Search Results (365)

Background: DEAD/H box 5 (DDX5) serves as a transcriptional coactivator for several transcription factors including E2F1, the primary target of the tumor suppressor pRB. E2F1 physiologically activated by growth stimulation activates growth-related genes and promotes cell proliferation. In contrast, upon loss of pRB function due to oncogenic changes, E2F1 is activated out of restraint by pRB (deregulated E2F1) and stimulates tumor suppressor genes such as ARF, which activates the tumor suppressor p53, to suppress tumorigenesis. We have recently reported that DDX5 augments deregulated E2F1 activity to induce tumor suppressor gene expression and apoptosis. During the analyses, we noted that over-expression of E2F1 increased DDX5 expression, suggesting a feed forward loop in E2F1 activation through DDX5. Objective: We thus examined whether the DDX5 gene is a target of deregulated E2F1. Method: For this purpose, we performed promoter analysis and ChIP assay. Result: The DDX5 promoter did not possess typical E2F binding consensus but contained several GC repeats observed in deregulated E2F1 targets. Insertion of point mutations in these GC repeats decreased responsiveness to deregulated E2F1 induced by over-expression of E2F1, but scarcely affected responsiveness to growth stimulation. ChIP assays showed that deregulated E2F1 induced by over-expression of E2F1 or expression of E1a, which binds pRB and releases E2F1, bound to the DDX5 gene, while physiological E2F1 induced by growth stimulation did not. Conclusions: These results suggest that the DDX5 gene is a target of deregulated E2F1, generating a feed forward loop mediating tumor suppressive E2F1 activity. Full article

Background: Fowl typhoid (FT), a septicemic infection caused by Salmonella Gallinarum (SG), and H9N2 avian influenza are two economically important diseases that significantly affect the global poultry industry. Methods: We exploited the live attenuated Salmonella Gallinarum (SG) mutant JOL3062 (SG: ∆lon ∆pagL ∆asd) as a delivery system for H9N2 antigens to induce an immunoprotective response against both H9N2 and FT. To enhance immune protection against H9N2, a prokaryotic and eukaryotic dual expression plasmid, pJHL270, was employed. The hemagglutinin (HA) consensus sequence from South Korean avian influenza A virus (AIV) was cloned under the Ptrc promoter for prokaryotic expression, and the B cell epitope of neuraminidase (NA) linked with matrix protein 2 (M2e) was placed for eukaryotic expression. In vitro and in vivo expressions of the H9N2 antigens were validated by qRT-PCR and Western blot, respectively. Results: Oral immunization with JOL3121 induced a significant increase in SG and H9N2-specific serum IgY and cloacal swab IgA antibodies, confirming humoral and mucosal immune responses. Furthermore, FACS analysis showed increased CD4+ and CD8+ T cell populations. On day 28 post-immunization, there was a substantial rise in the hemagglutination inhibition titer in the immunized birds, demonstrating neutralization capabilities of immunization. Both IFN-γ and IL-4 demonstrated a significant increase, indicating a balance of Th1 and Th2 responses. Intranasal challenge with the H9N2 Y280 strain resulted in minimal to no clinical signs with significantly lower lung viral titer in the JOL3121 group. Upon SG wildtype challenge, the immunized birds in the JOL3121 group yielded 20% mortality, while 80% mortality was recorded in the PBS control group. Additionally, bacterial load in the spleen and liver was significantly lower in the immunized birds. Conclusions: The current vaccine model, designed with a host-specific pathogen, SG, delivers a robust immune boost that could enhance dual protection against FT and H9N2 infection, both being significant diseases in poultry, as well as ensure public health. Full article

