Hemiballismus is defined as irregular, involuntary, large-amplitude flinging movements by the limbs, confined to one side of the body. Hemichorea refers to a state of excessive and irregularly timed, non-repetitive and randomly distributed, spontaneous, involuntary, and abrupt movements. It is widely believed that hemiballismus and chorea are suggestive of a lesion to the basal ganglia and subthalamic nucleus (STN). However, there are other etiologies that may influence the clinical presentation. Patients may present with certain common clinical features corresponding to the affected area of the brain. For example, infarctions of the motor cortex present with hemiplegia or paralysis of one side of the body. Similarly, infarctions involving the language areas of the brain present with aphasia and are detrimental to speech production or comprehension and the ability to read and write. Typically, acute-onset hemichorea is suggestive of a lesion in the STN. Herein, we present a rare case of acute hemiballismus and hemichorea following infarction of the left caudate nucleus, as determined by magnetic resonance imaging (MRI) and computerized tomography (CT) imaging modalities. Chorea is a unilaterally presenting involuntary movement disorder described as sudden, brief, spontaneous, non-stereotyped, and dance-like. Classically, the literature establishes chorea as the result of a lesion to the subthalamic nucleus (STN) or the nucleus hypothalamus/corpus Luysi. However, other investigations have identified localized lesions in other parts of the basal ganglia and caudate nucleus as the culprits of the movement disorder . DespiteChorea is a consequence of damage to the inhibitory pathways within the basal ganglia. Normally, the globus pallidus internus (GPi) inhibits the thalamus through inhibitory projections and thus modulates the movement pathways. However, when there is a decrease in the inhibitory transmission from the GPi to the thalamus, the thalamus starts randomly firing excitatory projections that overactivate the corticospinal and corticobulbar tracts. The resulting efferent innervation transmitted to the muscles on the contralateral side creates the abnormal movements described as chorea.The vascular supply of the basal ganglia is also a key component of chorea’s presenting pathology. Overall, the basal ganglia are supplied by a mix of small feeder vessels stemming from the anterior cerebral, middle cerebral, posterior cerebral, and posterior communicating arteries. The lateral lenticulostriate artery stems from the middle cerebral artery and supplies portions of the putamen, external capsule, and upper internal capsule. The anterior cerebral artery feeds the medial lenticulostriate artery and the medial striate artery of Huebner, which supply the globus pallidus and portions of the caudate, respectively. The caudate does receive some supply from the middle cerebral artery as well . The posLike any blood vessel in the brain, the vascular supply to the basal ganglia is at risk of damage from strokes. Strokes causing hemichorea-hemiballismus usually localize to a common functional network, with lesions occurring in regions functionally connected to the posterolateral putamen. To determine treatment efficacy, the neurology-neurosurgical team assesses perioperative neuronal activity. Monitoring studies have demonstrated decreased firing rates of cells within the GPi following pallidotomy, a surgical treatment aimed at reducing hyperkinetic movements. Considering the complex pathophysiology, hemiballismus is suggestive of a lesion to the basal ganglia STN. However, rare cases have demonstrated other etiologies to be responsible, with different etiologies having unique clinical features of their own. Herein, we present a rare case of hemiballismus following a stroke of the left caudate nucleus.A 64-year-old male with a medical history of a non-disabling stroke, tobacco use, and alcohol use disorder was admitted to the hospital due to a four-day history of right-sided weakness and involuntary shaking movements of his right arm and leg. He reported not feeling well and falling to the right with attempts to walk. The patient’s wife reported noticing involuntary choreiform movements in the patient’s right hand and foot and occasional arm-flinging, ballistic-like movements two days prior to admission to the hospital. A computerized tomography (CT) scan of the head revealed hypodensity involving the left caudate nucleus, consistent with an infarction Figure .Magnetic resonance imaging (MRI) of the brain was positive for an acute stroke of the left caudate nucleus with restricted diffusion and signal loss on the apparent diffusion coefficient (ADC) map Figures -1D. MagnOver the next few days, the right-sided weakness improved gradually, but the frequency of choreiform movements increased. The patient was started on low-dose haloperidol, which significantly improved his hemichorea symptoms.Hemichorea-hemiballismus is uncommonly reported following a stroke. The incidence of this hyperkinetic movement disorder following an acute ischemic stroke ranges between 0.4% and 0.54% . These cThe basal ganglia are modulators of motor control. Damage to these basal ganglia structures will lead to hyperkinetic or bradykinetic states. For example, loss of cells in the substancia nigra leads to parkinsonism with bradykinesia. Lesions involving the STN are felt to result in hyperkinetic states, chorea, and/or hemiballismus. Similarly, lesions of the medial globus pallidus increase motor activity . Acute-onset hemichorea has been felt to be caused by a subthalmic stroke . HoweverGiven the caudate’s mixed vascular supply of the anterior and middle cerebral arteries, it normally would be difficult to ascertain which vessel caused a presenting ischemic infarct. Fortunately, in our case, the severe stenosis of the left M1 of the middle cerebral artery leads us to believe that this was the causative vessel. The middle cerebral artery gives rise to the lenticulostriate perforates, which supply the superior head and body of the caudate and suggest possible localized areas of infarction. One caveat for individuals suffering from high levels of intracranial stenosis is the possibility of contralateral supply to the caudate nucleus .Medical management aims to relieve severe hyperkinetic movements using first- and second-generation antidopaminergic drugs that target dopamine receptors (D2Rs) , benzodiazepines (clonazepam), anti-epileptics (topiramate), and tetrabenazine -11. HemiIn the discussed case, the patient presented with multiple stroke risk factors and was found to be positive for stroke on MRI. Based on the patient’s medical history and MRI findings, a lab test was not required . The patWhen assessing patients presenting with involuntary movements in the acute stroke setting, identification of the dysfunctional area of the brain can be a challenge. In this setting, regular and rhythmic movements suggest focal-onset seizures, whereas irregular hemichorea or hemiballismus movements suggest disruption of deep basal ganglia motor control regions. In this instance, neuroimaging is an important tool for establishing a definitive and accurate diagnosis. Furthermore, imaging studies can help expand the current understanding of the impacts of the dysfunction of different brain regions.In the presented case, a patient with hemiballismus and hemichorea following an infarction of the caudate nucleus was identified by CT and MRI imaging modalities. This case highlights the value of diagnostic imaging and the potential for variable anatomic regions to be involved in the pathophysiology of involuntary movement disorders. Although hemichorea and hemiballismus are believed to be consequences of strokes involving the STN, this case demonstrates that infarction of other basal ganglia brain structures, specifically the caudate nucleus, may be responsible for this rare clinical stroke presentation.


