Medical sciences (Basel, Switzerland)最新文献

{"title":"Comprehensive Management of Foot and Ankle Conditions and Their Biopsychosocial Impact on Patients Diagnosed with Rheumatoid Arthritis.","authors":"Mercedes Ortiz-Romero, Luis M Gordillo-Fernández, José Pablo de León-Linares, César O García-García","doi":"10.3390/medsci14050526","DOIUrl":"10.3390/medsci14050526","url":null,"abstract":"<p><strong>Background/objectives: </strong>Rheumatoid arthritis (RA) affects a high percentage of people. This condition can lead to foot and ankle deformities frequently accompanied by severe pain and limitations in daily activities; together, these aspects reduce the quality of life.</p><p><strong>Methods: </strong>We carried out a systematic search of databases such as PubMed, Cochrane, and Scopus. We compared the outcomes of treatments with conventional disease-modifying antirheumatic drugs (DMARDs), anti-TNF biologic drugs, custom foot orthoses, and combined therapies over a six-month period. This systematic review and meta-analysis synthesized evidence from 21 included studies evaluating pharmacological, orthotic, and physical therapy interventions in adult RA patients with foot and ankle involvement.</p><p><strong>Results: </strong>Across pooled estimates, multidisciplinary interventions combining pharmacotherapy, custom foot orthoses, and structured physical therapy demonstrated substantial reductions in pain (VAS score mean reduction of: -5.0 points in VAS score) and kinesiophobia, alongside gains in health-related quality of life (EQ-5D increase of: +0.30 points). High statistical heterogeneity was observed across study designs (I^2 > 50%).</p><p><strong>Conclusions: </strong>Early assessment of foot pathologies and multidisciplinary collaboration are recommended, while future long-term randomized controlled trials are needed to confirm component-specific efficacy. Recommendations include early assessment of foot pathologies, collaboration among multidisciplinary teams, and future studies including 12-month follow-ups using specific assessment tools such as the MFPDI.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reported Slowing in Walking and Everyday Activities and Long-Term Mortality in Older Adults: The NEDICES Population-Based Cohort Study.","authors":"Julián Benito-León, Carla María Benito-Rodríguez, Álex Escolà-Gascón, Félix Bermejo-Pareja","doi":"10.3390/medsci14050524","DOIUrl":"10.3390/medsci14050524","url":null,"abstract":"<p><p><b>Background:</b> Objective gait speed, self-rated walking pace, and self-reported walking difficulty are consistently associated with mortality. Far less is known about the prognostic meaning of perceiving, or being told, that one has recently become slower in both walking and everyday activities. We examined whether reported slowing was associated with long-term all-cause mortality in older adults. <b>Methods:</b> The Neurological Disorders in Central Spain (NEDICES) study is a prospective population-based cohort of 5278 adults aged 65 years or older. At baseline (1994-1995), participants were asked whether they noticed, or had been told, that lately they walked or did things more slowly; the item was available for 3994 participants. Vital status was ascertained through 31 December 2017 by linkage to the Spanish National Population Register. Kaplan-Meier methods and Cox regression were used. The primary model included the Carey-based comorbidity score and adjusted for demographic, movement-disorder, musculoskeletal, and lifestyle covariates. <b>Results:</b> Reported slowing was present in 1516 participants (38.0%); 3426 deaths occurred. In the primary complete-case model (<i>n</i> = 3858; 3311 deaths), reported slowing was associated with mortality after multivariable adjustment (hazard ratio 1.10, 95% confidence interval 1.02-1.18; <i>p</i> = 0.012). The item changed Harrell's C-index from 0.7046 to 0.7048. The estimate was attenuated after excluding deaths within five years (1.08, 0.99-1.17; <i>p</i> = 0.087) and after exploratory adjustment for the Pfeffer Functional Activities Questionnaire score (1.08, 1.00-1.16; <i>p</i> = 0.055). <b>Conclusions:</b> Reported slowing in walking and everyday activities was associated with a modest increase in mortality after multivariable adjustment. It may serve as a simple indicator of slightly higher mortality risk, although its incremental contribution to individual-level prognostication was limited.