Angiogenesis plays a pivotal role in cutaneous wound healing by restoring vascular supply to regenerating tissues. Mesenchymal stem cell-derived exosomes (MSC-exosomes) are emerging as potent acellular mediators of angiogenesis, thanks to their cargo of bioactive molecules and immunomodulatory effects. This review synthesizes recent findings from in vivo and in vitro studies, including preclinical models of diabetic wounds, ischemic injuries, and burn healing. It draws upon peer-reviewed articles published in biomedical journals, with a focus on the mechanisms and efficacy of MSC-exosomes. MSC-derived exosomes enhance endothelial cell proliferation, migration, and tube formation. Their ability to activate pro-angiogenic signaling pathways, such as Wnt/β-catenin, AKT/eNOS, and angiopoietin/TIE2, is widely accepted. Additionally, their low immunogenicity, enhanced stability, and potential for bioengineered delivery systems are recognized advantages over other angiogenic therapies. Challenges persist regarding the standardization of exosome isolation, characterization, and large-scale production. Debate also exists about their long-term safety and therapeutic consistency across MSC sources. Incorporation of MSC-exosomes into hydrogels and scaffolds offers promising controlled delivery systems that enhance angiogenic efficacy. Preconditioning MSCs (e.g. with hypoxia or pharmacological agents) further improves the pro-angiogenic potency of exosomes. Future efforts should prioritize clinical translation by developing GMP-compliant production protocols, optimizing delivery strategies, and conducting rigorous clinical trials to assess safety, dosing, and therapeutic efficacy across diverse wound types.

Surgical intervention remains a cornerstone to restore function after acute Achilles tendon rupture (AATR), but evidence-based guidelines for surgical management are limited. A steering committee of 40 orthopedic surgeons identified nine key clinical questions on the surgical management of AATR. A systematic search of PubMed, MEDLINE, Web of Science, Cochrane Library, and EMBASE was conducted for studies published since 1980. Surgical management represents a reliable option to manage patients who suffered AATR. A well-designed operative strategy is essential to facilitate early recovery and achieve optimal functional outcomes. The surgical management of AATR remains challenging, particularly with respect to defining surgical indications, determining the optimal timing of intervention, selecting the most appropriate patient positioning, choosing between open and minimally invasive techniques, deciding on the role of primary augmentation, and establishing evidence-based postoperative rehabilitation protocols. In the absence of established guidelines for the surgical management of AATR, this evidence-based clinical practice guideline provides nine key recommendations designed to address current controversies in the field. Further studies are warranted to evaluate emerging strategies such as nutraceuticals, biomaterials, cellular therapies, bioprinting, gene therapy, and anti-inflammatory agents, as no single approach has yet been validated as the optimal method to accelerate or enhance recovery following AATR.

Cystic echinococcosis (CE) poses a significant medical and socio-economic burden worldwide, particularly in highly endemic, low-income regions with resource-limited settings, where control efforts are hindered by limited access to diagnostics and appropriate treatment options. In contrast, low prevalence settings, such as high-income countries, often face challenges related to low awareness of the disease, which can lead to misdiagnosis and inappropriate treatments including potentially harmful invasive procedures. Therefore, it is recommended that an interdisciplinary approach be adopted to prevent misdiagnosis and treatment failure in CE, a chronic, but mostly benign and preventable zoonosis. This review provides an updated synthesis of current research on CE, focusing on its epidemiology, clinical management, and recommended strategies for improving outcomes in diverse healthcare settings. Published scientific literature in PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases from the year 1980-2025. The World Health Organization (WHO) classification system for CE is based on ultrasound to assess cyst activity and size, thus facilitating the correct use of treatment options, including benzimidazole therapy, surgery and/or the PAIR technique.It is imperative to rule out CE before undertaking any invasive diagnostic procedures in order to prevent cystic dissemination. Given the lack of current updated guidelines this review gives a standardized overview over current recommendations for diagnosis and therapy. There is a need for more accurate, standardized diagnostic protocols and development of effective medical therapy and/or vaccines.