Purpose of review: Medication-overuse headache (MOH) is an important problem worldwide, with different areas of controversy regarding its entity. This article reviews the risk factors, comorbidities, pathophysiology, clinical presentation, effective management, and prognosis of MOH by summarizing and integrating the results and findings from previously performed more than 15,000 studies (from 2010 to 2023) available from the scientific database of the University Medical Library in the University Clinical Center of Niš, which aimed to investigate and define the complexity of this type of headache. Recent finding: It has been proposed that all acute migraine medications can lead to MOH, with differences in the propensity of different agents to cause the problem. Early data suggests that triptans and other painkillers used for the acute treatment of migraine may be an exception. Recent studies show that practitioners and the general public are still largely unaware of the problem of medication overuse and its damaging effects. Summary: Although it is likely that MOH does occur, restricting the number of acute medications is necessary to prevent it. It is also possible that increasing amounts of acute medications are simply a reflection of poorly controlled headaches rather than a cause. Further research needs to be developed to identify more precise mechanisms for effective MOH management and its evolution. Medication-overuse headache (MOH) is a secondary headache that is classified by the third edition of the International Classification of Headache Disorders  as a groThe estimated global prevalence of medication-overuse headaches (MOHs) is about 3%. MOH is one of the most common secondary headaches, affecting approximately 80 million people worldwide ,3. In teIn terms of negative impact on daily, individual, and social activity, as well as the life quality of patients and their living and work environments, MOH is highly ranked. Measuring through years of life with disability (YLDs), MOH ranks 18th among all investigated causers ,20. The The pathophysiology of medication-overuse headaches (MOHs) is not fully understood. In addition to factors related to previous headaches, psychological factors, personality traits, and a genetic predisposition play important roles ,27 Figu. Genes iGenetic studies suggest the possible importance of polymorphisms in genes related to the dopaminergic system  and genes involved in the neurobiology of the addiction syndrome   Figure . CentralFunctional neuroimaging studies have shown functional changes in regions involved in nociceptive processes, such as the mesolimbic reward system, the fronto-parietal system, and other regions ,54. The The risk of developing medication-overuse headache (MOH) is lower with excessive use of triptans and ergotamine than with combined analgesic therapy and opioids . AnotherExcessive use of any type of analgesic therapy can lead to the development of medication-overuse headaches (MOHs) . ExcessiThe presence of psychiatric comorbidities, certain personality traits, and socioeconomic status are considered important factors in the development of medication-overuse headaches (MOHs). Anxiety and depression are common in MOH patients compared to patients with episodic headaches and represent a risk factor for the development of MOH ,71,72. AAs mentioned previously, medication-overuse headache (MOH) has a significant negative impact on the daily and social activities and quality of life of affected individuals ,88. StudMOH can be uncomplicated (type 1) or complicated (type 2)  Figure .An important factor that influences the complexity of CGRP-related disorders (CRDs) is the duration of the disease (>1 year), the presence of relapses, and previous unsuccessful attempts at therapeutic management . InterpeRecognizing comorbidities in migraine patients is important to study their relationship, causality, shared etiology, pathogenesis, and other aspects. Psychiatric comorbidities are common, especially anxiety and depression ,95. In tMedication-overuse headache (MOH) occurs for 15 or more days per month and develops as a result of regular excessive use of medication for acute symptomatic headache  for at least 3 months . The exaA patient with preexisting primary headache who develops a new type of headache or a marked worsening of a preexisting headache in temporal relation to excessive medication use should have both criteria for MOH  .Patients who overuse multiple drugs for the treatment of acute or symptomatic headache but cannot provide accurate information about what, when, or how much they take are common in clinical practice. Daily monitoring/recording for several weeks is of particular importance, but it should not delay treatment of MOH if diagnostic criteria are met .The ideal treatment for medication-overuse headaches (MOHs) is the subject of numerous debates. Since there is a diverse spectrum of clinical manifestations and interindividual differences among patients, the ideal treatment for MOH should be individually tailored. Treatment for MOH should begin in the outpatient setting, with patient education, discontinuation of medications for excessive use, and initiation of transient or long-term preventive therapy. This approach may be effective in two-thirds of patients, whereas in the remaining patients, the effect is unsuccessful .Some studies have compared the effectiveness of outpatient discontinuation of excessive medication  with hospital-assisted discontinuation using detoxification strategies. The group consisted of patients with MOH without prior detoxification attempts and without significant psychiatric comorbidities. No differences in treatment success were observed between these groups (75% success rate in both groups) . A favorThere is not enough research examining the preventive effects of pharmacotherapy on the occurrence of MOH in patients with episodic headaches who are at increased risk for developing MOH. Topiramate has shown a significant effect in preventing episodic migraine from progressing to chronic migraine, compared to placebo, in a follow-up period of 6 months with a significant number of patients (756 patients) . TopiramThis therapy prevents the onset of withdrawal headaches. The use of naproxen, which has a relatively long duration of action compared to other NSAIDs, is beneficial for treating headaches during the process of medication overuse withdrawal . Low dosThere was no demonstrated superiority of intravenous methylprednisolone or paracetamol compared to placebo in controlling withdrawal headaches . Meta-anDiscontinuation of medication overuse is the cornerstone of the therapeutic approach for patients with MOH. A significant number of patients achieve satisfactory results and do not require additional preventive therapy after medication overuse withdrawal . Abrupt Discontinuation of excessive medication use before initiating preventive therapy is advised in several previous guidelines for the treatment of MOH ,146. TheNeuromodulation represents a new strategy for the treatment of MOH. High-frequency repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex, compared to a placebo group, had a limited effect on the success of discontinuing excessive medication use . Some stIn studies of onabotulinum toxin A use in the prevention of chronic migraine (PREEMPT 1 and PREEMPT 2), two-thirds of the patients had MOH . After tThe efficacy of monoclonal antibodies in the therapy of chronic migraine with and without MOH was examined . The effThe treatment of medication overuse syndrome can be pharmacological or non-pharmacological. The availability of healthcare professionals and psychological support are crucial for successfully overcoming withdrawal syndrome. Monitoring metabolic parameters, blood pressure, administration of parenteral therapy, sedation, and other symptomatic treatments are recommended. The use of dihydroergotamine, antidopaminergic therapy , valproic acid, ketorolac, magnesium, or corticosteroids is advised . There aFor chronic migraine patients, the CGRP monoclonal antibody was slightly better than botulinum toxin in terms of efficacy and safety . A doublMOH is considered a preventable headache disorder. Risk factors for the development of MOH include female gender, frequent prior headaches, frequent use of analgesic medications, inadequate control of previous headaches, use of benzodiazepines, smoking, physical inactivity, obesity, addictive behavior patterns, psychiatric comorbidities, other painful conditions, and lower socioeconomic status ,16,17,18A study conducted by Norwegian authors demonstrated that brief counseling interventions have a significant effect on the prevention of MOH and reverting it to an episodic headache pattern in up to 50% of patients (in comparison to a group that did not receive counseling) . In a stComparing the effectiveness of counseling interventions for discontinuation of excessive medication use in outpatient versus inpatient settings, no significant differences were observed . In a loClinical monitoring with access to a headache diary is necessary. Ideally, personal contact with the patient should be provided. Electronic diaries are considered significant in this process . In caseTherapeutic goals for MOH include reversing chronic headaches to episodic headaches, reducing the burden on daily functioning activities, and achieving headache control with the lowest possible amount of medication. Treatment of MOH has direct economic benefits for the healthcare system, leading to increased patient productivity and reduced indirect costs (reduced absenteeism) . The sucThe follow-up period for assessing discontinuation success ranges from 6 months to 9 years. The relapse rate after 6 months ranges from 0% to 41% ,95,143. In a study examining depression, anxiety, stress, tendency toward rumination, and quality of life in patients with newly diagnosed MOH compared to healthy controls, a total of 164 individuals were included, 33 males and 131 females, ranging in age from 18 to 65 years. The healthy control group consisted of 81 individuals, 22 males and 59 females, aged 20 to 65 years. The MOH group comprised 83 individuals, 11 males and 72 females, aged 18 to 65 years. The average