Search Results (7,846)

Binge eating disorder (BED) is a prevalent eating disorder lacking adequate pharmacological interventions. This review examines the therapeutic potential of glucagon-like peptide-1 receptor agonists (GLP-1RAs), medications approved for type 2 diabetes and obesity now being investigated for eating disorders through their modulation of metabolic and reward pathways. A narrative review was conducted using PubMed/MEDLINE, through May 2025, to examine GLP-1RA effects on BED, including preclinical and clinical studies, mechanistic investigations, and relevant reviews. GLP-1 receptors (GLP-1Rs) are expressed in hypothalamic nuclei, regulating energy homeostasis and mesolimbic circuits controlling food reward. Preclinical studies demonstrate that GLP-1RAs reduce food-seeking behavior, suppress dopamine signaling in reward circuits, and modulate neural transmission in key brain regions. These effects extend beyond appetite suppression to directly modify reward processing underlying compulsive eating. Emerging clinical evidence with semaglutide and liraglutide report reductions in binge eating episodes, decreased food cravings, and improved symptom scores. However, current studies remain small-scale with methodological limitations, and translating findings from animal models to human eating disorder complexity presents significant challenges. This review integrates preclinical and clinical evidence demonstrating that GLP-1RAs modulate both metabolic and reward pathways. By elucidating the underlying neurobiological mechanisms, GLP-1RAs may offer advantages over current symptom-focused therapies for BED. Full article

Background and Objectives: Low-grade triple-negative breast carcinomas (LG-TNBCs) represent a rare subset of breast cancers that deviate from the aggressive clinical course typically associated with triple-negative tumors. This narrative review aims to consolidate current knowledge on LG-TNBCs, highlighting their diagnostic features, molecular characteristics, and clinical implications to guide appropriate patient management and prevent overtreatment. Materials and Methods: We conducted a comprehensive narrative review using PubMed/MEDLINE, Embase, and Scopus databases up to September 2025. Search terms included combinations of “triple-negative breast carcinoma”, “low-grade”, “adenoid cystic carcinoma”, “secretory carcinoma”, “acinic cell carcinoma”, “tall cell carcinoma with reversed polarity”, “low-grade adenosquamous carcinoma”, and “fibromatosis-like metaplastic carcinoma.” Studies reporting clinicopathologic, immunohistochemical, or molecular data were included. Results: LG-TNBCs include seven distinct entities: adenoid cystic carcinoma, secretory carcinoma, acinic cell carcinoma, tall cell carcinoma with reversed polarity, low-grade adenosquamous carcinoma, fibromatosis-like metaplastic carcinoma, and mucoepidermoid carcinoma. These neoplasms are characterized by distinct morphologic patterns, specific immunohistochemical profiles, and recurrent molecular alterations such as ETV6-NTRK3 fusions and MYB rearrangements. Despite their triple-negative immunoprofile, they demonstrate indolent clinical behavior with excellent prognosis and low metastatic potential, although local recurrence is reported in variants exhibiting infiltrative, locally aggressive behavior. Conclusions: Recognition of LG-TNBCs is essential to prevent overtreatment and guide personalized patient management. Molecular characterization provides diagnostic confirmation and therapeutic opportunities, particularly for NTRK-fusion-positive tumors treatable with targeted inhibitors, highlighting the importance of precision medicine in rare breast tumors. Full article

