whether this relationship varies between treatment modalities. The present study aimed to evaluate the predictive value of insomnia for remission status following pharmacotherapy, psychotherapy, and combined therapy.

Data were obtained from five randomised clinical trials investigating the efficacy of MDD treatment in a homogeneous study population. Patients with MDD (N = 898) aged between 18 and 65 years were assessed for insomnia (item score ≥ 2) and remission (total score ≤ 7) using the Hamilton depression rating scale (HDRS-17). Logistic regression analyses were performed to evaluate and compare the predictive value of pre-treatment insomnia for remission status following 24 weeks of treatment while controlling for sex, age, and baseline depression severity.

Insomnia was associated with significantly lower odds of remission overall (OR = 0.618, 95%CI [0.450-0.849]) as well as for pharmacotherapy (OR = 0.219, 95%CI [0.069-0.692]) and combined therapy (OR = 0.583, 95%CI [0.348-0.976]) but not for psychotherapy. The predictive value was, however, not significantly different between the treatment modalities even though direct comparisons revealed significantly higher odds of remission following psychotherapy compared to pharmacotherapy in the insomnia relative to the control group (OR = 3.414, 95%CI [1.013-11.505]).

Insomnia is associated with a decreased likelihood of remission in MDD. The most profound impact is observed for pharmacotherapy and combined therapy whereas the clinical relevance for psychotherapy appears modest.

This study aims to report the trends and cross-national disparities in the burden of osteoarthritis (OA) by region, age, gender, and time from 1990 to 2021, and to further project changes through 2035.

In this systematic analysis based on the Global Burden of Disease (GBD) study, population survey data on osteoarthritis from 21 countries/regions and U.S. insurance claims data were used to estimate the prevalence and incidence of OA in 204 countries and regions from 1990 to 2021. The reference case definition for OA was symptomatic and radiographically confirmed osteoarthritis. Studies using definitions other than the reference, such as self-reported OA, were adjusted through a regression model to align with the reference case. The distribution of OA severity was derived from a pooled meta-analysis using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLD). An Autoregressive Integrated Moving Average (ARIMA) model was used to forecast the prevalence and incidence of OA through 2035.

In 2021, approximately 607 million (95%UI 538-671) people worldwide were affected by osteoarthritis, accounting for 7.7% of the global population. Compared to 2020, the age-standardized prevalence of OA among males is projected to increase from 5,763 per 100,000-5,922 per 100,000 by 2036, while the age-standardized prevalence among females is expected to decline slightly from 8,034 per 100,000-7,925 per 100,000. In 2021, the global age-standardized YLD rate for osteoarthritis was 244.5 (95%UI 117.06-493.11), the global age-standardized prevalence rate was 6,967.29 (95%UI 6,180.7-7,686.06), and the global age-standardized incidence rate was 535 (95%UI 472.38-591.97). In 2021, the age-standardized prevalence rate exceeded 5.5% across all regions, ranging from 5,675.8 per 100,000 (95%UI 5,001.76-6,320.8) in Southeast Asia to 8,608.63 per 100,000 (95%UI 7,674.07-9,485.19) in high-income Asia Pacific regions. The knee was the most commonly affected joint. High BMI and metabolic risks are the only two GBD risk factors for osteoarthritis. From 1990 to 2021, the age-standardized prevalence, incidence, and YLD attributable to osteoarthritis have been on the rise, with substantial international variations across indicators. Countries with high socio-demographic index (SDI) bear a disproportionately high burden of OA, and inequalities in the burden of disease due to differences in SDI between countries have been increasing over time.

As a major public health problem, the overall global burden of OA has shown an upward trend from 1990 to 2019, including an increase in the number of cases and inequalities in distribution across the globe, which has resulted in significant health losses and economic burdens. In addition, SDI-related inequalities between countries are increasing. In this regard, national public health authorities and the World Health Organization (WHO) should work together to improve diagnosis and early treatment rates by strengthening disease awareness and education, as well as strengthening international cooperation, providing necessary medical assistance to less developed regions, and actively exploring new strategies for the prevention and treatment of OA.

