Indigenous Peoples' experience inequitable access to population-based cancer screening programs compared to non-Indigenous people. Incentives including financial incentives, outreach programs, and educational programs have been used to increase participation; however, their effectiveness among Indigenous populations remains unclear. This systematic review investigated the effectiveness of incentives on cancer screening participation among Indigenous populations. Following PRISMA guidelines, we searched PubMed, Web of Science, EMBASE, and CINAHL for published articles from inception to September 2025. Eligible articles were reviewed and appraised by two independent reviewers using the Mixed-Methods Appraisal Tool. A total of 35 articles were included, reporting on education programs (63%), outreach programs (23%), and a combination of both (14%). Education-based interventions improved cancer screening participation rates (ranging from 11.7% to 370%) and/or knowledge among Indigenous populations. Outreach programs, particularly those with personalized follow-ups, improved participation by over 31%. Combining outreach and education was also effective, especially with trained healthcare workers and tailored community approaches. Financial and non-financial incentives like transportation and childcare increased engagement. Approaches co-designed with Indigenous communities were more effective in improving knowledge, attitudes, and increasing screening rates. Culturally tailored incentives, co-designed with Indigenous communities, should inform future cancer screening research, policy and practice.
ObjectiveThis study aims to investigate the facilitators and barriers to engagement in telerehabilitation programmes among people with Parkinson's disease. Furthermore, we examined whether the exercise modality (dance or multimodal exercise) influenced participants' perceptions of the telerehabilitation experience, including benefits, challenges and engagement.DesignThis is a qualitative component of a randomised clinical trial.SettingGroup-based telerehabilitation delivered via videoconferencing.ParticipantsSixty-three people with Parkinson's disease.InterventionTwo telerehabilitation groups: (1) Multimodal Exercise and (2) Dance, delivered twice a week, in 60-min sessions for three months.Main measuresSemi-structured interviews were conducted via live videoconferencing. We coded and organised the interviews using Atlas.TI software and applied a structured thematic analysis.ResultsTwo themes emerged: (1) Facilitators to engagement in telerehabilitation, including satisfaction, acceptance of online format, recognition of functional, emotional, cognitive and social benefits, appreciation for a disease-specific programme; and instructor's expertise (2) Barriers were problems in programme design and implementation, timing and scheduling conflicts, motor, cognitive and social barriers. The dance group focused on their experience with telerehabilitation, emphasising the emotional and mind-body aspects, while the multimodal exercise group focused on the motor function of activities of daily living.ConclusionsThis study identified facilitators and barriers to engagement in group-based telerehabilitation among people with Parkinson's disease. People with Parkinson's disease reported satisfaction and recognised telerehabilitation as feasible, and highlighted some motor, cognitive, social, technological and scheduling barriers. Additionally, the type of exercise (dance or exercise) influenced people with Parkinson's disease's perceptions of the telerehabilitation experience.
Functionalized coacervates, a type of nanomaterial inspired by biomolecular condensation, have emerged as an important research direction in biomedicine, particularly in cancer therapy. These membraneless structures formed by liquid-liquid phase separation (LLPS) self-assembly have high drug-loading capacity, favorable biocompatibility, and tunable responsiveness to tumor microenvironment (TME) cues. This programmability enables targeted delivery and controlled release. This review summarizes the latest progress in the design and therapeutic application of functionalized coacervates in cancer therapy. We first introduce the construction strategies, including basic driving forces, material platforms, and advanced architectures. Then, we explain the mechanisms that enhance therapeutic efficacy and reduce toxicity, including enhanced loading and stability, improved pharmacokinetics and tumor accumulation, and enhanced intracellular delivery that can overcome multidrug resistance (MDR). We also discuss spatiotemporal release triggered by TME cues, such as acidity, redox, or enzymatic activity. Next, we highlight applications in chemotherapy, nucleic acid delivery, cancer immunotherapy, multimodal combination therapy, and emerging directions. Finally, we discuss translational challenges and outline future research directions. We aim to provide a coherent framework for researchers and to facilitate the development and clinical translation of coacervate-based therapeutics.
