Non-pharmacological Strategy Research Articles

Aerobic exercise and metformin attenuate the cognitive impairment in an experimental model of type 2 diabetes mellitus: focus on neuroinflammation and adult hippocampal neurogenesis.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that increases the prevalence of cognitive impairment in the geriatric population. Aerobic exercise is an excellent non-pharmacological therapeutic strategy to prevent Alzheimer's disease, the most common form of dementia. The exact molecular mechanism of aerobic exercise (Exe) as an intervention to counter cognitive decline is far from clear. Metformin is a first-line agent against T2DM with neuroprotective properties. The present study assessed the role of treadmill exercise in combination with a low dose of metformin (Met; 70mg/kg) in cognitive impairment and its associated molecular mechanism in T2DM rats. The experimental model of T2DM-associated cognitive decline was created by administration of a high-fat diet (HFD) with a low dose of streptozotocin (STZ; 35mg/kg). Neurobehavioral assessments were performed to evaluate spatial recognition and fear-conditioned memory across the groups: control, HFD + STZ, HFD + STZ + Exe, and HFD + STZ + Exe + Met. In addition, we performed immunohistochemistry and western blotting on the rat hippocampal tissue from the above groups for protein expression studies. T2DM rats showed a significant cognitive decline compared to the control group, which improved in the long-term exercise and metformin co-administered animals. The level of neuroinflammation was significantly elevated in the hippocampal tissue of T2DM rats compared to the control and lowered after exercise and metformin treatment. T2DM reduced mature neurons and neurogenesis while increasing astrogliosis and microgliosis, ameliorated by exercise and metformin treatment. Moreover, T2DM impaired hippocampal neurogenesis by reducing the canonical Wnt/β-catenin pathway, which got upregulated in exercise and metformin-co-administered rats. Long-term aerobic exercise with metformin treatment ameliorated neuroinflammation and promoted adult hippocampal neurogenesis via upregulating the canonical Wnt/β-catenin pathway in T2DM rats.

Inhibition of Th17 cell differentiation by aerobic exercise improves vasodilatation in diabetic mice

ABSTRACT Background Aortic endothelial diastolic dysfunction is an early complication of diabetes and the abnormal differentiation of Th17 cells is involved in the development of diabetes. However, the exact role of exercise on regulating the Th17 cells differentiation and the underlying molecular mechanisms remain to be elucidated in diabetic mice. Methods db/db and db/m+ mice were randomly divided into exercise and sedentary groups. Mice in exercise group were exercised daily, 6 days/week, for 6 weeks and mice in sedentary groups were placed on a nonmoving treadmill for 6 weeks. Vascular endothelial function was measured via wire myograph and the frequencies of Th17 from peripheral blood in mice were assessed via flow cytometry. Results Our data showed that exercise improved insulin resistance and aortic endothelial diastolic function in db/db mice. In addition, the proportion of Th17 cells and IL-17A level in peripheral blood of db/db mice were significantly increased, and exercise could promote Th17 cell differentiation and reduce IL-17A level. More importantly, STAT3 or ROR-γt inhibitors could promote Th17 cell differentiation in db/db mice, while exercise significantly down-regulated p-STAT3/ROR-γt signaling in db/db mice, suggesting that exercise regulated Th17 differentiation through STAT3/ROR-γt signaling. Conclusions This study demonstrated that exercise improved vascular endothelial function in diabetic mice via reducing Th17 cell differentiation through p-STAT3/ROR-γt pathway, suggesting exercise may be an important non-pharmacological intervention strategy for the treatment of diabetes-related vascular complications.

