Duration Of Treatment Research Articles (Page 1)

Host-directed immunotherapy to enhance treatment of Mycobacterium tuberculosis infection.

Patient education initiatives for atopic dermatitis (AD) improve medication adherence, treatment satisfaction, severity of disease, and quality of life. An international survey was conducted to better understand the journey of diagnosis and treatment, unmet needs, and educational preferences of patients and caregivers for children diagnosed with AD residing in the US, Europe, Japan, and the Gulf region. A cross-sectional, anonymous, multilingual online survey was conducted from December 2024-January 2025. Eligible individuals were aged ≥ 18years and either a patient diagnosed with AD by a medical professional or a caregiver for a child ages 6-12years with AD. Of the 1103 survey participants (68% adult patients; 32% caregivers), 56% were from the US, 25% from Europe, 13% from the Gulf region, and 6% from Japan. Over half (61%) found it easy or very easy to find information on AD; however, responses indicated an interest in improved content of available AD education. Almost half (46%) indicated it would be beneficial to have a list of questions to take to their doctor's appointment, 42% wanted more information about AD triggers, and 40% wanted a way to communicate the impact of AD to their doctor. For new medications, participants wished to understand safety, mechanism of action, duration of treatment, and the possibility of freedom from symptoms. Patient and caregiver education in AD is essential for improving disease management and often-compromised quality of life. While access to disease information was reasonably high, there is a clear opportunity to improve and refine AD education content and provide actionable, patient-centered tools.

To identify health utility decrements of injection treatment-related attributes among patients with type 2 diabetes mellitus (T2DM) in China. Health states of four attributes (hypoglycemia, dose frequency, flexibility and injection site reaction) were generated using a vignette-based method. Patients with T2DM were recruited from eight cities in China. The sample was broadly consistent with Chinese T2DM population with regard to age and sex distribution. Respondents completed seven time trade-off (TTO) tasks during face-to-face interviews. The ordinary least square (OLS), fixed effects (FE) and random effects (RE) models were used for TTO data. In subgroup analysis, groups were categorized based on whether injection treatment was currently used, number of medications, needle phobia, duration of injectable treatment and travel frequency. A total of 400 patients (52.75% male, mean [SD] age 50.30 [12.05] years) were included in this study. Severe hypoglycemia had the largest disutility value of all attributes (-0.023, P < 0.001). Three times daily, twice daily and once daily injection (needed to be carried with the patient on short trips) were associated with -0.023 (P < 0.001), -0.018 (P < 0.001) and -0.011 (P = 0.022) disutility values compared with once weekly injection (not required to be carried with the patient on short trips), respectively. The disutility value associated with injection site reaction attribute was -0.013 (P < 0.001). In subgroup analysis, the relative importance of treatment-related attributes was found to depend on patient characteristics. This study provides disutility values associated with several injection treatment-related attributes for Chinese patients with T2DM. Hypoglycemia appears to be the most important attribute, followed by dose frequency, flexibility and injection site reaction.

Duration of treatment for uncomplicated enterococcal bacteremia is unknown. This study aims to evaluate the clinical outcomes of patients treated with short courses (4-10 days) compared to those receiving longer regimens (11-18 days). This retrospective study was conducted at the Lausanne University Hospital, Switzerland (January 2015-June 2024) and included adult patients with uncomplicated enterococcal bacteremia. Primary outcome was a composite of mortality, recurrence of bacteremia by the same enterococcal species and development of bone and joint infection within 120 days. During the study period, 331 episodes of uncomplicated enterococcal bacteremia were included. The median duration of antimicrobial treatment was 12 days (interquartile range: 8-15); 138 (42%) and 193 (58%) episodes received a short (4-10 days) and long (11-18 days) duration of antimicrobial treatment, respectively. The primary endpoint was observed in 77 (23%) episodes; 120-day mortality was 21% (69 episodes), recurrence of bacteremia was 4% (12 episodes), and bone and joint infection was 0.6% (2 episodes). No difference in primary endpoint was observed between episodes receiving short and long courses of antimicrobial treatment (23% versus 23%; P = 1.000). The Cox multivariable regression model found that malignancy (aHR 2.00, 95% CI 1.24-3.22), immunosuppression (1.78, 1.09-2.90), cirrhosis (2.53, 1.42-4.51), and sepsis or septic shock (2.48, 1.52-4.03) were associated with primary endpoint; a short course of antimicrobial treatment was not associated with primary endpoint (1.03, 0.65-1.62). Among uncomplicated enterococcal bacteremia giving a short duration of antimicrobial treatment is reasonable.