duration of MOH prior to diagnosis was 5.5 years, with the majority of patients experiencing migraines (64%) with an average duration of less than 8 years before MOH development, mostly episodic in nature in over 90% of cases. Half of these patients used over-the-counter analgesics for acute migraine therapy, achieving partial therapeutic effectiveness. The average number of days with MOH per month was slightly over 19 days. Slightly more than half of the patients used combination analgesics for MOH therapy. Female gender, lower level of education, and marital status (married) were more common in MOH compared to healthy controls. The absence of alcohol consumption habits and lower levels of physical activity were more common in MOH ,122,123.The results of this study mostly confirmed the hypotheses on which the research was based. Moderate levels of depression, anxiety, and stress were present in patients with MOH. A higher degree of rumination was observed in MOH. Impairment of physical, mental, and overall health was present in MOH. Selective dependence of these parameters on the examined sociodemographic, clinical, and laboratory findings was observed. The degree of anxiety and rumination style of thinking were predictors for the occurrence of MOH, while the degree of depression and stress were not predictors for the occurrence of MOH. The degree of depression  was a risk factor for the physical aspect of health in MOH. The degree of depression was a risk factor for mental and overall health in patients with MOH. The degree of anxiety, stress, and rumination style of thinking were not predictors of quality of life in MOH ,122,123.Based on the results of this study, it is concluded that assessing the degree of anxiety and rumination style of thinking in patients with chronic headaches could be useful for preventing the transformation of chronic headaches and the development of MOH. On the other hand, assessing the degree of depression in patients with MOH and its treatment would be beneficial for improving the quality of life of patients with MOH. The results indicate the necessity of a multidisciplinary, individualized approach to patients with chronic headaches and MOH. The goal of such an approach would be to prevent the occurrence of MOH and provide more effective treatment and a better quality of life for patients with MOH .MOH is a secondary headache disorder, although pathophysiologically and clinically it represents a complication or transformation of the most commonly occurring primary headaches. It is a complex entity with biological, psychological, and social aspects. Assessing the risk factors for MOH occurrence and treatment success is crucial for the primary and secondary prevention of this type of headache. The diagnosis of MOH is clinical, and its treatment is individualized and highly dependent on a multidisciplinary team approach  and should probably be attempted in primary care . For those who suffer from MOH and have poor information about MOH management, a detoxication and prevention program should be chosen based on their clinical condition and evidence of intervention effectiveness. Discontinuation of excessive medication should be carried out abruptly for those who excessively use common analgesics, ergot preparations, and triptans. Gradual discontinuation is advised for excessive use of opioids, barbiturates, and sedatives. In addition, it can be carried out on an outpatient basis or in a hospital setting . In spite of this, the type of MOH is a crucial factor in selecting the location and method for discontinuing excessive medication. All crucial conclusions are presented in Either the discontinuation of medication overuse, transitional therapy, preventive therapy, preventive relapse monitoring, or education and the patient’s awareness are the foundations of the therapeutic approach. All crucial conclusions are presented in In spite of all that was mentioned above, MOH is a treatable and preventable public problem worldwide. The gain from treating patients with MOH is potentially high and may lead to substantial economic savings for society as well as for individual patients.General conclusions and recommendations on the management of MOH are presented in


Frontotemporal disorders (FTD) are the consequence of impairment to neurons in the frontal and temporal lobes of the brain. Also, no definitive treatment has been found for FTD. Cannabinoid products can be used to manage treatment-resistant behavioral variants of Frontotemporal dementia (bvFTD).We describe the case of 34 years old male with two years of marijuana abuse. At first, he presented with symptoms of apathy and bizarre behavior, which became more severe, and led to disinhibition. The clinical symptoms and imaging findings made FTD probable for him, which was very interesting to report.While cannabis has demonstrated potential in managing behavioral and mental symptoms of dementia, the presented case highlights the profound impact of cannabis consumption on brain structure and chemistry, including the potential for neurodegenerative disorders like FTD. Frontotemporal dementia (FTD) is the consequence of damage to neurons in the frontal and temporal lobes of the brain, which is characterized by progressive deficits in behavior, executive function, or language. The disease can mimic many psychiatric disorders because of the prominent behavioural features .FTD is one of the most common types of dementia before 65 years of age  and rareSo far, no definitive treatment has been found for FTD, and current treatments are based on controlling symptoms and reducing their severity. Studies have shown that antidepressants and second-generation antipsychotics may help these patients . CannabiThis report discusses a case that developed early-onset FTD at age 34 following cannabinoid use. The items that make this case rare and reportable are the occurrence of FTD at a young age and its occurrence following the use of cannabinoids. At the same time, several studies have shown the short-term positive effects of cannabinoids on symptom reduction FTD.A 34 years old man without any significant previous psychiatric history except for marijuana abuse for the last two years, with normal neurodevelopment throughout his life, had his first medical encounter due to his family’s complaint of restlessness and a significant decline in social activities. His family reported that he was socially withdrawn and didn’t go to work recently. Other symptoms included anhedonia, apathy, and a significant decline in all areas of functioning. He was admitted to the psychiatric hospital. After mental status examination and history taking, an antidepressant was started for the patient. Finally, the patient was discharged after partial improvement (48 days) with the diagnosis of marijuana amotivational syndrome.According to the patient’s father, the patient’s symptoms worsened after the discharge. During the follow-up, the patient was referred to several doctors (neurologist and psychiatrist), and magnetic resonance imaging (MRI) was requested for him. MRI displayed Frontotemporal lobar degeneration, with cortical brain atrophy more significant in the frontal, parietal, and temporal lobes Fig. . Due to Two years after the onset of the first symptoms and hospitalization, the patient was brought into the emergency department (ED) with various progressive psychiatric symptoms. The patient had perseverative behaviors without obsession, as he bathed about ten times a day and performed long walking to count buildings and other objects in his neighborhood. He also suffered from disinhibition in such a way that he borrowed money from people around him without any purpose. Bizarre behaviors such as defecation, urination in the street, and worsening of amnesia from about a year ago have progressed to Anomia and prosopagnosia. The patient had hyperorality, as he placed both edible and inedible objects in his mouth, and finally, the patient suffered from apraxia and echolalia. He had symptoms of irritability, mutism, disorganized behaviors, increased appetite, memory impairment, urinary and fecal incontinence, and lack of pain perception. He also had anosognosia, did not demonstrate any insight into his life problems, including his divorce, and declined any psychiatric or medical problems. This presentation led to the second admission of the patient, antipsychotic was started for him, showing some benefits.For a workup of this atypical presentation of psychosis, and associated symptoms, a brain computed tomography (CT) scan was taken. Non-contrast spiral brain CT scan through the brain without gadolinium contrast demonstrates bilateral cortical brain atrophy inappropriate for the patient’s age, which was more in the frontal, parietal and temporal lobes and is suggestive of frontotemporal lobar degeneration Fig. .His family history was extensively reviewed except for one second-degree relative with a suicidal attempt and another second-degree relative with an unknown psychiatric illness requiring him to undergo Electroconvulsive therapy. No familial history of dementia, cognitive impairment, parkinsonism, and other neurodegenerative disease was noted.Due to the early-onset presentation and severe behavioral and personality changes, lack of previous psychiatric or medical history, lack of specific stressors or risk factors, lack of familial history of neurodegenerative disease, and brain imaging findings with prominent cortical brain atrophy, especially in frontal, parietal and temporal lobes, early-onset FTD post cannabinoids consumption was considered as the final diagnosis.We present a progressive case of early-onset frontotemporal dementia without significant past medical history except for Marijuana use for two years before the onset of symptoms. The diagnosis was made according to the typical presentation of almost all core features of the probable bvFTD, including behavioural disinhibition, apathy, loss of empathy, compulsive behaviours, hyperorality, and the inevitability of quitting his job due to deficit in executive functions. Our patient also showed significant insensitivity to pain . Brain iIntuitive attitude and a common misconception about the early-onset presentation