搜索结果：Journal of pharmacological sciences

Fibromyalgia syndrome (FMS) is a chronic condition characterised by the presence of complex multiple symptoms, often accompanied by psychiatric comorbidities and sleep problems. The wide spectrum of symptoms and comorbid problems complicates treatment and management of the ensuing disability and symptoms. Physiotherapy approaches and mind-body practices including yoga and mindfulness are among the non-pharmacological treatment methods commonly used in FMS treatment. While there is initial evidence for these interventions, definitive conclusions about their effectiveness are still lacking and research on their combined effectiveness is limited. Therefore, this study aims to evaluate the effectiveness of a multimodal integrative protocol, the PhYoMind (PYM) intervention, which combines specific physical therapy modalities with yoga and mindfulness practices on the overall impact of fibromyalgia and functional impairment. This monocentric study uses a parallel-group (1:1) randomised controlled design, in which the outcome assessor and statistician are blinded to group allocation. Individuals with a clinical diagnosis of FMS (n=40) will be included in the study (Cohen's f=0.675; α=0.05; power=0.80). Participants will be randomised to receive either PYM intervention in addition to Home Exercise (HE) programme or HE programme alone. The intervention period for both groups will last 8 weeks; PYM sessions will be held twice a week for 75 min each. The primary outcome is the broad disease impact and functional impairments measured by the total score of the Fibromyalgia Impact Questionnaire. Secondary outcomes include central sensitivity, as assessed by the Central Sensitisation Index; autonomic nervous system function, as measured objectively by heart rate variability; pain perception (current, average, worst), as assessed by the Visual Analogue Scale; fatigue, as assessed by the Multidimensional Fatigue Inventory; stress, as assessed by the Perceived Stress Scale; and sleep quality as assessed by the Pittsburgh Sleep Quality Index. Adherence and adverse events will be assessed for both interventions. Repeated measures ANOVA will be used to analyse the effect of time, intervention group and their interaction on primary and secondary outcomes under an intention-to-treat principle. Ethics approval was granted from the Ethics Committee at the Medical Faculty of Eberhard Karls Tuebingen University and at the University Hospital of Tuebingen (260/2025BO2) on 30 April 2025. The trial will be conducted in accordance with the updated principles of the Declaration of Helsinki. The study's findings will be disseminated and documented in a peer-reviewed publication, adhering to the Consolidated Standards of Reporting Trials guidelines. After completion of the study and publication of the results, participants who are interested will be offered a brief summary of the aggregated study findings. NCT07145788.

We sought to explore the knowledge and perceptions of obesity care among general practice nurses in the Republic of Ireland. Obesity is a complex condition driven by the interplay of social, cultural, environmental, genetic, biological and psychological factors. Despite its recognition as a chronic disease, it is underdiagnosed and undertreated in primary care. General practice nurses (GPNs) play a critical role in the monitoring of risk factors and treatment of chronic diseases, but their role in the management of obesity in primary care is less well described. A cross-sectional cohort study was conducted. An anonymous online survey was disseminated asking a broad range of questions on levels of training, knowledge, perceptions and barriers to obesity care. Of 240 GPNs who completed the survey, 93% were aware that obesity aetiology is multifactorial. Identified causes which imply "personal responsibility" rated highly (73%). Most GPNs are comfortable having discussions about weight (74%). They reported discussing behavioural interventions more frequently than pharmacological treatments or bariatric surgery. Perceived lack of time in appointments (83%), lack of training (71%), shortage of specialist care (72%) and cost of treatments (67%) were the highest rated barriers to providing care. Lack of time in appointments (67%) and fear of causing offence (57%) were the highest rated barriers to initiating a discussion with patients about weight. GPNs felt their own BMI influenced how patients with obesity view their advice. Many GPNs (40%) reported they had no training in obesity care, while 54% had attended at least one obesity-themed webinar or conference. GPNs recognise their essential role in obesity care. We have identified the need for dedicated consultation time and further training for GPNs to enable discussion of treatment options and support appropriate care pathways, including access to specialist care.

