Diosgenin, derived from Dioscorea alata, is a well-known traditional medicinal compound with therapeutic potential against various conditions, including cancer and cardiovascular diseases. This study aimed to synthesize diosgenin polyethylene glycol succinate (DPGS) from diosgenin and evaluate its acute and chronic toxicity in rats. DPGS was designed as a novel amphiphilic excipient for universal solubilization, improving drug delivery and therapeutic performance. The acute toxicity assessment involved administering DPGS to female Albino-Wistar rats, while the chronic toxicity study was conducted over 90 days in both male and female Albino-Wistar rats at doses of 0 (control), 500, 1000, and 2000 mg/kg body weight/day. Additionally, recovery groups from the control and high-dose categories were observed for another 28 days. In the acute toxicity study, no clinical toxicity or mortality was observed at the highest dose of 2000 mg/kg body weight/day. Similarly, in the 90-day chronic study, no mortality or significant treatment-related effects were detected across all dose groups in either sex, based on histopathological, hematological, and clinical chemistry evaluations. These findings suggest that the oral no-observed-adverse-effect level (NOAEL) of DPGS in Albino-Wistar rats is greater than 2000 mg/kg body weight/day. The results support the safety profile of DPGS and its potential application as an excipient in drug formulation and delivery systems.
Severe and enduring mental health problems (SEMHP) in youth often fall outside traditional diagnostic classifications, which may lead to insufficient assessment of these youth's characteristics in classification-based psychiatry practice. Therefore, the objective of this study is to explore how current diagnostic practices in child-and-adolescent psychiatry address specific characteristics of youth with SEMHP by mapping the diagnostic process. Moreover, we aim to identify facilitators and barriers to effective assessment of specific SEMHP-characteristics by analysing stakeholders' perspectives. The exploration involved: 1) mapping the diagnostic processes (e.g., steps, tools) used in a CAP facility in the Netherlands by conducting semi-structured preparatory interviews with eight professionals in CAP in July-September 2023, and 2) qualitative analysis of stakeholder experiences to understand how SEMHP-characteristics are assessed, and what factors facilitate or hinder adequate assessment of these SEMHP-specific characteristics through focus groups. Separate focus groups with ten clinicians (n = 5, n = 5), eight youth (n = 5, n = 3) and five caregivers (n = 5) were conducted, using a semi-structured topic guide in December 2023 till May 2024. Data was analysed using reflexive thematic analysis to unravel barriers and facilitators in SEMHP-assessment. While all examined SEMHP-characteristics in this study were addressed in the diagnostic process, still participants reported feeling unseen or misunderstood during the assessments. Participants identified factors that hindered and facilitated the diagnostic assessment including distrust in systems, masking behaviour of youth, lack of time and generational differences in recent societal developments such as social media. Our study highlights stakeholder-identified barriers, revealing a shared perception of disconnect within the diagnostic process. This disconnect refers to a mismatch between clinical assessments and the lived experiences of youth and caregivers, in which they feel unheard, share less and experience being overlooked. Overcoming barriers requires viewing diagnostics as a relational process, where, in addition to gathering information, the focus in on building a therapeutic relationship, prioritising youth's story and emphasising individual understanding.  Proper diagnostics is essential for achieving adequate care in child-and-adolescent psychiatry.Severe and enduring mental health problems (SEMHP) in youth do not fit traditional classifications, and therefore may be assessed insufficient in classification-based psychiatry practice.The SEMHP-characteristics examined in this study were addressed during the diagnostics process, yet participants felt unseen and misunderstood.A communication gap, affected by diagnostic language, perception and generational differences, can impact diagnostic quality of SEMHP-assessment in youth, and lead to misconceptions.A vicious cycle of distrust and youth feeling unheard, leading them to mask their true feelings, which in turn deepens their mistrust, can hinder accurate assessment of SEMHP-characteristics in youth, and lead to misunderstandings.To overcome barriers, a diagnostic approach should find balance between information gathering and fostering connection, trust and openness in a genuine dialogue.
