Search Results (28,785)

The purpose of this review is to highlight the complex influence of antibiotics on human fertility and the need for them not to be underestimated. In creating this review article, data and information from the following international databases were used: PubMed, Scopus and Clarivate Analytics. Only full text articles were used. Antibacterial antibiotics are a group of drugs essential in fighting infections, having multiple mechanisms of action at the level of the bacterial cell; but at the same time they also act on human cells. One of the important actions of antibiotics is on fertility. There are both experimental and clinical data showing the influence of some antibiotics on fertility. There are both positive and negative influences of these drugs on fertility. Some of the most important actions with a positive impact on fertility are: therapy of pelvic infections in women, treatment of endometritis, reduction in post-abortion infections, treatment of infections of the male genital tract—infections that reduce fertility. The most important negative implications of some antibiotics are the direct effects of reducing the production of gametes, decreasing the activity or quality of the gametes, reducing the synthesis of sexual hormones and negative influences on the evolution of pregnancy, including spontaneous abortion in some cases. Other negative influences are produced by the direct action of some antibiotics on the embryo. Some antibiotics such as azithromycin and nitrofurantoin increase the risk of miscarriage. Although only a limited number of antibiotics are known to have an influence on fertility, this influence should not be underestimated in clinical practice. Full article

Electronic cigarettes (e-cigarettes) have gained widespread diffusion as a perceived safer alternative to conventional smoking, particularly among women of reproductive age. The present systematic review provides an overview of the current literature on the effects of e-cigarette exposure on female reproductive function, embryonic development, and pregnancy outcomes, with a focus on underlying molecular mechanisms. A systematic literature search was conducted in PubMed, Web of Science, and Google Scholar, and the review was conducted in accordance with the PRISMA 2020 guidelines. A total of 11 studies met the eligibility criteria and were included in the qualitative synthesis, comprising six experimental and five clinical studies. Experimental studies suggest that e-cigarette exposure may impair ovarian function, leading to morphological alterations, disrupted folliculogenesis, and altered steroidogenesis, mainly through oxidative stress, apoptosis, mitochondrial dysfunction, and dysregulation of pathways such as Hippo signaling. Non-nicotine components, including propylene glycol (PG), vegetable glycerin (VG), and flavoring agents, appear to be key contributors. Adverse effects on implantation, embryo development, and placental growth have also been reported in experimental models, although further studies are needed. Clinical evidence remains scarce, suggesting possible associations between e-cigarette smoking and reduced ovarian reserve and fecundability in naturally conceiving women. No conclusive associations have been identified with in vitro fertilization outcomes. Overall, e-cigarette exposure may negatively affect female reproductive function, although the predominance of experimental data and the limited clinical evidence preclude definitive conclusions. Full article

(1) Background: Digital nature, delivered through different media, has been proposed as a scalable substitute for physical nature exposure to support psychological well-being, especially in high-income countries. This scoping review aimed to map the evidence on digital nature interventions and positive psychological outcomes. (2) Methods: Following PRISMA-ScR guidelines, we searched PubMed, ScienceDirect, and Google Scholar, supplemented by AI search and citation tracking, for studies published between 2020 and 2025. The first search was conducted between 15 November 2025 and 25 December 2025 and revisited between 5 June 2026 and 10 June 2026. We included articles published in English in peer-reviewed journals with the full text available. (3) Results: Our search yielded 67 studies from diverse cultural settings in three categories: primary studies (N = 46), review articles (N = 19) and conceptual articles (N = 2). Digital nature was associated with reduced stress and anxiety, better mood, greater restorativeness, and stronger nature connectedness, across healthy individuals, older adults, and clinical populations; reviews supported these findings at a larger scale, though some flagged mixed results for specific outcomes and technologies. Two conceptual articles explained these patterns through biophilic design and digital placemaking. (4) Conclusion: Overall, digital nature appears to be a promising approach for promoting psychological well-being, particularly where access to natural environments is limited. However, the evidence is mixed, geographically concentrated in Europe, East Asia, and North America, and methodologically heterogeneous, with no studies from low-resource settings. Further research is needed in these underrepresented regions. Full article