Background: Gestational diabetes mellitus (GDM) affects 7–9% of pregnancies worldwide and is associated with adverse maternal and neonatal outcomes. Nutritional therapy is a key component of GDM management. However, inconsistencies exist across international and national guidelines regarding macronutrient distribution, glycemic targets, and micronutrient supplementation. This systematic review aims to compare updated nutritional recommendations for GDM across major health organizations and identify areas of consensus, divergence, and evidence gaps. Methods: This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251026194). A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar (concluding March 2025), along with manual searches of official websites of professional health organizations (e.g., ADA, WHO, NICE, IDF). Guidelines published within the last 10 years (or the most relevant national guideline if slightly older), available in English or with access to translation, and including explicit nutritional recommendations for GDM were included. Data were extracted on macronutrient composition, glycemic targets, and micronutrient supplementation, with evaluation of the supporting evidence and regional context, incorporating findings from recent key guideline updates. Results: In total, 12 guidelines met the inclusion criteria. While all guidelines emphasized carbohydrate moderation and adequate fiber intake, significant discrepancies were found in carbohydrate quality recommendations (e.g., low-glycemic index focus vs. total carbohydrate restriction), postprandial glucose targets (e.g., 1-h vs. 2-h measurements and varying thresholds like <120 vs. <140 mg/dL), and the use of non-routine micronutrients such as chromium, selenium, and omega-3 fatty acids (generally lacking endorsement). Recent updates from key bodies like ADA, Diabetes Canada, and KDA largely maintain these core stances but show increasing emphasis on dietary patterns and acknowledgement of CGM technology, without resolving key discrepancies. Cultural adaptability and behavioral counselling strategies were minimally addressed across most guidelines. Conclusions: Despite general agreement on the principal recommendations of nutritional management in GDM, substantial variation persists in specific recommendations, even considering recent updates. Consistent, evidence-based, and culturally adaptable guidelines incorporating implementation strategies are needed to optimize care and reduce disparities in GDM management across regions. Full article

Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care. Full article

Background: Local audits of Helicobacter pylori (H. pylori) prescriptions and outcomes are necessary to assess guideline awareness among clinicians and treatment effectiveness. Aims: The aims were to investigate first-line prescriptions and effectiveness over a 10-year period in Ireland and evaluate the influence of the 2017 Irish consensus guidelines on these trends. Methods: Data were collected at e-CRF AEG-REDCap from the European Registry on H. pylori management (Hp-EuReg) and quality reviewed from 2013 to 2022. All treatment-naïve cases were assessed for effectiveness by modified intention-to-treat (mITT) analysis. Multivariate analysis was also performed. Results: Data from 1000 patients (mean age 50 ± 15 years; 54% female) were analyzed. Clarithromycin (C) and amoxicillin (A) triple therapy represented 88% of treatments, followed by sequential C, A, and metronidazole (M) therapy (4.3%) and triple C + M (2.7%). Bismuth quadruple therapy was prescribed in 1.7% of cases. Treatment durations of 14, 10, and 7 days accounted for 87%, 4.5%, and 8.5% of prescriptions, respectively. High-, standard-, and low-dose proton pump inhibitors (PPIs; 80 mg, 40 mg, and 20 mg omeprazole equivalent b.i.d.) were used in 86%, 0.9%, and 13% of cases, respectively. The overall eradication rate was 80%, while it was 81% for triple C + A. Good compliance and high-dose PPI were associated with higher overall mITT eradication rates (OR 4.5 and OR 1.9, respectively) and triple C + A eradication rates (OR 4.2 and OR 1.9, respectively). Overall eradication rates increased from 74% pre-2017 to 82% (p < 0.05) by the end of 2022. Similarly, the triple C + A eradication rates increased from 76% to 83% (p < 0.05). Conclusions: While first-line treatment effectiveness improved in clinical practice over time, cure rates remain below 90%. Alternative first-line strategies are required in Ireland. Full article