Antimicrobial resistance (AMR) in Salmonella Typhi (S. Typhi) is a serious health issue that can complicate typhoid fever treatment and increase fatality rates. The National Centre for Disease Control, Government of India, established a National Antimicrobial Surveillance Network to detect AMR in high-priority infections, including S. Typhi throughout geographical areas of India, and understand AMR dissemination and possible treatment options. The Gujarat State Biotechnology Mission, Government of Gujarat, India, has funded the "Network Program on Antimicrobial Resistance, Superbugs, and One Health" to track antibiotic resistance patterns in the Gujarat region. Given the enormity of the AMR problem in S. Typhi, in Gujarat, this study evaluated the antibiotic resistance patterns of S. Typhi isolates from the Ahmedabad and Vadodara regions of Gujarat, India, were used to determine the mechanism underlying antibiotic resistance and developed combination treatments to combat the extensive drug-resistant isolates. We collected 122 Salmonella isolates periodically (2022-2023) in the Ahmedabad and Vadodara regions of Gujarat, India. The antibiotic susceptibility for 122 S. Typhi isolates was prepared using the disc diffusion method and VITEK II compact system. Whole-genome sequencing and in-silico analysis were performed to identify potential antibiotic resistance genes (ARGs); in addition, combination antibiotic therapies were investigated, and resistance patterns were predicted for key antibiotics used in the treatment of typhoid fever. The study discovered notable levels of antibiotic resistance, specifically to cefuroxime (97.54%), doxycycline (97.54%), ceftriaxone (95.90%), cotrimoxazole (95.90%), ampicillin/sulbactam (95.90%), cefotaxime (94.26%), and ciprofloxacin (94.26%). Genetic analysis revealed the presence of aph(3'')-Ib (40.16%), aph(6)-Id (95.08%), blaCTX-M (89.39%), dfrA14 (68.85%), plasmid-mediated quinolone resistance (PMQR), and the qnrS1 gene (94.26%). IncFIB(K) and IncFIB(pHCM2) were detected in 96.71% of S. Typhi isolates. Point mutations in the QRDR region of gyrA identified three distinct modifications: Ser83Phen (91.80%), Ser83Leu (1.64%), and Ser83Tyr (0.82%). Three genes exhibited point mutations: gyrB (100%), Ile253Val, and parC (6.56%) multiple mutations, and the efflux gene mdtK (100%) Thr224Lys. By evaluating phenotype and genotype, the tests showed an average concordance of 91.69% and a discordance of 8.31%. The study revealed that 97.54% of isolates belonged to the H58 haplotype lineage II (ST1: 4.3.1.2), which is associated with high resistance to cephalosporins and fluoroquinolones in Southeast Asia. The combination therapy of β-lactam/β-lactamase inhibitors (BL/BLI) demonstrated good outcomes, with low MICs (<0.5 µg/mL) of ceftazidime/tazobactam, cefixime/tazobactam, and ceftriaxone/tazobactam effective against highly resistant S. Typhi. The emergence of MDR-XDR S. Typhi, attributed to mutations in gyrA, parC, and the H58 lineage, highlights widespread resistance. According to our research, a potential strategy against XDR S. Typhi is a combination treatment with BL/BLI.

One of the first studies to assess the antimicrobial resistance patterns of S. Typhi isolates from the Ahmedabad and Vadodara regions; this particular investigation provides vital information on the occurrence of key resistance genes and mechanisms. This study has significantly contributed by finding the β-lactam/β-lactamase inhibitor combination therapy as an appropriate treatment choice for XDR, which can potentially use S. Typhi on a larger scale. Additionally, it provides the antibiotic resistance prediction of key antibiotics used for treating typhoidal fever. The outcomes of this investigation highlight the urgent need to address the surge of XDR S. Typhi in high-burden regions of Gujarat. Our study highlights the possibility of rapid dissemination of antibiotic resistance due to chromosomal point mutations and plasmid-mediated gene transfer. The effectiveness of β-lactam/β-lactamase inhibitors in handling XDR S. Typhi suggests a plausible strategy for treatment that may be included among clinical guidelines.

The impact of mental health and chronotype on occupational outcomes has been examined, most of the studies linking mental disorders and eveningness with unfavourable occupational outcomes. However, no previous studies have explored the significance of chronotype in income and labour market attachment among individuals with mental disorders.

Utilizing the Northern Finland Birth Cohort 1966 with linkages to registers and questionnaire data, we compared income and labour market attachment until midlife among individuals with 1) morning or intermediate type (M/I-type) and no mental disorder (reference group), 2) evening type (E-type) and no mental disorder, 3) M/I-type and mental disorder, and 4) E-type and mental disorder by using cross-tabulations and regression analyses. We stratified our analysis by sex.

Compared to the reference group, E-types with mental disorders had the lowest cumulative income irrespective of sex. Among females, E-types with mental disorders had the highest risk for poor labour market attachment when compared to the reference group (OR (95 % CI) 2.33 (1.30-4.16)). Among males, M/I-types with mental disorders had heightened odds for poor labour market attachment (OR (95 % CI) 2.25 (1.55-3.27)), whereas for E-types with mental disorders, the risk was slightly non-significant (OR (95 % CI) 2.13 (0.95-4.78)).

This study highlights the significance of chronotype in income and labour market attachment among individuals with mental disorders. From the perspectives of healthcare and employers, individual interventions to support work ability should be targeted at E-types with mental disorders, as eveningness may contribute to poorer occupational outcomes in this group.