Balancing Tradition and Science: Acupuncture in Pain Control

Introduction: Pain management is a critical component of healthcare, addressing acute and chronic conditions that significantly impact quality of life. Traditional pharmacological approaches, while effective, often present side effects and dependency risks. Acupuncture, rooted in traditional Chinese medicine, has emerged as a complementary and alternative therapy, leveraging the body’s natural mechanisms to alleviate pain through the strategic insertion of fine needles at acupoints. Purpose of Work: This research investigates the role of acupuncture in pain management, examining its efficacy across various pain conditions, understanding its physiological mechanisms, and evaluating its integration into modern medical practice. It seeks to assess the scientific evidence supporting acupuncture and its potential as a non-pharmacological pain management strategy. State of Knowledge: Studies have demonstrated acupuncture's effectiveness in reducing pain intensity for conditions such as migraines, osteoarthritis, fibromyalgia, and postoperative pain. Mechanistic research highlights its role in modulating neural pathways, enhancing endogenous opioid release, and reducing inflammation. Guidelines from health organizations now recognize acupuncture as a viable option in multidisciplinary pain management. Material and methods: The study methodology entailed defining the objectives, conducting a systematic literature search, and implementing a structured process for screening relevant studies. The research encompassed a comprehensive search across scientific databases, such as PubMed and Google Scholar. Summary: Acupuncture presents a promising, evidence-supported intervention for pain management. By combining traditional techniques with modern scientific insights, acupuncture addresses the growing need for holistic, safe, and effective approaches to alleviating pain and enhancing patient well-being.

Immediate Effect of Uddiyana Bandha on Heart Rate Variability in Patients with Hypertension: A Randomised Controlled Study.

Hypertension, a prevalent cardiovascular condition, is linked to autonomic nervous system dysregulation, often evidenced by reduced heart rate variability (HRV). Yoga, particularly Uddiyana Bandha, may influence autonomic control and improve HRV, thus offering potential benefits for hypertension management. This study intended to assess the impact of the regular use of Uddiyana Bandha practice on HRV among hypertensive patients. This randomised controlled study included 60 hypertensive patients aged between 40 and 60. Participants were randomised into an intervention group practicing Uddiyana Bandha (n = 30) and a control group with no intervention (n = 30). The outcome measures included time and frequency domain HRV variables, specifically the standard deviation of NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), high-frequency (HF) and low-frequency (LF) components in normalised units (n.u), and the LF/HF ratio. These were assessed both before and immediately after the intervention. The intervention group performed three rounds of Uddiyana Bandha under supervision, while the control group rested quietly for an equivalent duration. The Uddiyana Bandha group demonstrated significant (p < .05) improvements in HRV parameters post-intervention compared to the control group. Mean RR interval, SDNN and RMSSD increased immediately after Uddiyana Bandha practice. The HF component (n.u) increased, while the LF component (n.u) and LF/HF ratio decreased (p < .05), indicating enhanced parasympathetic activity. No significant changes were observed in the control group. Uddiyana Bandha's practice immediately has notable effects on HRV in hypertensive patients, showing better autonomic balance and cardiovascular performance. These results suggest Uddiyana Bandha as a possible non-pharmacological strategy for hypertension management. Future studies with larger sample sizes and longer durations are needed to support these results and explore long-term effects.

Strength training attenuates neuropathic pain by Preventing dendritic Spine dysgenesis through Suppressing Rac1 and inflammation in experimental autoimmune encephalomyelitis

Chronic pain is a challenge and major health problem to basic science and clinical practice. Pain is one of the worst symptoms of multiple sclerosis (MS), which has a significant impact on their quality of life. Rac1 is an important intracellular signaling molecule involved in spinal dendritic spine pathology and activation of IL-1β and TNF-α that are associated with chronic neuropathic pain. As a result, targeting Rac1 presents a promising approach to managing neuropathic pain. Clinical studies have demonstrated that physical exercise is a non-pharmacological strategy that positively influences disease progression in individuals with MS, but underlying mechanism of exercise on Rac1- induced neuropathic pain is not well understood. This study examined the effects of a 4-week strength training on Rac1 expression, IL-1B, TNF-α, TGF-β1 levels, MDA concentrations, SOD activity, dendritic spine abnormalities in the dorsal horn of the spinal cord, as well as nociceptive behaviors (formalin test) and motor function (Rotarod test) during the chronic phase of experimental autoimmune encephalomyelitis (EAE). The findings indicated that strength training increased TGF-β1 expression and SOD activity while decreasing the expression of Rac1, IL-1β, TNF-α, and MDA and reducing dendritic spine dysgenesis in the dorsal horn of the spinal cord. We observed strength training effectively reduced nociceptive behaviors and improved motor function in mice with EAE. In summary, regular physical exercise may modulate neuropathic pain through inhibition of dendritic spine dysgenesis, inflammation and oxidative stress in the dorsal horn of the spinal cord.