'Building Healthy Public Policy' is one of the five strategic action areas in the 1986 Ottawa Charter for Health Promotion, highlighting the role of governments in enabling equitable access to the basic prerequisites for health, including food and income. Yet, 40 years later, 2.6 billion people worldwide are unable to afford a healthy diet, and more than 1 in 8 households in Australia experience food insecurity. In this perspective piece, we draw on the latest data to: (i) discuss the ongoing discordance between the primary drivers of household food insecurity and Australia's predominant means of addressing the issue; (ii) examine trends in social welfare spending and food insecurity in other high-income countries; and (iii) discuss opportunities for reducing food insecurity in Australia by increasing social welfare spending. In Australia, emergency food relief plays a crucial role in alleviating hunger in the short term and should continue to receive support. However, Australia's over-reliance on emergency food relief demonstrates the failure of welfare policies in allocating resources equitably. In line with international commitments, Australia's National Food Security Strategy must be underpinned by the human right to food. Actions to reduce food prices by tackling industry concentration and market power must be combined with actions to increase household incomes (e.g. by increasing social welfare payments) to enable ongoing access to affordable healthy food for all.
Tyrosine kinase 2 (TYK2), a key part of the inflammatory cascade responses, plays an integral role in the pathogenesis of psoriasis. Socrodeucitinib, an oral, TYK2 allosteric inhibitor, selectively inhibits TYK2 cytokine signalling pathways in psoriasis pathogenesis. To evaluate the efficacy and safety of socrodeucitinib in patients with moderate-to-severe plaque psoriasis. In this phase 2, double-blind, placebo-controlled trial, 125 patients were randomly assigned (1:1:1) to receive socrodeucitinib at 6 mg, 12 mg or placebo orally, once daily, for 12 weeks. The primary endpoint was the proportion of patients with a 75% or greater reduction from the baseline in the Psoriasis Area and Severity Index (PASI) score at week 12. At week 12, significantly more patients treated with socrodeucitinib achieved a 75% reduction from baseline in PASI score compared with placebo (28.6% at 6 mg, 72.1% at 12 mg vs. 7.5% for placebo, p < 0.05 and p < 0.001, respectively). At the 12 mg dose, socrodeucitinib resulted in significantly higher response rates compared to placebo, with 46.5% of patients achieving PASI 90 (p < 0.001) and 11.6% achieving PASI 100 (p < 0.05). The treatment of socrodeucitinib also led to significantly higher proportions of patients achieving sPGA responses of 0 or 1 compared to placebo: 33.3% at 6 mg and 65.1% at 12 mg versus 10% for placebo (p < 0.05 and p < 0.001, respectively). Most common adverse events included upper respiratory tract infection which demonstrated a certain dose dependency. Most treatment-related adverse events were mild or moderate, and serious adverse events were infrequent, with no clinically meaningful abnormal trend in laboratory parameters. Socrodeucitinib demonstrated significantly greater clearing of psoriasis plaques compared to placebo in patients with moderate-to-severe plaque psoriasis and illustrated a favourable safety and tolerability profile, warranting further investigation in longer-duration and larger trials.
Cancer-associated fibroblasts (CAFs) are key elements of the tumor microenvironment and influence cancer growth, progression, metastasis, and treatment resistance. They originate from multiple sources, including resident fibroblasts, stellate cells, epithelial and endothelial cells, and bone marrow-derived precursors, leading to substantial functional and molecular diversity. Most CAF subsets promote tumor development by remodeling the extracellular matrix, releasing growth factors and cytokines, inducing epithelial-mesenchymal transition, and suppressing antitumor immunity. However, some subsets can restrain tumor growth. This heterogeneity makes therapeutic targeting difficult. This review summarizes current knowledge of CAF origins, activation mechanisms, molecular markers, and functional subtypes, emphasizing their contributions to an immunosuppressive tumor microenvironment that limits the effectiveness of immunotherapy. It also discusses emerging therapeutic strategies such as CAF depletion, phenotype reprogramming, and extracellular matrix normalization, along with their potential benefits and challenges.