Wound healing in diabetic patients is mainly hindered by a combination of long-term glycosylation, persistent inflammatory response, and immunosuppressive state. The interaction of these factors not only results in considerable prolongation of the wound healing process but also elevates the likelihood of recurrent ulcer development, profoundly affecting patients' quality of life. Traditional treatments, including surgical debridement, anti-infection, dressing application, vascular intervention, and glycaemic control, can only relieve some symptoms. However, they are often ineffective in addressing the underlying cause of impaired wound healing. It is of concern that the importance of the immune microenvironment in diabetic wound healing has not yet been fully appreciated and investigated, and the homeostasis of the immune microenvironment is crucial for promoting cell proliferation, angiogenesis, and tissue repair. However, this microenvironment is often dysregulated in the diabetic state. This paper reviews the key factors leading to dysregulation of the immune microenvironment, including immune cell dysfunction, abnormal cytokine expression, and disruption of key signalling pathways, and introduces an innovative silicone-based microneedle drug delivery method, which takes advantage of microneedle's precise targeting and highly efficient drug loading capacity to deliver drugs with immunomodulatory functions directly to the wound in a sustained manner, activate the corresponding signalling pathways, promote the polarization of M1 macrophages into the M2 phenotype, and stimulate neovascularization, providing a low inflammatory and pro-angiogenic immune microenvironment for diabetic wound healing, which provides a new therapeutic idea and means for diabetic wound healing.

Intervertebral disc (IVD) degeneration is an age-related problem triggering chronic spinal issues, such as low back pain and IVD herniation. Standard surgical treatment for such spinal issues is the removal of the degenerated or herniated IVD and fusion of adjacent vertebrae to stabilise the joint and locally decompress the spinal cord and/or nerve roots to relieve pain. However, a key challenge of current surgical strategies is the increasing risk of adjacent segment degeneration due to the disruption of native biomechanics of the functional spinal unit, dominated by the loss of the IVD. In the past two decades, research has focused on developing a number of bioengineering approaches to repair and regenerate the IVD; in particular, tissue engineering of the IVD, using bioscaffolds and stem cells represents a promising area. This review highlights the current tissue engineering approaches utilising biomaterials, animal models and cell sources for IVD regeneration and discusses future opportunities.

The investigation and diagnosis of hematologic malignancy using blood cell image analysis are major and emerging subjects that lie at the intersection of artificial intelligence and medical research. This survey systematically examines the state-of-the-art in blood cancer detection through image-based analysis, aimed at identifying the most effective computational strategies and highlighting emerging trends. This review focuses on three principal objectives, namely, to categorize and compare traditional machine learning (ML), deep learning (DL), and hybrid learning approaches; to evaluate performance metrics such as accuracy, precision, recall, and area under the ROC curve; and to identify methodological gaps and propose directions for future research. Methodologically, we organize the literature by categorizing the malignancy types-leukemia, lymphoma, and multiple myeloma-and particularizing the preprocessing steps, feature extraction techniques, network architectures, and ensemble strategies employed. For ML methods, we discuss classical classifiers including support vector machines and random forests; for DL, we analyze convolutional neural networks (e.g., AlexNet, VGG, and ResNet) and transformer-based models; and for hybrid systems, we examine combinations of CNNs with attention mechanisms or traditional classifiers. Our synthesis reveals that DL models consistently outperform ML baselines, achieving classification accuracies above 95% in benchmark datasets, with hybrid models pushing peak accuracy to 99.7%. However, challenges remain in data scarcity, class imbalance, and generalizability to clinical settings. We conclude by recommending the integration of multimodal data, semisupervised learning, and rigorous external validation to advance toward deployable diagnostic tools. This survey also provides a comprehensive roadmap for researchers and clinicians striving to harness AI for reliable hematologic cancer detection.

This study examines how weight-adjusted waist index (WWI) correlates with the occurrence of migraine in U.S. adults.

Being overweight significantly increases the likelihood of experiencing migraines; nonetheless, conventional metrics like waist circumference (WC) and body mass index (BMI) might not completely capture the level of migraine risk tied to obesity. WWI integrates the strengths of WC while minimizing its correlation with BMI, which might make it a more accurate indicator of central obesity-related migraine susceptibility.

This study performed a cross-sectional analysis using data from 9,688 participants obtained from the National Health and Nutrition Examination Survey (NHANES), covering the years 1999-2004. Migraine occurrence was evaluated through questionnaires, and participants' WWI was computed. Weighted multivariable logistic regression models were used to examine the association between WWI and migraines. Restricted cubic splines (RCS) were applied to evaluate the dose-response relationship between WWI and migraines. Furthermore, interaction tests and subgroup analyses were executed. The receiver operating characteristic (ROC) curve, paired with DeLong et al.'s test, was employed to compare the predictive power of WWI, BMI, and WC for migraines.

The overall prevalence of migraines was found to be 21.50% (weighted population: 31,888,075 out of 148,278,824). In Model 3, the link between WWI and migraines in women showed no statistical significance (OR = 0.94, 95% CI: 0.82-1.07). In this model, each unit increase in WWI among men was linked to a 22% higher risk of migraines (OR = 1.22, 95% CI: 1.05-1.42). When stratified by quintiles, individuals in the third quintile (Q3) displayed a 69% higher likelihood of experiencing migraines compared to those in the first quintile (Q1) (OR = 1.69, 95% CI: 1.19-2.40), with a significant inflection point observed at 10.95 cm/√kg. Significant interactions were noted among various age groups (p for interaction = 0.018). WWI demonstrated a stronger predictive capability for migraine compared to BMI and WC.

