The menopausal transition represents a pivotal period in female aging, marked by profound endocrine, metabolic and cellular shifts. Increasing evidence indicates that menopausal symptoms - vasomotor instability, sleep disturbances, fatigue and cognitive complaints - are more than consequences of estrogen withdrawal, and may serve as a potential clinical indicator of biological aging. Experimental and clinical data suggest that declining estrogen signaling contributes to mitochondrial dysfunction, inflammation and telomere attrition, processes that are closely linked to cellular senescence and tissue deterioration. In addition to estrogen decline, the menopausal transition involves broader endocrine changes. Rising follicle stimulating hormone (FSH) levels, alteration in androgen balance and cortisol dysregulation of the hypothalamic-pituitary-adrenal axis may influence metabolic regulation, musculoskeletal health, stress physiology and body composition. Through these mechanisms, menopausal hormonal changes may contribute to increased cardiometabolic, musculoskeletal and neurocognitive vulnerability in midlife women. Clinical observations increasingly show that severe menopausal symptoms are associated with adverse cardiometabolic profiles, vascular dysfunction and markers of accelerated biological aging. Sleep disturbances and fatigue may further exacerbate metabolic dysregulation and systemic vulnerability, while cognitive complaints may reflect neuroinflammatory and vascular processes associated with aging. By restoring estrogen signaling, menopausal hormone therapy alleviates menopausal symptoms and may influence biological pathways involved in aging. Whether these effects translate into a modification of the aging trajectory remains unclear.

This study examined the impact of competition-related anxiety on psychological and behavioral parameters of Tunisian karate athletes. A total of 176 young Tunisian karate athletes (aged 16-25 years) with at least 1 year of training and competitive experience voluntarily participated in this study. Validated instruments were administered 1 week before and on the day of the competition, including the State-Trait Anxiety Inventory, the Pittsburgh Sleep Quality Index, the Brunel Mood Scale, and the International Physical Activity Questionnaire. Paired Wilcoxon signed-rank tests were used to compare changes over time, and multiple linear regression models were used to identify predictors of state and trait anxiety. Anxiety, mood, sleep, and physical activity changed from 1 week before to competition day (all P < .001). One week before, state anxiety was higher with tension (β = 1.22, P < .001), fatigue (β = 1.49, P < .001), and confusion (β = 1.14, P < .001); trait anxiety was higher with anger (β = 1.15, P < .001), depression (β = 1.38, P < .001), and fatigue (β = 0.42, P = .004), and lower with confusion (β = -0.36, P = .009). State anxiety was positively associated with sleep disturbances (β = 5.94, P < .001); trait anxiety with poorer subjective sleep quality (β = 2.87, P < .001) and longer sleep latency (β = 0.26, P < .001). Vigorous MET-minutes predicted lower state anxiety (β = -0.009, P = .02) and walking predicted lower trait anxiety (β = -0.007, P = .007). State anxiety increased with confusion (β = 1.47, P < .001) and decreased with vigor (β = -0.94, P = .003); trait anxiety increased with depression (β = 1.53, P < .001) and fatigue (β = 1.34, P < .001). Daytime dysfunction predicted higher state anxiety (β = 8.91, P < .001) and sleep latency predicted higher trait anxiety (β = 0.10, P = .031). Moderate MET-minutes predicted higher state anxiety (β = 0.008, P = .02). Increases in state anxiety aligned with higher tension (β = 0.93, P < .001), fatigue (β = 0.61, P = .004), and confusion (β = 1.89, P < .001), and decreases with depression (β = -0.54, P = .02). Increases in trait anxiety were driven by depression (β = 1.67, P < .001) and fatigue (β = 1.06, P < .001). Greater daytime dysfunction predicted increases in state anxiety (β = 9.28, P < .001), whereas longer sleep latency (β = 0.19, P < .001) and shorter sleep duration (β = -3.18, P < .001) predicted increases in trait anxiety; activity changes were not significant. Competition anxiety in young karate athletes is chiefly associated with mood disturbances and sleep parameters; implementing mood-regulation and sleep-focused strategies may reduce anxiety in youth combat sports.

Obesity and mental health disorders are among the greatest public health challenges of the 21st century. Interestingly, an altered microbiome profile has been associated with both conditions. The aim of this randomized, double-blind, placebo-controlled clinical trial was to evaluate the effects of dietary supplementation with a specific probiotic strain (Lactiplantibacillus plantarum KABP051) on body composition and gut microbiome balance, together with measures of mood state, in a population of healthy overweight subjects. Sixty healthy, moderately stressed, nondepressed and overweight or obese volunteers were supplemented for 12 weeks with probiotic (L. plantarum KABP051; 1 billion colony forming units/day) or placebo (microcrystalline cellulose). The KABP051 group experienced significantly greater improvements compared with placebo on body composition measurements, including a reduction in body weight and waist circumference, which decreased in 1.97 ± 0.77 (mean ± SE) kg and 2.15 ± 0.81 (mean ± SE) cm versus placebo at the end of the intervention (both P < .05, mixed model for repeated measures [MMRM] and post-hoc analysis). Microbiome composition improved in KABP051 group, with significant increase in the relative abundance of Lactiplantibacillus spp. versus placebo. Body fat percentage, profile of mood states fatigue, and confusion sub-scores showed a global trend toward improvement compared with placebo, with the change at 12 weeks being significant in the three measurements in post-hoc analysis (P = .015, P = .014, and P = .016, respectively). No serious adverse events were registered during the intervention period. These results suggest that a specific strain of probiotic bacteria (L. plantarum KABP051) may have both metabolic and psychobiotic effects and may be beneficial for enhancing weight loss and body composition, improving energy (less fatigue) and mood levels while embarking on a healthy lifestyle regimen. ClinicalTrials.gov identifier: NCT06808061.

