Emerging biomarkers for early detection of colorectal cancer.

Atomic layering thermostable antigen and adjuvant (ALTA®) provides unique, controlled antigen release to improve immune response to vaccination.

This study investigated the role of psychological variables (anxiety, depression, beliefs about medication, satisfaction and frustration of basic psychological needs, and mindfulness skills) on adherence in patients with inflammatory arthritis (IA). 250 patients with IA completed an online questionnaire at baseline (T0) and three months later (T1). Their adherence was assessed at T1 with the General Adherence for Chronic Disease Profile (GACID-P) exploring patients' daily life and medical domains of adherence. Measures carried out at T0 included sociodemographic variables, anxiety and depression, beliefs about medicines, basic psychological needs satisfaction and frustration, and mindfulness skills. Following descriptive analyses and correlations between variables, multiple linear regressions were performed to identify adherence predictors. All significant correlations between psychological variables and the two adherence domains were as expected. Three mindfulness skills (observing, acting with awareness and nonreacting) were found as predictors of both domains. Beliefs about treatment (necessity and overuse) predicted medical adherence, whereas the frustration of the relatedness need with relatives predicted daily life adherence. Mindfulness skills and treatment beliefs are critical psychological factors for improving general adherence in patients with IA. Acceptance and Commitment Therapy (ACT) is proposed as an appropriate integrative approach for improving adherence.

Protocol for the sequential multiple assignment randomized trial to reduce food insecurity and improve adherence in patients with hypertension (SMART-FI).

Wearable Devices and Artificial Intelligence to Enhance Perioperative Care in Total Knee Arthroplasty.

Effectiveness and safety of rivaroxaban following peripheral arterial endovascular revascularization in real-world practice.

Chronic prurigo (CPG) is a chronic neuroinflammatory skin disease characterized by persistent itch, repeated scratching, and the presence of multiple skin lesions. CPG is a highly burdensome disease that significantly impairs patients' quality of life. The objective of these consensus recommendations is to summarize available evidence and provide standardized guidance for the diagnosis and management of patients with CPG. These recommendations were developed using a Delphi methodology, conducted over two rounds of online voting by the participation of 23 Portuguese dermatologists. The strength of consensus was defined as strong consensus (≥ 95% agreement), consensus (≥ 75%), and majority agreement (≥ 50%). The diagnosis of CPG requires the concomitant presence of a ≥ 6-week history of pruritus; a history of repeated excoriation; and multiple skin lesions (including nodules, papules, umbilicated lesions, and linear lesions, among others). Diagnosis should be based on patient history and physical examination, and complemented by laboratory tests and additional investigations if needed. Treatment should follow a personalized protocol, according to disease severity and guided by both clinician- and patient-reported outcomes. Systemic therapeutic options for eligible patients include CPG-approved biological agents (dupilumab and nemolizumab), gabapentinoids, and antidepressants. Additional treatment options may be considered, including interleukin (IL)-13 inhibitors, Janus kinases (JAK) inhibitors, opioid receptor modulators, methotrexate, and cyclosporine. Treatment efficacy should be regularly assessed to ensure clinical improvement and patient adherence. This study provides guidance on the diagnosis and treatment of CPG supporting diagnosis and treatment decision-making.

Resistance to thyroid hormone alpha (RTHα) is a rare genetic disorder with symptoms of hypothyroidism, but normal or close-to-normal thyroid function tests. Treatment with levothyroxine (L-T4) may be beneficial. This study investigated the efficacy, safety and biochemical changes of high-dose L-T4 and liothyronine (L-T3) treatment. Four RTHα (Ala263Val) patients were treated with L-T4 (1.75 µg/kg) in a pilot open-label study and monitored for three years. Quality of life (QoL) was assessed using ThyPro. Analysis of auxiological- and biochemical-parameters, bone mineral density (BMD) and exploratory metabolomics was performed. A partial replacement of L-T4 with L-T3 was attempted. Treatment with L-T4 increased FT4, FT3, and rT3 to supraphysiological concentrations (relative to reference intervals) and suppressed thyroid-stimulating hormone with no adverse effects. Heart rate, bone markers, and sex hormone-binding globulin transiently increased. Several classes of lipids were reduced. BMD appeared unaltered. Patients reported improved QoL. One patient presented a short non-sustained ventricular tachycardia on L-T3 + L-T4. L-T4 treatment of adult RTHα patients was safe and improved QoL in adherent patients.