of dementia bring up genetic inheritance as the cardinal etiology. Nevertheless, plenty of observational studies show that only a minority of early-onset dementia, including both Alzheimer’s disease (AD) and FTD, have autosomal dominant patterns or can be accredited to known gene mutations –13. WhenConsidering our presenting case, the lack of significant familial history, the insufficiency of possible attributable risk factors, and the significant history of Marijuana consumption before symptom onset suggest us impute the connection between cannabis and early-onset FTD. A likely hypothesis is that as an illicit drug in the country without standardized preparation and processing, cannabis users are at high risk of receiving cannabis contaminants and toxins in unsafe quantities. Common cannabis contaminants are heavy metals, pesticides, and microbes  that canA large number of previous studies on the usage of cannabis indicate its promising effects on symptom control of behavioural and psychological symptoms of dementia (BPSD). Anti-oxidant, anti-neuroinflammatory effects, increase in the neurogenesis activation, and pro-survival factors including Brain-Derived Neurotrophic Factor (BDNF) and inhibition of tau hyperphosphorylation are among the contributing mechanisms , 19.Most studies examining the effect of cannabis on controlling BPSD involve AD patients or did not specify the type of dementia; in our literature review, only a few studies specifically present the effect of cannabis on FTD patients, and together they introduced nine FTD patients. Gopalakrishna et al. , in a caAlmost all the studies investigating the effect of cannabis and cannabinoid on BPSD were not contesting the long-term efficacy or the adverse effects of chronic marijuana use in dementia. They were conclusive based on the promising short-term results . HoweverCannabinoid use would impair the regulation of endocannabinoid system in its critical stage of development, Renard et al. showed that the chronic cannabinoid exposure during adolescence has been shown to induce long-term changes in the PFC, such as reduced dendritic arborization of pyramidal neurons, impaired synaptic plasticity, altered expression of synaptic markers, decreased gray matter volume, and abnormal connectivity. These changes may impair the communication between the PFC and other brain regions, such as the hippocampus, which is essential for learning and memory. As a result, chronic cannabinoid exposure during adolescence may increase the risk of developing frontotemporal dementia later in life .The duration of cannabis use that can cause neurocognitive problems is not clearly determined in the literature. However, some studies have suggested that chronic cannabis use, defined as regular consumption for at least one year with a minimum frequency of once per week, is associated with significant impairments in cognitive impulsivity, cognitive flexibility, attention and short-term memory , and verSince cannabis has a complex pharmacology, medical use demands extensive formulary studies. The two most prominent constituents of cannabis, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), have several paradoxical and sometimes confronting effects. THC, as the main psychoactive factor of cannabis, is shown to cause cognitive dysfunction, psychosis, and alteration in cortical structure and function in adolescents , 33. CBDThese severe effects on the brain structure and brain chemistry of chronic cannabis users may potentially contribute to the development of neurodegenerative disorders like FTD in genetically vulnerable individuals. While the warning about cannabis consumption’s impact on brain structure is valid, the scarcity of reported FTD cases in patients with chronic cannabis use suggests the need for more nuanced conclusions. Therefore, the recommendation of cannabis as medical management for BPSD should be approached with additional caution, particularly for early-onset patients who are more likely to engage in long-term use and dependence, increasing their vulnerability to neurodevelopmental abnormalities.


Epidemiologicaland clinical characteristics of monkeypox cases in Brazil in 2022: a cross-sectionalstudy emphasizes the need for laboratory quality control and awareness ofhealth professionals as success factors for the early identification of mpox.The letter published containing comments about the study entitled Of the 33,513 notified cases, 27,776 (82.9%) had a record of a laboratory test havingbeen performed and the test result was pending for 1,587 of them on the date of thestudy. Almost all confirmed cases  and discarded cases  hada laboratory diagnosis. Also, of the 456 cases that had inconclusive or indeterminatetest results, eight were classified as confirmed and 112 as discarded, according toother epidemiological criteria established by the health surveillance service. It isworth noting that, indeed, difficulty in accessing laboratory diagnosis and the need totrain health teams to identify cases and interpret results, are additional barriers tocontrolling the outbreak.,In Brazil, laboratory confirmation of mpox is done by molecular testing (q-PCR) followedby the sequencing technique, in accordance with the recommendations of the BrazilianNational Health Surveillance Agency .There are countless factors that can contribute to false-negative results, ranging fromtechnical reasons to poor sample quality. We recognize as legitimate educational actions in the health sector determined by theemergence of theoretical and methodological contributions, in the face of the appearanceof new diseases, and we reiterate the importance of continuing professionaltraining.


Editorial on the Research TopicDecoding complexity: new insights into the cellular and molecular mechanisms of cardiovascular and metabolic diseasesThe collection of research articles presented here provides a comprehensive exploration of the cellular and molecular mechanisms underlying cardiovascular and metabolic diseases. The research underscores the complexity of these chronic diseases and the need for a multi-faceted approach to understanding and addressing these conditions. The articles explore the roles of periodontitis, obesity, hypercholesterolemia, and nucleolar stress in cardiovascular diseases (CVDs), offering novel insights into the intricate interplay of several factors contributing to these conditions.Omar et al). The authors propose that periodontitis induces epigenetic changes in hematopoietic stem cells in the bone marrow, which persist even after the clinical elimination of the disease, thereby increasing CVD risk. This study underscores the importance of oral health in overall cardiovascular health and suggests that more research is needed to fully understand the long-term association between periodontitis and atherosclerotic CVD. Epigenetic modifications represent a promising target for the treatment of various human diseases, including CVDs . The study finds that while long-term moderate endurance exercise can partially reverse the effects of a high-fat diet, it may also trigger cardiac remodeling in the context of obesity. This research emphasizes the complex interplay between diet, exercise, and cardiac health, and suggests that more nuanced approaches may be needed to address obesity-related cardiac aging. The findings also highlight the need for personalized exercise prescriptions and dietary recommendations to optimize cardiovascular health in individuals with obesity.Aging elevates cardiovascular disease risk due to arterial stiffening, heart muscle changes, and cumulative exposure to lifestyle-related risk factors , 3. WhilGhai et al. focus on the role of Heat shock factor 1 (HSF1) as a prominent cardiovascular risk factor . The authors discuss how HSF1, a critical transcriptional factor of the proteotoxic stress response, is involved in lipid metabolism and cholesterol synthesis, both of which are key processes in the initiation of atherosclerosis. This review emphasizes the need for further research into the roles of HSF1 and heat shock proteins in the metabolic pathways of atherosclerosis. The insights provided in this review could pave the way for the development of novel therapeutic strategies targeting HSF1 and heat shock proteins to prevent or slowdown the progression of atherosclerosis.Atherosclerosis, a leading cause of cardiovascular disease, results in the constriction of crucial arteries, consequently causing conditions such as coronary heart disease, stroke, and peripheral arterial diseases. Delving deeper into the mechanisms that underpin atherosclerosis could offer significant insights, potentially leading to the development of more effective treatments. In this context, Yan and Hua). The authors discuss how disruptions in ribosome biogenesis in the nucleolus can lead to nucleolar stress and initiate stress-responsive pathways that play a crucial role in the pathogenesis of cardiomyopathy. This review highlights the importance of understanding the role of nucleolar abnormalities in the development of cardiac diseases. The findings suggest that targeting nucleolar stress could be a promising strategy for the prevention and treatment of cardiomyopathy.The nucleolus, a pivotal cellular structure, oversees ribosome biogenesis, is crucial for protein synthesis, and regulates various other cellular processes including stress response . The revCollectively, these articles underscore the multifactorial nature of cardiovascular and metabolic diseases and the need for a comprehensive approach to study, prevent, and treat them. They highlight the importance of considering factors beyond traditional risk factors, such as oral health and nucleolar stress, in our understanding of these diseases. They also emphasize the complexity of the relationships between diet, exercise, and cardiac health. As we continue to unravel these complexities, we will be better equipped to develop more effective strategies for preventing and treating cardiovascular and metabolic diseases. The research presented in this collection not only advances our understanding of the cellular and molecular mechanisms underlying these diseases but also provides a solid foundation for future research in this field.


