Search Results (4,178)

Age-related decline in immune system function is characterized by reduced numbers of naïve lymphocytes, the accumulation of senescent cells, impaired function of all immune cell types, and chronic low-grade inflammation (inflammaging). These alterations contribute to increased susceptibility to infections and malignancies, as well as to autoimmunity and other age-associated diseases. This article reviews current evidence on lifestyle interventions that may mitigate immune aging. Lifestyle-related strategies, including regular physical activity, nutritional interventions (e.g., different diets, caloric restriction, and other fasting-related approaches), stress reduction, and vaccination, are discussed as key modulators of immune function and systemic inflammation. Notably, vitamin D supplementation has been shown to reduce the incidence of autoimmune diseases by 22%. In comparison, caloric restriction has led to a decrease in CRP and TNF-α by 40% and 50%, respectively. Emerging complementary approaches, such as mind–body practices and controlled cold exposure, show promise, though current evidence remains limited and inconsistent. Therefore, integrated lifestyle strategies may slow aging-related immune decline and support healthy aging. However, longitudinal trials are required to define the optimal intervention parameters, population-specific thresholds, and the long-term durability of immune rejuvenation. Full article

Background: Chlorella, a unicellular green alga, is currently one of the most popular algae supplements due to its high content of bioactive compounds. Chlorella’s wide range of macro- and micronutrients, including chlorophyll compounds and carotenoids, has been suggested to influence various disorders related to the digestive and nervous systems. This review’s primary purpose was to critically analyze the effects of Chlorella intake on gut microbiota and brain function. Methods: The authors conducted a systematic review with narrative synthesis of peer-reviewed articles written in English and published in PubMed, Web of Science, and Scopus spanning the years 2009 to 2026 (PROSPERO registration number CRD42024527705). The search protocol was performed following PRISMA guidelines. Primary outcomes encompassed physiological variables, such as gut microbial composition, short-chain fatty acids, brain-derived neurotrophic factor, and hippocampal cell density. Secondary outcomes were assessed through neurobehavioral tests and psychological questionnaires. Results: Out of the 1333 articles identified, 47 studies were deemed eligible, and 21 met the predefined criteria, subsequently incorporated into this systematic review. In total, 10 articles documented interventions involving Chlorella and their effects on the gut microbiota, whereas 11 articles investigated several variables pertinent to brain function. Most of the studies included were conducted in animal models, with only a limited number of human trials. Nineteen studies (90%), predominantly preclinical, reported positive associations between Chlorella consumption, gut microbiota modulation, and physiological or neurobehavioral markers related to the gut–brain axis. Conclusions: Chlorella consumption may modulate gut microbiota composition and function, potentially influencing brain-related processes. However, the available literature lacks studies simultaneously addressing both gut microbiota and brain health parameters limiting the understanding of the underlying physiological mechanisms. Full article

Background/Objectives: Medication-related harm is a leading global patient safety challenge, yet patients’ lived experiences of medication safety remain underexplored in Central and Eastern European healthcare systems, where structural constraints significantly shape everyday medication use. Methods: This study provides an in-depth qualitative analysis of Hungarian patients’ online narratives, building on a prior netnographic mixed-methods study. Using grounded theory-informed principles and a patient-centred medication safety framework, we inductively analysed 5174 publicly accessible Hungarian-language comments posted on health forums and social media platforms between August 2020 and August 2023. The COM-B model was applied as a secondary lens to map findings onto modifiable behavioural determinants. Results: Access to services and communication emerged as the dominant medication safety concerns. Patients reported long waiting times, limited rural emergency services, and brief consultations leading to delayed or inadequate treatment. Communication gaps included insufficient information on medication duration, side effects, and follow-up, as well as conflicting advice from multiple sources, all of which eroded trust and prompted treatment discontinuation or reliance on informal online communities. Community pharmacists were largely absent from patients’ mental models of care, representing a significant missed opportunity given their accessibility. Less frequently mentioned were medication shortages, healthcare professional workload, and systemic safety culture. Conclusions: Clear, respectful communication and timely access to care are central to medication safety from the patient perspective. Netnography combined with a grounded theory-informed methodology offers a valuable approach for capturing authentic patient perspectives in structurally burdened healthcare systems, with findings relevant beyond the Hungarian context. Full article