Depression carries the highest burden of mental health-related disability in the United States. Approximately 13% of military veterans report elevated rates of depression. Despite the availability of evidence-based treatments for depression, nearly 50% of veterans in need of mental health care remain untreated. Internet-based interventions show promise in reducing this gap; however, there are currently no standard self-guided internet-based interventions for depressive symptoms in veterans. Deprexis is one such intervention that leverages cognitive behavioral therapy to target depressive symptoms. This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of Deprexis, a fully self-guided internet-based intervention for depression, in US military veterans with mild to severe depressive symptoms. This open-label pilot trial recruited 19 veterans with mild to severe depression (mean age 55.5, SD 8.2 y; baseline Quick Inventory of Depressive Symptomatology-Self-Report [QIDS-SR]: mean 16.2, SD 4.1) for an 8-week course of Deprexis, with self-report assessments at baseline, posttreatment (8 wk), and follow-up (16 wk). Primary outcomes included depressive symptoms (QIDS-SR), functional disability (World Health Organization Disability Assessment Schedule 2.0), and symptom-related disability (Sheehan Disability Scale). Feasibility was assessed through recruitment and retention rates, and acceptability was measured using validated questionnaires (Credibility and Expectancy Questionnaire and Client Satisfaction Questionnaire). Multilevel models examined change over time, with effect sizes calculated using pooled SDs from unconditional models. Recruitment and retention targets were met, with 15 out of 19 (79%) participants meeting the adherence criteria (ie, ≥60 min of active program use). Of these, 14 participants completed posttreatment questionnaires and were included in the completer analyses. The program received a positive acceptability rating: of the 18 participants who completed follow-up assessments, 78% (n=14) rated services as good or excellent and 72% (n=13) were satisfied with the amount of help received. No safety concerns were reported. Among completers (n=14), QIDS-SR scores decreased from baseline to posttreatment (estimate -2.22, SE 1.44; P=.14; d=-0.54, 95% CI -1.07 to 0.13) and follow-up (estimate -2.85, SE 1.19; P=.02; d=-0.70, 95% CI -1.21 to -0.08) with moderate-to-large effect sizes. Effect sizes were similar in the total sample. Functioning (World Health Organization Disability Assessment Schedule 2.0) improved among completers at follow-up (estimate -8.09, SE 3.80; P=.045; d=-0.41, 95% CI -0.96 to -0.05). Disability (Sheehan Disability Scale) did not significantly improve from baseline to posttreatment or follow-up. This pilot trial demonstrates that Deprexis is feasible and acceptable for veterans with mild to severe depression, with preliminary evidence of effectiveness for depressive symptoms. The delayed emergence of functional improvements and sustained gains at follow-up support the potential of this scalable intervention. The results provide a strong foundation for the ongoing randomized controlled trial.
Older adults face a substantial burden of common mental disorders, yet they are less likely to seek professional help compared to younger adults. In Chinese contexts, collectivist values and stigma may further deter help-seeking. Social norms are central to the theory of planned behavior (TPB) and nudge theory, suggesting that norm-based messages, especially those that are visually engaging, could strengthen perceived social approval and subsequent help-seeking intentions. This study aims to evaluate the effectiveness of co-designed norm-based nudges, delivered in descriptive (descriptive norm nudge) or pictorial forms (pictorial norm nudge), in improving subjective norms and intentions to seek mental health help among older adults, compared to an information-only control. This 3-arm randomized controlled trial (1:1:1) recruits adults aged ≥60 years via community partners in Hong Kong. Participants receive daily texting for 14 days and are allocated to the pictorial norm nudge (descriptive text combined with pictorial cultural games that evoke social support), the descriptive norm nudge (descriptive text only), or the control (mental health service information) groups. Assessments are conducted at baseline (T0), after intervention (T1), and at a 3-month follow-up (T2). Primary outcomes are subjective norms and help-seeking intentions, measured using the Chinese version of the TPB questionnaire. Secondary outcomes include perceived behavioral control, help-seeking attitudes, perceived barriers, depression, anxiety, and loneliness. A 2-level linear mixed model will be used in intention-to-treat analyses to examine the intervention's effectiveness. The study grant was awarded in June 2023, with recruitment of participants to the randomized controlled trial starting in December 2024 and concluding in June 2026. As of June 30, 2026, a total of 532 eligible participants had completed the baseline assessment. Among them, 470 (88.34%) completed the postintervention, and 408 (76.69%) completed the 3-month follow-up assessment assessments. Data collection and follow-ups are ongoing. A full report of the findings is expected by October 2026, with publication anticipated in early 2027. This study will provide critical insights into the feasibility and effectiveness of brief, co-designed nudges for promoting mental health help-seeking intentions. If effective, this approach will offer a scalable, culturally adaptive, and low-intensity strategy to improve mental health service use among older adults.