Adipose tissue secretes bioactive substances, adipokines, which affect cardiovascular health. The secretion of adinopectines is associated with decreases in metabolic and cardiovascular diseases risk-factors such as obesity and type 2 diabetes. High-intensity interval training (HIIT) exerts beneficial effects on cardiometabolic health, but its effect on adipokines is unclear. This systematic review and meta-analysis, aimed to report the effects of HIIT on adiponectin levels in overweight and obese individuals, was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was conducted in Web of Science, PubMed, ScienceDirect, and Google Scholar. The quality of the articles was evaluated using the Downs and Black checklist. HIIT training generally did not affect adiponectin levels in overweight and obese individuals. Most likely, this effect can result from the lack of weight loss of the subjects in some studies. One notable constraint within the scope of these investigations pertains to the relatively modest sample sizes employed. Consequently, future research endeavours should employ larger cohorts to enhance the generalizability of findings. HIIT focused on weight loss and fat percentage may effectively enhance the impact of HIIT on adiponectin levels. Future research should implement rigorous dietary controls to isolate the independent effects of HIIT on adiponectin modulation. CRD42024580266.

The accurate and safe assessment of physiological parameters, such as the highest oxygen consumption (V̇O2peak) and the lactate threshold (LT), plays a crucial role in optimizing training intensity and monitoring long-term progress, ensuring the safety of the trainees. Data were obtained during tests performed by 28 recreationally active young adults with varying levels and types of training. These individuals underwent a modified incremental Åstrand protocol for a treadmill test to exhaustion, during which their V̇O2peak and lactate threshold (Onset of Blood Lactate Accumulation method) were directly assessed. Tests to exhaustion are considered valid methods for directly measuring V̇O2peak and determining LT. However, the direct assessment of V̇O2peak and LT requires specific equipment and raises various practical issues. Indirect methods for estimating of V̇O2peak and lactate threshold are simpler to use, but these methods are often difficult to generalize or have a high margin of error from the many variables that can affect a subject's V̇O2peak and lactate threshold. These results enable estimation of V̇O2peak and LT in apparently healthy young adults engaged in regular physical activity, regardless of their specific training backgrounds. Future research should focus on developing more precise field-based methods for estimating V̇O2peak and lactate threshold, with lactate threshold presenting particular challenges due to the need for blood sampling equipment.

Despite significant advances in tissue engineering and regenerative medicine, articular cartilage repair remains a major clinical challenge. Conventional pharmacological and surgical interventions are largely ineffective in promoting durable tissue regeneration or halting progressive cartilage degradation. This review integrates evidence from recent peer-reviewed literature focusing on nanotechnology-based drug delivery, stem cell-based therapy, and biomimetic scaffold design for cartilage tissue engineering. There is a broad consensus that current standard treatments fail to restore native cartilage structure and function. The literature supports the view that integrating nanomedicine with tissue engineering strategies can enhance chondrogenic outcomes. In particular, nanocarriers enable targeted and controlled delivery of bioactive molecules, while synthetic extracellular matrix-mimicking scaffolds provide essential structural and biochemical cues for chondrogenesis. Key unresolved issues include identifying the optimal stem cell source, the long-term safety and biodegradability of nanomaterials, and the scalability of engineered constructs for clinical use. The immunogenicity of advanced biomaterials and the regulatory challenges associated with their clinical translation remain subjects of debate. Recent studies demonstrate the feasibility of integrating nanocarriers within three-dimensional biomimetic scaffolds to better replicate the native cartilage microenvironment. Advances in biofabrication techniques and in situ delivery systems are enabling the development of more physiologically relevant and functional cartilage models. Future research should prioritize in vivo validation of bio-activated scaffolds, comprehensive assessment of long-term functional outcomes, and strategies to facilitate clinical translation of combined nanocarrier-scaffold platforms. Further investigation into both patient-specific and off-the-shelf regenerative approaches is essential to overcome current translational barriers.

Our study explored how religious ritual engagement during Ramadan intermittent fasting (RIF) shaped athletes' performance perceptions and adaptive strategies in Tunisian professional football. We compared players who fasted only (G-FNRP) with those who also engaged in additional religious rituals (G-FRP). Semi-structured interviews were conducted with 24 professional footballers from Tunisia's League 2, divided into G-FRP (n = 10), who combined fasting with additional rituals such as Tarawih, Tahajjud, and Khatm al-Qur'an, and G-FNRP (n = 14), who observed fasting only. Data were analyzed through a reflexive thematic approach, using manual coding and Excel matrices to organize and interpret these players' reported experiences. Participants in the G-FRP group perceived religious rituals as a means of improving their spiritual awareness, resilience, and discipline, which they associated with a greater ability to cope with competition-related stress. In contrast, participants in the G-FNRP group did not establish a direct link between rituals and performance but rather emphasized perceptions of fatigue, sociocultural pressures, and reduced psychological resources such as motivation. We have shown that RIF-related religious rituals could be identity and motivational resources that influence how athletes perceive their ability to cope with performance demands. Understanding these dynamics can help to develop personalized strategies from an inclusive health and human perspective in sport. Further research should extend to different sports, contexts, populations, and religious ways of fasting.