ESR1 mutations mediate resistance to antiestrogen therapy in hormone receptor-positive metastatic breast cancer (MBC). Elacestrant, an oral selective estrogen receptor degrader, improves progression-free survival over standard endocrine therapy in ESR1-mutant MBC. We assessed real-world elacestrant use and clinical-genomic factors associated with outcomes. This study used the GuardantINFORM database, linking >42,000 real-world breast cancer cases with sequencing and claims data. We included patients with activating ESR1 mutations detected <6 months before elacestrant initiation (January 2023-March 2024). Outcomes of time-to-treatment-discontinuation (TTD), time-to-next-treatment (TTNT), and overall survival were estimated with Kaplan-Meier and Cox regression analysis, adjusting for clinical variables. We identified 756 patients (76% with prior CDK4/6 inhibitor and 38% prior chemotherapy exposure), and 742 (98.2%) were evaluable for outcomes. Median TTNT was 6.4 months, and TTD was 4.6 months. In those with ≤1 prior lines of metastatic therapy, TTNT was 8.8 months, compared to 6.0 months in the third-line setting. Prior fulvestrant exposure trended toward shorter treatment duration (HR 1.19, 95% CI 0.91-1.56). Higher ESR1 polyclonality (≥4 alterations; 11% of patients) correlated with shorter TTNT of 5.2 months (HR 1.44, 95% CI 1.01-2.06), but efficacy was consistent across ESR1 alleles (e.g., Y537S, D538G). Disease with dual ESR1 and PI3K-pathway mutations (PIK3CA, AKT1, PTEN) had a median TTNT of 5.2 months. In ESR1-mutant MBC, elacestrant treatment durations support the routine use of elacestrant monotherapy in appropriately selected patients. For patients with concurrent ESR1 and PI3K-pathway mutations, single-agent activity was comparable to outcomes observed in phase III studies.

Invasive candidiasis (IC) remains an infection with high incidence and mortality rates in the ICU setting, particularly among patients treated with broad-spectrum antibiotics. This study aims to investigate the association between detailed antibiotic usage profiles and the occurrence of IC, and to develop an IC-predictive model specialized for patients who received broad-spectrum antibiotics. We retrospectively collected detailed information on antibiotic categories, treatment duration, combination therapies and other clinical data of enrolled patients. Univariate and multivariate logistic regression analyses were performed to identify risk factors for IC and to construct a nomogram model. We analyzed 1,260 patients treated with broad-spectrum antibiotics and 877 without. After adjusting for IC-related risk factors using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), broad-spectrum antibiotics remained an independent risk factor for IC. Among patients receiving antibiotic monotherapy, lipopeptides, glycopeptides and oxazolidinones were the top three antibiotic classes associated with an increased risk of IC. The duration of antibiotic therapy showed a positive correlation with IC risk. Combination therapy significantly increased the risk of IC (odds ratio [OR] = 2.341, 95% confidence interval [CI]: 1.316-4.162), with the combination of beta-lactams/beta-lactamase inhibitors and glycopeptides showing the highest IC risk. Based on univariate and multivariate regression analyses, we developed an IC risk nomogram specific to patients receiving broad-spectrum antibiotics, including smoking history, sepsis, continuous renal replacement therapy (CRRT), prognostic nutritional index (PNI), use of beta-lactams/beta-lactamase inhibitors and plasma (1,3)-β-D-glucan (BDG) positivity. The model demonstrated good predictive performance with an area under the curve (AUC) of 0.863 (95% CI: 0.806-0.920) in the training dataset and 0.784 (95% CI: 0.685-0.883) in the validation dataset. Decision curve analysis (DCA) and clinical impact curve (CIC) analysis demonstrated favorable clinical benefits of the model. Our findings suggest that specific antibiotic profiles-type, duration, and combination-were significantly associated with IC. Furthermore, we developed a nomogram to predict IC risk among patients treated with broad-spectrum antibiotics, which showed good predictive performance and potential clinical utility.

