Search Results (801)

Allostatic load (AL) is a multisystemic indicator of the cumulative “wear and tear” on the body caused by chronic stress. In oncology, high AL is associated with a poorer prognosis, a higher number of postoperative complications, and lower treatment tolerance. Patients with head and neck cancer (HNC)—due to frequent smoking, alcohol abuse, low socioeconomic status, and high psychological and functional burden—belong to a group particularly vulnerable to high AL; however, its role in this population remains poorly understood. This narrative review includes publications from 2015 to 2026 from the PubMed/MEDLINE, Embase, and Scopus databases. We analyzed original studies, systematic reviews, and narrative reviews concerning AL in oncology, prehabilitation, and HNC. Additionally, we employed the snowballing method and included studies from key research groups. The results reveal a clear research gap—the lack of direct studies evaluating AL in HNC patients. In other cancers (breast, colorectal, lung), high AL is an independent risk factor for complications, longer hospital stays, and poorer survival. Multimodal prehabilitation (exercise, nutritional, and psychological support) shows potential for reducing AL, but no prospective studies evaluating this effect have been conducted in the HNC population. Assessment of AL may serve as a valuable tool for preoperative risk stratification and monitoring the effects of prehabilitation in patients with head and neck cancer. Prospective cohort and randomized trials are needed to integrate AL into precision medicine for this patient group. Full article

Maternal consumption of alcohol and drugs during pregnancy can compromise neural development with long-lasting impact on individuals’ health. The inhibitor of growth (ING) family of proteins is an epigenetic regulator that plays a central role in fetal brain development, contributing to neural stem cell maintenance, neuronal differentiation, and the regulation of genes involved in brain morphogenesis. Given the susceptibility of the developing nervous system to epigenetic dysregulation induced by alcohol and drugs, this narrative study aims to summarize literature evidence with the hypothesis that ING proteins may represent a critical but understudied mechanistic link between maternal substance dependence and adverse neurodevelopmental outcomes in newborns. We conducted a comprehensive literature search across three databases (PubMed, Scopus, and Web of Science) up to February 2026 to identify relevant studies. Search terms included combinations of “ING proteins”, “neural development”, “alcohol”, “drugs”, “epigenetic”, “oxidative stress” and “neuroinflammation”. The inclusion criteria were limited to original studies published in English that examined neural development in newborns; the exclusion criteria encompassed non-English publications, letters, editorials, and case reports, and those not directly addressing the specified topics. We identified 55 papers; six were excluded per the exclusion criteria, leaving 49 works discussed in this review. ING proteins are epigenetic regulators essential for embryonic and neural development, including neural stem cell fate and neurogenesis, while substances of abuse are disruptors of the essential pathways necessary for the right fetal brain development. Furthermore, substance abuse creates oxidative stress environments and activates pathways that require ING-mediated chromatin regulation. ING proteins likely act as mediators linking oxidative stress, neuroinflammation, and transcriptional reprogramming in the developing brain. Meanwhile, alcohol and drugs induce epigenetic reprogramming that may disrupt ING-mediated chromatin control. There is little evidence directly linking prenatal exposure (e.g., alcohol and drugs) to ING changes during fetal development. However, we hypothesize that ING proteins function as epigenetic stress response regulators whose disruption by oxidative stress, inflammation, and chromatin alterations induced by prenatal alcohol or drug exposure may contribute to impaired fetal neurodevelopment. Although direct experimental evidence remains limited, this could be a promising and relatively unexplored research area. Full article

Background: Young adult sexual minority men (SMM) disproportionately experience childhood interpersonal trauma. The Dimensional Model of Adversity and Psychopathology (DMAP) framework proposes that exposure to threat (i.e., emotional, physical, and sexual abuse) and deprivation (e.g., physical and emotional neglect) are differentially linked to adult psychopathology. Studies of predominantly heterosexual samples have revealed emotion regulation and mindfulness as mechanisms linking childhood trauma to mental health and health risk behaviors in adulthood. However, the influence of emotion regulation (ER) or mindfulness as associated with exposure to threat vs. deprivation has not been examined among SMM in adulthood. Objective: This study explored the relationships between childhood threat/deprivation and mental health and health risk behaviors among SMM with ER and mindfulness as mediators. Participants and Setting: The sample consisted of 317 SMM (M_age = 26.70; SD = 3.87; ages 18–35; 59.3% White) recruited from the community. Methods: Childhood experiences of threat and deprivation were assessed via the Childhood Trauma Questionnaire; ER difficulties and dispositional mindfulness were assessed using self-report. Mental health behaviors were assessed using a composite score consisting of self-reported depressive, anxiety, PTSD symptoms, and suicidality. Health risk behavior score included the Sexual Compulsivity Scale, Alcohol Use Disorders Identification Test, and smoking history (Y/N). Results: Threat and deprivation were both positively correlated with mental health and health risk behaviors. Threat was associated with both mental health and health risk behaviors via emotion regulation (ER) difficulties. Deprivation was associated with these outcomes through both ER difficulties and mindfulness. Conclusions: Treatment aimed at bolstering ER and mindfulness skills among those with histories of abuse and deprivation, respectively, may help reduce psychopathology risk among SMM. Full article