Identifying people with relapsing-remitting multiple sclerosis (pwRRMS) at risk of progression independent of relapse activity (PIRA) remains an unmet clinical need. Optical coherence tomography (OCT)-derived measures of retinal neuroaxonal damage may provide prognostic value. This study aimed to evaluate whether peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layer (GCIP) thickness predict PIRA within a heterogenous group of pwRRMS. We retrospectively screened pwRRMS with ≥ 2 years relapse-free follow-up from prospective observational cohort studies in Berlin (n = 74) and Munich (n = 146). PIRA was defined as disability worsening, determined by method-specific thresholds across multimodal assessments, sustained until end of follow-up. Analyses were restricted to non-optic neuritis eyes. Cox hazard models were used to assess the adjusted hazard (aHR) of PIRA with age-adjusted pRNFL or GCIP Z-scores. Out of 220 pwRRMS (age: 38.1 ± 9.9 years), 65 (29.5%) developed PIRA over a follow-up of 2.9 [IQR: 1.6-4.1] years. No associations between OCT measures and PIRA were found within the overall study population or Munich cohort. In the Berlin cohort, thinner pRNFL predicted PIRA (aHR [95% CI] = 1.41 [1.03-1.92], p = 0.032), while GCIP did not (aHR [95% CI] = 1.38 [0.90-2.10], p = 0.140). OCT measurements do not predict the hazard of PIRA within a heterogeneous group of pwRRMS. However, they have potential prognostic value in early disease stages. Clinical characteristics might influence the association and require further investigation.
Lichen sclerosus (LS) is a chronic inflammatory dermatosis with an autoimmune component, clinically observed to co-occur with pelvic floor disorders, particularly urinary incontinence (UI). However, the strength of this association remains unclear. This study was aimed at the quantitative synthesis of the prevalence of UI in female patients with LS and the risk of UI associated with LS. A systematic search was conducted in PubMed, Web of Science and Medline from inception to 29 December 2025. Observational studies reporting UI data in women with LS were included. Study quality was assessed using Joanna Briggs Institute checklists. A single proportion meta-analysis pooling the prevalence of UI and a comparative meta-analysis calculating risk ratio for UI in LS versus non-LS controls were conducted. Thirteen studies involving 52,002 participants were included. All studies involving 13,296 patients with LS were included for a single-proportion analysis. The pooled prevalence of UI was 0.23 (95% CI 0.12-0.38, I2 = 99.3%). The comparative meta-analysis of seven studies (12,370 LS vs 38,487 non-LS participants) showed a 68% increased risk of UI among patients with LS (95% CI 1.28-2.19, I2 = 89%). Subgroup analysis indicated that geographic region was a significant source of heterogeneity. Sensitivity analysis confirmed result robustness, although trim-and-fill adjustment suggested a more conservative prevalence estimate. This study suggests that LS in women might be associated with a significantly higher prevalence of UI. Despite considerable heterogeneity, the findings highlight the need for integrated, multidisciplinary care that includes routine urological assessment in the management of LS. Further prospective studies are required.