In recent years, the availability of effective vaccines has become a public health challenge due to the proliferation of different pandemic outbreaks which are a risk for the world population health. Therefore, the manufacturing of new formulations providing a robust immune response against specific diseases is of paramount importance. This can be partially faced by introducing vaccination systems based on nanostructured materials, and in particular, nanoassemblies obtained by the Layer-by-Layer (LbL) method. This has emerged, in recent years, as a very promising alternative for the design and optimization of effective vaccination platforms. In particular, the versatility and modularity of the LbL method provide very powerful tools for fabricating functional materials, opening new avenues on the design of different biomedical tools, including very specific vaccination platforms. Moreover, the possibility to control the shape, size, and chemical composition of the supramolecular nanoassemblies obtained by the LbL method offers new opportunities for manufacturing materials which can be administered following specific routes and present very specific targeting. Thus, it will be possible to increase the patient convenience and the efficacy of the vaccination programs. This review presents a general overview on the state of the art of the fabrication of vaccination platforms based on LbL materials, trying to highlight some important advantages offered by these systems. The Layer-by-Layer (LbL) method is a versatile tool for the fabrication of multifunctional nanomaterials, taking advantage of its simplicity for the assembly of supramolecular systems with a broad range of physicochemical properties and applications ,2. This The interest in the use of LbL materials in the fabrication of vaccines has been stimulated for the possibility that this methodology offers to fabricate well-sketched vectors in which their characteristics, including size, shape, surface properties, and composition , can be This review is intended to present a general overview of the potential interest of LbL materials to the development of vaccination platforms, providing an updated perspective on the potential interest in the use of type of nanoassemblies as a tool for improving the performance of vaccines. It is expected that this aim can only be achieved by a careful analysis of the main aspects governing the assembly of LbL nanomaterials as well as of the properties of the obtained nanoassemblies. For this purpose, this review includes a short introduction to the LbL method before paying attention to its application in the design of vaccines based on assembled nanostructures.The LbL method was introduced by Decher et al. ,19,20,21Moreover, the LbL method can be exploited for coating any kind of substrate, independently of their size, shape, or chemical nature, which contributes to increase the versatility and impact of this methodology . In factThe LbL method should be considered a low-cost methodology with a high level of modularity, versatility, and simplicity, which has opened important avenues for its use on the fabrication of multi-layered nanostructured materials with tailored structure, well-defined thickness, and composition. Moreover, the LbL approach enables the introduction of different functionalities in the final material, which is very useful to include specific chemical, biological, optical, mechanical, or electrical properties in the manufactured materials ,63,64,65To date, there is a deep theoretical and experimental knowledge about different aspects of LbL materials, including the dependence of the adsorbed amount on the number of adsorbed bilayers, and their potential application. However, there are other aspects, e.g., physico-chemical bases, driving the assembly of LbL materials and their properties, that are less understood, even though they are of paramount importance for establishing correlations between the internal structure and molecular properties of LbL nanoassemblies ,80,81. TIt should be noted that the understanding on how the above parameters allow tuning the structure of the multilayered nanoassemblies is of a paramount importance, especially because they may provide the bases for obtaining materials with specific physico-chemical properties and functionalities. This has allowed the fabrication of both passive and active LbL nanomaterials with a broad range of applications ,74, takiThe use of LbL flat films as real vaccination platforms has been limited for long time because this type of supramolecular architecture can only be used as strips for topical application, which in many cases is not a very effective route for vaccination purposes. Therefore, many studies related to the design of vaccines based on LbL flat films are aimed at providing a proof of concept for the fabrication of more complex architectures with real applications. However, in recent years, a promising practical application for LbL flat films as vaccination platforms has emerged in the form of sublingual patches . This tySu et al.  designedMonge et al.  proposed3 cores, including, after the assembly of a multilayer containing 5 polypeptide bilayers, a capping layer formed by epitopes of the circumsporozoite (CS) protein of Plasmodium falciparum. Thus, it was possible to produce synthetic vaccines against malaria containing a tri-epitope CS peptide (T1BT*) formed by the antibody epitope of the CS repeat region (B) and two T-cell epitopes, the highly conserved T1 epitope and the universal epitope T*. The application of such vaccine particles in mice contributes to the production of parasite-neutralizing antibodies and malaria-specific T-Cell response, including cytotoxic effector T-cells. Therefore, this type of vaccine elicited neutralizing antibodies and effector T-cells specific for the CS epitopes, providing protection to the treated individuals against mosquito challenge with Plasmodium sporozoites expressing Plasmodium falciparum CS repeats. Following a similar protocol, Powell et al. -3-aminopropyl}aspartamide) (PAsp(EDDPA)) and the model antigen chicken ovalbumin allows manufacturing LbL MNs which enable a fast implantation. In fact, this type of device requires only 1 min insertion into the skin to ensure the implantation (see 1 (immunoglobulin G1) for the group of mice vaccinated using a microneedle-based strategy was 9-fold and 160-fold higher than that found when the vaccination occurs using intramuscular and subcutaneous injection methods, respectively. Moreover, the use of the manufactured MNs gives as result an efficient immune activation characterized by the fast vaccine adjuvant uptake by the antigen existing in the cells.The fabrication of microneedles (MNs) based on LbL nanoassemblies presents a big interest for the fabrication of vaccination platforms densely loaded with different biological cargoes . HoweverDe Muth et al.  fabricatUppu et al.  proposedN-trimethyl chitosan chloride (TMC). This makes it possible to ensure an antigen dose high enough for vaccination purposes. The in vivo application of the fabricated microneedle arrays in rats was accompanied by the induction of IPV-specific antibody responses. For polio virus, very different immune responses were found depending on the used antigenic form. The use of microneedles loaded with the C-antigen (expressed on noninfectious virus particles) led to a high and robust antibody production which is equivalent to the immunization obtained upon intramuscular vaccination. However, the use of microneedles including the D-antigen (expressed in native polio virus) produced smaller immune response than that obtained after intramuscular vaccination, which suggests a possible virus denaturation during the coating process. Therefore, it is possible that the effectiveness of microneedles against the polio virus can be only ensured by stabilizing the antigenic material before its inclusion in the supramolecular nanostructure obtained by the LbL method. A similar strategy to the used for design microneedles against polio virus was exploited by Schipper et al. [van der Maaden et al.  designedr et al.  for fabr1→42 as an antigen. Moreover, the sustained release of the fMLP-MS helps the recruitment of immune cells, e.g., macrophages, close to the injection site. This leads to an efficient uptake and process of the secreted antigen to present epitopes of major histocompatibility molecules. This contributes to increasing the immune response relative to conventional hypodermic vaccines. Kim et al.  designedβ-amino-ester) and different DNA plasmids. These types of vaccines emerge as good alternatives to maintain the bioactivity of the genetic material, producing upon