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Ramadan Fasting on Intradialytic Hypoglycemia and Clinical Outcomes in Patients with Diabetes on Maintenance Hemodialysis: A Multicenter Prospective Cohort Study in Southern Thailand.","authors":"Ashari Saman, Jayanton Patumanond, Moragot Chatatikun, Atthaphong Phongphithakchai","doi":"10.3390/medsci14050522","DOIUrl":"10.3390/medsci14050522","url":null,"abstract":"<p><strong>Background: </strong>Patients with end-stage kidney disease (ESKD) and diabetes undergoing maintenance hemodialysis (HD) may be at increased risk of metabolic disturbances and intradialytic complications during Ramadan fasting. However, evidence regarding the safety of fasting in this population remains limited. This study evaluated the association between Ramadan fasting and intradialytic hypoglycemia and other clinical outcomes.</p><p><strong>Methods: </strong>This multicenter prospective cohort study included 153 patients with ESKD and diabetes undergoing maintenance HD at four centers in Thailand during the pre-Ramadan and Ramadan periods in 2024. Participants were categorized as non-fasting, partial fasting, or full fasting. All underwent HD using glucose-containing dialysate (100 mg/dL) and received standardized pre-Ramadan medication adjustments, including insulin dose reduction and oral glucose-lowering medication modification. The primary outcome was intradialytic hypoglycemia, defined as a blood glucose level <70 mg/dL. Secondary outcomes included HD-related complications, blood pressure, interdialytic weight gain (IDWG), dialysis adequacy, and laboratory parameters.</p><p><strong>Results: </strong>Among 153 participants, 73 were non-fasting, 44 were partial fasting, and 36 were full fasting. No intradialytic hypoglycemia occurred in the full- or non-fasting groups, whereas one episode (0.2%) occurred in the partial-fasting group. HD-related complications, blood pressure, IDWG, and dialysis adequacy (Kt/V) were comparable across groups. Serum potassium and parathyroid hormone levels increased during Ramadan in the full- and non-fasting groups without reported clinical events. Overall, participants remained clinically stable under the standardized protocol.</p><p><strong>Conclusions: </strong>In this cohort, Ramadan fasting was not associated with an observed increase in major intradialytic hypoglycemic events and hemodialysis-related complications, indicating that the practice is clinically feasible and well-tolerated under strictly supervised protocols. Therefore, fasting may be considered for carefully selected patients with ESKD and diabetes receiving maintenance hemodialysis, provided it is accompanied by individualized medication adjustments, meticulous monitoring, and shared decision-making.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-Care Assessment of Kidney Function in Chronic Kidney Disease: Current Technologies and Future Perspectives.","authors":"Atthaphong Phongphithakchai, Kraiyasak Wongna, Ratana Netphakdee, Wiyada Kwanhian Klangbud, Jongkonnee Thanasai, Fumitaka Kawakami, Moragot Chatatikun","doi":"10.3390/medsci14050521","DOIUrl":"10.3390/medsci14050521","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) requires assessment of both glomerular filtration and kidney damage, particularly albuminuria, for diagnosis, risk stratification, and longitudinal care. Point-of-care testing (POCT) can shorten turnaround time and improve access when conventional laboratory testing is unavailable or would delay a clinical pathway. This narrative review summarizes established and emerging POCT approaches for kidney assessment in CKD, with emphasis on creatinine/eGFR and urine albumin-to-creatinine ratio (UACR), and distinguishes analytical validity from workflow utility and patient-level clinical utility. Evidence is strongest for rapid creatinine measurement in selected workflows, especially pre-imaging assessment and decentralized screening, while quantitative/semiquantitative UACR POCT can support CKD detection when abnormal results are appropriately confirmed. Cystatin C microfluidic systems remain investigational, and kidney injury/stress or molecular biomarkers such as NGAL, KIM-1, L-FABP, [TIMP-2]·[IGFBP7], extracellular vesicles, and microRNAs should be regarded primarily as a research horizon rather than direct measures of GFR. Important implementation requirements include assay-specific validation, calibration traceability, quality assurance, recognition of biological and analytical interference, and confirmation of results near major clinical decision thresholds. Evidence that POCT improves long-term CKD outcomes, safety, adherence, or cost-effectiveness remains limited. Future studies should prioritize prospective clinical utility, implementation, cost-effectiveness, home-use validation, and patient-centered outcomes.