Periodontitis, a prevalent chronic inflammatory disease triggered by periodontal pathogens and exacerbated by the host immune response, leads to progressive destruction of the tooth-supporting tissues and ultimately tooth loss. Effective long-term treatment remains challenging, as conventional therapies often cannot simultaneously eradicate bacteria, control inflammation, and regenerate lost periodontal tissue. Here, we present an injectable curcumin-loaded Pickering emulsion (PE-CUR) as a multifaceted biomaterial-based therapy for periodontitis and investigate its therapeutic efficacy and underlying mechanisms. The Pickering emulsion formulation significantly enhances the bioavailability and therapeutic potency of curcumin. PE-CUR exhibits excellent biocompatibility and robust anti-inflammatory activity, notably scavenging reactive oxygen species (ROS). It also demonstrates potent antimicrobial effects, effectively eliminating key periodontal pathogens such as Porphyromonas gingivalis and Staphylococcus aureus. In a periodontitis model, PE-CUR treatment markedly attenuates periodontal inflammation and alveolar bone loss, indicating protection against tissue destruction. Mechanistically, PE-CUR promotes macrophage polarization toward an anti-inflammatory phenotype characterized by reduced M1-associated markers and enhanced M2-associated markers. This shift is accompanied by upregulation of anti-inflammatory cytokines and suppression of pro-inflammatory mediators, likely through modulation of the MAPK and PI3K/Akt signaling pathways. Additionally, PE-CUR inhibits osteoclast formation while promoting osteoblast activation and differentiation, thereby preserving alveolar bone and facilitating periodontal tissue regeneration. Collectively, these findings underscore the potential of PE-CUR as an innovative and comprehensive therapeutic strategy for periodontitis-one that concurrently addresses infection, inflammation, and tissue regeneration. This multi-functional approach holds promise as a novel periodontitis treatment and warrants further clinical investigation.
Eltrombopag is an effective second-line therapy for immune thrombocytopenia (ITP), but its long-term efficacy is limited. All-trans retinoic acid (ATRA) has immunomodulatory effects targeting ITP pathophysiology. We investigated whether combining ATRA with eltrombopag improves long-term outcomes for glucocorticoid-resistant or relapsed ITP. We conducted a multicenter, randomized, open-label trial in adults with glucocorticoid-resistant or relapsed ITP (platelets <30×109/l). Patients were randomly assigned 1:1 to ATRA (12 weeks) plus eltrombopag or eltrombopag monotherapy. The primary outcome was an 18-month sustained response (platelet count ≥30×109/l without clinically significant bleeding or rescue therapy). Ninety-six patients were randomly assigned, 48 per group. At 18 months, 60% (29/48) in the ATRA-plus-eltrombopag group achieved a sustained response, versus 35% (17/48) in the monotherapy group (odds ratio: 2.78; 95% confidence interval [CI]: 1.22-6.37; P=0.014). The combination was associated with a higher complete response rate (79% vs. 58%; 95% CI for difference, 2 to 39 percentage points) and longer median response duration (75 vs. 37 weeks; hazard ratio for relapse, 0.45; 95% CI, 0.23-0.86). Adverse events were comparable between groups, with no grade 3-4 events or treatment-related deaths. However, clinically significant bleeding of World Health Organization grades 2 or 3 was 21% in the combination group at baseline compared with 10% in the monotherapy group. In patients with glucocorticoid-resistant or relapsed ITP, a 12-week ATRA course with eltrombopag significantly enhanced the 18-month sustained response rate compared to eltrombopag alone. (Funded by Capital Health Research and Development of Special Fund and others; ClinicalTrials.gov number, NCT05438875.).
Type 1 diabetes begins as an autoimmune disease and can already be diagnosed in the presymptomatic early stage by detecting at least two positive islet autoantibodies (stage 1, International Classification of Diseases, 10th Revision, German Modification [ICD-10-GM]: R76.80; stage 2, ICD-10-GM: R73.00). Immunomodulatory therapies can slow disease progression and delay the clinical manifestation of type 1 diabetes. In parallel, cell therapy for β‑cell replacement is gaining increasing importance as a strategy to restore endogenous insulin production. This article provides an overview of the current status of immunotherapies and cell therapies in type 1 diabetes. The review "The future of type 1 diabetes therapy" by Ziegler et al. (2025) served as the basis. In addition, current guidelines, original