Background: Stroke leads to lasting disability by disrupting the connectivity of functional brain networks. Although several rehabilitation methods are promising, our full understanding of how these strategies restore network function is still limited. Here, we map how non-invasive brain stimulation (NIBS), brain–computer interface (BCI)/neurofeedback, virtual reality (VR), and robot-assisted therapy restore connectivity within the sensorimotor network (SMN), default mode network (DMN), and salience network, and we contextualize these effects within the known temporal evolution of post-stroke motor network reorganization. Methods: This scoping review adhered to PRISMA guidelines and searched PubMed, Cochrane, and Medline from January 2015 to January 2025 for clinical trials focused on stroke rehabilitation with functional connectivity outcomes. Included studies used conventional therapy, neuromodulation, or feedback-based interventions. Results: Twenty-three studies fulfilled the inclusion criteria, covering interventions like robotic training, transcranial stimulation (tDCS/TMS), brain–computer interfaces, virtual reality, and cognitive training. Motor impairments were linked to disrupted interhemispheric sensorimotor connectivity, while cognitive issues reflected changes in frontoparietal and default mode networks. Combining neuromodulation with feedback-based methods showed better network recovery than standard therapy alone, with clinical improvements closely associated with connectivity alterations. Conclusions: Effective stroke rehabilitation depends on targeting specific disrupted networks through various modalities. Robotic interventions focus on restoring structural motor pathways, feedback-enhanced methods improve temporal synchronization, and cognitive training aims to enhance higher-order network integration. Future research should work toward standardizing connectivity assessment protocols and conducting multicenter trials. This will help develop evidence-based, network-focused rehabilitation guidelines that effectively translate mechanistic insights into personalized clinical treatments. Full article

Background and Objectives: Cancer cachexia is a debilitating metabolic syndrome highly prevalent in colorectal cancer (CRC), characterized by progressive skeletal muscle wasting. The myostatin–FOXO signaling pathway contributes to this process by activating the E3 ubiquitin ligases MuRF-1 and Atrogin-1. Exercise is a promising non-pharmacological strategy, but its effects on this pathway in CRC cachexia remain unclear. This review aimed to synthesize preclinical evidence on the impact of exercise on the myostatin–FOXO axis. Materials and Methods: A comprehensive search was performed in PubMed/MEDLINE, Scopus, Web of Science, and Science Direct from inception through August 2025. Eligible studies included murine CRC models (C26 or Apc^Min/+) exposed to aerobic, resistance, or combined exercise interventions, with outcomes assessing myostatin, FOXO, MuRF-1, or Atrogin-1. Study quality was appraised using the CAMARADES 10-item checklist. Results: eleven studies met the criteria, with quality scores ranging from 6 to 8. Aerobic exercise, particularly voluntary wheel running, most consistently reduced MuRF-1 expression and systemic inflammation, whereas resistance and eccentric training exerted stronger inhibitory effects on FOXO and Atrogin-1. Myostatin was directly measured in two studies, yielding inconsistent results. Resistance and eccentric training promoted anabolic signaling (e.g., mTORC1), whereas aerobic protocols improved oxidative capacity. Variability in exercise type, intensity, and duration contributed to heterogeneity across findings. Conclusions: Exercise attenuates skeletal muscle catabolism in CRC-induced cachexia, mainly through modulation of the myostatin–FOXO pathway and downstream ligases. However, limited direct data on myostatin and methodological heterogeneity underscore the need for standardized protocols and translational studies. This review provides the first focused synthesis of exercise-mediated regulation of this pathway in CRC cachexia. Full article

Background/Objectives: Although systematic reviews and meta-analyses have examined immune-inflammatory indices in cardiovascular disease (CVD), the evidence remains scattered and inconsistent. This umbrella review aims to synthesize findings and evaluate the overall predictive value of these indices for clinical outcomes. Methods: We systematically searched PubMed, Cochrane Library, Web of Science, Embase, Scopus, and Medline for systematic reviews with meta-analyses assessing neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and systemic inflammation response index (SIRI) in patients with CVD. Study quality and certainty of evidence were appraised using AMSTAR-2 and GRADE, respectively. Results: A total of 35 meta-analyses covering 106 unique outcomes were included, of which 87 showed significant associations. Elevated NLR and SII were consistently linked to higher risks of CVD mortality, major adverse cardiovascular events, myocardial infarction, heart failure, and stroke. PLR and SIRI were primarily associated with poor recovery from stroke and increased mortality in ST-elevation myocardial infarction. Specifically, the methodological quality of the included reviews was generally moderate to high according to AMSTAR-2, whereas none of the associations reached high certainty based on GRADE, with most rated as low or very low and about one-quarter as moderate certainty. Conclusions: The overall certainty of evidence remains limited according to GRADE, alongside methodological heterogeneity, population variability, and inconsistent thresholds that further restrict the direct applicability of these findings in clinical practice. Nevertheless, available evidence indicates that elevated immune-inflammatory indices are likely associated with worse clinical outcomes in patients with CVD. Future research should prioritize establishing standardized cutoffs, improving methodological consistency, and validating these indices across diverse populations to support their integration into clinical risk-stratification frameworks. Full article