Cystic fibrosis (CF) leads to chronic airway obstruction, inflammation, and infection, resulting in pulmonary exacerbations (PEx) that negatively impact lung function, quality of life, and mortality. The introduction of highly effective CFTR modulator therapy (HEMT) has improved outcomes in people with CF (pwCF), reducing the frequency of PEx and antibiotics. Using data from a single-center retrospective review and the Pediatric Health Information System (PHIS) database, this study evaluates the impact of HEMT on antibiotic utilization in people with CF (pwCF). A single-center, retrospective analysis was conducted comparing antibiotic use in the pre-ETI (2017-2019) and post-ETI (2020-2022) periods. Inclusion criteria were pwCF receiving care at for at least one year in both periods. Data on antibiotic agent, duration, and route of administration were collected. Additionally, a multicenter, retrospective study using the PHIS database was performed between January 2015 through June 2023, analyzing antibiotic utilization in hospitalized pwCF across multiple pediatric hospitals. Metrics included days of therapy (DOT) per 1000 patient days and length of stay. In the single-center analysis, there was a 36.2 % decrease in IV and 19.5% decrease in PO antibiotic use in the post-ETI period, with no change in treatment duration. In the PHIS analysis, antibiotic utilization decreased from the pre-ETI to post-ETI period, with reductions in Anti-PsA and Anti-MRSA agents and a decrease in length of stay. The median DOT per 1000 patient days decreased from 2257 (IQR: 1950, 2417) to 1710 (IQRL 1371, 1909) (p<0.001). The introduction of HEMT has led to reduction in antibiotic utilization for PEx among pwCF, at a single center and across multiple institutions. This decrease in antibiotic use highlights the potential for antibiotic stewardship programs to reassess and optimize antibiotic management in pwCF. Additional research is needed to determine the optimal duration and choice of antibiotics in the context of HEMT, with the goal of minimizing antibiotic exposure and associated risks.

The involvement of a caregiver is fundamental in the process of caring for a person with eating disorders (ED). The aim of this study is to evaluate the functioning of family unit and the emotional burden of caregivers of individuals with ED treated at an outpatient service. We contacted by telephone the caregivers of individuals in care at ED Centre of the AUSL-Modena and selected a sample of 50 caregivers of 42 individuals with ED, who provided their informed consent. The following scales were administered to caregivers: caregiver burden inventory (CBI), Beck's depression inventory (BDI), family assessment device (FAD), depression, anxiety and stress-scale (DASS-21). The following scales were administered to the care recipients: global assessment of functioning and clinical global impression severity scale. Demographic variables relating to the individuals with ED and their caregivers were collected: sex, age, employment situation, marital status, number of family members, living condition, family role. Clinical variables of care recipients were collected: body mass index, ED diagnosis, duration of ED and treatment and care at ED centre, medical complications, psychiatric comorbidities, substance use. The data was statistically analyzed. All caregivers were the parents of individuals with ED, in particular the mother (76%), and were employed. Caregivers reported a mild to moderate emotional burden in CBI and mild to severe depressive symptoms in BDI in 62% of cases. Family functioning reported by FAD scale was slightly altered in the areas of "communication", "roles" and "affective involvement". Most care recipients were females (98%), suffering from anorexia nervosa (85.6%) with an average age of 18.54 ± 4.74. At multiple linear regression, two statistically significant associations were underscored with CBI score (dependent variable): the age of individuals in a negative way and the psychiatric comorbidities of the individuals with ED in a positive way. The parents of sons with ED represented their caregivers, who suffered from a mild emotional burden and depressive symptoms and lived in altered family functioning, especially in communications. Ensuring psychological support for the caregiver may be useful for improving both caring and family relationships.