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Remission Trajectories Beyond 12 Months in Severe Asthma Patients Continuing a Single Biologic: A Real-World Single SANI Center Cohort.","authors":"Simone Negrini, Stefania Nicola, Francesco Sardanapoli, Rocco Francesco Rinaldo, Marco Russo, Iuliana Badiu, Anna Quinternetto, Luca Lo Sardo, Francesco Blasi, Pierluigi Paggiaro, Enrico Heffler, Giovanni Rolla, Caterina Bucca, Giorgio Walter Canonica, Fulvia Ribolla, Paolo Solidoro, Luisa Brussino","doi":"10.3390/medsci14050523","DOIUrl":"10.3390/medsci14050523","url":null,"abstract":"<p><strong>Background: </strong>Clinical remission is an emerging therapeutic goal in severe asthma treated with biologics. However, remission may evolve beyond the conventional 12-month assessment, and limited real-world data are available on patients who continue the same biologic after incomplete remission at 12 months. We evaluated longitudinal remission trajectories in patients with severe T2-high asthma continuing the same biologic therapy.</p><p><strong>Methods: </strong>This retrospective real-world single-center SANI cohort included adults with severe asthma treated with one biologic agent and followed for at least 18 months. Clinical outcomes and remission status were assessed at 12 and 18 months according to the SANI definition, distinguishing complete remission, partial remission, and no remission.</p><p><strong>Results: </strong>The cohort included 146 patients; 64.4% were female, median age was 61 years, and all had a T2-high phenotype. Maintenance oral corticosteroid use decreased from 83.6% at baseline to 6.8% at 18 months, while symptomatic patients decreased from 100.0% to 11.0%. Median ACT improved from 12.0 to 22.0, and patients with ≥1 exacerbation decreased to 4.1% at 18 months. Complete remission increased from 36.3% at 12 months to 67.1% at 18 months, while no remission decreased from 54.1% to 16.4%. Among patients not in remission at 12 months, 43.0% achieved complete remission and 26.6% achieved partial remission at 18 months. Baseline oral corticosteroid use was associated with lower remission likelihood, whereas preserved baseline FEV₁ favored remission at 18 months.</p><p><strong>Conclusions: </strong>Among patients with severe T2-high asthma selected for continuing an unchanged biologic for at least 18 months, remission status was more favorable at 18 months than at 12 months. This observation describes the trajectory of biologic continuers and should not be generalized to all patients who remain outside remission at 12 months. Because patients who discontinued or switched biologics were excluded, these data do not establish that continuation is preferable to switching after an incomplete 12-month response.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic Risk Factors and Domain-Specific Cognitive Function in Prediabetes and Type 2 Diabetes.","authors":"Rohit Hariharan, Simon M Bell, Arshad Majid, Jack Feehan, Barbora de Courten, Aya Mousa","doi":"10.3390/medsci14050520","DOIUrl":"10.3390/medsci14050520","url":null,"abstract":"<p><p><b>Background</b>: Cardiometabolic risk factors are increasingly recognised as contributors to cognitive decline, yet their associations with domain-specific cognitive performance in adults with prediabetes or well-controlled type 2 diabetes (T2DM) remain poorly characterised. <b>Methods</b>: This cross-sectional study included 49 adults with prediabetes or well-controlled T2DM (managed by diet or metformin alone; HbA1c < 8%). Cognitive function was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), Trail Making Tests (TMTs) parts A and B, Stroop, and Digit Symbol Substitution Test (DSST). Multivariable linear regression examined associations between cardiometabolic predictors (adiposity [DXA], glycaemic indices [OGTT], and serum lipids) and cognitive outcomes, adjusting for age, BMI, and education. <b>Results</b>: Higher HbA1c was independently associated with increased false alarms on the rapid visual processing task (RVPPFA; β = 0.04 [95% CI 0.01, 0.07]; <i>p</i> = 0.015); fasting and 2 h glucose were not associated with any cognitive measure. Higher triglycerides were associated with lower sustained attention accuracy (RVPA; β = -0.02 [95% CI -0.04, -0.004]; <i>p</i> = 0.016) and lower DSST scores (β = -4.61 [95% CI -8.81, -0.40]; <i>p</i> = 0.033). Higher HDL cholesterol was independently associated with better sustained attention (RVPA; β = 0.08 [95% CI 0.02, 0.15]; <i>p</i> = 0.017). No consistent associations were found between adiposity measures and any cognitive outcome, with no effect modification by sex or diabetes status (all P<i>_interaction</i> > 0.05). <b>Conclusions</b>: In cognitively healthy adults with prediabetes or well-controlled T2DM, higher HbA1c and triglycerides and lower HDL were associated with poorer domain-specific cognitive performance in the absence of overt cognitive impairment. Larger longitudinal studies are needed to establish whether these associations represent early cognitive changes and to determine whether reducing cardiometabolic risk can preserve cognitive function.