administration a strong immune response against a model HIV antigen and enhanced memory for the generation of T-cells. Moreover, this vaccination approach elicits a gene expression that is about 140-fold higher than that obtained upon intradermal injection of DNA vaccines, which opens promising avenues for the use of microneedles for DNA vaccination.De Muth et al.  also expIn summary, the use of LbL microneedles is a powerful alternative to enhance the delivery of vaccines, providing an effective platform to guarantee a proper distribution of the vaccination agents and their stability during storage.Vaccination is currently the most powerful strategy to minimize the risk associated with the emergence of pandemic outbreaks of different diseases, reducing their mortality. However, many times it is very difficult to find suitable platforms ensuring their therapeutic efficiency and patient convenience, as well as their worldwide accessibility. The latter has become a very critical issue for reducing the impact of some diseases, especially in low-income countries where the accessibility to vaccination programs is very limited. In this context, the versatility and modularity of the Layer-by-Layer (LbL) method open new avenues for designing vaccination platforms with high efficiency and specific targeting, minimizing the economic impact associated with their fabrication. Moreover, the flexibility of LbL nanoassemblies offers important advantages to prepare a well-sketched platform with tailored properties to guarantee durable and functional immune responses, which opens very interesting perspectives for vaccination against clinically relevant diseases.Despite the promising framework offered for translational applications, it is mandatory to deepen the understanding of the release mechanism of LbL vaccines, and how to control it for clinically relevant applications. Moreover, the transition from laboratory to clinical practice requires a significant amount of work on screening by using human relevant models. Facing these issues will make it possible to obtain relevant bioengineered LbL materials, which can be exploited as platforms for clinical vaccination platforms. The avenue is open to the research and development of LbL materials as a tool for obtaining most effective vaccines under clinically relevant conditions. However, most of the results obtained to date have been limited to animal models, which, even if satisfactory, do not allow the safety and efficacy of LbL vaccines to be determined in humans. In addition, the translation of LbL vaccines from animal models to clinical use is complicated by several factors. LbL vaccines need to be optimized in terms of formulation, dosage, and delivery methods. This must consider that the human immune system is diverse, and the optimal formulation and delivery method may vary depending on the specific population or disease being targeted. This variability makes it challenging to develop a universal LbL vaccine. On the other hand, the regulatory process for vaccines is rigorous, and LbL vaccines must demonstrate both safety and efficacy in clinical trials before they can be approved for use. This process can be time consuming and resource intensive, requiring significant investment in research and development. Finally, the shelf life and storage requirements of LbL vaccines can pose logistical challenges, particularly in resource-limited settings.


Porous structure is an important three-dimensional morphological feature of the peripheral nerve guidance conduit (NGC), which permits the infiltration of cells, nutrients, and molecular signals and the discharge of metabolic waste. Porous structures with precisely customized pore sizes, porosities, and connectivities are being used to construct fully permeable, semi-permeable, and asymmetric peripheral NGCs for the replacement of traditional nerve autografts in the treatment of long-segment peripheral nerve injury. In this review, the features of porous structures and the classification of NGCs based on these characteristics are discussed. Common methods for constructing 3D porous NGCs in current research are described, as well as the pore characteristics and the parameters used to tune the pores. The effects of the porous structure on the physical properties of NGCs, including biodegradation, mechanical performance, and permeability, were analyzed. Pore structure affects the biological behavior of Schwann cells, macrophages, fibroblasts, and vascular endothelial cells during peripheral nerve regeneration. The construction of ideal porous structures is a significant advancement in the regeneration of peripheral nerve tissue engineering materials. The purpose of this review is to generalize, summarize, and analyze methods for the preparation of porous NGCs and their biological functions in promoting peripheral nerve regeneration to guide the development of medical nerve repair materials. The application of tissue-engineered conduits in peripheral nerve regeneration has been extensively studied and successfully implemented in clinical practice . AlthougIn this context, tissue-engineered peripheral nerve guidance conduits (NGCs) have emerged as a viable solution to overcome the limitations of autologous tissues . TypicalA porous structure of suitable pore size and connectivity was shown to be a determining factor for completion of the biological functions of NGCs, promoting the early adhesion, spreading, proliferation, and differentiation of Schwann cells to form cord-like structures (Bungner bands), promote vascularization, and reduce the formation of fibrous scars . The conAs shown in The porous structure of an NGC refers to the three-dimensional morphology of closed or penetrating voids in biomaterials . The porThe pore size, porosity, permeability, and connectivity are important in characterizing the porous structure of NGCs, particularly in the development of innovative 3D topographies, as they play a decisive role in nerve regeneration. Conduits constructed from spun fibers are usually characterized by the fiber diameter and thickness. The morphology of porous NGCs can be observed through field emission scanning electron microscopy (SEM) and transmission electron microscopy (TEM); the pore size distribution can be statistically analyzed using image analysis software . This me1) of anhydrous ethanol. Ethanol is forced into the pores of the conduit through a series of vacuum-release cycles, and the volume of the solution is recorded as V2. The conduits are removed, and the volume is recorded as V3. The NGC porosity is calculated using the following equation: porosity rate (%) = (V1 − V3)/(V2 − V3) × 100%. This method is simple and convenient, and it is not limited by the experimental equipment; however, the accuracy varies due to the volatility of ethanol, and closed pores cannot be measured. The gas adsorption method is an alternative for measuring the porosity and pore distribution of a conduit and is based on the adsorption of gas molecules on a solid surface . . 111]. TWhen a peripheral nerve is injured, the local microenvironment around the injured nerve and the nutrients needed for nerve regeneration are important for repair and reconstruction; these have an important relationship with the local blood supply . Early vThe pore structural characteristics of biomaterials such as pore size, porosity, and connectivity significantly affect cell invasion and angiogenesis. Macroporous structures contribute to cell permeability, oxygen and nutrient transport, and the formation of mature vascularized tissues . Some stSignificant development of medical tissue-engineered peripheral NGCs has enabled their successful use in clinical practice, which will be more extensive and routine in the future. Many studies have explored the 3D topological morphology of nerve grafting, from relatively closed nerve regeneration chambers to the construction of irregular pore structures, current pore structure instruments with controlled morphology, and asymmetric pore structures. A unified standard for the porous structure of nerve conduits is still lacking, and the ideal porous structure for promoting peripheral nerve regeneration remains controversial. According to recent research results, pore structure characteristics such as porosity, pore size, and connectivity have a comprehensive effect on the nerve regeneration graft, including the degradation rate, mechanical performance, permeability, and other physical properties. The most important factor is that the porous structure can change the roughness, permeability, and hardness of the NGC to have a comprehensive effect on the physiological process of peripheral nerve regeneration.