Working memory (WM) is fundamental to learning, reasoning and everyday functioning and is frequently impaired in cerebral palsy (CP). In severe dyskinetic CP, profound motor and speech impairments limit access to reliable cognitive assessment and intervention. Eye-tracking technology may provide an accessible interface for computerised cognitive training. This study examined the feasibility and preliminary efficacy of adaptive eye-tracking WM training in four young people with severe dyskinetic CP (14-20 years; all female). Participants completed a 5-week intensive Cogmed training (five sessions/week) using the Light (n = 3) or Standard (n = 1) version. Tobii PCEye Mini eye-tracker was used for training; assessments were conducted at baseline, post-intervention and 3-month follow-up using Tobii Dynavox TD Pilot integrated with the Pearson Q-interactive platform. Near-transfer outcomes comprised Cogmed Improvement Index (trained WM) and Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) Picture Span score (untrained WM). Far-transfer outcomes included WISC-V fluid reasoning, visuospatial reasoning and planning; language comprehension using the Computer-Based instrument for Low motor Language Testing (C-BiLLT) and everyday executive functioning (Behaviour Rating Inventory of Executive Function-Second Edition) reported by parents and teachers. All participants completed 23-25 sessions within five weeks, corresponding to 100% adherence; mean session duration ranged from 22 to 34 min. Trained (+10.5 to +27) and untrained WM (+12 to +21) scores increased post-intervention, with gains largely maintained at follow-up. Far-transfer effects were inconsistent across participants. Adaptive eye-tracking WM training appears feasible in severe dyskinetic CP and may yield cognitive benefits. Larger controlled studies are needed to establish efficacy and generalisation of training effects. Eye-tracking may provide an effective access method for delivering Cogmed Working Memory Training to individuals with severe dyskinetic cerebral palsy who cannot use conventional computer interfaces. Adaptive working memory training delivered via eye-tracking technology shows potential to improve both trained and untrained working memory tasks, with additional gains observed in language comprehension.The Cogmed Working Memory Training protocol was well tolerated in the included sample, suggesting that eye-tracking-based cognitive interventions may be feasible in school and rehabilitation settings. Incorporating reliable non-motor, non-verbal cognitive assessment using eye-tracking into rehabilitation practice may support more accurate cognitive profiling and inform personalised intervention planning.
Outdoor play supports children's physical, social, and cognitive development; yet, opportunities are declining as indoor, screen-based childhoods become the norm. Early Learning and Child Care (ELCC) centers are key settings for promoting outdoor play, but limited evidence exists on the health and developmental outcomes of licensed nature-based ELCC programs, particularly for children with and those without disabilities. The Sending Preschoolers Outside (SPROUT) and SPROUT-able studies aim to examine the impact of one of Canada's first purposely designed and built licensed outdoor-focused ELCC programs. The primary objective is to examine the health and developmental outcomes of children aged 10-59 months, with and those without disabilities, attending an outdoor-focused, full-day licensed ELCC program compared to those in conventional (eg, not outdoor-focused) ELCC settings. Secondary objectives are to (1) examine educator job satisfaction, health, well-being, and attitudes toward teaching outdoors for children with and those without disabilities; (2) examine caregiver beliefs and attitudes toward children's participation in outdoor play and learning; and (3) identify barriers and facilitators to outdoor play and learning for children with and those without disabilities (ie, the SPROUT-able substudy) in an outdoor-focused ELCC program. This prospective longitudinal open cohort study follows children, caregivers, and educators over 3 years. Participants are recruited from 1 outdoor-focused (experimental) and 3 conventional (usual care) ELCC centers in Ontario, Canada; all sites are licensed. Assessments occur every 6 months and include direct measures of children (eg, anthropometry, motor skills, and accelerometry) and caregiver and educator questionnaires. Mixed-effects modeling will examine changes over time and between groups (experimental vs usual care). As of August 2025, 86 caregiver-child dyads are enrolled in the study (67 experimental and 43 control). Of these, 70 children who enrolled at study initiation have completed baseline and T1 and T2 assessments (43 experimental and 27 usual care), while 18 children enrolled at the 6-month time point (T1; 13 experimental and 5 usual care) have completed T1 and T2 (with a missing baseline assessment). A total of 19 children from the experimental group were identified as having a disability meeting criteria for the SPROUT-able substudy: 4 with a formal diagnosis, 3 with caregiver-reported functional difficulties, and 12 receiving additional support from an inclusion support worker. By combining a holistic and comparative approach with a focus on children with and those without disabilities, the SPROUT and SPROUT-able studies will generate comprehensive evidence to inform ELCC practice and policy in Canada and internationally. This model within Canada provides timely evidence on outdoor-focused ELCC delivery, integrating disability inclusive outdoor play into ELCC settings, and has the potential to guide meaningful improvements in child development, educator well-being, and community health.