Background: In 2015, Spanish scientific societies published a consensus document on managing massive hemorrhage (MH). This study aimed to evaluate the knowledge and application of the Massive Hemorrhage Protocol (MHP) among healthcare professionals and to assess whether an educational intervention could improve compliance and patient outcomes. Methods: A two-phase observational study was conducted in four Spanish university hospitals. In phase one, compliance with MHP recommendations was surveyed. Based on the findings, educational sessions were implemented, focusing on the least known or followed recommendations. Compliance was then reassessed. Primary outcome was adherence to MHP; secondary outcomes included morbidity and 24 h and in-hospital mortality. Results: The MHP was activated in 303 MH episodes, mostly of surgical (42.6%) or traumatic (25%) origin. The most followed recommendation before the intervention was protocol activation (94%), which improved to 98.3% post-intervention (p = 0.049). Lesser-followed recommendations such as requesting a hemorrhage lab panel and correcting hypothermia improved after intervention from 39% to 50.4% (p = 0.05) and 31.3% to 43.8% (p = 0.027), respectively. Overall compliance increased from 68% to 73% (p = 0.05). Mortality remained high in both phases, 24 h (25.4%) and in-hospital (42.2%). Patients who required massive transfusion had higher mortality (53.6%) than those who did not (35.9%, p = 0.03). Survivors had higher protocol compliance (p = 0.003 at 24 h; p = 0.049 in-hospital). Conclusions: Educational intervention modestly improved adherence to MHP recommendations. Higher compliance was associated with better survival outcomes, supporting the need for targeted educational strategies to enhance protocol implementation and improve care in MH cases. Full article

Background/Objectives: Lurasidone ((3aR,4S,7R,7aS)-2-{(1R,2R)-2-[4-(1,2-benzisothiazol-3-yl)piperazin-1-ylmethyl]cyclohexylmethyl}hexahydro-4,7-methano-2H-isoindole-1,3-dione) is a second-generation antipsychotic approved for schizophrenia and mood disorders. Adolescents and children with bipolar disorder receive treatments that expose them to weight gain and metabolic syndrome. Lurasidone is relatively free from such side effects, so it may constitute a useful alternative for the treatment of these patients. We focused on the use of lurasidone in children and adolescents with bipolar disorder. Methods: On 11 June 2025, we used the following strategy on PubMed: lurasidone AND (“bipolar disorder” OR “bipolar depression” OR mania OR manic). We filtered for humans and ages 0–18 years and included case reports and clinical studies. Similar strategies adapted to each database were used to carry out our systematic review on CINAHL, PsycINFO/PsycARTICLES, Scopus, and the ClinicalTrials.gov register on the same date. We excluded reports without children/adolescent participants, those grouping adult participants with children/adolescents without providing data separately, reviews, and opinions/editorials with no data. Eligibility was determined through Delphi rounds; it was required that consensus was reached among all authors. We followed the PRISMA-2020 Statement. Results: Our search produced 38 results on PubMed on 11 June 2025. We included four case reports/series and five studies. One additional eligible study emerged from our Scopus inquiry, raising the number of eligible studies to six. One case series was moderately positive; one case report was neutral, another was positive, and one reported the induction of mania. The six longitudinal studies involved 16,735 participants and showed generally good efficacy. Conclusions: The use of lurasidone in adolescents/children with bipolar disorder obtains favorable results regarding the excitatory and depressive symptoms of bipolar disorder with no significant side effects. Full article

This research presents an IoT-empowered adaptive mobility framework that integrates high-dimensional gesture recognition with edge-cloud orchestration for safety-critical human–machine interaction. The system architecture establishes a three-tier IoT network: a perception layer with 60 GHz FMCW radar and TOF infrared arrays (12-node mesh topology, 15 cm baseline spacing) for real-time motion tracking; an edge intelligence layer deploying a time-aware neural network via NVIDIA Jetson Nano to achieve up to 99.1% recognition accuracy with latency as low as 48 ms under optimal conditions (typical performance: 97.8% ± 1.4% accuracy, 68.7 ms ± 15.3 ms latency); and a federated cloud layer enabling distributed model synchronization across 32 edge nodes via LoRaWAN-optimized protocols (κ = 0.912 consensus). A reconfigurable chassis with three operational modes (standing, seated, balance) employs IoT-driven kinematic optimization for enhanced adaptability and user safety. Using both radar and infrared sensors together reduces false detections to 0.08% even under high-vibration conditions (80 km/h), while distributed learning across multiple devices maintains consistent accuracy (variance < 5%) in different environments. Experimental results demonstrate 93% reliability improvement over HMM baselines and 3.8% accuracy gain over state-of-the-art LSTM models, while achieving 33% faster inference (48.3 ms vs. 72.1 ms). The system maintains industrial-grade safety certification with energy-efficient computation. Bridging adaptive mechanics with edge intelligence, this research pioneers a sustainable IoT-edge paradigm for smart mobility, harmonizing real-time responsiveness, ecological sustainability, and scalable deployment in complex urban ecosystems. Full article