Sportswear worn next to the skin is easily soaked by sweat and may become a breeding ground for the microbiome, thus a source of malodor. Malodor can cause social embarrassment and discomfort to both wearer and others. Given the risks current deodorant products pose to nature and human life, the development of sustainable textiles for odor control comes to the forefront. This review introduces the odor-generating mechanism in clothing from the perspectives of perspiration composition and cutaneous microbiome. With the knowledge of the significant role of sweat in odor formation, the sweat distribution of the human body, measurement techniques, and advanced technologies developed for quick-dry function are presented in the second part. Lastly, odor management in sportswear is evaluated, covering the odor-assessing techniques, the effects of various textile materials, and emerging solutions in terms of antibacterial treatment, adsorbent materials, and photocatalytic degradations of odorous compounds. Overall, it is of both personal and social value to develop novel textile materials with odor-control functions by making use of natural materials and fabric designs.  Chemical property; Materials application; Materials synthesis During physical exercises, the human body needs to consume its stored energy and thus would generate significant heat.Clothing has long been found significant in the formation of axillary odor.This review is aimed at providing a systematic and comprehensive understanding of the odor generation mechanism in clothing because of sweating, and the current and potential strategies targeting sweat management and odor control in sportswear. First and foremost, how odor is generated in sportswear is elaborated from the aspects of perspiration composition and cutaneous microbiome. Given the significant role of sweat in odor formation, the sweating pattern of the human body and the advanced techniques that have been developed for sweat management in sportswear are introduced in the second part. Next, the odor evaluation techniques, the effects of various textile materials, as well as the tackling strategies from the antimicrobial, adsorbent, and photocatalytic degradation perspectives are discussed. In this context, suggestions for the development of sustainable odor-control sportswear in the future are given in the outlook. It is hoped that the need for body odor management could be met without jeopardizing other living creatures or human safety in the next-generation sportswear.,The human body’s perspiration is a complex mixture of secretions from cutaneous glands, which mainly comprise sweat glands and sebaceous glands. Depending on whether or not the ductal opening is connected to a hair follicle, the sweat glands are roughly classified into two types: eccrine and apocrine.,,,As widely distributed as the sweat glands, sebaceous glands cover most of the human body except for the palms and soles, particularly concentrated in the scalp, forehead, and face areas.,,,Freshly produced sterile sweat is odorless but the bacterial degradation of precursors in the sweat can make it odorous. There exist trillions of bacteria, fungi, viruses, archaea, and small arthropods on the skin surface forming the skin microbiome.,,The malodor arising from sweat perspiration is mainly based on steroids, long-chain fatty acids, volatile fatty acids, and thioalcohols.In brief, the interplay of skin gland secretions and cutaneous microbiomes in the human body leads to sweat-induced body odor, as shown in In light of the significant role of sweat in the odor generation of sportswear, it is of necessity to have a full picture of the sweat loss quantification and the sweat mapping on the human body, especially under exercise-induced load. Diverse methods have been reported to study the sweating pattern of the human body in terms of whole-body sweat rate (WSR), regional sweat rate (RSR), and sweat composition.,,,,,−2·min−1) can be computed. This approach is quite direct and is commonly used in the laboratory, yet it is impractical for the quantification of whole-body sweating in real-life physical activities.For the determination of WSR and electrolyte content from the entire body, a whole-body rinse technique was preferably used.,2, and for some particular sites, such as the toe, the medial and lateral aspects of the foot, an exceptionally smaller size of 1.4 cm2 was used.,,,,,−2·min−1) can be calculated from the mass change, the surface area, and the application time of the patch. For most areas of the human body, custom-sized plastic sheeting was attached to each pad to prevent the evaporation of sweat, and stretchy long-sleeve T-shirts and trousers were put on to ensure that each pad is in intimate contact with the skin. For the breast area of females, pads with plastic sheeting were attached inside a sports bra.The most commonly used routes to measure RSR are via ventilated capsules and technical absorbents. Typically, the ventilated capsule method is to attach the capsules to the selected sites of the human body, either glued or secured with an elastic strip, and to ventilate them with air at a steady speed.,,,,Comparing the two approaches, each has its own merits and limitations. The ventilated capsules can provide a continuous trace of local sweating. However, their coverage area is limited and is impractical to use for athletes engaging in contact or outdoor sports.,,All of the sweating pattern measuring techniques aforementioned were performed by trained personnel in laboratory environments, utilizing costly equipment and complex sampling procedures. In the new era, revolutionary skin-based wearable sensors have been used to assess dynamic sweating in a continuous and portable way.,,2 max), with the lower intensity equaling 55% of VO2 max and the higher 75% of VO2 max. The medial and lower back , and the forehead (26) showed the highest RSR among all regions at both intensities, whereas the lowest RSR mainly lay in the hand regions , the plantar foot areas , the face regions , as well as the upper arm  and medial thigh (19). Overall, the torso showed a relatively higher RSR than the extremities at both intensities, and the RSR decreased from the medial to lateral across the torso. The increase in exercise intensity resulted in the increase in RSR in nearly all regions, except for feet and ankles, but has little impact on the whole-body sweat distribution.Because odor in sportswear is closely related to sweat, how sweat distributes across the human body should be comprehensively understood. The whole-body mapping of sweat distribution has been intensively studied using the absorbent technique by a research team from Environmental Ergonomics Research Center, Loughborough University, in the UK.2 max at 60% and VO2 max at 75%). It was found that for female participants, the medial upper back (7) shows the highest RSR at the lower intensity, whereas the bra triangle (b) tops at the higher intensity. For male participants, the top three showing the highest RSR are medial mid back (9), medial upper back (7), and lower back (12) at both intensities, consistent with the previous results targeting solely young males.,2. The comparison showed that RSR in the older is significantly lower than the younger group in almost all body regions at rest and specific regions  during exercise. In both groups during exercise, the highest RSR was found at the posterior torso, the upper and medial regions  in particular, and the lowest RSR was observed at the feet region.Adopting a similar measurement approach, the sweat distribution across the whole body, with the exception of the head, was studied targeting differences between young Caucasian females and males,,,Other studies have focused on the upper body sweat distribution when subjecting participants to exercise-related hyperthermia.,It should be noted that discrepancies occur between studies because of differences in environmental conditions, participant selections, heat-stimulating protocols, exercise intensities, measurement approaches, and measurement sites. For example, to build an environment that stimulates passive sweating, measures were taken by rising ambient temperature, immersing participants’ lower leg and/or feet in a hot water bath, and clothing the participants with hot water-perfusion suits.,Sportswear, worn next to skin, is in direct contact with human perspirations during heat-stimulated sports activities. Traditional hydrophilic fabrics such as cotton are easily wetted by perspirations but hard to be dried, leading to the accumulation of moisture in the space between the clothing and the skin.,,The first theory to obtain directional fluid transport is to create asymmetric wettability between the two faces of fabrics. One way is through the selection of yarns and the design of fabric structures. Usually, hydrophobic yarns and hydrophilic yarns are used for the inner side and the outer side respectively to create the directional water penetration in fabrics. Differently, a bilayer fabric was proposed with hydrophobic polyethylene terephthalate (PET) yarns inside and moisture-responsive yarns outside.,2 and hybrid silica).The other approach is through chemical treatment. A simple way to achieve asymmetric wettability is to apply a hydrophobic finishing on one face of a hydrophilic fabric or a hydrophilic finishing on one side of a hydrophobic fabric.