Oat-Protein-Based Diet Lowers Blood Pressure and Prevents Cardiac Remodeling and Dysfunction in Spontaneously Hypertensive Rats.

Background/Objectives: Hypertension and its associated complications, such as cardiac remodeling and dysfunction, continue to impose a significant burden on global healthcare. Nutritional interventions have been recognized as playing a crucial role in addressing this devastating condition termed a 'silent killer'. Plant-based proteins could potentially be utilized as a non-pharmacological strategy to combat hypertension and its related risk factors. In this study, we investigated the efficacy of an oat protein diet in managing hypertension and cardiac abnormalities. Methods: Four-week-old male spontaneously hypertensive rats (SHRs) and Wistar-Kyoto (WKY) rats were fed a regular diet with casein as a protein source or an oat-protein-based diet for 16 weeks. Twenty-week-old male SHRs showed high blood pressure (BP), cardiac remodeling, cardiac dysfunction, higher levels of markers of oxidative stress [malondialdehyde (MDA)] and inflammation [tumor necrosis factor-α (TNF-α)], as well as lower levels of a marker of vascular function (nitric oxide). Results: The oat protein diet was able to significantly lower high BP, prevent cardiac remodeling and dysfunction, improve the levels of nitric oxide, and reduce the levels of TNF-α. Oat protein, after in vitro gastrointestinal digestion, also exhibited angiotensin-converting enzyme inhibition and significantly higher antioxidant activity than casein when assessed with the 2,2-diphenyl-1-picrylhydrazyl and the iron-chelating assays in vitro.Conclusions: oat protein lowers BP and prevents cardiac remodeling and dysfunction partly via improving the levels of nitric oxide and TNF-αin SHRs. Its high antioxidant potential could contribute to the observed cardiovascular effects.

Power exercises with elastic bands combined with endurance training improve pulse pressure, systolic blood pressure, and functional parameters in older adults.

This study aimed to investigate the effects of power training (PT) using elastic bands combined with endurance training (ET) on pulse pressure (PP), systolic (SBP) and diastolic blood pressures (DBP), autonomic response (AR), and functional parameters in older adults. Thirty participants were randomly assigned to the control group (n = 15) and the intervention group (IG) (n = 15). IG participants performed PT with elastic bands combined with ET twice weekly for 8 weeks. PP, SBP, DBP, AR, and functional parameters were assessed before and after 8 weeks. PP, SBP, and functional parameters significantly improved after 8 weeks in the IG (P < 0.05). The study also found a clinically significant reduction in the SBP (Δ = -16.5 mmHg; η2p = 0.36) and DBP (Δ = -4.3 mmHg; η2p = 0.26), and a clinical reduction in the 5-Repetition Sit-To-Stand test (η2p = 0.63) and the elbow flexion test (η2p = 0.51). Our findings indicate that PT with elastic bands combined with ET improves PP, SBP, and functional parameters in older adults. Hence, our combined training protocol can be an easily accessible, low-cost, nonpharmacological strategy for strength, and conditioning professionals to prescribe as an exercise intervention to older adults.

Beyond Pharmacology: The Biological Mechanisms of Remote Ischemic Conditioning in Cerebrovascular Disease.