Exodontia and local anaesthesia are critical competencies in dental education, yet existing simulators lack integration. This study aimed to develop and validate a Tooth Extraction and Local Anaesthesia simulator (TELA-sim), one of the first haptic virtual reality platforms to immerse learners in the complete clinical workflow for tooth extraction (TE) and inferior alveolar nerve block (IANB). Dental students (undergraduates without clinical experience) and residents (postgraduate trainees with clinical experience) (N = 155) were grouped as novices (n = 72) or intermediates (n = 83) based on clinical experience for face and construct validity assessment. A separate skill-transfer cohort compared fourth-year undergraduates who received TELA-sim training (n = 79) with a historical control group that received only traditional training (n = 77). Performance was evaluated via simulator metrics, questionnaires, and practical skills examination (PSE) scores on phantom heads. The simulator showed strong face validity (median Likert scores > 3.0; no significant group differences). Construct validity was demonstrated by significant intergroup differences, with novices unexpectedly outperforming intermediates on overall protocol adherence (TE: median 91.50 vs 85.00, P < .001, δ = 0.39; IANB: 71.00 vs 62.00, P = .004, δ = 0.27). The TELA-sim group achieved markedly higher PSE scores 6 months later (median 84.00 vs 75.00, P < .001, δ = 0.76). This study successfully developed the TELA-sim and established its face and construct validity. The TELA-sim led to superior skill retention and transfer to clinical practice compared with traditional training alone. However, longer‑term retention beyond 6 months requires further investigation, while not all students responded favourably to the simulator during face validity assessment. The TELA-sim may help preclinical students prevent errors through repeated practice of standardised protocols in a risk-free environment. Its alignment with licensing requirements suggests potential for objective skills assessment. For practising clinicians, the simulator could offer skill refinement and retraining opportunities to reinforce safe protocols and support continuous professional development, though further study is needed.
Systematic integration of tobacco cessation treatment within cancer centers is needed to improve smoking cessation outcomes among cancer patients and survivors. The current study characterizes baseline rates of tobacco use, use of cessation support, and changes in tobacco use over time among 756 participants diagnosed with cancer and enrolled in 9 ECOG-ACRIN Cancer Research Group trials. Participants completed surveys at trial enrollment and at 3- and 6-month follow-ups. Descriptive statistics were used to characterize patient characteristics and selected items from the Cancer Patient Tobacco Use Questionnaire (C-TUQ). Generalized estimating equations were used to examine the time point effect on tobacco product use. At baseline, 11% of participants (n = 740) currently smoked cigarettes. Among participants with data available at all time points (n = 443), prevalence of current smoking was stable over time, with 7.2% of participants (n = 32) reporting current smoking at baseline, 7.0% (n = 31) at the 3-month follow-up assessment, and 6.8% (n = 30) at the 6-month follow-up assessment. Most participants (n = 77/104) who smoked cigarettes within the year prior to their cancer diagnosis continued smoking after their diagnosis, and during (n = 44/72) and following completion (n = 30/46) of their treatment. Sixty-two percent of participants (n = 81) who were currently smoking at baseline reported using smoking cessation medication and 32.1% reported use of nonpharmacologic smoking cessation support since their cancer diagnosis. In longitudinal analyses, the odds of using cigarettes since their cancer diagnosis, 3-month follow-up, and 6-month follow-up was higher than the odds of using cigarettes for the past 30 days at baseline (odds ratio [OR] = 1.97, OR = 1.62, and OR = 1.50, respectively; all ps < .01). Smoking persists over time among patients with cancer enrolled in therapeutic cancer trials. Findings highlight the importance of increasing access to integrated and longitudinal smoking cessation support.
Objective: The etiology of suicidal thoughts and behaviors (STBs) is complex, multifactorial, and difficult to predict, which limits suicide prevention efforts. The biopsychosocial model of suicide suggests that risk for suicidal ideation, attempts, and death by suicide emerges through the interplay of biological, psychological, and social factors. Yet, these factors are often studied in isolation and assessed inconsistently in practice, making it difficult for researchers and clinicians to appreciate their combined impact in suicide risk assessment and prevention.Method: Charlotte Wells' film Aftersun was examined through the lens of the biopsychosocial model of suicide. Cinematic depictions of important risk factors for STBs, including adverse childhood experiences, shame, social disconnection, financial difficulties, and alcohol use, were integrated with empirical evidence to illustrate how these factors may interact to influence suicide risk.Results: This analysis identifies several empirically supported risk factors for STBs depicted in Aftersun and illustrates how their co-occurrence may increase vulnerability to death by suicide. The film provides a useful example of how suicide risk may be shaped not by any single factor, but by the accumulation and interaction of multiple biological, psychological, and social vulnerabilities.Conclusion: Aftersun provides trainees, clinicians, and researchers with an accessible illustration of the multifactorial nature of suicide and the importance of considering interacting biopsychosocial risk factors during assessment and prevention efforts.