A U-shaped positive correlation of WWI with migraines was observerd among adult males in the U.S., while no significant correlation was found in females. Within the context of BMI and WC, WWI exhibited a superior predictive capacity for migraines.

This systematic review evaluated exergame interventions' efficacy in older adults, focusing on depressive symptoms, activities of daily living (ADLs), and fear of falling.

We searched five electronic databases from inception to June 2024. Data were synthesized using the inverse-variance method, reporting standardized mean differences (SMDs) with 95% confidence intervals (CIs).

Twenty-four randomized controlled trials (RCTs) with 1,128 participants were included. Exergames significantly improved depressive symptoms (SMD = -0.76, 95% CI: -1.11 to -0.40, p < .001). Meta-regression showed no influence of sample size, health status, intervention duration, gender, or gaming device. No significant effects were found for ADLs (SMD = 0.01, 95% CI: -0.75 to 0.76, p = .988) or fear of falling (SMD = -0.16, 95% CI: -0.40 to 0.08, p = .189).

Exergames enhance mental health in older adults but lack clear effects on physical function or fear of falling. High-quality, long-term studies are needed.

Exergames offer an engaging intervention to reduce depressive symptoms, complementing mental health therapies. Clinicians should use modern platforms and combine exergames with physical or behavioral interventions to address ADLs and fear of falling.

The aim was to estimate all-cause and cause-specific mortality in long-term prescription opioid users compared to the general population. This nationwide registry-based cohort study used data of patients aged 15 to 69 years with no previous cancer diagnosis and a recorded episode of long-term opioid analgesics use (anatomical therapeutic chemical [ATC] group N02A; N = 116,006) in Norway between 2011 and 2019. Sex-specific crude mortality rates (CMR) and age-standardized mortality ratios (SMRs) were calculated for all-cause and cause-specific mortality, ie, natural and unnatural causes for the whole study population and for different age groups (15-34, 35-54, and 55-69 years). Overall, 4.6% (2491/54,535) of men and 2.7% (1680/61,471) of women died during the follow-up period. Crude mortality rates for all-cause mortality were 1194 and 724 deaths per 100,000 person-years (PY) in men and women, respectively. Men had higher CMRs across all causes, particularly unnatural causes (221 and 101 deaths per 100,000 PY in men and women, respectively). Patients with long-term opioid use had a 4 times higher all-cause mortality (SMR = 3.8 [95% CI = 3.6-3.9] in men and 3.7 [3.5-3.9] in women aged 15-69 years) compared to the general Norwegian population of the same age. Excess mortality was observed across all causes, particularly suicide, accidents, and accidental poisoning. Standardized mortality ratios decreased with age and were highest for the youngest age group (15-34 years), particularly among men. Long-term prescription opioid use is associated with an increased risk of death. Clinicians should weigh the risks of long-term opioid use against the benefits.

Chronic obstructive pulmonary disease (COPD) is a major contributor to global morbidity and mortality, particularly during acute exacerbations that frequently require intensive care unit (ICU) admissions. Considering the hypercoagulability associated with COPD, which intensifies during acute episodes, prophylactic anticoagulation therapy may help reduce ICU mortality. However, this potential has not been explored specifically in this population of patients.

We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV, spanning patient records from 2008 to 2019 at the Beth Israel Deaconess Medical Center in Boston. This study focused on critically ill patients with COPD, employing feature selection methods, to identify key variables influencing clinical outcomes. The impact of prophylactic enoxaparin on prognosis was assessed using logistic regression models and Kaplan-Meier survival analysis.

Our analysis included 4,433 critically ill patients with COPD, of whom 446 received enoxaparin within the first 72 h of ICU admission. The primary analysis showed that patients treated with enoxaparin experienced a 48% lower ICU mortality (odds ratio 0.52 [95% confidence interval 0.31-0.86]) than that of those not treated with enoxaparin, with an E-value of 3.26. This association between enoxaparin use and lower ICU mortality persisted across all subgroups examined. Additionally, a visual analysis of patients with varying Oxford acute severity of illness score (OASIS) indicated that early enoxaparin use was linked to an improved prognosis in critically ill patients with COPD who had higher OASIS than in those without.

Early initiation of prophylactic enoxaparin therapy was significantly associated with low ICU mortality in critically ill patients with COPD, especially in high-risk subgroups. These findings support the need for randomized controlled trials to confirm the effectiveness of thromboprophylaxis in this specific patient population and to evaluate the potential bleeding risks.

The use of hyaluronic acid (HA) for the treatment of knee osteoarthritis holds clinical and financial implications for manufacturers, incentivizing spin, or the misrepresentation of study findings. We sought to identify the incidence of spin in abstracts of systematic reviews and meta-analyses evaluating the efficacy of HA injections used for the treatment of knee osteoarthritis.