Cerebrovascular diseases (CVDs), comprising predominantly ischemic stroke and chronic cerebral hypoperfusion (CCH), are a significant threat to global health, often leading to disability and mortality. Remote ischemic conditioning (RIC) has emerged as a promising, non-pharmacological strategy to combat CVDs by leveraging the body's innate defense mechanisms. This review delves into the neuroprotective mechanisms of RIC, categorizing its effects during the acute and chronic phases of stroke recovery. It also explores the synergistic potential of RIC when combined with other therapeutic strategies, such as pharmacological treatments and physical exercise. Additionally, this review discusses the pathways through which peripheral transmission can confer central neuroprotection. This review concludes by addressing the challenges regarding and future directions for RIC, emphasizing the need for standardized protocols, biomarker identification, and expanded clinical trials to fully realize its therapeutic potential.

Understanding the barriers and facilitators towards dietary change for dementia risk reduction among British South Asians

Up to 40% of dementia cases could potentially be prevented through targeting modifiable risk factors(1). South Asian communities are at increased risk for dementia, having an earlier onset and greater cumulative life-course exposure to dementia related risk factors(2). Research on dietary patterns, such as the Mediterranean Diet(3), has shown promise as a non-pharmacological strategy to reduce cognitive decline. Acculturation and the assimilation of dietary habits to that of the host country can mean that minority ethnic groups require tailored dietary advice to suit their needs(4). Therefore, cultural adaptation of dietary interventions is required to ensure that advice for brain health is culturally relevant. Research concerning which culturally adapted, or country-specific dietary interventions are brain healthy, is currently lacking. The aim of this research was to understand the perceived barriers and facilitators towards dietary change for dementia risk reduction among British South Asians.Five focus groups were conducted with individuals of South Asian ethnicity (n = 38) living in the North East of England. Patient and Public Involvement contributors from preliminary engagement activities supported recruitment from community and voluntary organisations. Data were transcribed and analysed using template analysis(4). This involved deductively analysing the data using relevant a-priori themes; pre-identified themes generated based on previous experience of the research team, and from a broad literature review.Participants were aged between 26-82 years with the majority being female (n = 26, 68.4%), unemployed (n = 22, 57.9%), Pakistani ethnicity (n = 28, 73.7%), with an education level of college attendance or higher (n = 22, 57.9%). Themes identified included a lack of awareness of dementia, and the link between diet and dementia. Shame and stigma surrounding dementia was highlighted as a major issue that could influence willingness to engage in preventative strategies. Participants reported the main barriers to dietary change as: the influence of religious beliefs; issues with interpretation, accessibility, and lack of culturally appropriate resources; engrained dietary habits; time, cost, and convenience. Generational influences relating to differences in eating habits and awareness of healthy eating were highlighted as both a barrier and facilitator to behaviour change. Peer support strategies and the provision of practical, culturally sensitive dietary advice were viewed as facilitators.This qualitative study highlights the need to increase awareness surrounding dementia prevention, specifically the role of diet, and to address this in a culturally sensitive way, that supports ethnic minority communities to improve their understanding and willingness to openly talk dementia. These findings will inform the development of a prototype for a dietary intervention, guided by the Medical Research Council guidance for complex interventions, and co-developed with the South Asian community, to explore how dietary advice for dementia prevention can be implemented in a culturally acceptable and feasible way in a community setting.

Metabolic Reprogramming via Ketogenic Diet: A Novel Approach to Combating Neurological Diseases

Epilepsy is a chronic neurological disorder characterized by a persistent tendency for the brain to generate seizures, affecting approximately 0.5–1% of the global population. Despite advances in pharmacological treatments and surgical interventions, around 30% of individuals with epilepsy continue to experience seizures, leading to significant impacts on quality of life. Among these individuals, many suffer from drug-resistant epilepsy (DRE), where seizures persist despite optimal drug therapy or surgical interventions.In recent years, the ketogenic diet (KD)—a high-fat, low-carbohydrate dietary regimen—has emerged as an effective non-pharmacological strategy for managing DRE. The KD works by inducing ketosis, a metabolic state where the body uses fat as the primary energy source instead of carbohydrates, which has been associated with neuroprotective effects and significant seizure reduction. Variants of the KD, such as the Modified Atkins Diet (MAD) and Low Glycemic Index Treatment (LGIT), offer less restrictive alternatives that have shown similar efficacy in reducing seizure frequency.This review explores the cellular and molecular mechanisms of the KD, evaluates its safety and tolerability across different age groups, and assesses its efficacy in treating epilepsy, particularly DRE. The findings underscore the potential of personalized dietary interventions to serve as effective adjunctive therapies in the management of epilepsy, offering new hope for individuals who do not respond to conventional treatments.