Myogenic contractures are a common consequence of stroke, yet their prevalence and severity remain unclear. This multicentred, retrospective, cross-sectional study assessed severity and prevalence of myogenic contractures in selected, clinically targeted upper- and lower-limb muscles using registry data and tested associations with spasticity severity, age, and disease duration. Data from 159 patients from specialised spasticity centres were analysed using first recorded muscle assessments at various time points post-stroke. Maximal passive muscle extensibility and spasticity were measured using the Tardieu Scale. Shoulder extensors, adductors, and thumb and finger flexors in the upper limb (22.0-35.7% shortening) and gastrocnemius, soleus, gluteus maximus, hamstrings, and rectus femoris in the lower limb (16.6-20.1%) were most affected. Mean contracture prevalence within selected, clinically targeted muscles was 90.9% within one year, with high proportions also observed at 1-10 years. Age and spasticity severity significantly correlated with contracture severity, while disease duration did not. This study provides clinic-based data on post-stroke myogenic contractures in selected, clinically targeted upper- and lower-limb muscles, highlighting high prevalence in these muscles. Shoulder extensors and adductors, along with plantar flexors, were most affected. The study emphasises the need for standardised contracture definition and measurement. Post-stroke myogenic contractures are common in clinically relevant upper- and lower-limb muscles associated with functional impairment.Shoulder extensors and adductors, along with plantar flexors, were identified as the most affected muscles.Early prevention and treatment of contractures through long-term, progressive static stretching postures and/or orthoses are important considerations in clinical management.Standardised definitions and measurement methods for contractures are of utmost importance for accurate assessment.
Spinal and bulbar muscular atrophy (SBMA) is a rare neuromuscular disorder without effective treatments available. There is an unmet need to identify biomarkers reflecting underlying disease processes and sufficiently responsive to detect slow changes to enable future clinical trials. Muscle MRI is a responsive measure of muscle volume and fat content, a pathologic hallmark of SBMA that precedes functional changes. We therefore assessed muscle MRI as a potential imaging biomarker for detecting change in SBMA severity. This was a noninterventional, longitudinal study enrolling patients with confirmed SBMA diagnosis and evidence of muscle fat replacement. All patients were assessed by MRI and clinical measures at baseline and at 6-month intervals for up to 18 months. Whole-body Dixon MRI scans were analyzed using AMRA Researcher, assessing 19 muscle groups bilaterally and quantifying lean muscle volume (LMV), muscle fat fraction (MFF), and muscle fat infiltration (MFI). Rate of change was calculated for whole-body and regional muscle composite measures. Key clinical outcome measures included the Spinal Bulbar Muscular Atrophy Functional Rating Scale (SBMAFRS) and 2-minute walk test (2MWT). Correlation between muscle MRI measures and clinical assessments was calculated using Spearman correlation analysis, and responsiveness to change was evaluated using standardized response mean (SRM). We included 26 patients with a mean age of 57.6 ± 7.12 years (range:44-71 years), mean SBMAFRS 40.6 ± 3.85 (range:33-48), and a mean baseline 2MWT distance of 126.09 ± 39.83 m (range:39.0-194.0). The mean changes and (SRM) over 12 months in whole-body muscle MRI were LMV -4.38 ± 2.48% (-1.76), MFF 2.49 ± 1.38p.p. (1.81), and MFI 0.79 ± 0.51p.p. (1.55) (p < 0.001). Baseline whole-body LMV/MFF/MFI showed moderate correlation to SBMAFRS (r:0.46/-0.41/-0.51, respectively) and modified SBMAFRS (r:0.50/-0.63/-0.67, respectively). Thigh LMV/MFF/MFI showed moderate correlation to 2MWT (r: 0.73/-0.53/-0.55). Consistent and reproducible decreases in whole-body and regional muscle LMV composites over time and increases in MFF and MFI were observed across SBMA patients. Baseline MRI assessments reflect disease severity correlating with SBMAFRS and 2MWT functional measures. SRM of muscle MRI was higher than SRMs of functional measures, indicating that muscle MRI is a responsive biomarker that tracks disease progression and potentially treatment effects in future clinical trials.