Objective To evaluate the joint orthodontic, paediatric and restorative (JOPR) clinic at Leeds Dental Institute, which manages complex dental cases requiring multidisciplinary care.Design Retrospective service evaluation.Setting Multidisciplinary clinic at Leeds Dental Institute.Materials and methods Data were collected from all new patient consultations at the JOPR clinic between March 2023 and April 2024. Referral sources, case types, patient demographics, treatment pathways, and outcomes were analysed, along with timeframes along the patient journey.Results Hypodontia was the most common reason for referral, followed by ectopic/impacted teeth, trauma, and developmental abnormalities. Most referrals originated internally, particularly from orthodontics. Treatment planning typically involved orthodontic-led space management, followed by restorative or paediatric input. A significant proportion of patients were referred to primary care for treatment delivery. The average triage time was 13 days, and average time from referral to clinic attendance was 69 days. Treatment duration varied significantly due to case complexity and interdepartmental coordination.Conclusion The JOPR clinic facilitates efficient interdisciplinary planning and care for patients with complex dental needs. This model improves coordination, reduces duplication, and supports targeted treatment delivery. Findings may inform the development of similar services and align with national care improvement initiatives.

Linezolid serum concentrations in critically ill patients show high variability. In this retrospective study, we analysed the linezolid plasma through levels (Cmin) in patients on intensive care units (ICUs) under extracorporeal membrane oxygenation (ECMO) support. The aim was to evaluate if patients' clinical or demographic characteristics influence drug concentrations and if these are within the therapeutic range. In total, 156 linezolid trough plasma concentrations from 52 ICU ECMO patients were analysed. Linezolid trough levels were correlated with the following clinical and demographic characteristics: Age, sex, body mass index (BMI), dosage per day, creatinine clearance (CrCl), and requirement for renal replacement therapy (RRT). Drug concentrations were quantified by liquid chromatography with tandem mass spectrometry. The European Committee on Antimicrobial Susceptibility Testing susceptibility breakpoints of 4mg/L of linezolid for staphylococci and enterococci and of 2mg/L for streptococci and other Gram-positive rods were used as minimum target concentration. Patients were treated with standard linezolid dosage (2 × 600mg iv per day; n = 88 Cmin, 56.4%) or by adjusted dosing regimens (n = 68 Cmin, 43.6%). The total amount of the drug ranged from 600 to 2400mg per day (median 1200, IQR 1200-1800mg). The mean of all trough levels measured among the cohort was 2.32mg/L (median 1.55mg/L, IQR 0.61-3.07). In total, 84.0% of all measurements were below the 4mg/L breakpoint (62.2% below the 2mg/L breakpoint), with 90.4% (78.8%) of patients showing inadequate levels in at least one measurement and 63.5% (36.5%) of patients below the threshold in every measurement. This result was irrespective of a standard or an adjusted dosing regimen. Female sex (p = 0.022), RRT (p = 0.047), increased CrCl (p = 0.012), and BMI (p = 0.023) were significantly correlated with lower Cmin levels. Patients' individual linezolid trough levels and outcomes did not display conclusive patterns, irrespective of dosing or duration of treatment. Both standard and increased dosing regimens of linezolid showed potentially inadequate linezolid plasma levels in the large majority of critically ill ECMO patients of our study. Future TDM studies with optimized dosing and application regimens in ECMO patients are warranted.