BackgroundLow-glycaemic diet may alleviate migraine; however, individual blood glucose variability can affect efficacy. In this open-label randomised controlled trial in Germany, we assessed whether the digital therapeutic (DTx) sinCephalea, which delivers personalised low-glycaemic nutritional recommendations supported by intermittent continuous glucose monitoring (CGM), reduces migraine frequency compared with a design-matched control application.MethodsThis open-label trial in Germany assessed the DTx sinCephalea for migraine prevention. Adults aged 18-65 years with episodic migraine were randomised 1:1 (in addition to standard treatment) to the digital therapeutic (intervention) or a design-matched control application. Patients completed a daily headache and medication diary, and 4-weekly patient-reported outcome questionnaires. Adherence to nutritional recommendations was monitored. Primary endpoint (Week 12): change from baseline in monthly migraine days (every 4 weeks) for intervention versus control. Secondary endpoints: change from baseline in monthly migraine days in patients with ≥50% adherence to nutritional recommendations, 30% response rates, migraine- and headache-related impairment, quality-of-life, and acute medication use for intervention versus control. Adverse events were recorded.Results842 patients were randomised between July 2021 and August 2023 (full analysis set: intervention = 416; control = 419). There were significantly greater reductions in monthly migraine days at week 12 for intervention versus control (mean [SD] change: 1.7 [3.4] versus 1.2 [3.2] days; between-group difference estimate: -0.53 [95% CI -0.98 to -0.09]; p = 0.0195) with similar monthly migraine days reductions observed in adherent patients (p = 0.0062; adjusted α = 0.05). Response rate was 54.9% (185/337) in intervention versus 42.9% (168/392) in control (odds ratio: 1.63 [95% CI 1.21-2.19]; p = 0.0012; adjusted α = 0.0125). Migraine- and headache-related impairment were lower at week 12 for intervention versus control (p = 0.0247, adjusted α = 0.0167and p = 0.0001, adjusted α = 0.01, respectively). There was no significant difference in quality-of-life or acute medication use and no digital therapeutic-related adverse events.ConclusionPersonalised nutrition, supported by intermittent CGM, via the DTx sinCephalea, was efficacious for migraine prevention without DTx-related adverse events. This study provides evidence in support of the link between diet and migraine frequency and symptoms. Additionally, as this is a non-pharmacological treatment with no DTx-related side effects, it may be an attractive option for patients. DTx could also reduce the burden of migraine on healthcare systems by providing a scalable, remote, non-invasive and convenient treatment option.

Assessment of a standard dietitian evaluation in pediatric patients with celiac disease.

Defining diagnostic disclosure in the acute care setting: A concept analysis.

Decoding why patients follow-or do not follow-fall-prevention instructions using the revised protection motivation theory: A cross-sectional study employing partial least squares structural equation modelling.

Effective communication in metabolic bariatric surgery (MBS) is essential for patient engagement and adherence, yet surgical residents often lack structured training. Artificial intelligence offers a novel approach to scaffold communication skills. To evaluate the impact of an AI-Guided metacognitive framework VALUE (Validate, Align & Reframe, Link & Educate, Unite in a plan) on shared decision-making (SDM) and communication outcomes in MBS consultations compared to self-directed learning. Forty surgical residents were randomized into two groups: AI-Guided (using the VALUE framework) and self-learning. The AI-Guided group used a structured prompt to interact with a large language model (DeepSeek-V3.2) to generate personalized consultation plans. Each conducted simulated consultations with standardized patients from a case library. Outcomes were measured using the Shared Decision-Making Questionnaire-9 (SDM-Q-9), Decision Conflict Scale (DCS), Four Habits Coding Scheme (4HCS), Surgeon Self-Efficacy scale (SSI-BS), Communication Outline Quality Scale (CQS), and AI Interaction Quality (AIIQ). The trial was registered on the Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/BAQH6 ). The AI-Guided group scored significantly higher on SDM-Q-9 (84.7 vs. 71.3, p < 0.01) and 4HCS (17.5 vs. 14.8, p < 0.01), and lower on DCS (19.5 vs. 32.1, p < 0.01). Communication outlines were also of higher quality (13.8 vs. 7.5, p < 0.01). Residents reported greater self-efficacy gains in information provision, values integration, decision facilitation, and emotional support. All secondary analyses remained significant after Benjamini-Hochberg correction for multiple comparisons. An AI-Guided metacognitive communication framework significantly improves shared decision-making, reduces decisional conflict, and enhances communication quality and self-efficacy in MBS consultations, suggesting a promising approach that requires further validation in larger, multi-site trials.

Best evidence summary for exercise adherence management in outpatient rehabilitation following coronary artery bypass graft surgery.

Artificial intelligence and machine learning in smart vaginal formulation development.