Introduction: The relationship between epilepsy and alcohol use is complex and clinically significant. Alcohol acts as a neurochemical modulator capable of lowering the seizure threshold during both intoxication and withdrawal, while chronic misuse may contribute to epileptogenesis through neuronal injury, metabolic stress, and neurotransmitter dysregulation. However, the long-term impact of alcohol use on mortality among people with epilepsy (PWE) remains insufficiently characterized. The purpose of this study was to assess all-cause mortality risk among individuals with epilepsy based on alcohol use history, stratified by race/ethnicity. Methods: Data from the 2008–2018 National Health Interview Survey (NHIS) were linked to mortality outcomes on 31 December 2019 from the National Death Index (NDI) for U.S. adults aged 18 years and older. PWE and alcohol use were determined using self-reported data. Survival probabilities were estimated using weighted Kaplan–Meier methods, and hazard ratios were calculated using Cox proportional hazards models adjusted for demographic and clinical covariates. Results: Our results indicated that among PWE, alcohol use was associated with increased all-cause mortality. The unadjusted hazard ratio (HR) for alcohol use among individuals with epilepsy was 1.30, increasing to 1.40 after multivariable adjustment. In contrast, alcohol use alone without epilepsy was not associated with elevated mortality risk after adjustment. When stratified by race, the combined effect of epilepsy and alcohol use was significantly associated with increased mortality among Black individuals but not White individuals. Conclusions: In this nationally representative cohort, the combined presence of epilepsy and alcohol use was associated with higher all-cause mortality compared with alcohol use alone. Racial differences were observed, underscoring the need for integrated clinical care and further research into genetic, biological, and social determinants influencing epilepsy outcomes. Full article

Background and Objectives: One of the strongest early factors influencing later psychoactive substance use is adverse childhood experiences (ACEs). Studies investigate a variety of adverse experiences in relation to substance use, yet not all adverse childhood experiences are equal in intensity and harm. Our study aimed to address this gap by examining in detail the associations between individual ACEs, broader ACE categories, and different forms of psychoactive substance use. Materials and Methods: The study included 709 participants who completed self-report questionnaires. ACEs were measured using the MACE questionnaire. Marijuana use was measured using the CUDIT-R, alcohol use using the AUDIT, and heavy psychoactive substance use using the ASSIST. Linear regression analyses were used to predict associations. As expected, only a small part of the sample reported hard drug use; some analyses are limited to substantially fewer observations. Results: All regression models were statistically significant and predicted all three categories of psychoactive substances, but if we count the individual adverse experiences, the results become different. Although the results showed that ACE is a significant predictor of hard drug use and explains 25% of the variance, it is separately only emotional neglect that is associated with hard drug use. The regression analysis also explains 14% of the variance in marijuana use, but when considered separately, we found associations only with emotional neglect. The severity of alcohol use explains 13% of the variance, but only a few ACEs reach statistical significance: peer physical bullying, physical violence, and sexual abuse. Conclusions: The findings of our study suggest that adverse childhood experiences may not be qualitatively equivalent and therefore may not be evaluated only as a cumulative risk score. Separate ACE evaluations, instead of aggregate calculation of ACEs, may be useful to understand better which specific negative experiences have the greatest impact on subsequent use of psychoactive substances. The regression models explain only a small portion of the variance, which suggests that other factors may contribute to a larger share. Full article