Systematic reviews and meta-analyses reporting on HA for knee osteoarthritis were extracted through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search of Embase, PubMed, and Cochrane databases. After two independent authors performed screening and data extraction, abstracts were evaluated for the 21 most common types of spin as reported by Yavchitz et al. Year and journal of publication, level of evidence, study design, funding source, adherence to PRISMA guidelines, and SCOPUS CiteScore were collected. Descriptive variable associations, calculated using Chi-square analyses, identified relationships between common spin types and abstract characteristics.

At least one type of spin was identified in 112 out of 114 extracted studies, with an average spin score of 5.07 ± 2.59 per publication. The most common spin type was "conclusion claiming beneficial effect of experimental treatment despite high risk of bias in primary studies" (98 of 114, 85.96%). A statistically significant association was found between older publication year and spin type, "authors hide or do not present any conflict of interest" (P = 0.011). There was a significant association between lower levels of evidence and "failure to report a wide confidence interval of estimates" (P = 0.002) and "failure to report the number of studies/patients contributing to the analysis for main outcomes" (P = 0.041).

Our findings demonstrated a high incidence of spin among systematic reviews and meta-analyses evaluating the efficacy of HA injections used for the treatment of knee osteoarthritis. Careful evaluation of misleading reporting in current literature is warranted when considering this treatment.

To investigate associations between maternal and child secretor status and early-life gastroenteritis risk, considering the roles of gut microbiota, breastfeeding, and daycare attendance.

In the COPSAC2010 cohort (n=700), parents recorded gastroenteritis episodes during the first three years of life. Secretor status, rs601338 in the FUT2 gene, was genotyped in both parents and children. The association between secretor status and gastroenteritis was assessed using quasi-Poisson regression. Fecal samples were collected at 1 week, 1 month, 1 year after birth. The interaction between secretor status, breastfeeding and daycare attendance were analyzed through Cox regression.

Maternal secretor status increased first-year gastroenteritis risk (incidence rate ratio [IRR]=1.48, 95% confidence interval [CI]:1.05-2.16, p=0.033); child status increased second-year risk (IRR=1.56, 95%CI:1.11-2.27, p=0.015), especially after daycare attendance (interaction p=0.006). Maternal status associated with microbiota differences at 1 week (weighted UniFrac F=2.4, R2=0.47%, p=0.048) and 1 month (F=3.3, R2=0.62%, p=0.026); child status at 1 year (F=2.5, R2=0.45%, p=0.027). Secretor children showed lower Bacteroides vulgatus (Median [interquartile range (IQR)]:1.00% [0.04-12.92] vs. 5.00% [0.09-24.80], p=0.023) but higher Escherichia/Shigella (1.35% [IQR:0.28-7.42] vs. 0.56% [IQR:0.13-2.62], p=0.002). B. vulgatus mediated 14% of child status effects (average causal mediation effect [ACME] IRR=0.95, 95% CI: 0.89-0.99, p=0.014).

Maternal and child FUT2 status demonstrates age-specific impacts on gastroenteritis and microbiota in early life, providing new insights into gastrointestinal health genetics and host-microbiome dynamics.

Asarum sieboldii, a species of wild ginger native to East Asia, has long been recognised as an important herb in Asian traditional medicine. It has been applied in the treatment of toothache, cough, asthma, and sinusitis. A. sieboldii has gained global interest because it offers solutions to multiple health concerns. The plant is renowned for its anti-inflammatory, analgesic, antimicrobial, antifungal, and antioxidant properties. Its roots exhibit a wide range of biological and pharmacological effects. The plant contains several chemical constituents, including methyleugenol, 3,4,5-trimethoxytoluene, and safrole, which contribute to its medicinal benefits. Whereas literature search highlights the potential application of A. sieboldii in herbal medicine, to date its application in dentistry remains largely unexplored, with the existing literature vastly fragmented in various sources. This review therefore, provides a comprehensive overview of the potential application of A. sieboldii in dentistry and oral health. The plant shows considerable promise and appears to be effective for managing common oral diseases such as tooth decay, periodontal diseases, toothache, oral cancer, oral ulcers, and gingivitis. Its ability to inhibit nitric oxide release, along with its neuroprotective effects, further enhances its potential for relieving pain and inflammation. With these therapeutic benefits, A. sieboldii presents a promising natural alternative or a complementary option to conventional dental treatments, capable of addressing a wide range of oral health conditions. The findings from this review could serve as a solid foundation for future research, supporting the development of high-quality, safe, and effective A. sieboldii-based products in dentistry and oral health.

Frailty has been linked to an increased risk of mental disorders. However, little is known about the impact of nutritional frailty, a crucial phenotype of frailty, on depression and anxiety. We aimed to examine the prospective associations between nutritional frailty and the incidence and progression of depression and anxiety among middle-aged and older adults.