Glaucoma is a progressive, irreversible optic neuropathy that leads to the loss of retinal ganglion cells, vision loss, and blindness. Elevated intraocular pressure (IOP) is the only modifiable risk factor, and topical hypotensive eye drops remain the mainstay of treatment, reducing disease progression by up to 60%. However, patient adherence to therapy remains a significant challenge since this disease is usually asymptomatic in its early stages. Patient preferences and individual characteristics play a key role in adherence. This study aimed to obtain further knowledge about patient preferences regarding glaucoma treatment to better understand factors influencing adherence. A cross-sectional, multicenter survey was conducted in Spain between March and December 2024 among patients with glaucoma receiving topical treatment for more than 6 months. A questionnaire was designed to collect patients' information about their beliefs, preferences, and adherence-related factors. Of 200 participants, 169 valid responses were analyzed. Most patients were aged 51-74years, 60.2% were women, and 71.2% had been on treatment for more than 12months. Although 93.5% recognized the importance of preservatives, only 36.0% reported having received information about them from their ophthalmologist. Preferences between multidose bottles (MDBs, 42.2%) and single-dose units (SDUs, 37.0%) were similar, although younger women (18-30years) showed a preference for SDUs (p < 0.05). Perceived ease of handling was strongly influenced by prior experience. Most patients considered SDUs as more hygienic, whereas MDBs were perceived as more environmentally friendly; nearly 79% valued ecological impact. Self-reported adherence to therapy was moderate, with 57.6% of participants denying missed doses. Nonadherent patients were more likely to favor reminder systems (74.5%, p = 0.029). Treatment efficacy was ranked as the most important factor, followed by side effects, ease of use, cost, and environmental impact. This study highlights substantial variability in patient preferences and underscores the importance of personalized, patient-centered glaucoma care. Enhanced education on preservatives, improved communication, and sustainable packaging could improve adherence and satisfaction. Larger multicenter studies are needed to confirm these findings and inform long-term adherence strategies.

Metabolic and bariatric surgery (MBS) provides durable weight loss and metabolic improvement but can also predispose patients to micronutrient deficiencies due to altered gastrointestinal anatomy. Lifelong nutrient supplementation is therefore essential; however, adherence typically declines over time. While chewable formulations are often recommended early postoperatively for presumed tolerability, real-world evidence comparing patient adherence, satisfaction, and preferences between chewable and swallowable supplements remains limited particularly in resource-constrained settings such as India, where cost, availability, and taste heavily influence long-term compliance. To compare adherence, tolerability, and satisfaction between chewable and swallowable supplements in an Indian patient cohort, and to explore factors influencing formulation choice, discontinuation, and perceived health impact. A cross-sectional survey was conducted among 110 adults at least one month post metabolic and bariatric surgery (Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG)) attending a tertiary center in Mumbai. A structured, self-administered questionnaire assessed supplement type, adherence patterns, swallowing difficulty, satisfaction (5-point Likert scale), and preference drivers (e.g., taste, cost, convenience). Associations between supplement formulation and adherence outcomes were analyzed. Participants were predominantly female (74%) with mean age 43 years; 60% had undergone RYGB. Swallowable formulations were most commonly preferred (70%). Overall, 41% had discontinued supplements after surgery, primarily due to forgetfulness (35%), cost or safety concerns (22%), and swallowing difficulty (14%). Swallowable users reported higher satisfaction (68% vs. 30%) and significantly greater current use compared with chewable/both users (93.5% vs. 75.8%, p = 0.021). Preference was mainly driven by ease of swallowing (35%), taste/mouthfeel (34%), and physician advice (23%). A majority of participants (72%) believed that supplement formulation could influence long-term health outcomes. Common improvement suggestions included fewer pills, better taste, easier swallowing, and affordability. These findings suggest that swallowable formulations may be acceptable in routine practice and highlight the importance of incorporating patient preference in long-term supplementation strategies. Despite widespread swallowing concerns, swallowable formulations were associated with higher patient satisfaction and better sustained adherence. While this study has many limitations, it provides a snapshot of patient preferences in an area that is relatively unexplored. In the Indian context, with limited specialized products and cost sensitivity, these findings highlight the need for patient centred supplement strategies emphasizing palatability, convenience, and accessibility.