Trauma and substance use disorders commonly co-occur, are clinically complex, and are associated with poorer outcomes. This study applies mixture modeling methods in a co-occurring model to examine group membership patterns across trauma and substance use to identify differences in treatment outcomes. Using the constructs of trauma and substance use, a co-occurring model was conducted to examine group membership patterns at intake and identify differences in outcomes among court-mandated participants in a trauma-informed substance abuse treatment program. This approach uses a joint/cross-classification of two independent Latent Profile Analyses (LPAs) to examine patterns. Findings from the LPA identified three trauma and four substance use profiles. Classes from each LPA were regressed in the co-occurring model, resulting in 12 unique pattern combinations, which were then compared to examine the differences in graduate rates. The results demonstrated that those in the Minimal Trauma/Alcohol Use group were more likely to complete treatment than other higher drug-using populations. Given the complexity of the clinical treatment and the prevalence of co-occurring disorders, the application of this approach can provide a means to examine different grouping patterns across two diagnostic criteria that can guide and tailor treatment efforts. Full article

Alcoholic liver disease (ALD), secondary to chronic alcohol abuse, encompasses a spectrum of liver disorders that progress from steatosis and hepatitis to fibrosis, cirrhosis, and acute-on-chronic liver failure. It poses a considerable global health burden due to its elevated rates of associated morbidity and mortality. The rising prevalence of ALD, coupled with the lack of approved pharmacotherapies, presents considerable unmet clinical needs. In this study, long-chain acyl-CoA synthetase 4 (ACSL4) was identified as a pathogenic driver in the context of chronic alcohol consumption. Hepatocyte Acsl4 ablation mitigated key pathological manifestations in Gao-Binge model mice, as evidenced by reduced inflammatory cell infiltration and attenuated lipid accumulation. Mechanistically, ACSL4 inhibition augmented cellular antioxidant defence through elevating gamma-glutamylcysteine (γ-GC) levels. In addition, γ-GC bound to and suppressed the expression of protein tyrosine phosphatase type IVA member 1 (PTP4A1). Both genetic silencing and pharmacological inhibition of PTP4A1 attenuated the activation of the downstream MAPK-NF-κB inflammatory cascade. Dronedarone, identified as a novel compound targeting ACSL4, demonstrated efficacy in ameliorating the progression of ALD. Overall, these findings elucidate a novel mechanism wherein ACSL4 modulates antioxidant responses via a small bioactive peptide, highlighting ACSL4 as a potential therapeutic target for ALD. Full article

Background: The COVID-19 pandemic significantly altered the daily routines of young adults. This study investigated alcohol consumption patterns and associated factors among young adults in Romania during this period. Method: A cross-sectional study was conducted using an online survey. Participants were asked to retrospectively report their alcohol consumption patterns before and during the COVID-19 pandemic, including the period of university campus closures. A cohort of 249 young adults (68.6% female) participated in an online survey focused on their alcohol consumption patterns, utilizing the standardized AUDIT-C questionnaire and some modified questions to better establish the habit of drinking. Results: In total, 41.7% of the included subjects were in medical school, 10% in IT, and 44% in various areas of work. Most respondents were female, between 20 and 25 years old (65%) and living in urban areas, with wine being the most favorable drink. Regarding AUDIT scores, approximately 90% fall into low-risk drinking or even abstinence, 10% belong to the high-risk group of alcohol consumption, and 3 people have a high score, which suggests drinking abuse and the likelihood of developing alcohol dependence. A comparison of pre- to post-closure drinking among medical students showed statistically significant changes in the typical number of drinks per week (from 11.5 to 9.9) and maximum drinks per day (from 4.9 to 3.3) and a slight increase in typical drinking days per week (from 3 to 3.2), p < 0.05, outlining a decrease in alcohol consumption. Conclusions: The study highlights specific drinking patterns during the pandemic. While some individuals decreased consumption, a significant portion remained at risk for alcohol-related complications, emphasizing the need for targeted screening and prevention programs. Full article

Background: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery. This study aimed to identify preoperative risk factors for AL using a five-year dataset from two Romanian surgical clinics. Materials and Methods: A retrospective cohort of 155 patients undergoing colorectal resection with primary anastomosis (105 from “Colentina” Hospital and 50 from “Dr. I. Cantacuzino” Hospital) was analyzed. Preoperative demographic, clinical, and laboratory data were extracted and assessed using univariate and multivariable logistic regression. Statistical analyses were performed using IBM SPSS. Results: The overall AL rate was 10.3%. Multivariable analysis identified high ASA class (OR 17.6; p = 0.001), emergency surgery (OR 32.2; p = 0.0007), and heavy alcohol use (OR 15.3; p = 0.004) as independent predictors of leakage. While low preoperative albumin and smoking were associated with leakage in a bivariate analysis, these did not remain significant after adjustment. Notably, all laboratory markers were based on preoperative values, distinguishing our approach from prior studies that commonly evaluated postoperative biomarkers. No statistically significant effect was found for neoadjuvant chemotherapy or radiotherapy after controlling for other covariates. Conclusions: High ASA score, alcohol abuse, and emergency surgery were the strongest independent predictors of AL in our cohort. The lack of predictive power of certain widely reported factors, such as low albumin, may reflect our dataset’s focus on preoperative optimization. These findings support the use of individualized risk assessment and reinforce the role of preoperative preparation in reducing leak incidence in colorectal surgery. Full article