Background/Objectives: Functional secondary hypogonadism is frequent in men with obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM), but whether testosterone replacement therapy (TRT) produces clinically relevant metabolic benefits remains uncertain. This systematic review evaluated double-blind randomized placebo-controlled trials of TRT in obese men with functional secondary hypogonadism and either T2DM or metabolic syndrome. Methods: PubMed and Scopus were searched up to May 2026. Eligible studies enrolled adult men with biochemical hypogonadism and T2DM or metabolic syndrome, compared TRT with placebo, and reported metabolic outcomes. Open-label, single-blind, and non-randomized studies were excluded. Risk of bias was assessed with the Cochrane RoB 2 framework and certainty of evidence with GRADE. Results: Eight trials were included. The most consistent signal was improvement in body composition, mainly increased lean mass and reduced fat mass. Effects on insulin resistance were favorable in several trials but heterogeneous. GRADE certainty was low for fat mass, lean mass, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and it was very low for clamp-derived insulin sensitivity, HbA1c, fasting glucose, lipid outcomes, inflammatory and vascular surrogate markers, and long-term safety. Conclusions: Low-certainty evidence suggests that TRT may improve body composition and HOMA-IR in carefully selected men with functional secondary hypogonadism and metabolic disease, whereas effects on glycemic and lipid outcomes remain very uncertain. TRT should not be regarded as an antidiabetic or lipid-lowering intervention. Larger phenotype-specific trials with longer follow-up are needed. Full article

Objectives: Celiac disease (CD) is an immune-mediated disorder triggered by gluten ingestion. Although a gluten-free diet (GFD) is the only effective treatment, patients may still experience inflammation, nutritional imbalances, and reduced quality of life. Physical activity (PA) has demonstrated anti-inflammatory benefits; however, its role in CD management remains unclear. This systematic review aimed to synthesize evidence on the associations of PA and the outcomes of exercise interventions in individuals with CD, focusing on metabolic, nutritional, clinical, and functional outcomes. Methods: Following PRISMA guidelines, we included peer-reviewed observational and experimental studies assessing PA in individuals with CD across all age groups, without language or date restrictions. Searches were conducted in PubMed, Scopus, Web of Science, EMBASE, and SPORTDiscus. The risk of bias was evaluated using JBI and Cochrane RoB 2 tools. Results: Fourteen studies (17 publications) were included, the vast majority of which were cross-sectional, along with one quasi-experimental study and two randomized controlled trial cohorts reported across five publications. Data from these predominantly observational studies suggested possible, yet inconsistent, links between higher PA levels and better profiles in body composition, inflammatory and oxidative markers, quality of life, and psychological outcomes. Positive associations were also observed in some studies regarding gastrointestinal symptoms and adherence to the GFD. However, findings on metabolic markers and bone mineral density were inconsistent and linked to dietary factors. Conclusions: While PA represents a potential adjunct in the comprehensive management of CD, particularly in relation to functional and inflammatory outcomes. However, the current evidence remains highly preliminary, limited, and inconsistent, which restricts the strength of any definitive conclusions. Therefore, high-quality, longitudinal studies and well-designed clinical trials are needed to confirm its long-term benefits, especially in the pediatric population, and to establish specific recommendations. Full article