Purpose: To provide an evidence-calibrated, time-bound clinical framework for using 38% silver diamine fluoride (SDF) as interim stabilization for severe early childhood caries (SECC) in young children, addressing gaps in existing guidelines regarding treatment duration, exit criteria, equity, and system accountability. Methods: This framework was developed from the American Academy of Pediatric Dentistry (AAPD) guidance (2017–2025), the 2024 Cochrane review, real-world utilization studies, and a narrative review proposing a preservation-to-precision heuristic. Recommendations are expressed using GRADE terminology. Results: The framework includes ten recommendations, a systems drift principle, explicit time thresholds (<6 months, 6–12 months, >12 months), a 12-month reassessment mandate, equity guardrails, a bridge vs. destination consent model, and a future research agenda. A clinical vignette contrasts appropriate short-term bridging with prolonged temporization due to access barriers. Conclusions: SDF is conditionally recommended for caries arrest in primary teeth. In children with SECC, SDF should be used within a documented, time-bound preservation-to-precision pathway. SDF should not become an open-ended substitute for definitive restorative care. Explicit equity implementation prevents the framework from penalizing underserved children. Full article

The integration of olfactory feedback into Virtual Reality (VR) applications remains significantly underexplored compared with other sensory modalities, particularly within room-scale Cave Automatic Virtual Environments (CAVEs), where related research is even more limited. To address this gap, this paper presents Scentree, a custom olfactory system capable of delivering scents in real time based on user interactions, along with Smelling Ancient Greece, an olfactory-enhanced VR experience developed for integration within our CAVE system. Central to the proposed approach is the concept of the Diegetic Olfactory Feedback Loop, which reframes olfaction from a passive ambient effect into an active, interaction-driven feedback mechanism embedded within the narrative context of the virtual environment. To evaluate the system, we conducted a technical performance assessment and an exploratory user study ($N=51$) examining participant perceptions of immersion, presence, perceived realism, usability, and overall user experience. The findings support the feasibility of interaction-driven olfactory feedback as a multisensory design approach for CAVE environments and provide a foundation for future controlled investigations of olfactory feedback in immersive VR. Full article

Modern prosthetic dentistry has been significantly reshaped by adhesive dentistry, CAD/CAM technologies, and advanced ceramic materials, leading to the development of minimally invasive all-ceramic restorative approaches. However, the longevity of the adhesive interface is fundamental to the long-term effectiveness of these restorations. With a focus on bond durability and clinical performance, this narrative review aims to evaluate modern adhesive strategies, tooth preparation requirements, and cementation techniques in all-ceramic minimally invasive restorations. Methods: A narrative review of the literature was performed using Google Scholar, Web of Science, and PubMed/MEDLINE databases. Publications from 2000 to 2026 were analysed. In vitro research, narrative reviews, and systematic reviews related to adhesive systems, resin cements, CAD/CAM materials, and minimally invasive prosthodontic principles were the core subjects of the research. Results: The findings indicate that material selection, surface conditioning techniques, and cementation methods have a significant impact on the clinical effectiveness of all-ceramic restorations. Retention and marginal sealing are greatly enhanced by resin-based adhesive systems. Nevertheless, hydrolytic degradation, procedure sensitivity, and substrate-related factors remain a challenge to the adhesive interface. Advances in CAD/CAM and ultra-conservative designs, like occlusal veneers and partial-coverage restorations, have increased treatment alternatives while ensuring acceptable functional and aesthetic results. Conclusions: Minimally invasive all-ceramic restorations represent a conservative and clinically effective treatment approach in modern prosthodontics. Their long-term performance is primarily dependent on adhesive interface stability and adherence to evidence-based clinical protocols. Continued developments in adhesive materials and ceramic systems are expected to improve bond durability and broaden clinical indications. Full article