Chronic low-grade inflammation has been implicated in the pathophysiology of cognitive dysfunction and neurodegenerative processes. Diet represents a key modifiable determinant of inflammatory status. We aimed to evaluate the associations between dietary inflammatory index (DII) scores and the serum levels of interleukin-6 (IL-6), leptin, and adiponectin in older adults with mild cognitive impairment (MCI), dementia, and normal cognition in Yucatan, Mexico. A case-control study was conducted between March 2022 and December 2025. Cases were defined as adults aged ≥ 55 years with a previous diagnosis of MCI or dementia, and controls were defined as adults aged ≥ 55 years with no prior history or current complaints of cognitive impairment and with normal performance on cognitive assessments. Dietary intake was assessed with a validated food frequency questionnaire, and the DII was calculated using 24 food parameters. Cytokine levels were determined using sandwich enzyme-linked immunosorbent assay kits. Participants with MCI and dementia exhibited a diet with higher pro‑inflammatory potential, characterized by lower intake of dietary fiber, vitamins, unsaturated fats and β-carotenes, as well as significantly higher adiponectin levels than controls. DII scores were inversely associated with adiponectin levels in patients with MCI and dementia (β = - 48, 95% CI: - 75 to - 22, p < 0.01). A pro‑inflammatory diet was associated with lower adiponectin in MCI and dementia, despite paradoxically elevated adiponectin. This association may be attenuated by excess adiposity. Adiponectin emerges as a promising biomarker, warranting longitudinal studies.
Skeletal Class II malocclusion with facial asymmetry, occlusal cant, and multiple impacted canines presents a significant clinical challenge requiring coordinated interdisciplinary care. This report describes the management of a 20-year-old female who presented with a retruded mandible, right-sided chin deviation, soft-tissue lip cant, and a Class II Division 1 malocclusion with deep bite, increased overjet, and missing permanent canines. Radiographic evaluation revealed right condylar hypoplasia, 9% condylar asymmetry, a difficult palatal impaction of tooth 23 according to the KPG difficulty index, and mid-alveolar impactions of teeth 33 and 43. Skeletal assessment confirmed mandibular retrognathia, a hyperdivergent pattern, and a 3-mm occlusal cant. Treatment involved the extraction of over-retained deciduous canines and third molars, orthodontic alignment, and space creation, followed by surgical exposure and traction of the impacted canines. After successful eruption, pre-surgical orthodontic decompensation was performed to optimize incisor inclinations. Bimaxillary orthognathic surgery, including left maxillary impaction and asymmetric mandibular advancement, was undertaken to correct the skeletal discrepancies and facial asymmetry. Post-surgical orthodontic finishing refined occlusal relationships, and implant-supported prostheses were placed to replace missing mandibular molars. The interdisciplinary approach achieved successful canine alignment, correction of skeletal discrepancies, normalization of the occlusal plane, and improved facial symmetry. At a 36-month follow-up, the results remained stable with satisfactory function and aesthetics. This case highlights the value of coordinated orthodontic, surgical, and prosthetic care in managing complex dentofacial deformities.
Duchenne muscular dystrophy (DMD) is a progressive, multisystem disease requiring long-term monitoring of respiratory, cardiac, and functional status. Advances in care have extended survival, increasing the need for continuous, coordinated management. In parallel, digital health technologies have enabled remote monitoring and data collection outside traditional clinical settings. This Viewpoint examines the role of device-based remote monitoring in DMD and argues that it should be understood as an emerging multisystem digital surveillance framework rather than a collection of isolated technologies. This Viewpoint is based on a synthesis of published literature on device-based remote monitoring and digital health technologies in DMD and experiences at our center. The aim was to outline the current clinical and technological landscape and support an interpretive perspective. Device-based monitoring in DMD encompasses a range of technologies, including home spirometry, ventilator-integrated telemonitoring, wearable activity sensors, cardiac rhythm monitoring, and interactive rehabilitation systems. These approaches enable longitudinal assessment of physiological and functional parameters in real-world settings. However, the current evidence base is heterogeneous and largely limited to feasibility studies, small cohorts, and extrapolated data. While data acquisition is technically feasible and increasingly available, integration into clinical workflows remains constrained by the lack of validated digital biomarkers, standardized monitoring frameworks, and interoperable data systems. Remote monitoring in DMD is evolving toward a connected, multisystem model of disease surveillance. Its clinical impact will depend on the validation of digital end points, development of decision support frameworks, and integration into multidisciplinary care pathways. Bridging the gap between data generation and clinical decision-making remains a key priority for future research and implementation. These findings support a shift from isolated technologies toward a coordinated, clinically integrated model of multisystem care in DMD.