Obesity is a chronic, relapsing disease and a significant oncological risk factor. The correlation is most pronounced and consistent for endometrial cancer. Conversely, evidence linking obesity to ovarian cancer is less robust and varies by histotype, while the association with cervical cancer is influenced by factors related to screening, diagnosis, treatment, and survival. This review examines obesity, particularly class III (morbid) obesity, in relation to the risk of gynaecological cancer, diagnostic approaches, and management strategies. A structured narrative review of PubMed/MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection was conducted for literature published between January 2000 and December 2025. Eligible evidence included systematic reviews, meta-analyses, cohort and case–control studies, mechanistic studies and clinical guidance relevant to obesity and endometrial, ovarian or cervical cancer. Title/abstract screening and full-text selection were conducted using predefined criteria for conceptual relevance and clinical applicability. Excess adiposity contributes to endometrial carcinogenesis through hormonal dysregulation, insulin resistance and hyperinsulinaemia, adipokine imbalance, chronic inflammation, and oxidative stress. In ovarian cancer, associations are generally weaker but appear more relevant for selected histological subtypes and cumulative adiposity exposure. In cervical cancer, obesity should not be interpreted as replacing HPV-driven pathogenesis; rather, it may affect screening adequacy, treatment selection, perioperative risk, and disease-specific survival in morbidly obese patients. Current evidence does not support morbid obesity as an independent driver of all gynaecological cancers. It supports obesity as a major modifiable risk factor and clinical modifier, particularly for endometrial cancer, and highlights the need for pragmatic risk stratification based on BMI class, adiposity distribution, metabolic comorbidity, functional status and cancer-site-specific pathways. Biomarker evidence remains hypothesis-generating, and obesity-integrated oncological pathways require prospective validation in patients with a BMI ≥ 40 kg/m². Full article

Background: Korean-language medical question-answering datasets are increasingly used for large language model (LLM) development, but structural completeness alone does not establish model performance or clinical validity. We examined two national Korean medical knowledge datasets by combining a public labeling-file audit with a secondary evaluation of item-level outputs distributed with the corresponding official LLM packages. Methods: We reviewed the official documentation and complete public download inventories, parsed 34 training/validation labeling archives containing 31,036 records, and audited required fields, duplication, text length, question type, and specialty distribution. We also audited the official Qwen2.5-14B LoRA model packages and independently recalculated performance from their distributed item-level KorMedMCQA output files (2494 identical items per model). Accuracy was reported with Wilson 95% confidence intervals; model outputs were compared using an exact McNemar test and a paired bootstrap confidence interval. Because no compatible local GPU was available, model inference was not independently rerun. Results: The documentation described 34,487 labeled QA pairs, of which 31,036 (90.0%) were present in the publicly accessible training/validation labeling files; no public test-labeling archive was listed. Required fields were complete, no duplicated qa_id values were found, and one duplicated question-answer pair occurred in the Essential dataset. Multiple-choice items comprised 78.7% of all documented QA pairs, and the top three domains comprised 56.8%. In the distributed KorMedMCQA outputs, the Essential-care model answered 1603/2494 items correctly (64.27%; Wilson 95% CI 62.37–66.13%), while the Specialized-medicine model answered 1596/2494 correctly (63.99%; 95% CI 62.09–65.85%). The paired difference was 0.28 percentage points (bootstrap 95% CI −0.44 to 1.00), with no significant difference by exact McNemar test (46 vs. 39 discordant correct items; p = 0.515). Conclusions: The public training/validation labeling files showed favorable basic structural completeness, but the unavailable test labels, multiple-choice predominance, domain imbalance, limited record-level provenance, and incomplete model-package traceability constrain claims of clinical readiness. The distributed model outputs demonstrated moderate examination-style benchmark performance without a significant difference between the two models. These findings support use as research infrastructure, not evidence of clinical validity, and indicate the need for independent inference reproduction, clinician-led open-ended and safety evaluation, temporal updating, specialty-stratified reporting, and human oversight before clinical use. Full article