The Role of Intermittent Fasting on Metabolic Syndrome: A Systematic Review and Meta-Analysis.

Intermittent fasting has gained popularity as a dietary intervention to improve metabolic health. Metabolic syndrome may benefit from intermittent fasting by improving weight, cholesterol levels, blood pressure (BP), and glucose control.This study aims to assess the effects of intermittent fasting on weight, BMI, cholesterol levels, BP, and glucose in individuals with metabolic syndrome.This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included 11 studies examining the effects of intermittent fasting on metabolic syndrome. A comprehensive search of PubMed and Google Scholar identified 6,451 studies, of which 11 met the inclusion criteria. Data on weight, BMI, cholesterol, BP, and glucose levels were extracted, and a random effects meta-analysis was conducted to assess outcomes. Analysis showed significant improvements in weight, with a mean reduction of 3.59 kg (95% CI: -4.59 to -2.59, p < 0.0001) and a decrease in BMI of 1.39 kg/m2 (95% CI: -1.87 to -0.92, p < 0.0001). Low-density lipoprotein (LDL) cholesterol levels dropped by 56.22 mg/dL (95% CI: -80.14 to -32.29, p < 0.0001), and systolic BP decreased by 5.54 mmHg (95% CI: -7.55 to -3.53, p < 0.0001). However, high-density lipoprotein (HDL) cholesterol showed minimal changes, and glucose levels remained stable. Intermittent fasting led to significant reductions in weight, BMI, LDL cholesterol, and BP, making it a promising non-pharmacological strategy for managing metabolic syndrome. Further research is needed to explore long-term effects and optimal fasting protocols for different populations.

Effect of Electrical Stimulation of Lingual Nerve on Xerostomia: A Randomized Controlled Trial.

Xerostomia is a subjective sensation of dry mouth affecting millions of people worldwide. Current management has limitations, often causing side effects. This study aims to investigate whether electrical stimulation of the lingual nerve could offer effective relief for xerostomia sufferers. Eligible participants were randomly assigned (1:1) to either the experimental or sham group, receiving electrical stimulation of the lingual nerve (n = 24) or sham stimulation (n = 23) for 12 wk. The primary outcome is the changes in xerostomia score using a 100-mm visual analog scale throughout the therapy. Participants assessed their dryness and assigned corresponding scores, with lower scores indicating more severe dry mouth. Secondary outcomes included remission rate in dry mouth frequency, changes in stimulated/unstimulated salivary flow rate (SSFR/USFR), and changes in Oral Health Impact Profile-14 (OHIP-14) questionnaire scores, where higher scores indicate greater impact on oral quality of life. At week 12, the electrical stimulation group showed greater improvement in xerostomia score compared to the sham group, with a mean between-group difference of 13.8 (95% confidence interval [CI], 10.0-17.6). The therapeutic effect of electrical stimulation was also confirmed by secondary outcomes. The remission rate of dry mouth was higher at 12 wk in the electrical stimulation group (61.9% [95% CI, 40.9%-79.3%] vs. 28.6% [95% CI, 13.8%-50.0%]). Participants in the electrical stimulation group also experienced a greater increase in USFR, with a mean difference of 14.5 (6.1-23.0) μL/min. Moreover, they exhibited significant improvement in OHIP-14 score after 12 wk of therapy, with a mean between-group difference of -10.0 (-13.9 to -6.2). No significant difference was observed between the 2 groups for SSFR (P = 0.702). Electric stimulation offers promise as a noninvasive, nonpharmacological strategy for the management of xerostomia. Further research is needed to understand its long-term effectiveness, optimal parameters, and underlying mechanisms. The study confirmed that electrical stimulation of the lingual nerve is a promising noninvasive and nonpharmacological modality for relief of xerostomia.