articles, and selected studies on immunotherapies and β‑cell replacement therapies were considered. With teplizumab, the first disease-modifying therapy for stage 2 type 1 diabetes is available. It delays the transition to clinically manifest type 1 diabetes (stage 3) by an average of 2-3 years. Other immunomodulatory therapeutic approaches show preservation of residual β‑cell function in stage 3 type 1 diabetes but are not yet approved for this indication. Stem-cell-based β‑cell replacement therapies are currently being clinically investigated in people with advanced diabetes and impaired awareness of hypoglycemia. Immunotherapies and cell therapies mark a paradigm shift in the treatment of type 1 diabetes. In the future, combination therapies will be particularly important to improve the durability of therapeutic effects, as will strategies to protect transplanted cells from alloimmunity and autoimmunity. HINTERGRUND: Der Diabetes mellitus Typ 1 beginnt als Autoimmunerkrankung und kann bereits im präsymptomatischen Frühstadium durch den Nachweis von mindestens zwei positiven Inselautoantikörpern diagnostiziert werden (Stadium 1, Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification [ICD-10-GM]: R76.80; Stadium 2, ICD-10-GM: R73.00). Immunmodulierende Therapien können das Fortschreiten der Erkrankung verlangsamen und die klinische Manifestation des Typ-1-Diabetes verzögern. Parallel dazu gewinnt die Zelltherapie zum Ersatz von β‑Zellen zunehmend an Bedeutung. Der Beitrag gibt einen Überblick über den aktuellen Stand der Immun- und Zelltherapien beim Typ-1-Diabetes. Als Grundlage diente der Review „The future of type 1 diabetes therapy“ von Ziegler et al. (2025). Ergänzend wurden aktuelle Leitlinien, Originalarbeiten sowie ausgewählte Studien zu Immuntherapien und β‑Zell-Ersatztherapien berücksichtigt. Mit Teplizumab steht erstmals eine krankheitsmodifizierende Therapie für das Stadium 2 des Typ-1-Diabetes zur Verfügung. Teplizumab verzögert den Übergang in den klinisch manifesten Typ-1-Diabetes (Stadium 3) durchschnittlich um 2–3 Jahre. Weitere immunmodulatorische Therapieansätze zeigen einen Erhalt der residualen β‑Zell-Funktion im Stadium 3 des Typ-1-Diabetes, sind jedoch bislang nicht für diese Indikation zugelassen. Stammzellbasierte β‑Zell-Ersatztherapien befinden sich derzeit in klinischer Prüfung bei Personen mit fortgeschrittenem Diabetes und Hypoglykämiewahrnehmungsstörungen. Immun- und Zelltherapien markieren einen Paradigmenwechsel in der Behandlung des Typ-1-Diabetes. Zukünftig werden insbesondere Kombinationstherapien entscheidend sein, um die Dauerhaftigkeit therapeutischer Effekte zu verbessern, und Strategien, um transplantierte Zellen vor Allo- und Autoimmunität zu schützen.
The influence of condylar fracture treatment on facial symmetry and its relationship with mandibular parameters remains relatively unexplored. Understanding the effects of different treatment modalities on skeletal remodeling and temporomandibular joint (TMJ) function is important for improving clinical outcomes. In this study, facial soft tissue-related linear measurements derived from CBCT were evaluated in relation to underlying skeletal changes and TMJ functional outcomes following different management approaches for condylar fractures. A retrospective study was conducted on 60 patients with condylar fractures who underwent plate fixation, screw fixation, or closed reduction. Cone-beam computed tomography was used to assess craniofacial measurements and soft-tissue changes at three-time intervals. Mandibular parameters, facial symmetry indices, and TMJ dysfunction scores were analyzed and compared among the treatment groups. Treatment modality and follow-up time significantly affected skeletal and soft-tissue outcomes. At 6 months, the tragion-pogonion (T-Pog) distance was 136.64 ± 6.10 mm in the plate group, with mean reductions of 3.58 mm, 4.82 mm, and 4.54 mm in the plate, screw, and closed reduction groups, respectively. The closed reduction group exhibited significantly higher TMJ dysfunction scores. Ramus length was positively correlated with T-Pog distance, whereas mediolateral condylar inclination was negatively associated with facial measurements. Condylar fractures Management significantly influences mandibular dimensions and facial symmetry, particularly following closed reduction. Surgical fixation methods provide greater skeletal stability and improved functional outcomes. Treatment modality plays a key role in facial symmetry and TMJ function, with surgical fixation resulting in better outcomes. Optimal results may depend on precise anatomical reduction supported by advanced surgical techniques.