Background/Objectives: Increasing physical activity is important for reducing cardiometabolic risk. However, evidence on the effects of high-intensity interval training (HIIT) in physically inactive individuals, including those with extremely sedentary behavior, remains inconsistent. We evaluated the effects of HIIT on body composition and cardiometabolic outcomes compared with a non-exercise control (CON) and moderate-intensity continuous training (MICT). Methods: PubMed, Web of Science, Embase, the Cochrane Library, Ovid-hosted resources, and ClinicalTrials.gov were searched through 8 July 2026. The protocol was registered (PROSPERO CRD420251230848). Random-effects models were used. Risk of bias, evidence certainty, and robustness were assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, Grading of Recommendations Assessment, Development and Evaluation (GRADE), and leave-one-out analyses, respectively. Results: Twenty-four randomized trials involving 877 participants were analyzed. A conservative study-level summary classified all studies as having at least some concerns, including five at high risk of bias. Compared with CON, HIIT reduced body weight (weighted mean difference [WMD] = −1.60 kg), systolic blood pressure (WMD = −2.85 mmHg), diastolic blood pressure (WMD = −6.57 mmHg), low-density lipoprotein cholesterol (WMD = −0.29 mmol/L), and total cholesterol (WMD = −0.42 mmol/L), and increased maximal oxygen uptake (VO₂max; WMD = 7.72 mL/kg/min). Compared with MICT, most outcomes showed no statistically significant differences, but HIIT produced a greater VO₂max increase (WMD = 3.72 mL/kg/min). Several findings were sensitive to individual-study removal, and certainty of evidence was low or very low. No serious adverse events were reported in 11 studies; attendance or adherence was generally high in 15 studies, despite incomplete reporting and supervised interventions. Conclusions: HIIT may improve selected body composition and cardiometabolic outcomes, with VO₂max showing a relatively consistent direction of effect. However, the certainty of evidence for most outcomes was low or very low; therefore, these findings should be interpreted with caution. Current evidence is insufficient to establish equivalence to MICT or identify an optimal HIIT protocol. Larger, longer-term, high-quality trials using objective measures of sedentary behavior are needed, particularly in extremely sedentary populations. Full article

Background/Objectives: Commercial wearables are increasingly used after total hip and knee arthroplasty (THA/TKA) to record activity and gait outside the clinic and may help tailor recovery pathways. We reviewed the evidence on commercial devices, digital phenotyping, and data-informed rehabilitation after arthroplasty. Methods: We performed a structured narrative search of PubMed and Google Scholar. Of 916 records, 63 duplicates were removed, 853 were screened, 245 full texts were assessed, and 76 publications were included. Findings were synthesized thematically; no formal risk-of-bias assessment or evidence grading was undertaken. Results: Recovery differed by outcome and procedure. PROMs commonly improved within 1–3 months, while gait-quality measures recovered over about 7–13 weeks after THA and 13–24 weeks after TKA. Frequency-domain gait features, sample entropy, and machine-learning models provided information beyond step counts. Tracker-based interventions most consistently increased postoperative steps when introduced early and combined with behavior-change support, while digital rehabilitation was generally non-inferior to conventional rehabilitation. Wrist-worn consumer devices remained inaccurate with gait aids, compliance definitions varied, and higher step counts did not consistently correspond to better PROMs. Conclusions: Commercial wearables already support phenotyping and remote follow-up of individual recovery trajectories, but evidence for fully adaptive rehabilitation remains limited. Full article

Heart failure (HF) remains a major global health burden despite substantial therapeutic advances. Vericiguat, an oral soluble guanylate cyclase (sGC) stimulator, represents a distinct pharmacological strategy targeting impaired nitric oxide–sGC–cyclic guanosine monophosphate (NO–sGC–cGMP) signaling, a pathway closely linked to endothelial dysfunction, vascular stiffness, myocardial fibrosis, and adverse remodeling. This narrative review synthesizes the current evidence on the efficacy, safety, and clinical positioning of vericiguat across the heart failure spectrum, with a particular focus on worsening heart failure with reduced ejection fraction (HFrEF), while integrating recent trial data, updated guideline recommendations, and emerging real-world evidence to define its contemporary role in clinical practice. Randomized trials, subgroup analyses, and contemporary meta-analyses indicate that vericiguat provides a modest but clinically relevant reduction in HF-related outcomes, especially in high-risk patients with recent decompensation. However, its overall effect appears smaller than that of foundational therapies such as angiotensin receptor–neprilysin inhibitors and sodium–glucose cotransporter 2 inhibitors. Recently published data from the VICTOR program further refine the role of vericiguat in compensated outpatients with chronic HFrEF, showing a neutral primary outcome but providing supportive hypothesis-generating signals across a broader risk continuum while confirming a favorable safety profile. Overall, vericiguat should be regarded not as a replacement for cornerstone therapy but as a mechanistically complementary, risk-targeted adjunct for selected patients with persistent residual risk despite guideline-directed medical therapy. Full article