Background/Objectives: Intoxication by psychoactive substances (PASs) in children, adolescents, and young adults is a growing public health concern, with evolving patterns of use and hospital presentation. This study aimed to analyze the trends in hospital admissions for PASs among children and youth aged 10 to 24 years in Slovenia during the 2013–2023 period. Methods: We performed a retrospective observational study on patients discharged after hospitalization due to poisoning by PASs, according to ICD 10 AM. We considered four groups: children (aged 10–14), adolescents (aged 15–19) and young adults (20–21 and 22–24 years old). Annual hospitalization rates were stratified by sex, age group, and PAS category. The joinpoint regression model was used to estimate the average annual percentage change (AAPC) and annual percentage change (APC) response time trend. Results: Of those hospitalized, 52% were male and 65% were adolescents, followed by children (13%). A statistically significant decrease in alcohol-related hospitalizations was observed in the 10–14 and 15–19 age groups for both sexes in the period 2013–2023, while a statistically significant increasing trend was observed for alcohol in 22–24-year-old males during the period 2019–2023, and in multiple drug/other/unspecified PASs in the 15–19 age group in the period 2015–2023. Conclusions: Slovenia has some peculiarities in the abuse of PASs. Sex reversal phenomena are present already among children (especially for alcohol), and there are shifting risks in polydrug use in adolescents and emerging threats, as well as an increase in sedative or hypnotic poisoning in female adolescents since 2017. Full article

Background and Objectives: Emergency physicians practice in high-pressure environments and face occupational stressors that may affect their mental health. This study was designed to evaluate the prevalence of depression among emergency physicians in South Korea and examined environmental, sociolegal, and individual factors associated with depressive symptoms in the post-pandemic period. Materials and Methods: This nationwide cross-sectional study analyzed data from the 2025 Korean Emergency Physician Survey. Screening positive for depressive symptoms was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10, indicating moderate-to-severe depressive symptom severity. Measures included the PHQ-9, the Korean Epworth Sleepiness Scale (KESS), and the Adult APGAR, a brief self-administered instrument assessing overall wellness. Multivariable logistic regression was performed to identify factors associated with depression after adjusting for demographic, clinical, and work-related variables. Results: Of the 1050 physicians who responded (response rate: 37.5%), 743 emergency physicians completed the PHQ-9 section (completion rate: 70.8%; mean age, 43.2 ± 7.78 years; 86.5% male), and 111 (14.9%) screened positive for depressive symptoms. Objective workload indicators, including total work hours and number of night shifts, did not differ between physicians with and without depression. However, emergency physicians screening positive for depression reported higher perceived burdens related to staffing shortages and patient-related stressors. Protective factors included being married (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08–0.58), longer sleep duration (AOR, 0.65; 95% CI, 0.50–0.86), better sleep quality (AOR, 0.45; 95% CI, 0.27–0.74), fixed mealtimes (AOR, 0.60; 95% CI, 0.39–0.93), and higher Adult APGAR scores (AOR, 0.72; 95% CI, 0.60–0.86). Factors associated with increased odds of depression included a history of cancer (AOR, 14.63, 95% CI, 2.53–84.61), current alcohol consumption (AOR, 2.54, 95% CI, 1.14–5.68), daytime sleepiness (AOR, 1.17; 95% CI, 1.04–1.31), and more frequent verbal abuse during the previous 12 months (AOR, 1.25; 95% CI, 1.08–1.44). Conclusions: Depression was prevalent and was associated with perceived work burden, sleep health, lifestyle regularity, and psychosocial factors. Interventions should address sleep quality, workplace safety, and social support. Full article

The Preliminary Exploration into Adoption Reunions (PEAR) survey examined the mental health issues faced by adoptees and first mothers. Data were collected from 1313 adoptees, first mothers, and first fathers. Study results indicate that adoption has lasting adverse effects on both adoptees and first mothers. Adoptees and first mothers are significantly more likely to attempt suicide (35 times and 37.7 times, respectively), abuse alcohol, display hypersexual behaviors, and restrict their eating compared to their peers: While first mothers have a lower life expectancy and are more likely to die by suicide than women who did not lose their children to adoption, adoptees frequently struggle with their identity and sense of belonging. They expressed experiencing trauma from their separation from their first mothers, regardless of the quality of their adoptive parents. The findings also highlight the negative impact of the secrecy surrounding adoption. Themes of secrecy and shame were prevalent in the responses from both adoptees and first mothers. The findings highlight the importance of listening to and validating the experiences of adoptees and first mothers and that there needs to be transparency in adoption practices, which may reduce the stigma associated with adoption, and facilitate healing. Full article