This umbrella review aimed to synthesize systematic reviews and meta-analyses to evaluate the effectiveness of non-pharmacological interventions (NPIs) on agitation, depression, anxiety, cognitive function, and quality of life in individuals living with dementia, and to examine the stability and methodological quality of the evidence base. Systematic searches of MEDLINE (via EBSCOhost), PubMed, CINAHL, PsycINFO, and Web of Science databases were conducted from inception to February 2025. Systematic reviews and meta-analyses evaluating NPIs for older adults with dementia were included. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Evidence overlap was quantified using the corrected covered area (CCA), and effect estimates reported in the included reviews were synthesized narratively. Twelve systematic reviews, including 147 randomized controlled trials, were included. Methodological quality varied across reviews, and all reviews had at least one non-critical weakness. Review overlap was very slight (CCA = 1.8 %). Across reviews, NPIs were associated with small but consistent reductions in agitation (standardized mean difference ([SMD] -0.25, 95 %CI: -0.36 to -0.13), depression ([SMD] -0.20, 95 %CI: -0.29 to -0.11), and anxiety ([SMD] -0.21, 95 %CI:-0.34 to -0.09). A modest improvement was observed in cognitive function ([SMD] 0.22, 95 %CI:0.11 to 0.34 ), whereas no significant effect was found for quality of life ([SMD] 0.08, 95 %CI: -0.15 to 0.32). The most consistent benefits were reported for information and communication technology-based interventions, massage and touch therapies, and physical exercise. Evidence certainty was moderate for agitation, depression, and anxiety, but low or very low for cognitive function and quality of life. NPIs were associated with small but consistent improvements in agitation, depression, anxiety, and cognitive function among older adults with dementia. Although effect sizes were modest and evidence certainty varied across outcomes, the findings support NPIs as key components of person-centered dementia care. Further high-quality research is needed to clarify optimal intervention modalities, dosage, mechanisms of action, and implementation strategies across diverse care settings.

High body mass index (BMI) accounts for approximately 7% of total mortality in Sweden and represents a major global public health challenge. In recent years, new anti-obesity medications (AOMs) have been introduced; however, knowledge about how primary care physicians (PCPs) perceive these medications in clinical practice is limited. Understanding PCPs' perspectives is essential as these medications are expected to play an increasingly important role in obesity care. To explore PCPs' experiences and perceptions of AOMs, and to identify perceived challenges and opportunities related to their clinical use. A qualitative study was conducted, including 11 in-depth interviews with PCPs working in regional and private primary health care centers in Skåne, Sweden. Data were analyzed using qualitative content analysis. The analysis yielded one overarching theme: Negotiating tensions and shifting responsibilities in the transformation of obesity treatment, supported by five categories and 13 sub-categories. AOMs facilitated person-centered discussions about weight management but posed challenges due to limited clinical experience and recent introduction. The multifactorial nature of obesity raised questions regarding clinical responsibility, treatment duration and resource allocation. Pharmacological treatment of obesity was perceived as useful for initiating discussions and supporting weight loss. However, PCPs reported challenges related to obesity complexity, lack of consensus on classification and treatment, unclear treatment duration, and economic barriers. Clear guidelines and shared understanding of obesity treatment may reduce uncertainty and provide stronger support for PCPs. Further research incorporating patient perspectives and other Swedish regions can inform national guidelines and enhance the overall understanding of AOMs.