The skin serves as the body’s first line of defense against environmental threats, acting as a barrier between external aggressors and internal systems. Current evidence regarding the roles of sulfur dioxide (SO₂) in biology and medicine is limited. Environmental pollutants, including SO₂, can increase the production of reactive oxygen species in the skin, leading to oxidative damage that may worsen various dermatological conditions. Endogenous SO₂, proposed as the fourth member of the gasotransmitter family, functions as a biological signaling molecule. It is generated in various human skin cells, including vascular smooth muscle cells, endothelial cells, mast cells, keratinocytes, macrophages, adipocytes, fibroblasts, dermal immune cell population, etc, where it performs multiple functions at physiologically relevant concentrations. Endogenous SO₂ plays a crucial role in regulating cell signaling and maintaining skin homeostasis through its antioxidant, anti-inflammatory, and cytoprotective effects. Abnormal generation and metabolism of SO₂ are linked to several critical processes in the skin, including vascular biology, immune response, cell proliferation, pigmentation, malignancy, protective barriers, senescence, and resistance to stress. This paper provides a narrative review of the significant roles of SO₂ in skin health and disease. A comprehensive understanding of the complex molecular effects and mechanisms mediated by SO₂ in human skin, along with the development of gas therapy, will be essential for translating fundamental research into clinical applications. Full article

Urban water insecurity is an increasingly critical challenge in rapidly urbanizing regions of the Global South, driven by population growth, environmental degradation, infrastructure limitations, and institutional constraints. Kathmandu Valley, Nepal, exemplifies these interconnected pressures. This study presents a systematic review of 45 peer-reviewed and selected grey literature sources published between 2000 and 2025, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they examined drinking water contamination, public health risks, household coping practices, wastewater-related exposure, or governance dynamics in Kathmandu Valley, Nepal. Findings were synthesized using a narrative thematic approach. The review identifies widespread contamination across municipal supply systems, groundwater, tanker water, traditional water sources, and household-stored water. Microbial contamination, particularly total coliforms, fecal coliforms, and Escherichia coli, emerged as the most consistently reported and immediate public health concern. Chemical and physicochemical contaminants, including ammonia, iron, arsenic, nitrate, and turbidity, were also widely reported, especially in shallow and deep groundwater systems. Seasonal dynamics further influenced exposure risks, with increased microbial contamination during monsoon periods and greater dependence on alternative and less regulated water sources during dry seasons. The findings further indicate that unsafe water exposure is associated with a substantial burden of waterborne diseases and emerging risks such as antimicrobial resistance. Although household water treatment practices reduced contamination in some cases, risks often persisted due to recontamination during storage and handling. These burdens disproportionately affected marginalized and peri-urban populations with limited access to safe and reliable water infrastructure. The review also highlights persistent governance challenges, including institutional fragmentation, weak regulatory enforcement, inadequate infrastructure investment, and growing dependence on informal water supply systems. Together, these conditions contribute to a hybrid urban water system in which formal and informal sources coexist without consistent quality control. Overall, the evidence demonstrates that water insecurity in Kathmandu Valley is a systemic condition shaped by the interaction of environmental contamination, unequal exposure, household coping limitations, and fragmented governance. By integrating environmental, public health, and governance evidence, this review advances understanding of urban water insecurity in rapidly urbanizing contexts and highlights the need for integrated, equity-oriented, and governance-informed interventions. These findings have broader relevance for cities across the Global South experiencing similar environmental and infrastructural pressures. Full article

Introduction: Teprotumumab (Tepezza^®), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols. Full article

Background: Cardiac telemetry monitoring represents an important aspect of in-hospital patient safety in both telemetry and critical care settings. Despite technological advancements, telemetry effectiveness may be diminished due to systemic failures including operational processes, instructional policies, and human factors. Alarm fatigue, recognized by the Joint Commission as a leading contributor to serious patient harm, lies at the forefront of these failures. Objective: This narrative review utilized and synthesized sources indexed through PubMed, PubMed Central, MEDLINE, Web of Science, Google Scholar, Directory of Open Access Journals (DOAJ), and Scopus to illustrate the factors involved in hospital related monitoring failures. We purport that alarm fatigue and telemetry monitoring failures are the result of complex systemic failures comprising technological and human failures. Through this narrative, we propose an evidence-based framework known as the Safer Telemetry Architecture (STA) to pinpoint redundancies and promote closed-loop communication regarding alarm management. Conclusions: Monitored in-hospital environments represent a key area of preventable morbidity and mortality due to systemic design flaws. Our STA framework addresses such flaws via improvements in nurse-driven protocols, alarm routing, mandatory coverage standards for backup, and increased performance auditing. Systemic improvements via such a framework may represent an important institutional strategy for hospitals with cardiac monitoring, but requires further prospective validation. Managing redundancies in alerts and sounds, improving backup and nursing telemetry protocols, and promoting closed or continuous loops targeting alarm response times and telemetry utilization are key to effectively improving patient safety. Full article