Parkinson's disease (PD) causes motor impairments, with postural instability and gait disturbances among the most disabling symptoms. Textured insoles enhance sensory feedback, and auditory cues improve stride rhythm. This study evaluated whether combining textured insoles with auditory cueing provides complementary benefits compared with textured insoles used alone for improving postural stability and gait parameters in individuals with PD, while comparing both approaches to progressive walking training alone. Twenty-seven individuals with PD (Hoehn & Yahr stages 2.5-3) were randomized into three groups: textured insoles with auditory cues (TI+A), textured insoles only (TI Only), and control. Over a 6-week period, all groups completed progressive walking goals (2000-3000 steps/session). Postural stability was measured using the Functional Gait Assessment (FGA), and gait parameters were analyzed with the G-Walk sensor system. Postural stability improved across all groups at 6 weeks. Both sensory intervention groups achieved significantly greater FGA improvements than the control group, with the TI+A group demonstrating the largest gains (group × time interaction, p = .010). No significant between-group differences were observed in gait parameters. Sensory-based interventions improved postural stability in individuals with PD. Combining auditory cueing with textured insoles provided task-specific advantages for dynamic balance tasks. Combining textured insoles with auditory cueing is a well-tolerated intervention among individuals with Parkinson’s disease (PD).The combination of textured insoles and auditory cueing appears effective for improving postural stability and functional mobility in individuals with PD.However, this combined intervention may not be superior to other rehabilitation approaches for improving gait parameters.
Intravenous drug incompatibility is a significant medication safety hazard, particularly in complex multidrug regimens. Traditional text-based, pairwise query methods are inefficient and impose a substantial cognitive load on clinicians. While network visualization has the potential to address these challenges, its application in drug compatibility queries remains underexplored. This study aimed to design, develop, and evaluate a novel drug compatibility query system based on a WeChat Mini Program. The system integrates diverse data sources and uses network visualization to present complex compatibility relationships. We sought to empirically assess its impact on efficiency and user experience. A preliminary crossover usability and efficiency evaluation was conducted. Phase 1 involved the construction of a drug compatibility knowledge base from authoritative handbooks and drug labels, and the development of the query system. Phase 2 comprised a system evaluation with 36 pharmacists, 6 physicians, and 5 nurses. The evaluation included a scenario-based task completion time analysis comparing the system (Mode A) with traditional print-based resources (Mode B), a quality assessment using the Mobile Application Rating Scale (MARS), and structured posttask user feedback to gather insights on user experience. The query system demonstrated a substantial reduction in task completion time, with median time savings of 2.85 (IQR 1.98-4.15) minutes, 5.45 (IQR 3.95-7.20) minutes, and 31.2 (IQR 27.5-35.1) minutes, respectively, in 3 scenarios with different complexity. The system received a high mean overall quality score of 3.88 (SD 0.35) on the MARS. The functionality dimension scored the highest (mean 4.21, SD 0.51), while engagement scored the lowest (mean 3.21, SD 0.62). Posttask structured feedback revealed five major areas of user feedback: (1) baseline experience and first impressions, (2) user experience with network visualization, (3) perceived efficiency and cognitive load, (4) trust and information quality, and (5) future application considerations. Users praised the system's efficiency and intuitive design but expressed a strong need for transparent data sources and management advice to build trust. A query system based on network visualization demonstrates potential to support the efficiency of multidrug compatibility queries within this preliminary evaluation. It may mitigate cognitive load and offer an at-a-glance understanding of complex drug relationships. However, formal clinical accuracy validation remains a mandatory precondition before bedside clinical deployment is considered.
Spinal cord injury (SCI) causes severe and often permanent neurological deficits, including neurogenic lower urinary tract dysfunction. Although restoration of bladder function is a major clinical priority after SCI and would profoundly improve care and quality of life, it remains underrepresented in neurotrauma research. Central to this pathology is Repulsive Guidance Molecule a (RGMa), a potent inhibitor of axonal outgrowth and neuronal differentiation that is upregulated following central nervous system injury. In this study, we evaluated the therapeutic efficacy of elezanumab, a human anti-RGMa monoclonal antibody tested in clinical trial for acute SCI, on bladder function in a clinically relevant bilateral impact-compression model of traumatic thoracic SCI in female rats. Quantitative urodynamic and cystometric analyses demonstrated that elezanumab administered initially at 3 h post-SCI and then weekly for 6 weeks significantly reduced urinary retention, reflex bladder activity, and intravesical pressure in SCI rats. Morphological assessment revealed that RGMa neutralization limited pathological bladder hypertrophy, with reductions in bladder mass correlating with reduced urine retention. Neuroanatomical mapping via retrograde tracing, together with exploratory transsynaptic tracing, was consistent with increased supraspinal connectivity in pathways involved in micturition. Moreover, elezanumab promoted axonal plasticity of descending catecholaminergic and serotonergic fibers within the lumbosacral spinal cord. These structural changes were associated with reduced bladder pressure and improved neurological recovery. Together, these findings suggest that RGMa inhibition via elezanumab promotes recovery within key components of the micturition circuitry following traumatic SCI.