Background: Pain is one of the most common and challenging clinical problems in pediatric care, affecting up to three-quarters of hospitalized children. Hydromorphone has gained increasing clinical interest as an alternative opioid in pediatric settings, although evidence supporting its use remains limited. Methods: A narrative literature review was conducted in accordance with SANRA recommendations using PubMed, Embase, and the Cochrane Library to identify studies evaluating hydromorphone use in pediatric and adolescent patients across perioperative, postoperative, intensive care unit (ICU), and emergency settings. Results: Available evidence suggests that hydromorphone may provide effective analgesia in pediatric patients across multiple clinical contexts, including postoperative pain control, patient-controlled analgesia, analgosedation in the ICU, and acute pain management in the emergency department. However, the available data are largely derived from small, heterogeneous, and predominantly retrospective studies, often limited to single-center experiences. Conclusions: Hydromorphone may represent a useful alternative opioid for pediatric pain management and analgosedation, particularly when morphine is ineffective or poorly tolerated. Nevertheless, the current evidence base is limited, heterogeneous, and largely observational, precluding robust conclusions regarding its comparative effectiveness and safety. Further well-designed pediatric studies are required to better define its role in clinical practice. Full article

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease of the nasal and paranasal sinus mucosa, associated with significant impairment in quality of life, frequent postoperative recurrence, and repeated need for systemic glucocorticosteroid therapy. Despite the availability of biologics targeting IL-4/IL-13, IL-5, and IgE, a subset of patients shows incomplete or insufficient clinical response. In this context, upstream targeting of epithelial alarmins, particularly thymic stromal lymphopoietin (TSLP), has emerged as a potential therapeutic strategy. To critically review current evidence on the role of TSLP in CRSwNP and to evaluate available data on the mechanism of action, clinical efficacy, and therapeutic potential of tezepelumab in severe and recurrent disease. Materials and Methods: A narrative review was conducted using PubMed, Scopus, and Web of Science. Studies published between 2016 and 2026 were included, comprising experimental research, phase II–III clinical trials, systematic reviews, and international guidelines. Results: TSLP functions as an epithelial alarmin that initiates and amplifies type 2 inflammation via dendritic cell activation, Th2 polarization, and activation of type 2 innate lymphoid cells (ILC2). Data suggests that tezepelumab, a monoclonal antibody targeting TSLP, may reduce inflammation and regulate the immune system. Evidence from asthma populations and relevant CRSwNP subgroups indicates potential improvements in nasal polyp score, congestion, olfactory function and quality of life. It is our understanding that the safety profile appears comparable to placebo, with no new safety concerns having been identified in long-term studies. Conclusions: Tezepelumab is a promising biologic that targets inflammation in CRSwNP. It may benefit severe, recurrent, treatment-resistant disease by modulating immune pathways. However, evidence is indirect and limited, and more trials are needed to define its efficacy, identify biomarkers, and clarify its role in treatment algorithms. Full article