Power disparities in the food system are reflected in food policy processes and outcomes that are failing to address major food system challenges. As interest in investigating and addressing these power disparities grows, it is important to assess the research methods that have been used to examine power in food policy, and how methodological choices shape our understanding. This scoping review critically maps the methodological approaches applied in empirical studies of power in national-level food policy. A systematic search across fourteen databases identified 46 empirical studies published between 2014 and 2025: 33 qualitative, 9 discourse analytic and 4 quantitative. Qualitative research examined the relative power of food system actors and their strategies, as well as the structural dynamics sustaining unequal influence. Quantitative analyses studied the patterns of structural and positional power within policy networks and across political systems. Discourse analytic studies examined how ideas and discourses construct and legitimize understandings of food policy problems and solutions. Across methods, most research investigates how entrenched power constrains progress on food system challenges, with fewer studies exploring examples of resistance. Each approach demonstrates strengths and limitations that are shaped by theory and data. This review highlights the need for methodological innovation-including applying mixed methods, longitudinal designs, and comparative analyses-to expand our understanding of power in food policy and identify actionable strategies to address disparities for the benefit of people and planet.
This case illustrates a large right ventricular myxoma causing severe right ventricular outflow tract obstruction. Multimodality imaging, including echocardiography and CT, guided the diagnosis. The patient underwent successful surgical resection, with histopathology confirming the benign tumor, leading to hemodynamic relief.
The present study assessed intrinsic capacity (IC) and its potential health-associated behaviors among three groups of older people (community dwellers, hospital outpatients, and hospital inpatients). In a cross-sectional study, 1225 older people (mean age=72.9 years [SD±7.4]; 51.3% females) from the three different settings participated. The participants' IC and their frequency of various health-related behaviors were assessed (i.e., physical activity [PA] engagement, alcohol drinking, and cigarette smoking). The community dwellers had the highest IC, followed by outpatients and inpatients. Community dwellers also had the highest regular PA engagement (83.4%) and the lowest former cigarette smoking (11.4%), current cigarette smoking (3.1%), and former alcohol drinking (1.2%) levels, again followed by outpatients and inpatients. Former alcohol drinking and PA engagement, as well as being community dwellers and outpatient status, were significantly associated with IC. After stratifying based on settings, PA engagement remained significantly associated with IC for all participants from different settings, while former alcohol drinking remained a significant correlation among community dwellers and outpatients. PA engagement was consistently associated with IC among Taiwanese older adults differently across different settings. These differences should be considered for any intervention program to improve IC among older people. Among older adult inpatients especially, specific modes to deliver effective intervention to improve PA engagement after discharge might be considered (e.g., establishing screening and brief motivational interventions).
BackgroundStudies have shown that the performance on the Clock Drawing Test (CDT) is influenced by age and education. Thus, normative scores are needed.ObjectiveTo develop normative Norwegian scores for Shulman's version of CDT.MethodsPerformance on CDT of 2572 cognitively healthy people between age 25 and 95 years were included. Ordinal regression analysis was used to derive regression-based norms with sex, age and education as covariates.ResultsOf all, 76.4% scored five, 12.9% scored four, 8.1% scored three and 2.5% scored zero to two. Men scored higher than women. An interaction between age and education was found. The probability of higher CDT score is highest at younger ages and among those with highest education. It progressively declines with increasing age, while higher education delays, but does not prevent this decline. Participants scoring zero to two fell below the 5th percentile, except among women above 93 years and men above 85 years. By age 95, the probability of different scores converged. In the age range of 60 to 90 years a score of three corresponded to percentiles of 3.7-26.9 in men and 5.2-34.1 in women, while a score of four corresponded to percentiles of 9.7-50.4 in men and 13.2-59.0 in women.ConclusionsScores four and five are considered normal for any person aged 60-90 years. Whether a score of three is normal depends on the person's sex, age and educational level, whereas score zero to two should not be regarded as normal.