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Vitamin D Intake, <i>VDR</i> Levels, and Relevant Gene Polymorphisms in Early-Stage Thai Colorectal Cancer Patients Following Vitamin D₃ Supplementation.","authors":"Natthaporn Kuendee, Aunchana Rodrungnok, Kamphon Intharanut, Alisa Naladta, Oytip Nathalang, Sakda Daduang, Sophida Sukprasert","doi":"10.3390/medsci14050518","DOIUrl":"10.3390/medsci14050518","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have reported associations between vitamin D receptor (<i>VDR</i>) gene polymorphisms and colorectal cancer (CRC). However, the findings thus far are inconsistent. This study aims to clarify the association of vitamin D intake, <i>VDR</i> levels, and relevant polymorphisms in early stages of CRC in Thai patients following vitamin D₃ supplementation.</p><p><strong>Methods: </strong>Total RNA and genomic DNA were isolated from the buffy coats of CRC patients (<i>n</i> = 27). The levels of <i>VDR</i>, <i>RXR</i>, <i>CYP27B1</i>, and <i>CYP24A1</i> were measured using quantitative real-time PCR. Associations of nine single-nucleotide polymorphisms (SNPs) of <i>VDR</i>, <i>CYP27B1</i>, <i>CYP24A1</i> and serum vitamin D levels were investigated.</p><p><strong>Results: </strong>The expression levels of <i>VDR</i>, <i>RXR</i> and <i>CYP27B1</i> were significantly elevated in the vitamin D₃-treated group. However, no significant associations were observed between vitamin D intake and the specific <i>VDR</i> SNPs, including FokI, BsmI, ApaI, TaqI, and Tru9I. Furthermore, none of the SNPs or haplotypes within the <i>VDR</i>, <i>CYP27B1</i> (rs10877012), or <i>CYP24A1</i> (rs6013897, rs158552, rs17217119) were linked to colorectal cancer susceptibility.</p><p><strong>Conclusions: </strong>This finding demonstrated that vitamin D intake enhances the expression of <i>VDR</i> and related genes in early-stage CRC patients; these effects are independent of <i>VDR</i>, <i>CYP27B1</i>, and <i>CYP24A1</i> genetic polymorphisms. This suggests that gene expression changes may be driven more by vitamin D status than by underlying genetic variation.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Pain: A Pilot Study of Neurodegenerative and Mitochondrial Pathway Alterations in Sickle Cell Disease Using Platelet Proteomics.","authors":"Keesha Powell-Roach, Ugochi O Ogu, Erielle Culp, Kalpna Gupta, Eboni I Lance, Xueyuan Cao, M Dennis Leo, Daniel Johnson, David Kakhniashvili, Yenisel Cruz-Almeida, Margaret R Wallace, Diana J Wilkie, Steven R Goodman","doi":"10.3390/medsci14050517","DOIUrl":"10.3390/medsci14050517","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) is a systemic disorder marked by chronic pain and neurocognitive deficits, yet the molecular drivers of these neurocognitive features remain poorly defined. Platelets, central to inflammation and vascular homeostasis, may reflect broad pathophysiologic processes in SCD.</p><p><strong>Methods: </strong>We performed high-resolution mass spectrometry on ultra-purified platelets from 16 adults with SCD and moderate to severe pain (self-reported ≥ 3/10 in the past year), identifying 4196 proteins, of which 1046 were significant (FDR < 0.05). Unsupervised clustering was used to stratify individuals into high- and low-pain phenotypes.</p><p><strong>Results: </strong>Contrary to expectations, canonical pain pathways were not enriched. Instead, significant alterations were observed in neurodegeneration, mitochondrial metabolism, ATP regulation, mitophagy, and tRNA aminoacylation pathways between high- and low-pain phenotypes. High-pain individuals exhibited elevated levels of proteins involved in proteostasis and neurodegenerative disease processes, whereas low-pain individuals showed increased expression of proteins linked to mitochondrial integrity, neuroprotection, and reduced oxidative stress. Protein-protein interaction networks revealed tightly connected clusters within neurodegenerative and central nervous system-related pathways. Disease association analysis ranked neurodegenerative and mitochondrial pathways above traditional hematologic and nociceptive mechanisms.</p><p><strong>Conclusions: </strong>These findings suggest that platelet proteomics may serve as a peripheral window into PNS or CNS vulnerability and cognitive risk in SCD. The enrichment of tRNA aminoacylation and mitochondrial regulation pathways underscores the metabolic complexity of SCD and highlights novel targets for biomarker development and therapeutic intervention.