The SLC4A11 gene encodes a membrane transporter implicated in congenital hereditary endothelial dystrophy, Harboyan syndrome, and certain cancers. Despite its clinical importance, current data on SLC4A11 expression patterns, transcript variants, and functional roles remain inconsistent and sometimes contradictory. We have systematized existing data, identified areas of consensus, and highlighted discrepancies. This review addresses SLC4A11 transcript and isoform diversity and how this complexity influences both the interpretation of its tissue expression patterns (particularly in the corneal endothelium) and the investigation of its functional roles in health and disease. Our review also untangles the evolving understanding of SLC4A11 function, from its initial classification as a bicarbonate transporter to its established roles in NH₃- and pH-regulated H⁺/OH⁻ transport, lactate efflux, cellular stress responses, and adhesion. The review details how pathogenic mutations disrupt protein maturation, membrane localization, or transport activity, contributing to corneal fluid imbalance and disease. We also discuss the emerging role of SLC4A11 in cancer metabolism and the common metabolic features of dystrophic corneas and tumors. Methodological challenges are appraised, encouraging caution in interpretation and the need for isoform-specific studies. Overall, this review provides a comprehensive update on SLC4A11 biology and identifies key gaps for future research. Full article

Background and aims: Recent advances in acute stroke interventions have highlighted the importance of accurate determination of infarct volume in the evaluation of acute stroke patients, carrying important prognostic and therapeutic implications for treatment planning, outcome prediction, and evaluation of the success of therapeutic interventions. However, there is no consensus on the methodologies employed to measure cerebral infarct volume. We aimed to assess the reproducibility and reliability of methods employed in the clinical determination of infarct volume in acute ischaemic stroke. Methods: We carried out a systematic review of studies assessing methodologies for the determination of infarct volume in the acute phase (<24 h). We searched Medline PubMed, Scopus, Cinahl, Cochrane Library, Web of Science, and Embase for studies examining image-based diagnosis of acute ischaemic stroke < 24 h by CT or MRI. Data on patient cohorts, imaging type, time from symptoms onset, methodologies and quantification strategies, rater reliability, accuracy, sensitivity, and specificity were compared. Results: We identified eighteen eligible studies with a total of 3298 ischaemic stroke patients assessing a variety of manual, semi-automated, and fully-automated methods. The ABC/2 method was found to be highly reliable, reproducible, and accurate, and provides the best manual estimate of infarction, but has a tendency to under- or overestimate infarct volume. Semi-automated and automated approaches with user refinement showed excellent inter-rater and intra-rater correlation. However, differences in operating algorithms and lack of standardisation of image acquisition parameters, quality, and format may impact performance and reproducibility. Conclusions: Of all methods, automated and semi-automated approaches utilising rater judgment and refinement represent the most robust approaches, with semi-automated tools demonstrating consistent and repeatable results. We recommend a standardised reporting of study methodologies for the accurate interpretation and comparison of efficacy of therapeutic interventions and patient outcomes, especially in a multi-centre setting. This may allow for more effective evaluation of stroke therapies and accelerate ischaemic stroke treatment decisions. Full article

Background and Purpose: Accurate and reproducible methods for assessing infarct volume in acute ischaemic stroke have important therapeutic and prognostic implications for the choice and success of acute therapeutic interventions. However, there is no international consensus on the methodology employed in infarct volume assessment. We aimed to assess the reliability of the ABC/2 score and e-ASPECTS in the determination of infarct volume in acute ischaemic stroke. Methods: Infarct volume was measured from NCCT in stroke patients recruited ≤12 h of symptoms onset and at 24 h using the ABC/2 method. Automated ischaemic volume measurements were carried out using e-ASPECTS software. Measurements using ABC/2 were compared with e-ASPECTS to assess volume differences and reliability using Lin’s concordance correlation coefficient. Results: Thirty-three patients with CT < 12 h from onset of symptoms and follow-up at 24 h were included in the analysis. Use of ABC/2 demonstrated low agreement between observers (0.490, CI 0.236–0.743, p < 0.001) on admission (<12 h). High agreement was found between observers at 24 h (0.724, CI 0.564–0.884, p < 0.001). High agreement was observed between the mean observed infarct volumes using ABC/2 and e-ASPECTS on admission (0.794, CI 0.691–0.898, p < 0.001). Conclusions: Our results suggest that e-ASPECTS is a reliable platform for ischaemic volume determination particularly in the hyperacute phase to inform management. However, the use of ABC/2 represents an alternative approach to e-ASPECTS in the rapid and reliable estimation of ischaemic infarct volume to inform prognosis and treatment decisions, particularly in cases of delayed presentation where infarction is established and arterial territory boundaries are easily identifiable. Full article