Introduction: Adolescent idiopathic scoliosis (AIS) presents not only physical but also psychological challenges for affected patients, frequently requiring comprehensive management that includes psychological interventions. Accurate and transparent reporting of interventions is essential to support reproducibility, facilitate clinical translation, and advance research quality. However, the completeness of intervention reporting and adherence to standardized guidelines in published studies on psychological interventions for pediatric AIS patients remains unclear. Methods: We searched Medline, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies involving psychological interventions in AIS. Intervention reporting was analyzed using the Template for Intervention Description and Replication (TIDieR) checklist. Adherence to reporting guidelines was assessed for different study designs. Results: We identified 18 studies, which had suboptimal reporting of interventions. For key TIDieR items, all studies reported the brief name and rationale, but completeness for other elements varied: methods (14/18 studies), materials (10/18), provider (6/18), and mode of delivery (8/18) were described inconsistently. Setting was reported in only 3/18 studies, whereas the details about tailoring, modifications, and fidelity were largely lacking or deemed non-applicable. For eight randomized trials, several critical CONSORT items, such as trial design, randomization procedures, blinding, and trial registration were often unreported. Among five observational studies, reporting of STROBE key elements such as study design, setting, eligibility criteria, and funding was more consistent, but methods addressing bias, participant flow, missing data, and category boundaries for variables were largely insufficient. Similar gaps were observed for relevant TREND checklist items for nonrandomized intervention studies. Conclusions: The reporting of psychological interventions for AIS in the literature is frequently incomplete, especially for intervention details essential for the reproducibility of the intervention and assessment of risk of bias. Adoption of standardized reporting guidelines is necessary to improve intervention transparency, replicability, and translation into clinical practice. Future research should focus on prospective evaluations of reporting guideline implementation and its impact on research quality in this field. Full article

Background: Mandibular canal (MC) variants are common and clinically relevant for anesthesia, implant placement, third-molar surgery, and osteotomies. Reported prevalences vary widely because they depend on imaging modality, acquisition parameters, and operational definitions. Methods: This was a focused narrative review with structured methods (PubMed/MEDLINE and Scopus, 2000–6 October 2025; last search 6 October 2025), predefined eligibility criteria and dual independent screening; no meta-analysis was conducted. Study-selection counts are reported in the text. Prevalence statements are contextualized by modality, imaging parameters (e.g., cone-beam computed tomography (CBCT) voxel size magnetic resonance imaging (MRI) field strength/sequences), and diagnostic thresholds (e.g., anterior loop (AL) criteria). Results: Compared with panoramic radiography (PR), CBCT consistently reveals more variant pathways. Typical CBCT estimates for bifid MC fall in the single-digit to low double-digit range, contingent on voxel size and definitions, whereas PR detects far fewer. Trifid canals are uncommon (≈1–2% in CBCT series). Reported retromolar canal frequencies vary broadly across populations and protocols, and AL length and prevalence are threshold-dependent. Selective MRI may complement CBCT by depicting soft-tissue branches not accompanied by a bony canal. We synthesize a variant-aware, imaging-led workflow: PR for screening; CBCT when predefined criteria are met and results are reasonably expected to change management; MRI reserved for targeted soft-tissue questions, in line with As Low as Reasonably Achievable (ALARA)/and As Low As Diagnostically Acceptable (ALADA) principles. We apply the Landfald Clinical Framework (LCF) as a hypothesis-generating, clinical synthesis tool linking variant patterns to procedural modifications and risk mitigation. Conclusions: A narrowed, clinically oriented approach—contextualizing prevalence by modality and definitions and applying an imaging-led, variant-aware workflow—can improve planning and safety in the posterior mandible. The LCF is used pragmatically within this workflow and does not constitute a new anatomical taxonomy; formal reliability and validity testing remain necessary. Full article