Abstract This study investigates the effects of plasma surface modification parameters—specifically gas type, plasma power, and treatment duration—on the performance of commercial polysulfone (PS) membranes in a membrane bioreactor (MBR) treating synthetic fruit juice wastewater. Two gases (H₂O vapor and N₂) were tested at different power levels (40–100 W) and exposure durations (1–30 minutes). The membrane characteristics were evaluated using contact angle, FTIR, SEM, and AFM analyses. Operational performance was assessed under varying organic loading rates (OLRs: 0.5, 1.0, and 2.0 kg COD m⁻³ d⁻¹), including flux and resistance profiles. Results showed that increasing plasma power and exposure time significantly improved membrane hydrophilicity and roughness. The optimal condition—H₂O plasma at 100 W for 30 minutes—reduced the contact angle by 53% and increased surface roughness by 371%. These surface enhancements directly translated into improved filtration performance: the equilibrium flux increased by up to 44%, and total membrane resistance (Rt) decreased by up to 51%. Among the resistance components, cake resistance (Rc) remained the dominant factor under all conditions. To the best of our knowledge, this is the first study to systematically optimize plasma treatment parameters for PS membranes in an MBR treating high-strength industrial effluent. This work addresses a critical research gap by linking specific plasma parameters to longterm hydrophilicity, fouling resistance, and filtration stability, thereby providing a scalable, environmentally friendly approach for industrial wastewater treatment.

Introduction Post-COVID syndrome is characterized by persistent, unexplained symptoms including chronic cough, palpitations, insomnia, and fatigue that develop following SARS-CoV-2 infection without identifiable causes. Current treatments show limited efficacy, requiring alternative options. This study aims to observe the effectiveness of Five-Element Regulation Therapy (FERT), a Traditional Chinese medicine (TCM) intervention, in managing post-COVID syndrome. Methods A retrospective cohort study was conducted using clinical records of 127 post-COVID syndrome patients from the TCM outpatient department of Peking University Third Hospital. The participants were divided into two groups: 81 cases receiving FERT treatment were assigned to the exposure group, while 46 cases undergoing conventional TCM therapy served as the control group. The treatment duration was 2 weeks for both groups, followed by immediate follow-up. The outcomes included the clinical cure rate and clinical response rate at 2 weeks after the treatment initiation. Results The FERT group demonstrated superior clinical outcomes, achieving a 61.7% cure rate and 88.9% response rate, significantly higher than the control group’s 21.7% ( p &amp;lt; 0.001) and 67.4% ( p &amp;lt; 0.01), respectively. Conclusion This study provides preliminary evidence that FERT may be superior to conventional TCM therapy in managing post-COVID syndrome. Results should be interpreted with heightened caution due to the study’s inherent limitations.

Exuberant granulation tissue (EGT) is a second intention wound healing disorder. It commonly occurs in the distal limb of horses. EGT causes significant increase in the duration and cost of treatment, potentially leading to the decision not to pursue treatment and euthanize the patient. The underlying pathomechanisms of this fibroproliferative disorder remain unclear, particularly in terms of collagen composition and the association between myofibroblasts and blood vessels. This study investigated the collagen composition in naturally occurring EGT following trimming in 19 horses (EGT group). In both the superficial and deep wound beds of EGT-affected horses, the collagen distribution was assessed and compared to control wounds (n = 6 horses, control group, punch biopsies) using histology. Immunofluorescence was performed to colocalize activated alpha smooth muscle actin-positive myofibroblasts in EGT as well as angiogenic markers. Our histological findings showed significantly higher amounts of immature collagen (type III) in the superficial and deep regions of EGT compared to the controls while the total amount of collagen in both groups did not differ significantly. In EGT, occluded microvessels and endothelial cell hypertrophy were present in the deep layer and myofibroblasts were ubiquitously found in the whole wound bed. Markers for intermediate filaments were reduced in the superficial region. In conclusion, collagen composition in EGT differed significantly from control wounds, indicating tissue immaturity. Consequently, promoting tissue maturation towards a more mature ECM composition could serve as a valuable target for future therapeutic interventions enabling better regeneration.

