Abstract Background Interventions that use nature contact to promote health and well-being exist at the societal/infrastructural level (incl. nature-based solutions) and the individual/group level (incl. nature-based therapies). One way nature-based therapies promote health is by fostering resilience to manage stressors. Nature-based biopsychosocial resilience theory (NBRT) provides a framework to explain how nature plays a role in how resilience-related adaptive resources are built and maintained but this has yet to be tested. Methods The current paper outlines a four-year multi-country (Austria, Belgium, Bulgaria, Denmark, Italy, the Netherlands, Spain, Sweden, the UK) research programme that tests the NBRT framework and explores how nature-based therapies can build and maintain individual and community resilience. As well as reviewing and mapping existing interventions globally, nine case studies across Europe are exploring how nature promotes resilience across: (1) whole populations (three case studies); (2) individuals at-risk of metabolic syndrome (three case studies); and (3) individuals with existing issues such as chronic stress, mobility challenges, or cognitive impairments (three case studies). Three case studies use longitudinal cohorts, five use randomised controlled trials, and one a practitioner shared-experience approach. The determinants and impacts of nature-based therapies are also considered beyond effects on individual participants, by assessing distributional issues (e.g., health equity), environmental impacts, financial implications, broader societal acceptability and engagement, as well as the barriers and enablers to successful implementation. In three specific case studies (Barcelona, Padua and Salzburg), this is done through multi-sectoral social innovation actions we refer to as ‘Resilience Hubs’. Results will be summarised in academic publications, a series of sector-specific guides, and an overall ‘What works’ guide for practitioners, policy makers, and the public. Discussion We use a novel theoretical framework to structure a research and innovation programme to inform the implementation of nature-based therapies across Europe and globally. Challenges include the integration of terminology and research practices from multiple disciplinary perspectives, participant recruitment and attrition, especially among marginalised groups, a potential lack of local stakeholder time and interest, potentially small effect sizes of time-limited interventions, and difficulties in identifying distinct causal mechanisms. Mitigation strategies are discussed. Trial registration Of nine case studies (CSs), five are intervention trials and have been registered: a) CS4 doi.org/10.1186/ISRCTN74582097 (22.07.2024); b) CS5 doi.org/10.1186/ISRCTN14169596 (10.06.2024); c) CS6 clinicaltrials.gov/study/NCT06622629 (30.09.2024); d) CS7 doi.org/10.1186/ISRCTN93192592 (29.05.2024); e) CS8 clinicaltrials.gov/study/NCT06205940 (15.05.2024). All nine case studies have received ethical approval (see Declarations section).
With increasing life expectancy, a growing proportion of inguinal hernia repairs is performed in elderly patients. Evidence regarding perioperative safety and long-term outcomes in octogenarians remains limited. This study compared perioperative outcomes and one-year follow-up between patients aged < 80 and ≥ 80 years using data from the Herniamed Registry. A total of 394,309 fully documented unilateral primary inguinal hernia repairs with valid one-year follow-up were extracted from the Herniamed Registry (data export October 2025). After applying predefined inclusion and plausibility criteria, 45,576 patients aged ≥ 80 years and 348,733 patients aged < 80 years were eligible for analysis. A 1:1 propensity score–matched analysis was performed using demographic, hernia-related, surgical, and comorbidity variables, with exact matching for sex, surgical approach, and procedure type. Outcomes included intraoperative, general, and postoperative complications, complication-related reoperations, and one-year endpoints (pain at rest, pain on exertion, pain requiring treatment, recurrence, trocar hernia, secondary hemorrhage, seroma, and infection). McNemar’s test and odds ratios were used for statistical comparison. Before matching, octogenarians more frequently underwent emergency surgery (6.8
The perinatal period is a high-risk time for stroke, with possible lifelong effects. We aimed at identifying factors associated with long-term neurological outcomes and post-stroke epilepsy in patients with neonatal arterial ischemic stroke (NAIS). We analyzed patients with NAIS from the Italian Registry of Infantile Thrombosis (RITI). Associations between clinical variables and outcomes (neurological deficits and epilepsy at last follow-up) were evaluated using univariate logistic regression. Among the 181 patients included (56.2
Articular cartilage is crucial for joint function; however, it has limited regenerative capacity when damaged, a hallmark of many rheumatic diseases. Non-invasive imaging is essential for early diagnosis, therapeutic monitoring and prognostication. MRI remains the reference standard, offering detailed assessment of both morphological and compositional cartilage changes. Technological advances, including high-resolution and compositional MRI techniques such as T2 mapping, T1ρ, delayed gadolinium-enhanced MRI of cartilage, sodium imaging, diffusion imaging and ultra-short echo-time imaging, enable early detection of matrix alterations that precede structural breakdown. CT arthrography, although it involves radiation, serves as a valuable alternative when MRI is contra-indicated, offering high performance in the detection and evaluation of cartilage surface lesions. Emerging modalities, such as ultrasonography and PET, offer additional functional insights but are currently limited in scope. Artificial intelligence is poised to transform cartilage imaging through accelerated acquisition, automated segmentation, improved interpretation and enhanced efficiency, with growing clinical adoption. Advanced cartilage imaging will probably have an increasingly important role in clinical rheumatology, particularly for the optimization of individualized management of cartilage pathology. Non-invasive imaging of articular cartilage has evolved markedly and can be used to monitor response to treatment and predict disease outcomes. This Review provides rheumatologists with a comprehensive update on current and emerging imaging and analysis techniques for the assessment of cartilage.
Robotic liver resection (RLR) has emerged as a minimally invasive alternative to open liver resection (OLR) for selected primary liver tumors, but its application for major hepatectomies remains limited. This retrospective study included patients who underwent hepatectomy for hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (iCC) at Ulm University Hospital (Nov 2020–Sep 2023) and Klinikum Nuremberg (Dec 2023–Jun 2025). Patients underwent RLR (n = 65) or OLR (n = 35). Demographics, operative data (including IWATE score), and postoperative outcomes—length of stay (LOS), blood loss, complications (Clavien–Dindo), and 90-day mortality—were compared using Fisher’s exact and Mann–Whitney U tests (p < 0.05). A total of 100 patients were analyzed. Median age was 68.0 years (IQR 63.0–74.0) in RLR vs. 70.05 years (IQR 63.5–78.3) in OLR. LOS was significantly shorter after RLR (5 days [IQR 4–7] vs. 11 days [IQR 7–20.5], p < 0.001). Operative time tended to be lower with RLR (173 min [IQR 135–237] vs. 219 min [IQR 177–287], p = 0.072), and blood loss was significantly reduced (300 ml [IQR 100–625] vs. 750 ml [IQR 400–1450], p = 0.001). Bile leakage occurred in 4.6