−1·cm−2·V−1) at low voltage (1–6 V), and the combination with insoles and sportswear illustrated the application possibility in real-life situations.Taking inspiration from the water-collecting and droplet-transporting abilities in natural creatures, such as desert beetles,Novel textile or fibrous materials with sweat-managing ability are under continuing development. The theories behind sweat management in textiles are focused on the unidirectional water transport via Janus wettability, wettability gradient, or a combination of both. Further exploration by exploiting the electroosmotic pump mechanism provides new ideas on active sweat transportation in sportswear. The main purpose is to provide excellent physical comfort for the wearer under the circumstance of substantial sweating during active activities. Nevertheless, wearer comfort and product sustainability are often ignored in these studies, and the added functionality tends to make the products less recyclable because of the use of fiber blends and surface chemical treatments.,E/m3 according to EN 13725. It has been argued that the laboratory setting of dynamic olfactometry makes it unreliable to predict people’s real-world reaction to odor, because various perceptual and physiological responses may occur when the human body is entirely exposed to odor in real life.,,,To demonstrate the effects of textile materials on the odor-control function in sportswear, various odor evaluation techniques have been used by researchers, which can be broadly classified into the sensory method and the instrumental method. The sensorial technique involves a panel of assessors, trained or untrained, to determine the odor concentration, odor intensity, and hedonic tone.,,,,14C-labeled isovaleric acid, a representative substance of sweat odor, to/from knitted fabricsThe instrumental methods, on the other hand, appear more objective, standardized, and scientific, and are usually used to separate, quantify and/or identify the chemical compositions. A common procedure for odor analysis involves three steps: sample preparation and injection, separation, and detection. Diverse combinations have been used for VOC measurements regarding odor formation in textiles, such as GC-MS,It has been mentioned in previous sectors that body odor arises from the synergy of secretions from the human skin, and clothing, especially sportswear, would easily generate an unfavorable odor when soaked with sweat. An experimental study as early as 1953 has identified the contributing role of clothing in the production of axillary odor.Staphylococcus spp.; differently, the other dominating microbiome on the skin was Corynebacterium spp., which was generally regarded as the most important species causing axillary odor, whereas the other prominent microbiome on textiles was Micrococcus spp., which was held responsible next to Corynebacterium species.Staphylococcus spp. were detected in relatively large amounts in almost all fabrics, while Micrococcus spp. were predominantly identified in 100% polyester and mixed synthetic fabrics.A study in 2007 investigated the effects of fiber type  and knit structure  on the axillary odor intensity of apparel fabrics, and further the link with bacterial populations.,Tg) of wool under the action of moisture.Two theories have been proposed to explain why polyester tends to be more odorous than cotton and wool B87: (1) ,β-cyclodextrin finish to cotton and polyester fabrics.,,A large quantity of chemical compositions has been identified in the complex mixture of VOCs from the human body and textile samples, varying between genders, ages, body sites, fiber types, and even the methods used to collect scent.To date, most research focused on the effects of various fiber types and contents , some on textile finishing, but few on fabric structures. Possible explanations for varied odor-control properties of different textile materials include but are not limited to the reaction between functional groups in fibers and odorant compounds, selective growth of the bacterial species that contribute majorly to malodor, and the microclimate change between the clothing and human body.There are three mainstream routes to resolve the odor issue in textiles: (1) To avoid the generation of odor from the source by eliminating the bacteria; (2) to adsorb the odorous chemicals using adsorbent materials; (3) to degrade the odorous compounds by way of photocatalysts. But each has its possible problems, as shown in ,Given the crucial role of microorganisms in turning sweat from the initial odorless and sterile state to an acrid odorous state, imparting antimicrobial properties to fibers and/or fabrics has become the most common strategy to tackle odor issues. Antimicrobial agents used in commercial textiles include silver, triclosan, metal salts, polyhexamethylene biguanide (PHMB), and quaternary ammonium compounds (quats). Methods to incorporate these antimicrobials into textiles vary depending on the agent and fiber type. There has been a mature market featuring antimicrobial fibers or textiles. However, the effectiveness of antimicrobial-treated fabrics in odor management might be limited,,A different approach involves applying adsorbent finishes on textile materials to adsorb the odorous molecules. The odor-control behaviors of different fiber materials basically are all related to adsorption. The diverse functional groups on the surface of fiber materials and the functional groups of the odor molecules determine the adsorption behavior. In addition to the inherent adsorption property of fibers/fabrics, other adsorbers have been developed to endow textile materials an enhanced odor removal ability, such as activated carbon, zeolites, and cyclodextrins.,2) is the most commonly used photocatalyst for either purpose. Substrate textile materials range from commonly used cotton and polyester fibers to glass fibers and acrylic/cellulose diacetate blend fibers.,,,2 on textiles, the first of which is to add TiO2 to the melt polymer of synthetic fibers before extrusion, and the other is to directly finish fabrics with TiO2 using padding, coating, or impregnation methods.Another alternative option is to convert odorous VOCs into odorless constituents by the use of photocatalysts. This technique has been considered promising in indoor air purification, and its application in the textile field has also been reviewed.In summary, there are plenty of drawbacks in current deodorant products, which call for the development of new odor-control textiles. The antimicrobial technique appears to be the most popular way, but concerns, including the risk of antibiotic/antibacterial resistance, effect on the resident flora of the human body, and the adverse impact on the environment, arise, not to mention the questionable effectiveness, and the likely impaired properties of textiles. Little research has been conducted on the influences of the adsorbent materials on the odor-managing property of textiles after exposure to perspiration. And the possibility of applying photocatalytic decomposition to resolve sweat odor issues in sportswear remains a puzzle.To sum up, body odor arising after sweating is a synergistic effect of skin secretions and bacterial degradation. The degradation of precursor compounds in perspiration by bacteria in the humid micro-environment leads to the production of odorous chemicals, the volatilization of which triggers the human olfactory sensing of malodor. The transferring and clinging of on-skin substances to sportswear make clothing a second source of the odor. Considering the significant role of sweat in odor formation, the sweat distribution of the human body and the advanced sweat-managing techniques were reviewed. Despite differences in sweating rate between genders, the sweat distributions of both are alike. To realize directional fluid transport in textiles, current methods include creating asymmetric wettability in Janus fabrics with hydrophobic inside and hydrophilic outside, inducing a wettability gradient through the thickness of fabrics, and forming Murray hierarchical structures. None of the sweat management developments in textiles, however, has addressed their effects on sweat-induced odor. Moreover, the odor in fabrics is usually assessed with the human sensory method, and/or instrumental method. Consensus is reached through experiments that wool shows the best odor adsorption and retention, closely followed by cotton, and polyester has been repeatedly shown to be among the worst odorous textile material. Other proposed influence factors embody textile finishing agents, the physical structure of fibers and fabrics, and microclimate change.(1)It remains unclear whether or not the fabrics having superior sweat transport abilities could demonstrate an improved odor-control function. Further experimental analysis is needed to reveal the association between sweat-managing and odor-control properties of fabrics.(2)The study on the influence of fabric structure variations on the odor adsorption/desorption of fabrics is very limited. It would be both cost-efficient and eco-friendly if the optimized combination of knit design and fiber selection could be determined for odor reduction in textiles.(3)More plant-based substances and fibers with antibacterial actions could be exploited. The efficacy of sustainable cyclodextrin treatment on various textiles to adsorb sweat-induced VOCs could also be further explored.(4)Considering the selective growth of bacteria on different textile materials, targeted antimicrobial agents could be taken into account to replace the wide-spectrum ones, to reduce their side effects on profitable strains.(5)New sportswear design may be explored to use different fiber materials or treatments in specific target areas which are prone to sweat concentration and malodor development. For example, the unidirectional moisture transport properties of sportswear fabrics could be improved by novel yarn materials, knit structure designs, and surface modification of fibers or fabrics.Based on different mechanisms, the solutions to malodor in sportswear are classified as antimicrobial, adsorbent, and photocatalyst degradation types. Similar to antimicrobial deodorants, antimicrobial-treated fabrics may impose hazardous impacts not only on aquatic creatures but also on the safety of humans themselves. The other two approaches, by contrast, are a long way from application in sportswear because of a lack of relevant research and possible drawbacks, such as high cost, impairment to comfort and physical properties, irritation to the skin, and safety issues especially when metal ions are used. In light of the progress made on sweat management and odor control in textiles, more need to be done to develop next-generation sportswear that exhibits superb odor elimination or suppression properties. To this end, the following areas warrant further research.