Background. Febrile neutropenia is a common cause of hospital admissions among pediatric cancer patients. To optimize personalized approaches for hospitalization and antibiotic treatment, risk stratification has been proposed. This study aimed to explore the impact of clinical and laboratory parameters on risk stratification for patient discharge. Methods. This prospective study included pediatric lymphoma and solid tumor patients who were hospitalized due to febrile neutropenia between June 2018 and June 2019. Patient characteristics, primary oncological diagnosis and disease status, comorbid conditions, time elapsed after the last course of chemotherapy, use of granulocyte-colony stimulating factor (G-CSF) prophylaxis, presence of port catheter, infection type, fever values/duration, physical examination findings, and duration of neutropenia were collected. Laboratory investigations including complete blood counts, acute phase reactants at the onset of the episode, culture results were also recorded. Results. The study examined 142 febrile neutropenic episodes from 88 consecutive patients. The median age of the study group was 6.8 years, with 19.3% of cases being lymphoma and 80.7% having solid tumors. The median hospital stay was 7 days. Factors associated with longer hospitalization periods included a lymphoma diagnosis, presence of comorbid conditions, bone marrow involvement, and febrile neutropenic period during hospitalization. Patients presenting with fever ≥ 39 °C at admission, poor general appearance, hypotension, prolonged capillary filling time, and severe infection signs had longer hospital stays. In febrile neutropenic episodes, absolute monocyte count ≤ 100 cells/mm3, platelet count ≤ 50,000/mm3, and prolonged neutropenia delayed discharge time. Patients with microbiologically defined infections, especially those with positive catheter cultures, also had delayed discharge. Conclusion. The diagnosis of lymphoma, poor general condition at admission, presence of microbiologically defined infection, thrombocytopenia, delayed recovery of absolute neutrophil counts, and prolonged fever duration were significant factors in determining the treatment duration and predicting discharge time.

This systematic review and meta-analysis aimed to evaluate the predictability of tooth movement, and clinical effectiveness of clear aligners in extraction-based orthodontic therapy. A comprehensive search of seven electronic databases (PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, CINAHL and ProQuest) was conducted up to April 19, 2025, adhering to PRISMA guidelines. Eligible studies included prospective and retrospective designs assessing clear aligner treatment in patients aged ≥ 12 years with premolar extractions. Primary outcomes encompassed predicted versus achieved tooth movement and root angulation/parallelism, with secondary outcomes including treatment duration and clinical indices (American Board of Orthodontics Objective Grading System [ABO-OGS], Peer Assessment Rating [PAR]). Risk of bias was evaluated using the Swedish Council on Technology Assessment in Health Care (SBU) grading system and Centre for Reviews and Dissemination (CRD) criteria. Random-effects meta-analyses were performed for homogeneous outcomes. Twenty studies (536 aligner patients, 173 fixed appliance patients) were included. Meta-analyses revealed significant discrepancies between predicted and achieved movements, including excessive mesial tipping of maxillary first molars (mean difference: -6.08°, 95% CI: -7.89 to -4.26). Under-retraction (-1.93 mm, 95% CI: -2.15 to -1.71), and increased vertical displacement of maxillary incisors. Root divergence and anchorage loss were prevalent. Compared to fixed appliances, aligners exhibited inferior root control and occlusal contact scores. Four randomised controlled trials provided high-quality evidence, but the predominance of retrospective studies contributed to a moderate risk of bias. Clear aligners demonstrate biomechanical limitations in achieving precise root control and bodily movement in extraction cases, necessitating strategic overcorrections and adjunctive mechanics. Trial Registration: PROSPERO (CRD42024613540).