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracellular Vesicles at the Interface of Cancer Therapy and Regenerative Medicine: Biology, Bidirectional Roles, and Engineered Therapeutics.","authors":"Jun-Hyeog Jang","doi":"10.3390/medsci14050519","DOIUrl":"10.3390/medsci14050519","url":null,"abstract":"<p><p>Extracellular vesicles (EVs), including exosomes and microvesicles, are nanoscale membrane-enclosed particles that transfer proteins, lipids, mRNAs, and microRNAs between cells. The same communication system is now being developed in two apparently opposing settings: mesenchymal stem/stromal cell (MSC)-derived EVs are explored as cell-free regenerative therapeutics, whereas tumor-derived EVs can promote metastasis, immune evasion, and treatment resistance while also serving as liquid-biopsy biomarkers. Rather than treating these studies separately, this review compares them along shared mechanistic axes: producer-cell identity and state, luminal cargo, membrane and surface composition (including the biomolecular corona), dose and administration route, biodistribution, and recipient-cell context. This cross-field perspective shows that angiogenesis, immunomodulation, matrix remodeling, and tissue tropism are not intrinsically regenerative or oncogenic; their consequences depend on where, how, and to which cells EV signals are delivered. We review EV biology and MISEV2023-aligned nomenclature, examine bidirectional regenerative and cancer-associated functions, and survey engineering strategies for cargo loading and surface modification together with plant-derived exosome-like nanovesicles. We further compare EVs with lipid nanoparticles, adeno-associated viruses, polymers, and virus-like particles, and discuss how engineering can improve potency and targeting while increasing manufacturing and characterization complexity. Finally, we address tumor-related safety considerations for regenerative EVs and the unresolved biological, technical, manufacturing, and regulatory questions that must be addressed for clinical translation.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Transfusion in End-of-Life Cancer Care: Clinical Evidence, Patient Blood Management and Goal-Concordant Practice.","authors":"Saikat Mandal, Manideepa Maji, Ashish Sharma, Arkadeep Dhali","doi":"10.3390/medsci14050512","DOIUrl":"10.3390/medsci14050512","url":null,"abstract":"<p><p>Blood transfusion near the end of life for patients with cancer may relieve symptoms attributed to anaemia or control bleeding, but its palliative value depends on whether benefit occurs within the patient's expected survival and outweighs the clinical and practical burden of treatment. This structured narrative review examines evidence concerning red-cell and platelet transfusion, transfusion-sparing patient blood management, hospice access and alternative delivery models in adults receiving palliative or end-of-life care. Structured searches of MEDLINE, Embase, Scopus and the Cochrane Library identified original studies, audits, qualitative research and relevant evidence syntheses. The evidence was predominantly observational and methodologically heterogeneous. Reported symptomatic response rates after red-cell transfusion ranged from 31% to 70%, most commonly involving short-term improvement in fatigue, dyspnoea or general well-being. Benefit often diminished within 14 days, while 23-35% of participants in historical cohorts died within two weeks, limiting the opportunity to experience benefit. Response was not reliably predicted by haemoglobin concentration. Red-cell transfusions were frequently guided by laboratory values, administered late in the disease course and not followed by systematic reassessment. Evidence concerning platelet transfusion remains largely descriptive and does not establish a prophylactic threshold for end-of-life care. Intravenous iron and haemostatic radiotherapy may reduce transfusion requirements in selected patients, although their applicability depends on clinical stability, the source of bleeding and sufficient time to benefit. In haematological malignancies, transfusion dependence has been associated with lower hospice enrolment and shorter hospice stays, whereas home- and hospice-based transfusion may reduce travel and waiting burdens for appropriately selected patients. Transfusion near the end of life should therefore be considered a goal-concordant, time-limited trial. A patient-valued outcome should be defined beforehand, the fewest units likely to achieve that outcome should be administered, and benefit should be reassessed using the same measure. Further transfusion should be offered only when documented symptomatic or functional benefit outweighs adverse effects and treatment burden for the individual patient.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}