BackgroundShort-chain organic acids (SCOAs) may have paradoxical effects on neurocognition, acting as either neuroprotective bioenergetic substrates or potential neurotoxicants. However, the joint effects of SCOA mixtures on cognitive impairment and the mechanisms underlying their divergent associations remain unclear.ObjectiveTo investigate the joint effects of serum SCOAs mixtures on cognitive impairment and elucidate underlying mechanisms.MethodsSerum levels of 11 SCOAs were quantified in 4192 older adults. Logistic regression and Bayesian kernel machine regression (BKMR) were used to assess individual and mixture associations with cognitive impairment. Potential targets were screened from public databases, intersected with cognitive impairment-related genes, and mapped to protein-protein interaction networks. Core targets were validated using four machine learning algorithms. Functional enrichment and molecular docking analyses were performed to explore potential mechanisms.ResultsIn adjusted models, β-hydroxybutyric, butyric, and propionic acids were inversely associated with cognitive impairment, whereas isobutyric and crotonic acids were positively associated. BKMR revealed a non-linear joint effect, with the overall association shifting from positive to negative when the mixture quantile exceeded 0.5; butyric acid showed an inverted U-shaped relationship. Network analysis identified two functional groups: the inverse group centered on GAPDH, AKT1, CASP3, NFKB1, and STAT3 and was enriched in PI3K-Akt and insulin signaling, whereas the positive group centered on ribosomal proteins and HSP90AA1, implicating ribosomal stress and NOD-like receptor signaling.ConclusionsSerum SCOAs showed divergent associations with cognitive impairment. Bioenergetic metabolites were linked to putative neuroprotective signaling, whereas risk-associated metabolites were linked to ribosomal stress signatures.
To assess the suitability of intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) for infertile couples with teratozoospermia primarily caused by sperm head abnormalities. A retrospective analysis was conducted on 856 infertile couples with teratozoospermia. Patients were stratified into four groups by sperm head malformation type and severity: head acrosome malformation < 95%/> 97%, and head shape malformation < 95%/> 97%. Key outcomes (fertilization rate, 2PN fertilization/cleavage rates, blastocyst formation/high-quality blastocyst rates, pregnancy/live birth rates) were compared across groups. In the head shape malformation < 95% subgroup, IVF had higher fertilization and blastocyst formation rates. IVF also achieved a significantly higher fertilization rate in the head acrosome malformation < 95% subgroup (p < 0.05). ICSI yielded a higher proportion of high-quality blastocysts in the head acrosome malformation > 97% subgroup. No significant differences in 2PN fertilization/cleavage rates, pregnancy rates, or live birth rates were observed between IVF and ICSI across all subgroups (p > 0.05). IVF is preferred for sperm head abnormality rate < 95% to enhance fertilization efficiency, while ICSI is advisable for acrosome malformation > 97% to improve high-quality embryo yield, providing evidence-based guidance for individualized assisted reproductive technology (ART) selection.
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To explore patients' experiences and perceptions of physical activity in the context of gout and gout flares. Interpretive description informed the design of this qualitative study. Individual interviews were conducted with 25 people with gout. An interview guide was used to lead discussions, focusing on participants' experiences of gout flares, physical activity engagement, and the perceived impact of flares on activity levels. Key questions were designed to capture culturally specific understandings and experiences related to gout and physical activity. Interviews were audio-recorded and transcribed verbatim. Data were analysed using reflexive thematic analysis. Four themes were generated from the data: (1) The experience of physical activity is shaped by societal misconceptions about gout; (2) A loss of physicality comes with a loss of autonomy; (3) Reclaiming body and identity through physical activity; and (4) Living with uncertainty: wanting to be active but not knowing how. Gout flares disrupted mobility, independence, work, family roles, and identity. Participants described stigma, fear of judgement, activity modification, pacing and uncertainty about whether exercise could trigger flares or damage joints, particularly in the absence of gout-specific advice. This study offers new insights into how societal misconceptions about gout influence the patient experience of physical activity, including loss of autonomy, identity reconstruction through movement, and uncertainty around safe exercise. These findings may inform future intervention development, and patient-centred physical activity guidance that supports people with gout to move safely, confidently, and meaningfully.