Background/Objectives: Emotion processing has increasingly been conceptualized as a transdiagnostic mechanism underlying psychological adaptation and psychopathology. From an attachment perspective, individual differences in emotion perception may be rooted in internal working models shaped by early relationships. This systematic review synthesized the literature on the relationship between adult attachment representations and intrapersonal emotion perception (Impathy) and interpersonal emotion perception (Empathy). Methods: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted on 9 February 2026, in PsycINFO, PsycArticles, and PubMed. Studies were included if they investigated adolescents or adults, assessed attachment representations using narrative-based measures (Adult Attachment Interview (AAI) or Adult Attachment Projective Picture System (AAP)), and examined intrapersonal and/or interpersonal emotion perception. Findings were synthesized narratively, and a random-effects meta-analysis examined the association between attachment security and reflective functioning. Results: Thirty-eight studies, including 2736 participants, met the inclusion criteria. Across studies, attachment representations were systematically associated with intrapersonal and interpersonal emotion perception. The strongest evidence emerged for reflective functioning, the Impathy dimensions Perceiving and Understanding, and cognitive-empathic processes. Secure attachment representations were consistently associated with higher reflective functioning and more adaptive emotion perception, whereas insecure and especially unresolved attachment representations were linked to impairments in emotional self-awareness, alexithymia-related processes, differentiated emotional understanding, and cognitive-empathic processing. The meta-analysis showed a large positive association between secure attachment representations and reflective functioning (k = 8; r = 0.64, 95% CI [0.50, 0.74]). Conclusions: Attachment representations appear systematically associated with the perceptual foundations of emotion processing. Intrapersonal and interpersonal emotion perception may therefore represent attachment-sensitive processes relevant to psychological adaptation, psychopathology, caregiving, and therapeutic change. Full article

As generative AI expands the technical frontiers of prediction, measurement, and design, a growing tension has emerged between algorithmic fluency and institutional trust. This conceptual article offers a narrative synthesis of recent work in learning analytics, educational data science, human–AI interaction, and AI governance to propose stewardship as a necessary fourth paradigm of educational data science. Stewardship represents the professional, epistemic, and institutional work of governing judgment in an environment where analytic systems are increasingly generative and persuasive. Rather than treating stewardship as a general ethics checklist, the article positions it as the governance of epistemic and pedagogical authority: who determines what counts as evidence, interpretation, and educational action when AI systems help produce those judgments. The synthesis suggests that while GenAI can support bounded analytic tasks, evidence for systemic educational transformation remains limited and uneven. The field’s primary challenge is therefore not technical performance alone, but the governance of interpretation, validation, delegation, and action. By centering provenance, uncertainty, accountable oversight, learner agency, and institutional learning, stewardship provides an actionable framework for anchoring analytic innovation in responsible educational improvement. Full article

Listeria monocytogenes is a ubiquitous Gram-positive bacterium responsible for listeriosis, a foodborne zoonotic disease affecting humans and animals. Although infection in immunocompetent individuals is often asymptomatic or limited to mild self-limiting gastroenteritis, Listeria monocytogenes may cause severe invasive disease in vulnerable groups, including pregnant women, neonates, elderly individuals, and immunocompromised patients. Although the incidence of listeriosis is relatively low compared with many other foodborne pathogens, the high hospitalization and mortality rates associated with clinical cases make this bacterium a major concern for food safety and public health. The evolutionary success of L. monocytogenes reflects the interaction between a conserved core genome and a dynamic accessory genome shaped by horizontal gene transfer (HGT), ecological selection, and expansion of specific clones. Transient intestinal carriage in humans and animals, potentially influenced by gut microbiome composition, creates ecological interfaces where plasmids, transposons, prophages, and integrative conjugative elements contribute to the exchange of antimicrobial resistance determinants, virulence factors, and stress tolerance systems. Virulence diversification is further influenced by the differential distribution of pathogenicity islands such as LIPI-1, LIPI-3, and LIPI-4 across specific clonal lineages. These evolutionary processes occur across interconnected farm, food-production, environmental, and clinical ecosystems consistent with the One Health framework. Advances in whole-genome sequencing have clarified lineage-specific gene flow, expansion of specific clones, and the dynamics of the resistome and mobilome in L. monocytogenes populations. This narrative review aims to synthesize current knowledge on the mobile genetic elements and ecological interfaces that shape horizontal gene transfer in L. monocytogenes. Its novelty lies in integrating antimicrobial resistance, virulence-associated genomic islands, stress adaptation, and gut microbiome-mediated selection within a One Health and metapopulation framework. The main message of this review is that HGT should be interpreted as a context-dependent contributor to L. monocytogenes adaptation, acting together with clonal background, ecological selection, and mobile genetic elements. Full article