The TGF-β/Smad signaling pathway plays a central role in the pathogenesis of idiopathic pulmonary fibrosis (IPF) and is modulated by sphingolipid metabolism. Ceramide, a key intermediate in this pathway, is synthesized in various acyl-CoA chain lengths by ceramide synthases (CerS). However, the specific role of ceramide synthase 5 (CerS5) in pulmonary fibrosis remains unclear. Therefore, this study aimed to elucidate the role of CerS5 in fibrotic responses using human lung fibroblasts (HFL1), IPF-derived myofibroblasts (IPF-MyoFs), and a bleomycin-induced mouse model of pulmonary fibrosis. CerS5 knockdown attenuated TGF-β1-induced expression of α-smooth muscle actin (αSMA), collagen I, fibronectin, and phosphorylated Smad2/3 in both HFL1 cells and IPF-MyoFs. It also suppressed TGF-β1-induced nuclear translocation of Smad2/3. Notably, CerS5 knockdown reduced protein levels of Smad3 and Smad4 even in the absence of TGF-β1 stimulation. Smad4 knockdown replicated the effects of CerS5 knockdown by decreasing TGF-β1-induced expression of fibrotic markers, phosphorylated Smad2/3, and total Smad3 levels. In vivo, CerS5 knockout significantly reduced bleomycin-induced lung fibrosis and Smad3/4 expression. These findings suggest that CerS5 regulates fibrotic responses via modulation of Smad4 and the TGF-β1/Smad signaling pathway. Targeting CerS5 may therefore represent a promising therapeutic strategy for the treatment of IPF.

Nanoplastics (NPs) have been shown to cross the placental barrier and disrupt systemic metabolism, raising concerns about their potential impact on developmental health. Despite accumulating evidence implicating NPs in metabolic toxicity, the effect of early-life NPs exposure on offspring vascular lipid metabolism has not been fully elucidated. In this study, pregnant mice were exposed to 100-nm PS-NPs at drinking-water concentrations of 0.1, 1, and 10 µg/mL throughout embryonic-lactational, and male offspring were examined at postnatal day 21. Our findings demonstrated that exposure to PS-NPs during the embryonic and lactational periods induced lipid accumulation in the medial layer of the aorta in male offspring, accompanied by elevated serum triglyceride (TG) levels, suggesting that early-life exposure disrupts vascular lipid homeostasis. In vitro findings further confirmed that PS-NPs exposure led to lipid accumulation in mouse aortic vascular smooth muscle (MOVAS) cells, accompanied by elevated intracellular TG levels. Mechanistically, PS-NPs exposure activated the MAPK/ERK signaling pathway, accompanied by the upregulation of UHRF1, a key epigenetic regulator of lipid metabolism. Further pharmacological inhibition of ERK using PD98059 significantly attenuated both UHRF1 expression and lipid accumulation, providing additional evidence supporting the critical role of the MAPK/ERK/UHRF1 axis in PS-NPs-induced lipid dysregulation. Additionally, siRNA-mediated knockdown of UHRF1 alleviated PS-NPs-induced lipid accumulation, supporting the pivotal role of UHRF1 in the cellular response to PS-NPs exposure. Overall, these findings demonstrate that prenatal and lactational exposure to PS-NPs disrupts early vascular lipid homeostasis in male offspring by activating the MAPK/ERK/UHRF1 signaling pathway in vascular smooth muscle cells.

Inflammatory Bowel Diseases (IBD), including Ulcerative Colitis and Crohn&s Disease, are chronic and recurrent conditions that severely impact patients' quality of life and increase the risk of complications. Providing accurate and evidence-based health information is a non-pharmacological strategy that may improve disease outcomes. This study aimed to evaluate the effect of physician-prescribed information on patients' quality of life and disease Relapse. In this randomized controlled trial, 160 patients with IBD were randomly assigned to two groups. The intervention group received a structured information prescription (IP) developed by a trained medical librarian and approved by a physician, while the control group received routine oral explanations. The World Health Organization Quality of Life Questionnaire (WHOQOL) and Time to Relapse Questionnaire (TRQ) were used to assess quality of life and Relapse, respectively. Statistical analyses included t-tests, Chi-square, and Mann-Whitney tests using Stata17 software. The Relapse rate in the intervention group was significantly lower than in the control group at both two months (12.5% vs. 87.5%, p=0.004) and four months (15% vs. 42.5%, P<0.001). The risk of Relapse in the control group was more than twice as high compared to the intervention group (Hazard ratio: 2.1; 95% CI: 1.6-2.8). The mean overall quality of life scores showed an improvement in the intervention group, while a decline was observed in the control group. A significant improvement was also indicated in all quality-of-life domains in the intervention group when compared to the control group (P < 0.001). Physician-prescribed information interventions significantly enhance quality of life and reduce disease Relapse in IBD patients, offering a promising complementary approach in clinical care.