Background/Objectives: This narrative review examines how developmentally appropriate safety and health education interventions in early childhood settings impact the incidence and severity of pediatric conditions requiring neurosurgical intervention, and which educational approaches most effectively promote neurological health and injury prevention among preschool-aged children. Methods: This narrative review employed a systematic literature search across medical and educational databases (ERIC, PsycINFO, MEDLINE, CINAHL, Education Source, and specialized neurosurgical sources) to identify relevant studies from 2000 to 2025. Results: Structured, play-based safety education in early childhood settings significantly reduces traumatic brain injury incidence. Programs integrating parent–educator partnerships have shown greater effectiveness in establishing protective behaviors than classroom-only approaches. Culturally responsive interventions have demonstrated specific success in high-risk communities, reducing complications from untreated hydrocephalus resulting from infections. Early childhood education can significantly impact recognition of neurological warning signs. Conclusions: Early, developmentally appropriate health education establishes protective behaviors that reduce pediatric neurosurgical cases. Implementation should prioritize experiential safety learning, recognition of neurological warning signs, and strong family–educator partnerships. Findings support integrating neurosurgical prevention strategies within early childhood curricula and developing interdisciplinary approaches connecting medical specialists with early childhood educators to reduce traumatic brain injuries, acquired hydrocephalus, and neural tube defects. Full article

Background: Curettage is a well-established treatment for benign bone tumors. Among the adjuvant treatments available to minimize the risk of local recurrence after curettage, cryotherapy is one of the most used and documented. Our study aims to summarize the results of curettage and intraoperative cryotherapy for the treatment of bone tumors in the modern literature. Methods: We systematically reviewed the existing literature, searching for cases treated with intraoperative cryotherapy after bone curettage in orthopedic oncology. Articles from the PubMed and MEDLINE databases, published between January 2000 and January 2025, were included. Our research was conducted in accordance with PRISMA guidelines. Case reports were excluded. For each study, we recorded the number of cases, their histological diagnosis, the curettage technique, and the cryotherapy administration strategy. Complications and recurrence rates were recorded, as well as post-operative functional performance. Results: Twenty-two studies met our inclusion criteria. A total of 1451 cases with benign and low-grade malignant bone tumors were recorded. After a mean follow-up of 55.7 months, the mean recurrence rate was 7.4% and the global complication rate was 8.7%. The mean MSTS score was 27.8. Conclusions: The combination of curettage and intra-operative cryotherapy, administered with either open or closed contact techniques, can be effective in eradicating benign and low-grade bone tumors and has low complication rates and a limited impact on patients’ functionality. Full article

COVID-19 is associated with gut microbiome alterations that may influence disease outcomes through immune and inflammatory pathways. This systematic review and meta-analysis evaluated global evidence on gut dysbiosis in COVID-19. We searched PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library up to 5 October 2025 (PROSPERO CRD420251160970). Alpha-diversity indices and microbial taxa log-fold changes (logFC) were analyzed using random-effects models. The pooled standardized mean difference (SMD) for the Shannon index was −0.69 (95% CI −0.84 to −0.54; I² = 42%), confirming reduced microbial diversity. Faecalibacterium prausnitzii showed a significant pooled depletion (logFC = −1.24; 95% CI −1.68 to −0.80; k = 10; I² = 74%), while Enterococcus spp. was increased (logFC = 1.45; 95% CI 1.12–1.78). Egger’s test did not suggest publication bias (p = 0.32). Gut dysbiosis was consistently associated with reduced microbial diversity and enrichment of pathogenic taxa, correlating with increased disease severity and mortality (HR = 1.67). These findings highlight the potential of microbiome profiling as a prognostic tool in COVID-19, although clinical translation requires further validation. Full article