Objective: To systematically evaluate the effectiveness and safety of radiofrequency ablation (RFA) for managing pain caused by spinal metastases. This review aimed to consolidate evidence on RFA’s analgesic efficacy and associated risks to inform clinical practice in palliative cancer care. Methods: A systematic review adhering to PRISMA guidelines was conducted. Databases were searched for studies evaluating RFA for spinal metastases pain. Inclusion criteria specified: randomized or non-randomized studies (prospective/retrospective); ≥3 adult patients; RFA used alone or combined with other treatments; reported pre- and post-RFA pain assessments; English language publication. Data extracted included patient demographics, primary tumor type, lesion location, pain scores (e.g., NRS/VAS), and complications. Pain response was assessed using definitions including the International Consensus Pain Response Endpoints (ICPRE) and definitions for moderate (≥2-point reduction) and high (≥4-point reduction) effectiveness. Results: This review included 33 studies, totaling 1336 patients (53.7% female) and 1787 treated lesions. The majority (85%) of studies reported highly effective pain management (≥4-point pain score reduction). The remaining 15% showed moderate effectiveness (≥2-point reduction). All studies reported achieving at least a partial pain response per ICPRE criteria. Mean pain scores decreased significantly from baseline (7.56/10) within 24–72 h (3.65) and remained low at 4 weeks (2.99), 12 weeks, and 24 weeks (both 2.70). Common primary cancers were lung (27.6%), breast (26.2%), and genitourinary (11.3%). Lesions were primarily in the thoracic (47.9%) and lumbar spine (47.3%). Crucially, no life-threatening (grade IV–V) complications occurred. The overall rate of grade I–III complications was low at 2.11%. Limitations: This systematic review is limited by its study-level nature, preventing detailed subgroup analyses regarding specific metastasis characteristics or the impact of complementary therapies. Conclusions: This systematic review suggests that RFA is a safe and effective treatment for pain control in patients with spinal metastases. It provides both rapid (within 24 h) and durable mid-term (up to 24 weeks) analgesia. The favorable safety profile, with a low complication rate, supports RFA as a valuable complimentary option within the multidisciplinary palliative management of painful spinal secondary tumors. Future randomized-controlled studies may help to further define its role when associated with other treatments. Full article

Introduction: Para-cycling is a competitive sport governed by the World Body for Cycling, Union Cycliste Internationale (UCI), encompassing various cycling disciplines tailored to athletes with physical or visual impairments. This study aimed to prospectively monitor the incidence of injury and illness in Para cyclists during the 2024 Paralympic season. Methods: This prospective, observational study included ten professional Para cyclists (five male, five female) with impairments ranging from spinal cord-related, neuromuscular, and musculoskeletal conditions to vision impairment. The definitions of an ‘athlete health problem’, ‘injury’, and ‘illnesses’ followed the Para sport translation of the IOC consensus. Injury and illness data were collected weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems V2 (OSTRC-H2), with the addition of subjective markers of well-being and training load, between February 2024 and October 2024. All medical contacts for any injury or illness were logged in line with consensus statement recommendations. Results: The OSTRC-H2 questionnaire had a response rate of 76.5% (±12.2%, range 55–88%) across the 35 weeks. Athletes reported 7.36 (95% CI: 5.41–9.46) health problems per 365 days, with a medical attention rate of 5.56 (95% CI: 3.91–7.36) per 365 days. The overall injury rate was 1.94 per 365 athlete days (95% CI: 1.23–2.93), with a higher incidence in males (2.44, 95% CI: 1.53–3.67) than in females (1.51, 95% CI: 0.68–2.95). Conversely, illness rates were higher in females (5.40, 95% CI: 3.00–8.11) than in males (1.80, 95% CI: 0.60–3.30), with an overall illness rate of 3.60 per 365 days (95% CI: 2.29–5.10). Conclusions: This is the first study to present prospective injury and illness epidemiology rates in Para cyclists in combination with subjective well-being markers. The findings underscore the importance and feasibility of longitudinal health monitoring in Para cyclists, ensuring that both physical and mental health concerns are systematically tracked and addressed. This enables a proactive, multidisciplinary support system to respond effectively to fluctuations in well-being, particularly during periods of injury or illness. Full article