Scabies, caused by Sarcoptes scabiei var. hominis, remains a significant public health problem in Syria, where socioeconomic hardship and overcrowding contribute to persistent transmission. This study examines current treatment practices among Syrian dermatologists and evaluates the extent to which these practices align with internationally recommended management approaches. A structured online questionnaire was administered to 159 dermatologists across multiple Syrian provinces. The survey captured detailed treatment practices, including the exact permethrin regimen applied, frequency and pattern of applications, alternative or intensive regimens, reasons for deviating from guideline-recommended weekly application, management of household contacts, estimated adherence rates, perceived treatment resistance, and reported adverse effects. Additional items assessed the use of adjunctive therapies and clinician demographics. International guideline adherence was defined as applying 5% permethrin to the whole body for 8-12 h and repeating after 1 week. Responses were analyzed in SPSS using descriptive statistics and appropriate inferential tests. Only 54 physicians (34.0%) of participants reported using the classical weekly permethrin regimen, 87(54.7%) used modified permethrin-based regimens (e.g., three times weekly for 2 weeks),and 18 (11.3%)used sulfur as first line. The most reported reasons for not following the classical protocol included poor patient or household-contact adherence (57.1%) and medication-related concerns such as perceived resistance or reduced drug effectiveness (37.1%). Skin irritation was reported variably, and combination therapy was used by nearly one-third of respondents. Most respondents (N=139, 87.4%) estimated contact adherence to be below 80%. Syrian dermatologists employ a variety of treatment strategies for scabies, largely influenced by patient adherence, perceived drug resistance, and conflict-related limitations. The findings underscore the need to strengthen patient and household education, enhance physician training, and renew adherence to guideline-based management.

Introduction Major Depressive Disorder (MDD) is a prevalent global mental health challenge with a multifactorial etiology, including genetic, environmental, and biochemical influences. Current pharmacological treatments, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), face limitations, including delayed therapeutic onset, systemic side effects, and poor permeability across the blood-brain barrier (BBB). To overcome these challenges, intranasal NE (NE) drug delivery systems have emerged as a promising approach for enhancing drug bioavailability and facilitating direct nose-to-brain transport. Methods A comprehensive review of recent advancements in NE-based drug delivery for MDD was conducted, focusing on formulation strategies, pharmacokinetic improvements, and therapeutic outcomes. Studies evaluating the efficacy of NE formulations for delivering antidepressants, antipsychotics, and natural compounds, such as curcumin and resveratrol, were analyzed. The role of mucoadhesive agents like chitosan in enhancing nasal retention and drug absorption was also explored. Results NE formulations demonstrated superior drug delivery to the CNS, bypassing the BBB and reducing systemic toxicity. Preclinical and clinical studies indicate enhanced therapeutic efficacy, increased drug concentration at target sites, and improved patient compliance. The inclusion of mucoadhesive agents further optimized nasal retention, prolonging drug absorption and enhancing therapeutic effects. Additionally, NEs mitigated hepatic first-pass metabolism, leading to lower dosing requirements and reduced side effects. Discussion Nanoemulsion-based intranasal delivery presents a promising strategy for treating MDD, offering physiological and pharmacological advantages over oral routes. By bypassing the blood-brain barrier, these systems enable rapid and targeted brain delivery, enhancing drug efficacy. The nanoscale size improves solubility and absorption of poorly water-soluble compounds like curcumin and resveratrol. Incorporation of mucoadhesive agents such as chitosan further enhances nasal retention and drug uptake. Despite encouraging preclinical results, challenges remain in translating this approach clinically. Conclusion Intranasal NE-based drug delivery presents a transformative strategy for treating MDD and other CNS disorders. By integrating nanoscale formulation approaches with tailored pharmacokinetics, this system offers improved drug efficacy, safety, and patient adherence. Future research should focus on optimizing formulations, ensuring long-term stability, and advancing clinical translation for broader CNS applications.

Alopecia, or hair loss, is a multifactorial condition that may arise from genetic, hormonal, or autoimmune causes. This review outlines the major types of alopecia and discusses their underlying etiologies, along with the limitations associated with current therapeutic approaches, including poor efficacy, adverse effects, and low patient adherence. In recent years, lipid-based nanoparticles have emerged as promising carriers for improving the delivery of therapeutic agents to the scalp and hair follicles. The present review summarizes different treatment strategies for alopecia while highlighting the potential role of lipid-based nanocarriers in enhancing drug delivery. The review critically summarizes recent advances in the use of these nanocarriers for alopecia management, with focus on their ability to improve skin penetration, follicular targeting, drug stability, and sustained release characteristics. In addition, the advantages and limitations of different lipid-based systems are comparatively discussed, together with current challenges related to formulation stability, large-scale production, safety, and regulatory considerations in dermatological nanomedicine. Overall, this review provides an updated perspective on the therapeutic potential and translational prospects of lipid based nanocarriers as emerging platforms for alopecia treatment, while highlighting the need for further preclinical and clinical validation.