Background: Pancreaticopleural fistula is a rare complication of chronic pancreatitis resulting from pancreatic duct disruption, typically presenting with pleural effusion and predominant respiratory symptoms. Bilateral pleural involvement is exceptionally uncommon and poses significant diagnostic and therapeutic challenges. Case Presentation: A 56-year-old man with a history of chronic alcohol abuse presented with progressive dyspnea and mild epigastric pain. Imaging revealed bilateral pleural effusions, an atrophic pancreas with a markedly dilated main pancreatic duct containing calculi, and a fistulous tract extending from the pancreatic body through the esophageal hiatus into the mediastinum. Magnetic resonance cholangiopancreatography confirmed the diagnosis of chronic calculous pancreatitis complicated by a pancreaticopleural fistula. After unsuccessful conservative management, the patient underwent distal pancreatectomy, resection of the fistulous tract, and Roux-en-Y pancreatojejunostomy. The postoperative course was uneventful, with complete resolution of pleural effusions and sustained clinical improvement. Conclusions: This case highlights the importance of considering pancreaticopleural fistula in patients with unexplained pleural effusions and minimal abdominal symptoms, particularly in the context of chronic pancreatitis. Bilateral involvement, although rare, should not preclude timely diagnosis. Appropriate diagnostic studies by computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography are crucial for establishing the diagnosis. Surgical management offers definitive treatment in patients with ductal obstruction and calculous disease, resulting in excellent long- term outcomes. Full article

Alcoholic liver disease (ALD) is a condition caused by alcohol abuse. Although its incidence is rapidly increasing, effective treatments for this disease remain limited. The pathogenesis of ALD involves multiple aspects, such as direct damage from alcohol, oxidative stress, inflammation, lipid metabolism disorders, and dysbiosis of the gut microbiota. Under the combined action of multiple damaging factors, liver inflammation worsens and leads to liver fibrosis. In this review, we focused on in vitro and in vivo experiments to investigate the mechanistic pathways by which natural products exert effects against the progression of ALD. The accumulated and collected data indicate that some natural products may regulate oxidative stress, inflammation, autophagy, lipid metabolism, and the intestinal barrier, thereby protecting the liver. This review presents an updated overview of the potential benefits of these natural products for the prevention and treatment of ALD, identifying potential new therapeutic lead compounds and providing a reference for innovative drug development and clinical treatment for ALD. Full article

Background/Objectives: Viral hepatitis A–E represents a significant public health problem. Data on the prevalence of viral hepatitis markers among alcoholics are inconsistent. Methods: The study included 151 patients treated for alcohol abuse in one Croatian center. The control group consisted of 110 individuals from the general population tested for a routine check-up. The prevalence of viral hepatitis markers was assessed using serology and molecular methods. Results: The prevalence rates of hepatitis markers among patients were as follows: anti-HAV, 15.2%; anti-HBs, 11.9%; anti-HBc/anti-HBs, 2.6%; anti-HCV, 4.0%; and anti-HEV, 14.6%. HCV RNA was detected in one patient (0.6%). Compared with the control group, patients showed significantly higher HCV seroprevalence (4.0 vs. 0%), while the prevalence of other hepatitis markers did not differ significantly between the groups. The anti-HAV prevalence was associated with age (from 0% in patients aged <40 years to 42.9% in patients aged 60+ years), employment status (highest among retired individuals at 46.2%), and age of occasional alcohol consumption (highest seroprevalence of 26.3% in those who reported consumption between 22 and 25 years). The association between anti-HEV and educational level was of borderline significance. Logistic regression showed that older and retired patients and those who consumed alcohol occasionally between 22 and 25 years showed higher odds for HAV seropositivity (OR = 11.454–49.400, OR = 6.857, and OR = 4.464, respectively). Patients with university degrees were at lower risk for HEV seroprevalence (OR = 0.083). Conclusions: Alcoholic patients showed a higher HCV seroprevalence than the general population, while the prevalence of other viral hepatitis markers did not differ between the groups. Further studies on a larger cohort of patients are needed to confirm these findings. Full article