Advances in surgical techniques and neoadjuvant care for rectal cancer have increased sphincter preservation, allowing restoration of bowel continuity through low anterior resection (LAR). However, up to 75% of patients experience low anterior resection syndrome (LARS), which is bowel dysfunction characterised by faecal incontinence, frequency, urgency and clustering of bowel movements, significantly impairing quality of life (QoL). Current management is largely empirical, using lifestyle or pharmacological strategies with variable success. Transanal irrigation (TAI) is a non-surgical intervention that allows controlled colonic washouts, improving symptom control. Evidence supporting TAI for LARS is limited by small sample sizes and is primarily observational, highlighting the need for a rigorous randomised controlled trial (RCT). This study aims to compare TAI with conventional LARS care on QoL, bowel function, faecal incontinence and satisfaction in adults with LARS following LAR. This is a pragmatic, multicentre, crossover RCT conducted at eight academic hospitals across Quebec, Ontario and British Columbia, Canada. Eligible participants are adults (&#x2265;18 years) with an LARS score >20, at least 6&#x2009;months post-LAR and without an ostomy or active colorectal complications. Participants will be randomised to receive either 3&#x2009;months of daily TAI or conventional LARS care, followed by a 1&#x2009;month washout and crossover to the alternate intervention. The TAI intervention includes an irrigation system, access to a web-based educational platform and virtual training with a research team member. Primary outcome is difference in global QoL between interventions, assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Secondary outcomes include bowel function (LARS score), faecal incontinence (Cleveland Clinic Faecal Incontinence Score) and satisfaction. Sample size (n=66, accounting for 10% attrition) was determined using Monte Carlo simulations to detect a 6-point difference in QoL with 85.8% power. Data will be analysed using linear mixed-effects models accounting for period, treatment and sequence effects. All study data will be collected via Research Electronic Data Capture and maintained in secure, password-protected systems; participant confidentiality will be ensured throughout. Safety monitoring will include training on proper TAI technique and reporting of adverse events. The study has received ethics approval from each participating site. The trial adheres to the Canadian Tri-Council Policy Statement on the use of human participants in research. Findings will be disseminated through peer-reviewed journals, conference presentations and scientific meetings, with authorship following the International Committee of Journal Editors guidelines. NCT05007015.

Xihuang Pill (XHP), a classic traditional Chinese medicine (TCM) compound formula, exhibits antitumor activity, yet its therapeutic potential and underlying molecular mechanism against lung adenocarcinoma remain elusive. In this study, single-cell Raman spectroscopy (SCRS) was employed to investigate the effects and molecular mechanisms of XHP on human lung adenocarcinoma A549 cells. Results demonstrated that XHP inhibited the metabolic activity of A549 cells in a concentration-dependent manner, impaired cellular integrity, and induced structural remodeling of lipids and proteins accompanied by characteristic spectral shifts. Collectively, these alterations led to metabolic reprogramming in tumor cells. Pharmacological prediction and experimental validation indicated that prostaglandin-endoperoxide synthase 2 (PTGS2) is a relevant target mediating the pharmacological effects of XHP: XHP downregulated the expression of PTGS2, while overexpression of PTGS2 attenuated the therapeutic effects of XHP. This study provides direct, single-cell-level spectroscopic evidence for the efficacy of XHP against lung adenocarcinoma and reveals a PTGS2-associated mechanism, offering new insights for the development of TCM-based therapies for lung adenocarcinoma.