Sarcopenia is an age-related progressive decline in skeletal muscle mass, strength, and physical performance that increases the risk of falls, disability, and reduced quality of life among older adults. Its pathogenesis is multifactorial and involves chronic low-grade inflammation, hormonal disturbances, insulin resistance, and mitochondrial dysfunction, leading to an imbalance between muscle protein synthesis and degradation. The aim of this study was to summarise current knowledge regarding the mechanisms underlying sarcopenia, contemporary diagnostic methods, and the effectiveness of modern nutritional and exercise-based strategies, with particular emphasis on technologies supporting patient monitoring. This study is a structured narrative review conducted across PubMed, Scopus, and Web of Science databases, with the literature search completed on 1 March 2026. Separate searches were performed for thematic sections, including pathophysiology, diagnosis, physical activity, nutritional interventions, plant-derived compounds, and digital health technologies. While the core search focused on publications from 2023–2025, specific time-bound deviations were applied: the search for plant-derived compounds was extended back to 2020, and combined interventions were searched up to March 2026 to ensure the inclusion of the most recent evidence. The review included 53 peer-reviewed primary studies (RCTs and observational) and secondary literature (reviews and meta-analyses) involving individuals aged ≥60 years. The most robust evidence supports multicomponent interventions, particularly the synergy between resistance training and adequate protein intake (1.2–1.5 g/kg/day), often supplemented with leucine, vitamin D, omega-3 fatty acids, and creatine. Such strategies effectively counteract anabolic resistance by combining mechanical loading with the stimulation of the mTORC1 signalling pathway, leading to significant improvements in muscle mass, strength, and physical function. While isolated protein or micronutrient supplementation shows limited effectiveness in the absence of exercise, their role as supportive elements in multimodal strategies is well-documented. Furthermore, emerging digital health technologies—including wearable sensors and telerehabilitation—are proving essential for clinical practice, enabling precise, continuous monitoring of physical activity and gait parameters under free-living conditions, which enhances both patient adherence and long-term therapeutic outcomes. Full article

Alcohol-related liver disease (ALD) and metabolic dysfunction and alcohol-related liver disease (MetALD) are increasingly recognised as biologically heterogeneous conditions, but circulating novel adipokines have not been systematically synthesised in this setting. We searched PubMed/MEDLINE, Embase, Web of Science, Scopus and Cochrane CENTRAL from inception to 31 December 2025 for studies measuring chemerin, visfatin/nicotinamide phosphoribosyltransferase (NAMPT), vaspin, omentin-1 or retinol-binding protein 4 (RBP-4) in adults with ALD or MetALD; data were synthesised narratively using Synthesis Without Meta-Analysis (SWiM). Grey literature and non-English databases were not searched, which may have led to incomplete retrieval of small single-centre studies. Five studies were included. Direct ALD evidence came mainly from three cross-sectional alcoholic cirrhosis cohorts, while one population cohort linked baseline RBP-4 to incident MetALD/ALD. RBP-4 showed a phase-dependent pattern, increasing before incident MetALD/ALD but decreasing in established cirrhosis with impaired synthetic function. Chemerin was reduced, omentin-1 was markedly elevated, vaspin was nonspecific and historical visfatin/NAMPT assays were difficult to interpret. Current evidence supports a hypothesis-generating three-axis framework: hepatic source failure, impaired hepatic clearance/portal-systemic shunting and alcohol-driven adipose-liver inflammation. The available evidence chiefly reflects chronic alcohol-related cirrhosis together with limited incident MetALD/ALD risk data, rather than the full ALD/MetALD spectrum. Prospective MetALD-stratified cohorts with isoform-specific assays and objective alcohol biomarkers are required. Full article

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary cicatricial alopecias with no FDA-approved treatments and a limited evidence base for any intervention. Alopecia areata (AA), while better studied, similarly lacks a well-tolerated, locally acting non-pharmacologic option. The 308 nm excimer laser is established in inflammatory dermatoses, yet its role in hair loss conditions has not been systematically characterized. This review provides an updated appraisal of the AA evidence base and the first systematic appraisal of excimer therapy in LPP and FFA. Methods: We searched PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane CENTRAL and synthesized findings narratively, given substantial heterogeneity across included studies. Results: In total, 33 studies reporting 634 unique patients met the inclusion criteria across AA subtypes (patchy/localized, totalis, universalis, ophiasic, and pediatric), LPP, and FFA. Most evidence (30/33 studies, 613/634 patients) pertains to AA, where excimer therapy produced meaningful hair regrowth in a large proportion of patients. Cicatricial data was more limited (3/33 studies, 21/634 patients). LPP data suggest improvement in inflammatory symptoms; FFA results were mixed. Adverse effects were mild and transient, primarily erythema and hyperpigmentation. Conclusions: The use of 308 nm excimer therapy may be a well-tolerated non-pharmacologic option when pharmacologic therapy is contraindicated, poorly tolerated, or inadequately effective, though limited evidence, especially for LPP and FFA, warrants further investigation across these and other conditions not yet studied. Full article