Trigger Warning: How Modern Diet, Lifestyle, and Environment Pull the Trigger on Autosomal Dominant Polycystic Kidney Disease Progression

Understanding chronic kidney disease (CKD) through the lens of evolutionary biology highlights the mismatch between our Paleolithic-optimized genes and modern diets, which led to the dramatically increased prevalence of CKD in modern societies. In particular, the Standard American Diet (SAD), high in carbohydrates and ultra-processed foods, causes conditions like type 2 diabetes (T2D), chronic inflammation, and hypertension, leading to CKD. Autosomal dominant polycystic kidney disease (ADPKD), a genetic form of CKD, is characterized by progressive renal cystogenesis that leads to renal failure. This review challenges the fatalistic view of ADPKD as solely a genetic disease. We argue that, just like non-genetic CKD, modern dietary practices, lifestyle, and environmental exposures initiate and accelerate ADPKD progression. Evidence shows that carbohydrate overconsumption, hyperglycemia, and insulin resistance significantly impact renal health. Additionally, factors like dehydration, electrolyte imbalances, nephrotoxin exposure, gastrointestinal dysbiosis, and renal microcrystal formation exacerbate ADPKD. Conversely, carbohydrate restriction, ketogenic metabolic therapy (KMT), and antagonizing the lithogenic risk show promise in slowing ADPKD progression. Addressing disease triggers through dietary modifications and lifestyle changes offers a conservative, non-pharmacological strategy for disease modification in ADPKD. This comprehensive review underscores the urgency of integrating diet and lifestyle factors into the clinical management of ADPKD to mitigate disease progression, improve patient outcomes, and offer therapeutic choices that can be implemented worldwide at low or no cost to healthcare payers and patients.

The Role of Online Well-Being Therapy in Overcoming Allostatic Overload in Medical Workers: A Pilot Randomized Controlled Study

Introduction: Stress may lead to allostatic overload. Well-being therapy (WBT) might mitigate it by enhancing psychological well-being and protecting from psychological symptoms. Since no reports are available on the use of WBT in allostatic overload, we evaluated online WBT effects in reducing allostatic overload in medical workers during the coronavirus pandemic. Methods: Sixty-six participants with allostatic overload were enrolled and randomly assigned to eight sessions of online WBT (n = 32) or eight sessions of an online psychoeducation program on healthy lifestyle (CON) (n = 34). The primary outcome was the prevalence rate of allostatic overload in the two groups at session 8 (T2). Secondary analyses were performed on changes in the PsychoSocial Index (PSI) and Psychological Well-Being (PWB) scales scores at the same time points. Generalized estimating equation models were employed. Results: The WBT group showed a significantly lower rate of allostatic overload at T2 than the CON group (28.13% vs. 70.59%, p < 0.001); similar results were found at T1, T3, and T4 (p < 0.001). Compared to CON, WBT produced a significant decrease in psychological distress (p < 0.001) and abnormal illness behavior (p = 0.031), as well as a significant improvement in PWB autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance (p < 0.001). Conclusion: Online WBT may be an effective non-pharmacological therapeutic strategy for individuals with allostatic overload. These findings need to be further validated in different clinical populations.

Acute effect of different types of moderate intensity physical exercise on affective response and mood state in individuals with substance use disorder

Substance use disorder (SUD) affects a significant percentage of people around the world, negatively influencing aspects of physical and mental health. Physical exercise can promote acute and chronic effects on the affective response and mood of individuals and has shown promising effects in all phases of rehabilitation. The objective of this study was to verify the acute effects of two types of physical exercises at moderate intensity on the mood state and on the affective response of individuals hospitalized for the treatment of SUD. For this purpose, 43 individuals (31 men and 12 women) underwent two physical exercise sessions (one aerobic and one functional) and a control session. Before and immediately after the sessions, subjects answered questionnaires about mood, affective valence, and perceived arousal. Generalized estimating equations (GEE) followed by the Bonferroni post hoc test were used to assess the effect of timing and session on the variables. The results showed significant improvements after both physical exercise sessions in mood (reduction in levels of tension, depression, anger, fatigue, and confusion) and in affective valences (feeling of pleasure and arousal perception), with no changes after the control session. It is observed that different types of physical exercises can positively impact the mental health of individuals undergoing treatment for SUD and should be used as a non-pharmacological strategy in the rehabilitation process.