Post-cardiac arrest care for patients resuscitated from out-of-hospital cardiac arrest (OHCA) includes multiple pharmacological and physiological interventions, yet optimal strategies to reduce post-cardiac arrest syndrome-related morbidity and mortality remain uncertain. The DANOHCA (Danish Out-of-Hospital Cardiac Arrest) trial evaluates four such interventions-high-dose dexamethasone, prophylactic olanzapine, elevated backrest position, and early wakeup-in a factorial trial framework. This manuscript presents the complete statistical analysis plan for analyses common to all four DANOHCA interventions. DANOHCA is an investigator-initiated, multicenter, randomized, 2&#x2009;&#xd7;&#x2009;2&#x2009;&#xd7;&#x2009;2&#x2009;&#xd7;&#x2009;2 factorial clinical trial enrolling comatose adult OHCA patients with a presumed cardiac etiology who achieve sustained return of spontaneous circulation, with randomization within 180&#x2009;min of return of spontaneous circulation. Participants are co-randomized to Dexamethasone versus placebo, olanzapine versus placebo, backrest elevation at 35&#xb0; versus 5&#xb0;, and early (&#x2264;&#x2009;6&#x2009;h) versus late (28-36&#x2009;h) wakeup, with pharmacological interventions blinded and physiological interventions open-label. This statistical analysis plan specifies the primary and secondary outcomes, covariate adjustment, handling of missing data, assessments of interactions between interventions, and assumption checks, with all primary analyses conducted according to the intention-to-treat principle. The analysis plan is finalized prior to completion of randomization. The primary outcomes are 90-day all-cause mortality for the dexamethasone and backrest interventions, and days alive outside hospital within 30&#x2009;days for the olanzapine and early wakeup interventions, with common secondary and tertiary endpoints including mortality at later time points, neurological function, health-related quality of life, organ function, and safety outcomes. Mixed-effects regression models, Cox regression, stratified nonparametric tests, and prespecified sensitivity analyses will be applied to minimize bias and quantify intervention effects, including their associated uncertainties. This predefined statistical analysis plan provides a detailed, transparent framework for the primary analyses and reporting of the DANOHCA trial. Clinical Trials Information System (CTIS): 2024-515997-28-00.

Autosomal dominant kidney hypomagnesemia with RRAGD variants (ADKH-RRAGD) is a hereditary disorder characterized by kidney tubulopathy and dilated cardiomyopathy (DCM). RagD, encoded by the RRAGD gene, is a small GTPase involved in activating the mechanistic target of rapamycin complex 1 (mTORC1) by amino acids. Although several gain-of-function variants in the RRAGD gene have been identified, their contributions to DCM remain unclear. Here, we hypothesize that these RRAGD variants induce mTORC1 overactivation, thereby contributing to the manifestation of DCM. To investigate this, we established T-REx HeLa cell lines that overexpress the RRAGD p.(Ser76Leu) or the wild-type (WT) variant to assess the effects on mTORC1 signaling. Additionally, we developed the first cellular model of ADKH-RRAGD utilizing genetically edited human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) that express the mutated variant. Our data indicate that the RRAGD p.(Ser76Leu) variant maintains the phosphorylation of mTORC1 targets (i.e., S6K, 4E-BP1, and TFEB) during amino acid starvation, in contrast to RRAGD WT in T-REx HeLa cells. The pharmacological inhibition of mTOR with Torin1 reversed these changes. In 2D-cultured RRAGDWT/p.(Ser76Leu) hiPSC-CMs, mTORC1 remained responsive to amino acid starvation. Results from bulk RNA sequencing showed an upregulation of pathways associated with cytoskeletal organization and a downregulation of muscle development in RRAGDWT/p.(Ser76Leu) hiPSC-CMs. Moreover, a prolonged duration of Ca2+ transients was observed in the mutant cardiomyocytes. Altogether, our data demonstrate that gain-of-function variants in RRAGD cause mTORC1 activation in T-REx HeLa cells. Consequently, cardiomyocytes develop impaired intracellular Ca2+ clearance and activation of transcriptional programs, suggesting dedifferentiation.