Data were obtained from a large prospective cohort study with over 500,000 participants. Nutritional frailty was defined as the copresence of physical frailty (assessed by weight loss, exhaustion, low physical activity level, slowness, and weakness) and nutritional imbalance (assessed by body mass index, skeletal muscle index, and sodium, potassium, and iron intake). Depression, anxiety, and their comorbidity were identified via the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision and Tenth Revision, on the basis of the primary or secondary diagnosis. We performed Cox proportional hazards models to investigate the associations between nutritional frailty and incident depression, anxiety, and their comorbidity. Multistate models were used to examine how nutritional frailty influences transitions from a baseline state to single mental disorders, their comorbidity, and mortality.

We included 176,987 participants with a mean age of 56.1 years (SD 8.0), of whom 2648 (1.5%) had nutritional frailty at baseline. During a median follow-up of 12.2 years, 4794 (2.7%) developed depression, 6081 (3.4%) developed anxiety, and 1610 (0.9%) developed both conditions. Individuals with nutritional frailty had a significantly greater risk of developing depression, anxiety, and their comorbidity than robust individuals and those with physical frailty and nutritional imbalance (depression: nutritional frailty HR 3.21 [95% CI 2.77-3.73]; physical frailty 3.11 [2.70-3.58]; nutritional imbalance 1.19 [1.11-1.28]; anxiety: 2.25 [1.93-2.63], 2.17 [1.87-2.51], 1.20 [1.13-1.28]; comorbidity: 3.69 [2.92-4.66], 3.43 [2.74-4.28], 1.31 [1.15-1.50]), even after multivariable adjustment. Baseline nutritional frailty adversely impacts transitions from a baseline state to single mental disorders (depression: 2.89 [2.49-3.36], anxiety: 1.82 [1.54-2.16]) and death (1.95 [1.71-2.22]), from single mental disorders to their comorbidity (depression: 1.96 [1.32-2.89]; anxiety 1.78 [1.17-2.71]), and from comorbidity to death (2.04 [1.07-3.91]).

Nutritional frailty is an independent risk factor for incident depression, anxiety, and their comorbidity and adversely influences the progression of these conditions among middle-aged and older adults.

Chronic kidney disease is the fastest-growing chronic disease in terms of prevalence and one of the biggest causes of global mortality according to the Global Burden of Disease Collaboration. This study aimed to project the natural disease progression of this disease in people with diabetes, and to quantify the costs and consequences in the Portuguese context. This was achieved by developing an analytical model reflecting the epidemiology of chronic kidney disease and integrating the various stages of disease progression.

A population-based cohort Markov model was used, to follow an adult cohort of people with diabetes and chronic kidney disease as they progressed through different risk categories, in annual cycles, over a period of 50 years. The model considered the natural progression of chronic kidney disease through 18 risk categories based on the KDIGO classification system, as well as the probability of patients receiving renal replacement therapy, including dialysis and kidney transplantation, and the probability of death. Each stage is associated with an annual cost and a disability weight, so the model allowed survival, years lived with disability and lifetime costs to be estimated for the entire population with chronic kidney disease and for patients in different risk categories.

Over the cohort´s lifetime, the model estimated, for the total population with chronic kidney disease and diabetes, an average survival of 8.62 years, with 0.59 years lived with disability, and an average cost of €24 613. These figures correspond to a loss of more than 410 000 years lived with disability and a total lifetime cost of 17.0 billion euros. The progression of this disease was associated with lower survival, more years lived with disability and higher costs.

The results of this study characterize the natural progression of chronic kidney disease in people with diabetes mellitus type 2, as well as the associated costs and consequences in the national context. Since diabetes mellitus type 2 is a risk factor for chronic kidney disease, it is expected that the real impact will be greater than estimated in the coming decades. Analysis by risk level shows that progression of the disease is associated with worse outcomes.

Background At least 10% of all patients with knee osteoarthritis (OA) undergo treatment with injectable corticosteroids or hyaluronic acid (HA). Although both have been shown to help with symptomatic pain relief, their long-term effects on knee OA progression remain inconclusive. Purpose To investigate the association between intra-articular knee injections, specifically corticosteroids and HA, and OA progression using a detailed whole-joint semiquantitative MRI evaluation and clinical outcomes for a period of 2 years. Materials and Methods This secondary analysis uses data from the Osteoarthritis Initiative (OAI), a multicenter, longitudinal, prospective study (February 2004 to January 2015). Participants who received a reported injection of corticosteroid or HA and propensity-score-matched controls (on age, sex, body mass index [calculated as weight in kilograms divided by height in meters squared], and clinical variables) were analyzed. Using the Whole-Organ MRI Score (WORMS) system for cartilage, bone marrow lesions, and meniscus, 3-T MRI performed at the time of injection, 2 years prior, and 2 years after were semiquantitatively graded. Postinjection progression was quantified using WORMS difference between time of injection and the 2-year follow-up. Associations with injection type were analyzed using repeated measures of analysis of covariance. Results There were 210 participants analyzed (mean age, 64 years ± 7.9 years [SD]; 126 female participants). Corticosteroids were associated with greater WORMS progression compared with controls (mean difference, 0.39; 95% CI: 0.05, 0.75; P = .02) and HA (0.42; 95% CI: 0.01, 0.84; P = .04). HA was associated with decreased WORMS progression compared with the injection-concurrent time frame (mean difference, -0.42; 95% CI: -1.34, -0.28; P = .003). Both corticosteroids (mean difference in Western Ontario and McMaster Universities Osteoarthritis Index scores, -5.20; 95% CI: -6.91, -3.48; P = .001) and HA injections (-2.15; 95% CI: -4.42, -0.13; P = .04) were associated with reduced pain after injection. Conclusion Corticosteroid injections were associated with higher OA progression than HA injections and controls, whereas HA was associated with decreased progression at MRI for up to 2 years after injection. ClinicalTrials.gov Identifier: NCT00080171 © RSNA, 2025.