Impact of Lifestyle Interventions on Multiple Sclerosis: Focus on Adipose Tissue.

Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by demyelination in the central nervous system (CNS), affecting individuals globally. The pathological mechanisms underlying MS remain unclear, but current evidence suggests that inflammation and immune dysfunction play a critical role in the pathogenesis of MS disease. Adipose tissue (AT) is a dynamic multifunctional organ involved in various immune diseases, including MS, due to its endocrine function and the secretion of adipokines, which can influence inflammation and immune responses. Physical activity represents an efficacious non-pharmacological strategy for the management of a spectrum of conditions that not only improves inflammatory and immune functions but also directly affects the status and function of AT. Additionally, the exploration of nutritional supplementation represents an important field of MS research aimed at enhancing clinical symptoms and is closely tied to the regulation of metabolic responses, including adipokine secretion. This review, therefore, aims to elucidate the intricate relationship between lifestyle and MS by providing an overview of the latest published data about the involvement of AT and the main adipokines, such as adiponectin, leptin, and tumor necrosis factor α (TNFα) in the pathogenesis of MS. Furthermore, we explore whether physical activity and dietary management could serve as useful strategies to improve the quality of life of MS patients.

Memory Reconsolidation Updating in Substance Addiction: Applications, Mechanisms, and Future Prospects for Clinical Therapeutics.

Persistent and maladaptive drug-related memories represent a key component in drug addiction. Converging evidence from both preclinical and clinical studies has demonstrated the potential efficacy of the memory reconsolidation updating procedure (MRUP), a non-pharmacological strategy intertwining two distinct memory processes: reconsolidation and extinction-alternatively termed "the memory retrieval-extinction procedure". This procedure presents a promising approach to attenuate, if not erase, entrenched drug memories and prevent relapse. The present review delineates the applications, molecular underpinnings, and operational boundaries of MRUP in the context of various forms of substance dependence. Furthermore, we critically examine the methodological limitations of MRUP, postulating potential refinement to optimize its therapeutic efficacy. In addition, we also look at the potential integration of MRUP and neurostimulation treatments in the domain of substance addiction. Overall, existing studies underscore the significant potential of MRUP, suggesting that interventions predicated on it could herald a promising avenue to enhance clinical outcomes in substance addiction therapy.

Undernutrition, cognitive decline and dementia: The collaborative PROMED-COG pooled cohorts study

Background & aimsUndernutrition may negatively impact cognitive function, but evidence of this relationship is not yet consolidated. Under the “PROtein enriched MEDiterranean diet to combat undernutrition and promote healthy neuroCOGnitive ageing” (PROMED-COG) project, we evaluated the association between undernutrition, and cognitive decline and incident dementia in older adults. MethodsRetrospective data harmonization was performed on three Italian population-based studies: the Italian Longitudinal Study of Ageing (ILSA), the Progetto Veneto Anziani (Pro.V.A.), and the Bollate Eye Study-Follow-Up (BEST-FU). The associations between undernutrition, operationalized using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and decline on the Mini-Mental State Examination (MMSE) or dementia incidence follow-up were evaluated with Cox proportional hazard regression models. ResultsThe pooled cohort comprised 9071 individuals (52% females) aged between 42 and 101 years. The prevalence of undernutrition at the baseline was 14.3%, significantly higher among females (15.4% vs 13%) and in older age, ranging from 3.5% in those aged <60 years to 28.8% in those 85+ years. Undernutrition was associated with both cognitive decline over a median 8.3-year follow-up (Hazard Ratio (HR) 1.20, 95% Confidence Interval (CI) 1.02–1.41, p = 0.028) and incidence of dementia over a median 8.6-year follow-up (HR = 1.57, 95%CI 1.01–2.43, p = 0.046). For cognitive decline, the association with undernutrition was more marked in males than females (HR = 1.36, 95%CI 1.05–1.77, p = 0.019 vs HR = 1.10, 95% CI 0.89–1.36, p = 0.375). ConclusionUndernutrition is prevalent among older people and is associated with an increased risk of experiencing cognitive decline and dementia. The prevention and early identification of undernutrition could be an important nonpharmacologic strategy to counteract neurodegeneration.