Breast cancer (BC) remains a leading cause of cancer-related deaths among women. Administration of anthracyclines and/or anti-human epidermal growth factor receptor-2 (HER2) antibodies has been associated with chemotherapy-induced cardiotoxicity. Cardio-oncology rehabilitation programs aim to mitigate these outcomes. However, their preventive role in cancer therapy-related cardiac dysfunction (CTRCD) remains uncertain. To evaluate the effectiveness of a structured exercise program compared with only exercise recommendation in preventing CTRCD, defined by the 2022 European Society of Cardiology criteria, as a left ventricular ejection fraction above 50%, with a relative decrease in global longitudinal strain exceeding 15% from baseline and/or a newly detected elevation in cardiac troponin I or T or natriuretic peptides. Secondary outcomes include the impact on systolic and diastolic echocardiographic parameters, cardiometabolic biomarkers, quality of life, and exploring the role of traditional cardiovascular risk factors in CTRCD onset. CARPTOX-BC is a randomized, open-label clinical trial with an active control group. Women aged 18-70&#xa0;years with stage I-III BC scheduled for neoadjuvant or adjuvant therapy with anthracyclines and/or trastuzumab will be eligible. The intervention includes three supervised out of five weekly aerobic and resistance exercise. A total of 284 participants will be randomized 1:1 to intervention or control arms. Results will be disclosed at completion. We expect a structured exercise program may reduce the incidence of CTRCD associated with anthracycline and/or HER2 antibody and provide a potential non-pharmacological therapy that could also enhance cardiometabolic markers and quality of life among this population. NCT06881940 (registered March 18th, 2025).

Castanopsis sieboldii is a phenolic-rich evergreen species in the family Fagaceae, yet comprehensive quantitative and tissue-specific metabolite profiling remains limited. In this study, an integrated analytical workflow comprising UHPLC-PDA quantification, LC-QToF-MS identification, and chemometric analysis was developed to characterize phenolic constituents in leaves, flowers, fruits, and stems. A validated UHPLC-PDA method enabled the simultaneous quantification of six major phenolics, with limits of detection ranging from 0.01 to 0.05&#x202f;&#x3bc;g/mL and limits of quantification from 0.025 to 0.1&#x202f;&#x3bc;g/mL. Among all tissues, 3&#x2011;O&#x2011;galloylshikimic acid (Compound 1) was the predominant metabolite (0.1-204&#x202f;mg/g), followed by caffeoylquinic acids (Compounds 2-3), ellagic acid (Compound 4), and flavonoid glycosides (Compounds 5-6). LC-QToF-MS analysis facilitated the tentative annotation of 185 metabolites, including phenolic acids, ellagitannins, galloylshikimic acids, and flavonoid glycosides, based on accurate mass measurements and characteristic MS/MS fragmentation patterns. Chemometric evaluation using principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and hierarchical clustering analysis (HCA) revealed clear tissue-specific clustering, with leaves exhibiting the highest chemical diversity and phenolic abundance, whereas fruits showed minimal levels. PCA captured 80% of total variance in the first two components, and the PLS-DA model showed strong predictive performance (R&#xb2;Y &#x2248; 1.00; Q&#xb2; &#x2248; 0.98) although interpretation should consider the limited sample size. This study provides a comprehensive, tissue-resolved phenolic profile of C. sieboldii, establishing a robust chemical foundation for future pharmacological, ecological, and quality-control applications.

Menopause affects nearly one-third of women's lives and is associated with a wide range of physical and psychological symptoms-including sleep disturbances, mood fluctuations, and reduced quality of life-that represent a significant public health concern. While pharmacological treatments carry well-documented risks, evidence-based non-pharmacological interventions such as Mindfulness-Based Stress Reduction (MBSR) remain understudied in this population, particularly with respect to multiple psychosocial outcomes. This study aimed to evaluate the effects of a Mindfulness-Based Stress Reduction (MBSR) program on quality of life, life satisfaction, sleep quality, and mental well-being among menopausal women. A randomized controlled trial with a pretest-posttest control group design. The study was conducted between February 28 and December 22, 2025, at a primary healthcare center in T&#xfc;rkiye. A total of 84 menopausal women were included (intervention: n&#x2009;=&#x2009;43; control: n&#x2009;=&#x2009;41). Data were collected using the Utian Quality of Life Scale, Riverside Life Satisfaction Scale, Pittsburgh Sleep Quality Index, and Warwick-Edinburgh Mental Well-Being Scale. The intervention group participated in an 8-week MBSR program, while the control group received no intervention. Data were analyzed using IBM SPSS Statistics (version 26.0). Compared with the control group, participants in the MBSR group demonstrated significant improvements in quality of life, life satisfaction, and mental well-being, along with significant reductions in sleep disturbances (p&#x2009;<&#x2009;0.001). Within-group analyses showed significant improvements across all outcomes in the intervention group (p&#x2009;<&#x2009;0.001), whereas no significant changes were observed in the control group (p&#x2009;>&#x2009;0.05). The MBSR program was associated with improvements in psychosocial well-being and sleep quality among menopausal women. These findings suggest that MBSR may be a beneficial non-pharmacological approach for managing menopausal symptoms.