Background/Objectives: Natural compounds are being increasingly explored as potential adjuvants to conventional drugs in oncological treatments. Regarding breast tumors, several studies indicate that garlic (Allium sativum) may protect against onset, counteracts aggressiveness, and prevents malignant progression of cells from non-invasive tumors. It has been widely demonstrated that garlic derivatives induce apoptosis and reduce invasive potential in ER-positive and triple-negative breast tumor cells. However, the current literature lacks studies investigating their effects on HER2-positive (HER2+) breast cancers. This study therefore aimed to explore the effects of a garlic extract and diallyl disulfide (DADS), one of its most bioactive organosulfur compounds, on HER2+ phenotype breast tumor cells. Methods: The effects of a garlic extract and diallyl disulfide (DADS) were investigated on MDA-MB-453 and SKBR3 breast tumor cell lines. Cell growth, invasive potential, and Akt-related signaling were assessed after 4–72 h of garlic derivatives administration. The intracellular localization of β-catenin was examined with immunofluorescent confocal microscopy. Results: A dual role of DADS, dependent on the duration of treatment, was revealed. Acute administration induced a significant decrease in invasive potential, while prolonged treatment promoted HER2+ cell invasiveness. These effects were directly correlated with the activation of Akt and the nuclear accumulation of β-catenin, known to induce expression of genes associated with tumor malignancy. Conclusions: Although further investigations are needed to establish the exact mechanism and to assess the in vivo reproducibility of these phenomena, our results highlight the heterogeneous response to natural compounds of complex diseases like cancer.

Helminthic therapy, as an emerging strategy for Diabetes Mellitus (DM), demonstrates significant clinical benefits by modulating host immune and metabolic systems. Studies have shown that this approach effectively enhances insulin sensitivity, reduces chronic inflammation, and restores metabolic homeostasis through the regulation of gut microbiota. However, certain diabetic patients undergoing helminthic therapy may encounter risks such as infections or metabolic disturbances, necessitating the development of safer and more precise therapeutic methods. This review, conducted following the PRISMA guidelines, systematically retrieved and analyzed 163 high-quality studies from PubMed, Web of Science, and Scopus databases. It comprehensively evaluates the mechanisms, clinical outcomes, and safety improvement strategies associated with helminthic therapy. To ensure the safe application of this treatment, we propose strategies including genetic editing, real-time monitoring, targeted therapeutics, and helminth-derived molecules, along with a detailed clinical decision-making framework. This framework encompasses the matching of host health status with helminth species selection, guidance on dose optimization and treatment duration, and the application of modern intelligent technologies for real-time monitoring of therapeutic processes and potential adverse effects. Helminthic therapy has demonstrated success in alleviating hyperglycemia, chronic inflammation, and insulin resistance in diabetic patients, offering substantial health benefits through its immunomodulatory and metabolic regulatory effects. These findings suggest that helminthic therapy holds the potential to become a revolutionary approach in the field of DM.

Background Chronic pain afflicts approximately 20% of the global adult population and is frequently undertreated, with available pharmacologic options often associated with significant long-term adverse effects. Although omega-3 fatty acids are known for their anti-inflammatory and immunomodulatory effects, current clinical evidence regarding their efficacy in pain management remains inconclusive. Objective To determine how well omega-3 fatty acids reduce chronic pain, and to investigate how factors like disease type, dosage, treatment duration, and study design influence their effectiveness. Methods We searched four databases (PubMed, Embase, Cochrane Library, and Web of Science) from inception to 14 February 2025 with no language restrictions. Forty-one randomised controlled trials (RCTs; n = 3,759) met predefined criteria. Risk of bias was assessed with RoB 2. Pooled standardised mean differences (SMDs) for pain intensity were obtained through random-effects meta-analyses. Subgroup, sensitivity, and publication-bias analyses were also conducted. Results Omega-3 fatty acids showed a moderate, statistically and clinically significant reduction in pain intensity with a standardized mean difference (SMD) of −0.55 (95% CI –0.76 to −0.34; I 2 = 87%). The relief was noticeable at 1 month (SMD = −0.27) and improved by 6 months (SMD = −0.83). Lower doses (≤1.35 g/day) were more effective (SMD = −0.60) compared to higher doses (&amp;gt;1.35 g; SMD = −0.53). The benefits were significant for rheumatoid arthritis, migraine, and other mixed chronic pain conditions, but not for osteoarthritis or mastalgia. There was minimal publication bias according to trim-and-fill adjustment, and leave-one-out tests confirmed robust results. Conclusion Omega-3 fatty acid supplementation offers a clinically meaningful and time-dependent reduction in chronic pain, particularly at moderate doses and in certain disease contexts. Standardization of outcome measures, dose optimization, and long-term trials are needed to better define its role in pain management. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251035960 , Identifier CRD420251035960.