The International Association for the Study of Pain defines 3 pain types presumed to involve different mechanisms-nociceptive, neuropathic, and nociplastic. Based on the hypothesis that pain types should guide the matching of patients with treatments, work has been undertaken to identify features to discriminate between them for clinical use. This study aimed to evaluate the validity of features to discriminate between pain types.

Subjective and physical features were evaluated in a cohort of 350 individuals with chronic musculoskeletal pain attending a chronic pain management program. The analysis tested the hypothesis that, if features nominated for each pain type represent 3 different groups, then (1) cluster analysis should identify 3 main clusters of patients, (2) these clusters should align with the pain type allocated by an experienced clinician, (3) patients within a cluster should have high expression of the candidate features proposed to assist identification of that pain type. Supervised machine learning interrogated features with the greatest and least importance for discrimination, and probabilistic analysis probed the potential for the coexistence of multiple pain types.

Results confirmed that data could be best explained by 3 clusters. Clusters were characterized by a priori specified features and agreed with the designation of the experienced clinician with 82% accuracy. Supervised analysis highlighted features that contributed most and least to the classification of pain type, and probabilistic analysis reinforced the presence of mixed pain types.

These findings support the foundation for further refinement of a clinical tool to discriminate between pain types.

Greater self-perceived rhythmicity of mood-related symptoms and behaviors has been associated with depressive symptoms in the general public. We aimed to evaluate differences in adolescents at risk for or with a diagnosis of major depressive disorder (MDD) regarding perception of symptom rhythmicity and actimetry parameters. In this cross-sectional study, 96 adolescents were stratified into three groups based on either a diagnosis of MDD or on a composite score for the risk of developing depression: MDD, high risk (HR), and low risk (LR). Participants completed questionnaires regarding depressive symptoms (Mood and Feelings Questionnaire for adolescents) and self-perceived mood rhythmicity (Mood Rhythm Instrument for Youth - MRhI-Y). Actimetry data were collected for 10 continuous days and Non-Parametric Circadian Rhythm Analyses were performed. The MDD group reported higher MRhI-Y total scores, particularly in affective symptoms compared to both other groups. In spite of actimetry variables that did not correlate with MRhI-Y total scores, cluster analysis using MRhI-Y and actimetry revealed three distinct profiles corresponding to all groups. Identifying rhythmicity in mood-related behaviors in adolescents may help distinguish different groups at-risk for MDD and in a current depressive episode. Understanding these patterns could inform early interventions, potentially preventing the onset of the disorder in susceptible individuals.

OBJECTIVE: To investigate the barriers and facilitators to physical activity and exercise among people with chronic low back pain (CLBP). DESIGN: A qualitative evidence synthesis. LITERATURE SEARCH: We searched the MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PsycINFO databases from inception to July 2023. This review was prospectively registered on the Open Science Framework (OSF) (https://archive.org/details/osf-registrations-uwnqh-v1). STUDY SELECTION CRITERIA: Qualitative or mixed-methods studies with a qualitative approach were included. Studies must have recruited adults, of both sexes, aged 18 years or older with CLBP. DATA SYNTHESIS: We used a thematic analysis approach in our review. First, participant quotes in the "Results" section of included studies were analyzed and coded. Second, the codes were used to create our coding framework. Then, the coding framework was applied to included studies. Finally, 2 reviewers independently analyzed the themes constructed in our qualitative evidence synthesis to identify barriers and facilitators for people with CLBP to engage in physical activity. RESULTS: Fifty-seven studies were included. The quality assessment (Critical Appraisal Skills Program) revealed that most studies (77%) had minor concerns. Barriers to physical activity were mainly related to pain intensity, fear of movement, intervention type, lack of information, motivation, and support. Facilitators of physical activity were adequate information, professional and social support, perceived benefits, and favorable conditions to engage in physical activity. Based on the GRADE-CERQual, most themes and subthemes presented moderate quality of evidence. CONCLUSION: The barriers to people with chronic LBP engaging in physical activity included pain intensity and fear of reinjury, type of intervention, lack of information, motivation and support, and occupational and socioenvironmental factors. The main facilitators were receiving information and support from health professionals, motivational activities, knowledge about benefits of the intervention, and external factors. J Orthop Sports Phys Ther 2025;55(5):1-19. Epub 7 April 2025. doi:10.2519/jospt.2025.12905.