Melatonin, an endogenous indoleamine primarily synthesized in the pineal gland, has emerged as a promising adjunctive agent within integrative oncology due to its pleiotropic biological actions. Beyond its well-known chronobiological functions, melatonin exerts potent redox-regulatory, anti-inflammatory, oncostatic, and immune-modulating effects that are relevant across multiple stages of carcinogenesis and cancer therapy. Oxidative stress (OS), defined as an imbalance between reactive oxygen and nitrogen species (ROS/RNS) generation and antioxidant defenses, plays a central role in DNA damage, protein adduct formation, and lipid peroxidation, ultimately contributing to mutation accumulation, treatment resistance, and tumor progression. Melatonin modulates these OS-related processes through both receptor-dependent and receptor-independent mechanisms, including mitochondrial stabilization, enhancement of antioxidant enzyme activity, inhibition of pro-oxidant pathways, regulation of cell-cycle checkpoints, and promotion of apoptosis in malignant cells while protecting healthy tissues. Preclinical studies demonstrate synergistic interactions between melatonin and chemotherapy, radiotherapy, targeted agents, and immunotherapies, with consistent reductions in treatment toxicity and improvements in tumor control. Emerging clinical evidence supports its potential benefits in quality of life, sleep regulation, fatigue, and selected oncologic outcomes, although heterogeneity in dosing, formulations, and study design remains a key limitation. At the organizational and system levels, successful integration of melatonin into oncology practice requires interdisciplinary collaboration, standardized protocols, clinician awareness, regulatory clarity, and evidence-based implementation strategies. The aim of this narrative review is to synthesize current molecular, experimental, and clinical evidence on melatonin in integrative oncology, with particular emphasis on redox-related mechanisms, therapeutic interactions, and implementation challenges.

A 46-year-old man with non-Hodgkin lymphoma (NHL) in remission since 2014 presented with progressive dizziness, fatigue, and dark-colored urine. Laboratory workup revealed hemoglobin levels of 5.9 g/dL, elevated lactate dehydrogenase (LDH), hyperbilirubinemia, low haptoglobin, and a positive direct Coombs test for IgG, C3, and poly-specific antibodies, confirming warm autoimmune hemolytic anemia (wAIHA). Immunoglobulin profiling showed low IgM and IgA with high-normal IgG, suggesting chronic immune dysregulation, whereas abdominal imaging revealed mesenteric calcifications, raising concern for residual lymphomatous tissue potentially driving ongoing autoimmune activation. Despite corticosteroids and intravenous immunoglobulin (IVIG), persistent hemolysis necessitated four units of packed red blood cell (PRBC) transfusions and escalation to rituximab, after which gradual clinical stabilization was achieved, highlighting the refractory nature of wAIHA in the setting of previous lymphoproliferative malignancy. Serial monitoring of hemoglobin, reticulocyte count, and LDH throughout the clinical course demonstrated dynamic trends consistent with partial but meaningful immunosuppression, underscoring the value of longitudinal laboratory surveillance in guiding therapeutic escalation decisions. The presence of mesenteric calcifications, combined with a skewed immunoglobulin profile, provided important structural and immunologic clues to the underlying pathophysiology, illustrating how multimodal diagnostic evaluation can reveal occult contributors to delayed autoimmune phenomena even in the absence of overt malignancy recurrence. This case underscores the importance of recognizing delayed AHA in NHL survivors and the necessity of long-term hematologic surveillance, periodic cross-sectional imaging, and a low threshold for multidisciplinary consultation even after prolonged remission.

Burkitt lymphoma is a very fast-growing non-Hodgkin lymphoma (NHL) characterized by rapid tumor progression and increased lymphocyte proliferation. It often involves the jaw and facial bones. The current case report represented a 37-year-old male patient with Burkitt's lymphoma who sought dental care for persistent and dull pain and paresthesia on the left side of his mandible extending to the periauricular region. The initial diagnosis suggested a dental origin, leading to the lower left third molar (LL8) extraction. Despite this, the patient continued to experience worsening pain, which radiated to the lower extremities, accompanied by fatigue and weakness. The patient was referred to an oral and maxillofacial medicine specialist, where ultrasonography (US) revealed hypoechoic masses. A subsequent biopsy of a submandibular mass confirmed the diagnosis of Burkitt's lymphoma. The patient was referred to an oncologist and underwent chemotherapy and radiotherapy. After 3 years of follow-up, the patient is in remission. This unique case presentation related to systemic involvement as well as generalized bone pain (suggesting systemic involvement or more advanced disease) alone underscores the importance of a thorough diagnostic approach when facing unusual or persistent symptoms. It can also significantly impact future patient care by highlighting the need for a comprehensive evaluation and the importance of maintaining a high level of suspicion, particularly in cases where the initial diagnosis does not fully explain the patient's symptoms.