Background/Objectives: Sarcopenia (SA), an age-related impairment in skeletal muscle mass and function, is related to gut microbiota (GM) through inflammation and short-chain fatty acid (SCFA) generation. However, data on this relationship in older Japanese adults remain limited. We investigated the relationship of GM composition with SA, based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, among elderly Japanese outpatients. Methods: Between June 2022 and January 2023, this prospective cross-sectional study enrolled 356 community-dwelling outpatients aged ≥ 65 years at the Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center. SA was determined based on the AWGS 2019 consensus criteria. GM was analyzed using 16S rRNA gene sequencing, and alpha/beta diversity, taxonomic composition, detection rates, and correlations with skeletal muscle mass index (SMI), grip strength, and gait speed were investigated. Results: Among 356 (144 males, 212 females) participants, 50 (35 males, 15 females) had SA. Differences in GM diversity and composition were primarily noted among male participants. Men with SA had lower alpha diversity and distinct beta diversity profiles. Six bacterial genera—Eubacterium I, Fusicatenibacter, Holdemanella, Unclassified Lachnospira, Enterococcus H, and Bariatricus—had lower abundances in the SA group. Several of these genera showed positive correlations with SMI, grip strength, and gait speed. Conversely, no differences in GM characteristics were seen among females. Conclusions: GM composition was associated with SA among older Japanese men. These sex-specific differences emerged consistently, highlighting the potential of microbiota-based strategies for SA prevention in older males. Full article

Objective: This systematic review and meta-analysis aims to evaluate the temporal changes in Helicobacter pylori antibiotic resistance in Russia based on studies published over the past 15 years. Materials and Methods: We conducted a comprehensive literature search in MEDLINE/PubMed, EMBASE, the Russian Science Citation Index, and Google Scholar, following the PRISMA 2020 guidelines. Our meta-analysis was pre-registered in PROSPERO (CRD 420251025636). The inclusion criteria included original research, published in English or Russian in 2011–2024, involving antibiotic susceptibility testing in treatment-naive Russian adults using validated diagnostic methods. Two independent researchers selected studies and extracted data using standardized procedures, with methodological quality assessed via the Newcastle–Ottawa Scale. Pooled resistance rates were calculated using fixed/random-effects models in MedCalc 23.1.5 and Python 3.9.21, with meta-regression investigating temporal trends and subgroup analyses examining regional and methodological variations. Results: We identified 16 studies comprising 1206 H. pylori isolates. The pooled analysis of studies (2011–2025) revealed an overall clarithromycin resistance rate of 15.236%, with a significant temporal increase from 11.903% pre-2015 to 21.024% in 2020–2024 (p = 0.0049). Metronidazole showed consistently high pooled resistance (33.309%), while amoxicillin (1.828%), levofloxacin (19.014%), tetracycline (1.328%), and rifampicin (5.803%) maintained low resistance rates, and dual clarithromycin–metronidazole resistance was observed in 2.793% of isolates. Regional disparities were notable in the two largest cities of Russia, with 18.763% clarithromycin resistance in Moscow versus 28.540% in Saint-Petersburg. Conclusions: Russia surpasses the Maastricht VI Consensus resistance threshold for clarithromycin (15%), necessitating revision of empirical treatment strategies. The significant increase in clarithromycin resistance, potentially exacerbated by antibiotic use during the COVID-19 pandemic, underscores the urgent need for resistance-guided therapies and ongoing national surveillance programs to optimize H. pylori management. Full article