Sexually transmitted infections (STIs) remain a significant public health concern. Given the asymptomatic nature of many STIs, diagnostic testing is critical for determining the appropriate treatment, enabling effective tracing and reducing the risk of further transmission. Nucleic acid amplification tests (NAATs) are the most sensitive and the most widely used in well-resourced settings. The majority of available NAATs are based on polymerase chain reaction (PCR), which requires highly trained personnel and costly equipment, making it impractical for resource-limited settings. Loop-mediated isothermal amplification (LAMP) has emerged as a simple, rapid, sensitive and low-cost alternative for pathogen detection, particularly well-suited for point-of-care tests (POCT). In this review, we evaluate LAMP assays reported in the literature for the detection of pathogens linked to the high incidence STIs prioritised by the World Health Organization (WHO) for POCT in 2023. These include Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, T. pallidum subspecies pallidum, as well as other common STIs such as herpes simplex virus, hepatitis B virus and human immunodeficiency virus (HIV). For each LAMP assay, we identified and summarised the key elements such as the type and number of tested clinical specimens, chosen target gene, detection system, reference test and clinical outcomes. We highlight the advantages and limitations of these assays and discuss the gaps that should be addressed to improve their applicability for POCT.

To determine whether psychosocial factors, such as resilience, perceived stress, catastrophizing, anxiety, depression, pain self-efficacy, and social support, explain the persistence of pain and disability in individuals with rotator cuff-related shoulder pain (RCRSP) following an education program.

One hundred forty-three individuals with persistent RCRSP were included in this prospective cohort study. At baseline, participants completed self-reported questionnaires related to pain, disability, and psychosocial constructs, including resilience, stress, catastrophizing, anxiety and depressive symptoms, pain self-efficacy, and social support. Thereafter, participants took part in an educational program aimed at promoting self-management of RCRSP that included 2 meetings with a physiotherapist. After 12 and 24 weeks, participants filled out pain and disability questionnaires and, based on their scores, were classified as having persistent shoulder pain or as recovered.

A univariable modified Poisson regression showed that higher perceived stress (RR adjusted : 1.02; 95% CI: 1.01-1.04), catastrophizing (RR adjusted : 1.01; 95% CI: 1.01-1.02), symptoms of depression (RR adjusted : 1.03; 95% CI: 1.01-1.06) and anxiety (RR adjusted : 1.03; 95% CI: 1.01-1.06), along with lower resilience (RR adjusted : 0.90; 95% CI: 0.81-1.00), were associated with ongoing RCRSP at 12 weeks. In addition, reduced pain self-efficacy was associated with persistent pain at both 12 weeks (RR adjusted : 0.98; 95% CI: 0.97-0.99) and 24 weeks (RR adjusted : 0.99; 95% CI: 0.98-1.00). Multivariable regression indicated that only pain self-efficacy served as a protective factor against persistent RCRSP (RR adjusted : 0.98; 95% CI: 0.97-0.99).

This study sheds light on the impact of psychosocial factors on persistent RCRSP, underscoring the importance of positive beliefs in pain management. Importantly, pain self-efficacy emerges as a key factor in recovery.

BackgroundChronic low back pain can severely affect quality of life. While several treatments are available, the combination of therapies often results in better outcomes.ObjectiveThis study delves into the comparative effectiveness of combining monopolar dielectric diathermy radiofrequency (MDR) with supervised therapeutic exercise against the latter treatment alone.MethodsA randomized single-blind controlled trial was conducted. The intervention group (( n = 30 ) 30) received MDR with supervised therapeutic exercises for eight weekly sessions for four weeks. The control group (n = 30) received only the same exercise protocol. The following self-report measures were assessed before the first treatment session, at four, and 12 weeks: disability, pain, kinesiophobia, quality of life, sleep quality, emotional distress, isometric trunk strength, and trunk flexion range.ResultsRepeated ANOVA measures revealed significant time*group interactions for the McQuade test (p = 0.003), the physical role (p = 0.011), vitality (p = 0.023), social function (p = 0.006), and mental health subscales (p = 0.042). Between-group analyses showed significant differences for all outcomes at each follow-up: RMDQ (post-treatment, p = 0.040), ODI (post-treatment and 12-week, p = 0.040), VAS (p < 0.001), TSK (p < 0.001), and McQuade Test (p < 0.020).ConclusionThe combination of diathermy radiofrequency with supervised therapeutic exercise significantly surpasses the efficacy of supervised therapeutic exercise alone, showcasing improvements in pain, disability, kinesiophobia, lumbar mobility in flexion, and overal quality of life in patients with chronic low back pain.