Knowledge and Experience of In-Home Virtual Reality for Chronic Pain in Sickle Cell Disease

Many adults with sickle cell disease experience chronic, nonvaso-occlusive pain that can benefit from nonpharmacological interventions available for use in the home setting. Virtual reality (VR) has been shown to be effective in decreasing pain in chronic pain conditions and may be useful for home-based self-management of chronic pain in sickle cell. However, the literature lacks studies examining this potential. Additionally, the knowledge and experiences of adults with sickle cell who have tried VR for home-based chronic pain management have not yet been reported. This qualitative, descriptive pilot study explored the knowledge and perceptions of VR among adults with sickle cell and their experience with using in-home VR for chronic pain. Nine participants completed demographic questionnaires and an individual interview that was recorded, transcribed verbatim, and analyzed using thematic analysis. Participants were 21 to 38 years of age, and most were female (88.9%) with a medium or high sickle cell disease severity (88.9%) and a chronic pain-grade classification of grade III (high disability-moderately limiting) or grade IV (high disability-severely limiting) (55.5%). Interview themes, which aligned with the technology acceptance model, were 1) pain beliefs and self-management, 2) VR as another world, and 3) experience of using in-home VR. Based on preliminary data, VR shows promise as a strategy for nonpharmacological management of chronic pain in adults with sickle cell. However, further investigations are warranted to mitigate the challenges and limitations associated with using VR in this capacity. PerspectiveFew evidence-based, nonpharmacological interventions exist for chronic pain in adults with sickle cell disease. This first qualitative, pilot study of in-home VR for chronic pain in adults with sickle cell disease suggests that VR interventions need further exploration as a nonpharmacological strategy for mitigating their pain in the home setting.

The Impact of Exercise on C-reactive Protein Levels in Hypertensive Patients: A Systematic Review.

Hypertension, defined as persistently elevated blood pressure, is a prevalent chronic condition and a significant global health issue, closely linked to cardiovascular complications, with inflammation being one of the underlying mechanisms. In hypertensive patients, C-reactive protein (CRP), an inflammatory marker, is often elevated and associated with increased cardiovascular risk. Alongside pharmacotherapy, exercise is recommended as a non-pharmacological approach to managing hypertension, with evidence suggesting that exercise can also reduce inflammation. This study examines the impact of exercise on CRP levels in hypertensive patients. Fourteen studies focusing on exercise interventions and physical fitness related to CRP in individuals with high blood pressure were identified through an extensive search of PubMed, PubMed Central, ScienceDirect, Cochrane Library, and Google Scholar. The findings indicated that most studies involving aerobic exercise consistently demonstrated reductions in CRP levels among hypertensive patients, with significant effects observed under supervised conditions, and additional benefits seen when combined with dietary control. Resistance training showed mixed results, with significant reductions in CRP observed primarily in longer-term interventions. Combined exercise training, incorporating both aerobic and resistance elements, effectively reduced CRP levels and improved cardiovascular health markers. Physical fitness assessments, such as a bicycle exercise test to exhaustion, revealed a relationship between physical fitness and decreased CRP levels. Therefore, regular, consistent aerobic and combined training, as well as prolonged resistance exercise, significantly reduce CRP levels in hypertensive patients, highlighting exercise's role as a non-pharmacological strategy for managing hypertension through the reduction of inflammation. Further research is essential to validate these findings and investigate the underlying mechanisms and differential effects of various exercise modalities.