Fibromyalgia is a complex, heterogeneous and often disabling syndrome that seriously affects the quality of life of patients. It is characterized by chronic widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairment. Its pathophysiology remains poorly understood, and conventional treatments often offer limited efficacy while carrying significant side effects, highlighting the urgent need for alternative therapeutics strategies. We report a retrospective case series evaluating a novel protocol that combines low frequency Pulsed Electromagnetic Field (PEMF) therapy, medical ozone insufflation, and targeted nutritional supplementation in three patients with refractory fibromyalgia who had previously shown inadequate response to conventional treatments. Following the intervention, patients experienced substantial pain relief and significant improvement in quality of life, which were sustained at the 30-day follow-up assessment. These findings suggest that the combination of PEMF and ozone therapy may induce durable physiological benefits, presenting a promising complementary strategy for managing refractory fibromyalgia.

Concurrent development of therapy-related acute myeloid leukemia (t-AML) and lymph node tuberculosis (LNTB) following comprehensive anti-tumor therapy for locally advanced lung squamous cell carcinoma (LSCC) is extremely rare in clinical practice. This is not a new biological concept but represents a rarely documented clinical scenario in the setting of neoadjuvant chemoimmunotherapy, surgery, and anti-PD-1 maintenance therapy. Herein, we systematically summarize the clinical features, pathogenesis and individualized therapeutic strategies of these two concurrent rare complications based on a single rare case and the latest relevant literature, to provide a reference for clinical diagnosis and treatment. A 54-year-old male patient was initially diagnosed with locally advanced LSCC. After four cycles of neoadjuvant therapy with carboplatin, albumin-bound paclitaxel and pembrolizumab, the tumor lesion regressed markedly. Thoracoscopic right upper lobectomy was then performed, followed by maintenance immunotherapy with single-agent pembrolizumab postoperatively. Four months after maintenance therapy, the patient developed abnormalities on routine blood work, low-grade fever, fatigue and superficial lymphadenopathy. t-AML was confirmed by bone marrow aspiration, immunophenotyping, gene mutation and cytogenetic examinations, accompanied by breast cancer susceptibility gene 2 (BRCA2), DNA (cytosine-5)-methyltransferase 3 alpha (DNMT3A), and isocitrate dehydrogenase 2 (IDH2) mutations, and positivity for lysine (K)-specific methyltransferase 2A partial tandem duplication (KMT2A-PTD). Meanwhile, LNTB was diagnosed by lymph node aspiration pathology combined with tuberculosis-specific assays. The patient was treated with an optimized quadruple anti-tuberculosis regimen (HZEM), and induction chemotherapy for AML with VA regimen (venetoclax plus azacitidine) plus revumenib, and supportive therapy. Subsequently, the patient achieved partial remission of leukemia, with no uncontrollable severe adverse events. In this case, LSCC was managed with neoadjuvant therapy, thoracoscopic right upper lobectomy and postoperative maintenance therapy with single agent pembrolizumab. The development of t-AML is primarily driven by cytotoxic DNA damage induced by chemotherapeutic agents, whereas the potential contribution of immune checkpoint inhibitors remains largely speculative. The potential contribution of immune checkpoint inhibitors via immune microenvironmental disturbance remains largely speculative and insufficiently documented by current clinical evidence. The impaired immune function caused by comprehensive anti-tumor therapy may further elevate the risk of LNTB. The overlapping clinical manifestations of the two concurrent diseases substantially increase diagnostic difficulty. Timely and thorough bone marrow examination, lymph node pathological biopsy and tuberculosis-specific screening are the keys to early and accurate diagnosis.

Multiple sclerosis (MS) is a disease of the central nervous system (CNS) that often results in walking and balance impairments, fatigue, depression, and reduced quality of life (QOL). Exercise is beneficial for people with MS, and mind-body approaches like Pilates offer unique benefits, perhaps through activity-dependent neuroplasticity. The paper provides an overview of Pilates exercise as therapy in MS, and presents evidence from RCTs supporting its benefits, safety, and application in MS. We located 31 RCTs examining Pilates interventions in MS. There was consistent evidence for improvements in fatigue, balance, QOL, walking performance, mood, and select biochemical markers. However, the generalizability of the RCT evidence is limited by the predominance of studies from a single geographic region and mainly samples of young and middle-aged adults with MS, variability in intervention protocols, underrepresentation of important outcomes such as motor-cognitive function, and inconsistent reporting of adherence and safety. Overall, Pilates represents a holistic, evidence-informed approach with considerable potential for improving outcomes in people with MS, and we offer recommendations for future research on Pilates in MS.