Background/Objectives: Adult survivors of childhood and young adult Hodgkin’s lymphoma (HL) are at a higher risk than the general population for moderate to life-threatening chronic health conditions (CHCs) including cardiac, vascular, endocrine and pulmonary impairments. Regular physical activity (PA) can improve physical fitness, reducing the risk of severity for CHCs. However, it is unclear whether adult survivors of HL experience the same benefits from PA as their peers. This scoping review aims to describe the associations between PA, physical fitness, perceived health, chronic disease and mortality in adult survivors of HL. In addition, body composition, autonomic dysfunction and associated treatment-related risk factors were included. Methods: MEDLINE (via PubMed), Web of Science, CINAHL and Cochrane databases were searched for potential studies that involved PA or physical fitness and outcomes such as body composition, autonomic dysfunction, associated treatment-related risk factors, associated chronic disease/mortality or perceived health. Results: A total of 2886 records were retrieved. After screening, 20 studies were included for review. In comparison to the general population, adult survivors of HL reported lower PA levels and had lower physical fitness. In addition, survivors were more likely to have abnormalities in body composition (i.e., reduced bone mineral density) and perceived health, autonomic dysfunctions and a higher risk of chronic disease and mortality than controls. An exposure to thoracic and neck radiotherapy seemed to be consistently associated with poor fitness (i.e., reduced muscle strength, lower cardiopulmonary fitness) and body composition, physical inactivity and autonomic dysfunctions. Conclusions: Interventional studies are needed to determine the maximum effective doses of PA regarding frequency, intensity, time, type, volume and progression (exercise prescription principles) that best optimize cardiovascular adaptations and health benefits in adult survivors of HL. Full article

Background: Hip fracture surgery in elderly patients carries significant risks of both bleeding and thrombotic complications. Anaesthetists frequently face a dilemma between neuraxial anaesthesia, which may reduce thrombotic risk but is often limited by contraindications, and general anaesthesia, which is widely applicable but may exacerbate bleeding. Previous reviews have not specifically addressed bleeding and thrombotic outcomes, leaving a critical gap that this meta-analysis seeks to answer. Study objective: To evaluate the effect of neuraxial anaesthesia compared to general anaesthesia on the incidence of bleeding and thrombotic complications in acute neck of femur fracture surgery. Methods: Relevant studies comparing neuraxial and general anaesthetic for hip fracture surgery were searched for through Medline, Embase, Scopus, CINAHL and PubMed. Inclusion criteria were randomised control trials of hip fracture surgery patients aged >16 years with relevant outcome data. In total, 24 randomised control trials were included, with 5479 patients. A meta-analysis was performed using RevMan 5.4 software. The study was registered with PROSPERO ID: CRD42022348039. Outcome measurement: Primary outcomes were intra-operative blood loss, intra- or post-operative blood transfusion and post-operative deep vein thrombosis. Secondary outcomes were post-operative pulmonary embolism, post-operative myocardial infarction and post-operative stroke. Results: Neuraxial anaesthesia reduced deep vein thrombosis incidence by 45% and reduced blood loss by 58 mL, both of which reached statistical significance (p < 0.05). Albeit not reaching statistical significance, neuraxial anaesthesia also had a 35% relative risk reduction in myocardial infarction, and a 35% relative decrease in stroke in current studies published after 2010. Despite practise evolution over the decades, protective neuraxial trends have remained. Conclusions: Patients undergoing acute hip fracture surgery under general anaesthesia have higher volumes of blood loss, without requiring increased blood transfusion. General anaesthesia is also associated with higher thrombotic complications, with a 45% increased relative risk of deep vein thrombosis, compared to neuraxial anaesthesia. Multi-modal thromboprophylaxis is important, as up to a third of DVT cases occur in the non-operative leg. In frail patients with a low cardiopulmonary reserve for bleeding or in high-thrombotic-risk patients, extra consideration and optimisation for neuraxial technique is advised. Future studies on comorbidities and operation type may reveal a subgroup of patients which would benefit from a specific anaesthetic type. Full article