Non-alcoholic fatty liver disease (NAFLD), recently reclassified as metabolic dysfunction-associated fatty liver disease (MAFLD), is closely linked to mitochondrial dysfunction and impaired lipid metabolism. Bifidobacterium bifidum has emerged as a promising probiotic candidate for restoring metabolic balance, yet its mitochondrial-targeted mechanisms remain underexplored. This study investigates the role of B. bifidum in modulating hepatic mitochondrial β-oxidation pathways and key transcriptional regulators involved in fatty acid metabolism. MAFLD was induced in male Sprague-Dawley rats using a high-fat diet and streptozotocin (STZ). Following disease induction, B. bifidum was administered over two treatment durations (6 and 14 weeks). Liver function tests, lipid profiles, and stereological analyses were performed, and hepatic gene expression of UCP2, CPT1A, PGC-1α, PPAR-α, and PPAR-γ was evaluated using quantitative RT-PCR. B. bifidum treatment significantly reduced serum triglycerides, total cholesterol, and LDL-C levels, while showing a non-significant upward trend in HDL-C levels. Gene expression analysis revealed that B. bifidum restored downregulated PGC-1α, CPT1A, and PPAR-α expression and normalized elevated UCP2 and PPAR-γ levels, suggesting enhanced mitochondrial fatty acid oxidation. Histological and stereological assessments confirmed structural improvements in liver tissue, including reduced steatosis and improved hepatocyte morphology. These findings provide new mechanistic evidence that B. bifidum exerts hepatoprotective effects by reprogramming mitochondrial lipid metabolism through the PPAR-α/PGC-1α/CPT1A axis. This probiotic may offer a novel, mitochondria-targeted therapeutic strategy for managing MAFLD and related metabolic disorders. Further studies are warranted to evaluate strain-specific effects and long-term outcomes in clinical settings.

Differentiated thyroid carcinoma (DTC) is typically managed surgically with favourable outcomes. However, surgery may have dire consequences when the tumour invades critical structures. Neoadjuvant therapy with tyrosine kinase inhibitors (TKIs) has emerged as a potential strategy to improve resectability and reduce morbidity in advanced DTC. We evaluated the efficacy and safety of neoadjuvant TKI therapy in patients with advanced or unresectable DTC. A retrospective study was conducted on patients with advanced DTC treated with neoadjuvant TKIs (lenvatinib or dabrafenib/trametinib) followed by curative intent surgery between 2023 and 2025. Data on disease extent, genetic alterations, treatment regimens, and adverse effects were collected. Radiologic response was assessed by CT or PET-CT according to the RECIST 1.1 criteria. Surgical outcomes were evaluated by the degree of morbidity and by tumour involvement in the surgical margins. Nine patients were included, seven treated with lenvatinib, two treated with dabrafenib/trametinib on the basis of molecular alterations. The median duration of TKI therapy was 5 months, and no disease progression was observed throughout. Radiological assessment revealed a median reduction in tumour burden of 23.53%, contributing to improved tumour resectability. All patients underwent surgical resection with preservation of critical structures. Elevated TSH levels during neoadjuvant therapy was correlated with a positive treatment response (p = 0.028). Neoadjuvant TKIs may improve the surgical outcomes of patients with advanced DTC. Decision-guided radiological and blood-based surrogate biomarkers, such as TSH, can assist in evaluating treatment response and guide decisions regarding treatment duration and extent of surgical resection.