Cardiovascular medicine continues to move towards precision-based, individualised patient care, supported by novel biomarkers, refined imaging protocols, and multidisciplinary risk assessment. The studies featured in this issue of Acta Cardiologica span cardio-oncology, structural heart disease, immune and proteomic biomarkers, sepsis-related cardiac dysfunction, arrhythmia management, and vascular disease. Collectively, they underscore the growing importance of individualised diagnostic and therapeutic strategies across the cardiovascular spectrum, from cancer-related heart failure to conduction system pacing and cardiac arrest prevention.
BackgroundThis study aimed investigate and document organizational strategies in prehospital care when dealing with the challenge of assessing patients with suspected COVID-19 when transporting and triaging patients for hospital admission.MethodsData about door-to-door management, i.e., from their homes to the entrance door of an emergency department, of suspected COVID-19 patients, were collected from 50 participants, recruited from staff from Temporary Triage and Treatment areas (TTTs) located outside the hospital emergency departments and ambulance services in Sweden, Poland, and the United States. The data were, analyzed and subjected to a thematic analysis based on the CSCATT framework, i.e. (Command and Control, Safety, Communication, Assessment, Triage, Treatment, and Transport).ResultsThe results revealed a successful collaboration within the healthcare organizations. Team roles were, according to the respondents, distributed efficiently, and staff participated actively in the workflow. Challenges included a shortage of training, and preparedness, inadequate facilities, insufficient facility preparedness, and, at times, a fear of working with COVID-19 patients. Excessive guidelines, frequently changing protocols, and the constant release of new information were other challenges.ConclusionThe conclusion emphasizes the importance of proactive measures, such as robust contingency plans, education, and information dissemination. Future strategies should focus on developing robust, scalable models that can be rapidly deployed. This includes investing in diagnostic tools, enhancing the production capabilities for essential medical supplies, and ensuring a streamlined supply chain. Future healthcare strategies can be more resilient, responsive, and equipped to manage public health emergencies effectively.
Digital health literacy is an essential skill for processing health-related information in today's technology-driven society. Recent literature highlights deficits in digital health literacy among adolescents and legislative initiatives to secure its promotion have been introduced (eg, in the German Social Code Book V). However, few interventions target adolescents; existing programs often overlook critical aspects like graph literacy or lack applicability in schools and rigorous scientific evaluation. To overcome these limitations, short mobile interventions-optimized for mobile devices and flexible deployment in schools-were developed to promote digital health literacy. This study aimed to evaluate the effectiveness of one of these interventions (focusing on graph-based health information) and to assess its quality and applicability within educational settings as a proof-of-concept for the further development of similar interventions for adolescents. A randomized-controlled pre-post trial with an active control group was conducted across two independent samples in a web-based survey: adolescents in secondary schools (14-17 years) and teachers. Participants in each sample were randomly assigned (1:1 allocation) to the experimental or control group. Following baseline data collection (T1), participants completed their assigned interventions, immediately followed by postassessments (T2). The experimental intervention is a mobile-friendly e-learning module (approximately 10 minutes) featuring interactive tasks focused on interpreting graph-based health information. The control intervention followed the same design and logic but covered a different topic. The primary outcome was subjective knowledge regarding the intervention's topics. Secondary outcomes included objective knowledge (quiz scores) and 2 adapted subscales of the Digital Health Literacy Instrument (DHLI: "evaluating reliability" and "determining relevance"). Educational quality, visual aesthetics, and practical applicability were also assessed at T2. Among adolescents (experimental group: n=251; control group: n=249), a significant interaction effect was observed only for objective knowledge (F1,498=70.42, η²p=.124; P<.001), but not for the other three outcomes (subjective knowledge: F1,498=2.04, η²p=.004; P=.15; evaluating reliability: F1,498=0.28, η²p<.001; P=.60; determining relevance: F1,498=0.25, η²p<.001; P=.62), meaning that the intervention improved fact-based but not subjective knowledge and no broader health literacy related skills. For teachers (experimental group: n=301; control group: n=302), the results showed significant interaction effects for subjective knowledge (F1,601=32.42, η²p=.051; P<.001), objective knowledge (F1,601=128.79, η²p=.177; P<.001), and one facet of digital health literacy (evaluating reliability: F1,601=6.21, η²p=.010; P=.01), while the interaction effect for "determining relevance" was not significant (F1,601=1.97, η²p=.003; P=.16), suggesting that the intervention improved teachers' knowledge and one facet of digital health literacy. Both samples evaluated the visual and educational quality of the intervention as positive. This study demonstrates that short mobile interventions hold significant promise for the promotion of digital health literacy (eg, graph literacy) within school environments. These interventions can effectively teach objective knowledge to adolescents and teachers, but improving their digital health literacy may require more comprehensive or multimodule approaches. German Clinical Trials Register DRKS00037830; https://drks.de/search/de/trial/DRKS00037830/details.