Background: Cancer pain affects approximately 44.5% of all patients with malignancy and up to 55–65% of those with advanced or metastatic disease; a substantial proportion remain inadequately controlled with conventional pharmacological approaches alone. Peripheral nerve stimulation (PNS), a minimally invasive neuromodulatory strategy, has emerged as a potential opioid-sparing analgesic option for the perioperative management of oncologic surgical patients. Objectives: This narrative review synthesizes current evidence on the application, mechanisms, clinical efficacy, safety, and integration of temporary and permanent PNS systems in cancer patients, with specific focus on cancer-specific pain syndromes, key clinical studies, opioid-sparing immunological implications, evidence quality, and directions for future research. Methods: As a narrative review, this work was structured in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) to ensure methodological transparency. A focused, non-systematic literature search of PubMed/MEDLINE, Embase, and the Cochrane Library was performed from database inception through March 2026, supplemented by hand-searching of reference lists and targeted retrieval of clinical practice guidelines. Sources were selected on the basis of relevance to PNS or closely analogous peripheral neurostimulation modalities in oncologic, perioperative, or chronic pain contexts. Evidence was synthesized narratively, with each cited study graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence framework to enable transparent calibration of confidence. Results: Available preliminary and largely extrapolated evidence supports PNS as a promising but not yet established useful adjunct in oncologic perioperative care; because cancer-specific data rest substantially on a single pilot study (n = 12), one retrospective review (n = 15), and extrapolation from non-cancer populations, these conclusions should be regarded as hypothesis-generating. Randomized controlled trial data from non-cancer cohorts demonstrate opioid consumption reductions of approximately 80–90% in the PAINfRE trial, while the post-amputation trial demonstrated ≥50% pain-relief responder rates and reductions in pain interference, with clinically meaningful improvements in pain and function. Oncologic-specific pilot and retrospective evidence confirms feasibility and a 58–67% success rate across diverse cancer pain subtypes. Conclusions: The opioid-sparing properties of PNS carry additional biological plausibility for preserving perioperative antitumor immune function. High-quality prospective trials specifically designed for oncologic surgical populations remain needed to establish evidence-based recommendations. Full article

Ocimum species (family Lamiaceae) are among the most extensively utilized medicinal plants across low- and middle-income countries (LMICs), yet their pharmacological evidence base has not been comprehensively synthesized within an LMIC healthcare framework. A systematic review was conducted following PRISMA 2020 guidelines and a prospectively registered protocol (PROSPERO). Five electronic databases, PubMed, Scopus, Embase, Web of Science, and Google Scholar, were searched from January 2010 to December 2025. Studies reporting ethnobotanical, phytochemical, or pharmacological data on any Ocimum species were eligible. The study selection, quality assessment and data extraction were done by two independent reviewers utilizing Rayyan software. Findings were synthesized using a narrative approach. Ninety-seven studies were included. O. basilicum, O. tenuiflorum, and O. gratissimum were most studied. Key bioactive constituents rosmarinic acid, eugenol, linalool, β-caryophyllene, and ursolic acid, demonstrated consistent antimicrobial [minimum inhibitory concentration (MIC): 0.31–1.25 mg/mL], antioxidant [2,2-diphenyl-1-picrylhydrazyl (DPPH) IC₅₀: 12.5–89.3 µg/mL], anti-inflammatory (35–55% edema reduction), and antidiabetic (α-glucosidase IC₅₀: 0.3–1.5 mg/mL) activities. Larvicidal efficacy exceeding 90% against Anopheles spp. was demonstrated in field trials. The safety profile was broadly favorable (LD₅₀ > 5000 mg/kg). Ocimum species represent a pharmacologically credible and preclinically well-supported botanical resource with practical relevance for LMIC health systems, particularly in antimicrobial, antidiabetic, anti-inflammatory, and vector-control applications. To realize their therapeutic potential, future research must prioritize LMIC-contextualized randomized controlled trials, standardized phytochemical reporting, and chemotype-aware product development. Full article