Workplace mental health is a growing global priority. Traditional approaches to intervention delivery often face barriers of scalability and engagement. Recent advances in artificial intelligence (AI) offer new opportunities for dynamic, personalized support, but their effectiveness and implementation in occupational settings remain unclear. This systematic review included 17 studies published between 2018 and 2024, identified from six databases. Studies were appraised using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and risk of bias was assessed with Cochrane Risk of Bias 2.0 (RoB 2.0) and ROBINS-I tools. AI-based interventions, such as chatbot using cognitive behavioural therapy and predictive analytics, show promise for improving worker's mental health, enhancing resilience, and improving engagement. Acceptability was generally high across studies. Despite positive findings, intervention maturity remains low, and outcome reporting is inconsistent. Few studies systematically addressed adverse events, rollout scalability, or ethical concerns, and the added value of AI over traditional approaches is uncertain. AI interventions may offer flexible, adaptive solutions for improving workplace mental health, with strong engagement indicators. There is a pressing need to support clinicians and occupational health teams in evaluating potentially useful AI tools. Future research must prioritize high quality randomized trials, long-term follow-up, and real-world implementation studies. Standardized frameworks for reporting effectiveness, harms, and ethical considerations are important for safe, trustable, and sustainable adoption in occupational health.

Marathon running has evolved into a global phenomenon, with rising participation across age and experience groups. Training for a marathon requires adherence to well-established principles involving pacing, training volume, and periodization. With the increasing integration of artificial intelligence (AI) into healthcare and fitness, it remains unclear whether AI can reliably prescribe evidence-based training programs for such demanding endurance events. We conducted a descriptive study using outputs from leading AI models: Claude 3.5 Sonnet, Claude 3.5 Haiku (Free), ChatGPT 4.0 (o-model), ChatGPT 0.1, ChatGPT 4 (free), Gemini 2.0 Flash, Gemini 2.0 Flash Thinking, and DeepSeek R1. Each was prompted to generate a 6-month marathon training plan tailored to three athlete levels: Beginner, Intermediate, and Advanced. Outputs were compared with peer-reviewed literature on the determinants of marathon training. Most AI systems identified key training components: weekly mileage progression, tapering, and intensity distribution (>80% at low intensity), which aligns with current endurance training theory. AI responses varied in accuracy and completeness. Some engines omitted key details (e.g. weekly mileage), failed to differentiate clearly between athlete levels (intermediate and advanced have been merged as if they were the same level), or offered inconsistent pacing data, especially for advanced runners. This descriptive analysis evaluated qualitative adherence to evidence-based training principles rather than quantitative outcomes requiring statistical inference. AI demonstrates strong potential in accessible, structured training content. When properly prompted, outputs often align with contemporary training principles, though significant limitations regarding personalization and professional oversight necessitate further validation before clinical implementation. Future studies should evaluate the real-world outcomes of AI-generated programs in randomized trials including the integration of personal physiological data. Inizio moduloFine modulo.

Evidence highlights the potential of human-dog relationships to support the health and wellbeing of patients, caregivers, and healthcare professionals. This review examines the application and impact of dog-assisted interventions (DAIs) in healthcare contexts. A narrative review of research from 2009 to 2025 was conducted utilizing multidisciplinary databases, including, PubMed, MEDLINE, APA PsycINFO, Academic Search Complete, ProQuest One Business, and Scopus. DAIs have been shown to reduce loneliness, depression, low mood, and anxiety in hospitalized patients; lessen pain perception and improve perceptions of healthcare in children; and reduce burnout, stress, and anxiety among healthcare professionals. The increasing use of DAIs in healthcare points to potential benefits, but more high-quality research is required. Research has generally overlooked differing attitudes toward dogs in clinical settings and given little consideration to the animals' own health, welfare, and ethical treatment. DAIs may be beneficial, even when brief, with potential to reduce anxiety and strain and enhance job satisfaction, restoration, and reflective practice among healthcare professionals. Future research should establish causal relationships, recruit balanced samples, incorporate biometric, psychological, and social measures and critically evaluate existing dog visitation programs.