Uterine fibroids and adenomyosis are common estrogen- and progesterone-dependent disorders associated with heavy menstrual bleeding, pelvic pain, anemia, and impaired quality of life. Although surgery remains widely used, there is an increasing demand for effective uterus-preserving medical therapies. Oral gonadotropin-releasing hormone (GnRH) antagonists have recently emerged as a novel therapeutic option, allowing rapid, reversible, and dose-dependent suppression of ovarian steroidogenesis. This narrative, based on a targeted PubMed/MEDLINE literature search and review of major guideline documents published up to May 2026, summarizes the pharmacological properties, mechanisms of action, and clinical evidence regarding GnRH antagonists (elagolix, relugolix and linzagolix) in uterine fibroids and adenomyosis. Evidence from randomized controlled, extension studies, and emerging literature was critically reviewed, focusing on control of heavy menstrual bleeding, pain reduction, quality of life, safety, and the role of add-back therapy. GnRH antagonists represent a major advance in the medical treatment of uterine fibroids and are highly effective in controlling heavy menstrual bleeding. Their role in adenomyosis appears promising, although evidence remains limited. These agents should currently be considered suppressive rather than curative therapies, as symptoms often recur after discontinuation. Long-term integration into individualized treatment strategies will require further safety and comparative effectiveness data.

Pain is common in intensive care unit (ICU) patients with up to one-third experiencing pain at rest and even more during mobilization and clinical procedures. This survey aimed to explore physicians' attitudes and preferences regarding pain management in adult ICU patients in the Nordic countries. We conducted an electronic survey targeting physicians working regularly in an ICU in the Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. The survey focused on pain assessment, pharmacological treatments, and post-discharge follow-up of adult ICU patients. The survey was distributed to 606 physicians, and 360 responses were received (overall response rate 59%). Respondents were primarily from Denmark, with only a few respondents from the remaining Nordic countries. Most respondents were specialists in anesthesiology working in mixed ICUs in public specialist hospitals. Standardized pain assessment tools were widely used in non-sedated patients, while only half of respondents employed standardized pain assessment tools in sedated patients. Respondents reported that pain was assessed multiple times daily in both non-sedated and sedated patients. Daily wake-up calls in sedated patients were considered important by almost all respondents. Morphine was the preferred opioid for oral- and intravenous bolus administration, while remifentanil was preferred for intravenous continuous administration. However, preferences varied across countries with regard to both opioid- and non-opioid analgesics. Nearly half of respondents expressed concerns regarding the development of opioid-induced hyperalgesia. Methadone was the most frequently preferred drug for opioid weaning, although preferences varied between countries. Most respondents acknowledged the importance of ICU-follow up programs, but only about half of respondents reported that their ICU currently offered a follow-up service. This Nordic survey explored ICU physicians' attitudes and preferences regarding pain management in adult ICU patients. Respondents reported assessing pain frequently, employing standardized pain assessment tools primarily in non-sedated patients. Daily wake-up calls in sedated patients were generally perceived as important. Interestingly, preferences regarding opioid- and non-opioid analgesics varied between Nordic countries. ICU-follow up programs were recognized as important but were not consistently implemented. Despite a high overall response rate, the generalizability of our findings is impaired by limited participation in most Nordic countries except Denmark. This survey describes the physician perspective on predominantly pharmacological pain management in selected ICUs within the Nordic countries.