Background: Oral mucositis (OM) is a frequent complication of anticancer therapy which arises from cytotoxic injury, having significant clinical implications. Nutritional and supplement-based interventions have been proposed as adjunctive strategies to improve outcomes. Objectives: This systematic review aimed to identify and synthesize evidence from randomized controlled trials (RCTs) evaluating nutritional or natural supplement interventions for prevention or management of OM in pediatric oncology. Methods: We conducted a systematic search (17 August 2025) of Scopus, PubMed/MEDLINE, and Google Scholar (1 January 2000–1 June 2025) following PRISMA guidelines and registered in PROSPERO (CRD420251134454). The review included randomized controlled trials in pediatric cancer patients (≤18 years; up to 25 years for follow-up) receiving chemo-/radiotherapy, assessing nutritional, dietary, or natural product interventions for oral mucositis prevention or treatment. Non-randomized, adult, non-English, non-peer-reviewed, or inaccessible studies were excluded. Outcomes included incidence, severity, duration of OM, and mucositis-associated pain. Risk of bias was assessed using the NIH Study Quality Assessment Tools and the Cochrane RoB 2 tool. Results were qualitatively summarized. Results: Of 5870 records identified, 20 RCTs met inclusion criteria resulting in 1430 total included patients. Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes. Discussion: Study designs and sample sizes varied considerably, and outcome measures were heterogeneous. Challenges with blinding, variable compliance, and inconsistent reporting reduce confidence and precision in the findings. Conclusions: Evidence from pediatric RCTs remains limited but highlights nutritional and natural products as promising supportive care options for OM. Findings suggest potential for practical, low-cost adjuncts to established oral care protocols, warranting further high-quality multicenter trials. Full article

Background: Reconstruction of the distal nose represents a major surgical challenge due to the aesthetic and functional relevance of this subunit. Various techniques—including local, regional and free flaps and grafts—have been described, but high-quality evidence comparing outcomes remains limited. Methods: Following PRISMA guidelines, a systematic review was conducted using PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Google Scholar. A single-arm meta-analysis was performed to evaluate complications, revision surgeries, and aesthetic and functional outcomes. Secondary outcomes included flap necrosis, revision procedures, and airway function. Results: Forty articles were included in the qualitative synthesis and 38 in the quantitative analysis, from an initial 587. The analysis involved 1362 patients (mean age 60.6 years) undergoing distal nasal reconstruction, most commonly for malignancy. The pooled complication rate was 11%, and was highest with regional flaps (26%). Flap/graft necrosis occurred in 5% of free flaps and 2% of regional flaps, with none reported for local flaps or grafts. Revision surgery was required in 7% overall, but was greater with mixed flaps (11%), compared to graft (3%), local (1%), and regional (0%) techniques. Dermabrasion and secondary contouring were infrequent. Aesthetic outcomes were inconsistently reported, precluding meta-analysis. Conclusions: This systematic review and meta-analysis provide an overview of reconstructive options and outcomes for distal nasal defects. Local and regional flaps remain the most reliable and versatile solutions for small-to-moderate, partial-thickness defects, offering low complication and revision rates. Free flaps, while essential for extensive or full-thickness reconstructions, are associated with greater morbidity and revision burden. Standardised reporting of outcomes relative to defect size and thickness is required to guide evidence-based decisions. Full article

Background: Smoking cessation has been associated with reduced lung cancer mortality. This study aimed to synthesize current evidence on the impact of quitting smoking at or around the time of diagnosis of lung cancer on survival, considering factors such as histological subtype, cancer stage, and cessation intervention. Methods: A systematic search was conducted in the Ovid-MEDLINE, Ovid-EMBASE, Cochrane Central Register of Controlled Trials, and KoreaMed databases up to September 2024. Randomized controlled trials and cohort studies enrolling adult current smokers with pathologically confirmed lung cancer and comparing smoking cessation at or around diagnosis with continued smoking, were included. The primary outcome was overall survival (minimum follow-up of 3 months). The included studies were critically appraised using the revised Risk of Bias for Nonrandomized Studies (RoBANS 2) tool and meta-analyzed. Results: A total of 25 cohort studies comprising 17,584 patients were reviewed. Quitting smoking at diagnosis was associated with a 26% reduction in mortality risk (adjusted HR [aHR] 0.74, 95% CI 0.68–0.81). In subgroup analyses, quitting smoking was associated with improved survival in both non-small cell lung cancer (aHR 0.73, 95% CI 0.64–0.83) and small cell lung cancer (aHR 0.61, 95% CI 0.51–0.72), with a more pronounced benefit among patients with early-stage disease (stage I–III or limited stage; aHR 0.64, 95% CI 0.56–0.74). Furthermore, active smoking cessation interventions were significantly associated with improved survival (aHR 0.55, 95% CI 0.35–0.88). Conclusions: The findings underscore the importance of encouraging smoking cessation at the time of lung cancer diagnosis as an integral part of patient management to improve survival outcomes. Full article