Fibromyalgia Syndrome (FMS) is a chronic pain disorder characterized by widespread pain and central sensitization that significantly impacts the quality of life (QoL). For management to be effective, a multidisciplinary approach to care is typically required. Photobiomodulation therapy (PBMT), a non-pharmacological treatment, has garnered attention lately, though its clinical relevance and applications are not well defined. The objective of this review was to assess the effectiveness of PBMT in reducing FMS symptoms. This systematic review was registered at PROSPERO (CRD420251084730) and conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. A total of seven randomized controlled trials were identified following an extensive literature search across various databases, including PubMed, Scopus, Web of Science, the Cochrane Library, Embase, Ovid and ProQuest. To evaluate the methodological quality of these studies, the Cochrane Risk of Bias (RoB 2.0) tool was applied. PBMT demonstrated consistent short-term reductions in pain intensity and improvements in QoL. Additional positive effects on sleep quality and psychological well-being were observed, indicating that PBMT may provide additional therapeutic benefits beyond pain reduction, including improvements in sleep quality and psychological well-being. PBMT has shown promise as a safe, non-pharmacological adjunct therapy that may provide short-term improvements in pain levels and QoL, but substantial heterogeneity limits generalizability. Clinical trials with large samples and standardized methodologies should be conducted to better clarify the role of PBMT in multidisciplinary therapy for FMS.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease that profoundly impacts patients' daily lives. While pharmacological therapies continue to advance, less is known about how patients experience the burden of disease across different periods after IPF diagnosis, resulting in a lack of evidence for the development and optimisation of patient-centred intervention strategies. Therefore, this study aimed to explore how individuals with IPF experience the disease and its impact on daily life in China. This multicentre qualitative study was conducted using semistructured interviews with participants from six geographic regions in China between November 2024 and March 2025. Participants were grouped by time since diagnosis to reflect different periods following diagnosis. Data were collected and analysed inductively and iteratively by using practical thematic analysis until thematic saturation was achieved. 53 participants were interviewed to explore the patient experience at different periods following IPF diagnosis. Thematic analysis identified that participants commonly reported the influence of IPF on quality of life, including (1) symptom experience, (2) sleep, (3) eating habits, (4) physical activity, (5) social participation, (6) psychological well-being and (7) financial status. Cough and breathlessness were consistently reported as the most troubling symptoms, often accompanied by psychological challenges related to diagnosis and disease progression. The findings highlight the experience and need for patient-centred care across China that addresses not only clinical symptoms but also emotional and social dimensions of living with IPF. Enhancing public awareness may also help reduce stigma and social isolation.

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that significantly impairs quality of life. Despite pharmacological advances, there is increasing interest in adjunctive nutritional interventions. This review evaluates the efficacy, mechanisms, and safety of dietary models-including low-starch, gluten-free, dairy-free, vegan/vegetarian, and Mediterranean diets-for axSpA management. A comprehensive literature search was conducted across Medline/PubMed, EMBASE, Scopus, Web of Science, and the Directory of Open Access Journals (DOAJ) databases for peer-reviewed articles published up to June 1, 2026. The search strategy utilized Boolean operators (AND, OR) to combine Medical Subject Heading (MeSH) terms and free-text keywords encompassing concepts of 'axial spondyloarthritis' and various dietary interventions (e.g., Mediterranean, gluten-free, and low-starch diets). Studies focusing on isolated nutrient supplementations without a broader dietary framework were excluded. Restrictive diets (e.g., low-starch or gluten-free) offer theoretical anti-inflammatory benefits via gut microbiota modulation but pose risks for unsupervised micronutrient deficiencies. While the Mediterranean diet is a feasible and safe option for general health, evidence for specific dietary interventions in axSpA remains limited and predominantly observational, with few randomized controlled trials available. Integrating personalized nutritional counseling into the multidisciplinary management of axSpA may help safely prevent deficiencies, optimize body weight, and improve patient well-being. However, current evidence remains insufficient to universally recommend a specific dietary model for axSpA.