Search Results (19,462)

Introduction: The management of resectable non-small cell lung cancer has long relied on a relatively limited set of determinants, primarily anatomical resectability and pathological stage. Although these parameters remain central to therapeutic planning, accumulating clinical and translational evidence indicates that they do not fully explain variability in outcomes observed after lung cancer surgery. The primary aim of this review is to evaluate whether current evidence supports the need for a novel heuristic framework in resectable NSCLC. Secondary aims are to examine how host-related, clinical, and data-driven factors contribute to prognosis and treatment selection beyond conventional staging systems. Methods: This review integrates evidence from clinical studies, national registries, and translational analyses to examine how these dimensions contribute to prognosis and treatment selection. Results: Over the past two decades, advances in surgical techniques, perioperative management, systemic therapies, and large-scale clinical databases have revealed additional determinants of prognosis beyond tumor burden, including physiological reserve, nutritional condition, systemic inflammatory state, comorbidities, and socioeconomic environment. Developments in multimodal strategies and minimally invasive surgery have reshaped the therapeutic landscape. Data-driven approaches have identified clinically meaningful subgroups not captured by conventional staging systems. Conclusions: A heuristic framework integrating tumor biology, patient characteristics, and treatment context may better reflect the complexity of contemporary thoracic oncology practice. Full article

The scope of actual pro-environmental initiatives, programs, interventions, and campaigns is limited. Therefore, spillover effects from these activities to other domains of economy, the private sphere, and society are crucial to achieve a transformation of society towards sustainability. Starting from the known literature and using Google Scholar as a platform for searching additional studies, this explorative, traditional narrative review analyses behavioural spillover effects, where either one behaviour influences the likelihood of another behaviour, or an intervention shows an impact on an environmentally significant behaviour, which it did not primarily address. In the scientific literature, spillover is classified by direction (environmentally positive versus negative), involved behaviours (similar or cross-behavioural), timing (short or long term), context (e.g., work to private life), and social scope (personal, interpersonal, intra- and inter-organisational, intergroup, or international). Positive spillover can result from cognitive dissonance reduction, consistent self-perception, pro-environmental values, norms, self-identity, action-based learning, and habit formation. Negative spillover emerges through rebound effects, moral licensing, and psychological reactance. Stronger spillover is observed between similar behaviours, while cross-domain spillover is generally weaker. According to previous research, a facilitated participatory approach with strong pro-environmental orientation appears recommendable for practitioners to foster the value change required for effective and sustained positive spillover. Full article

Laparoscopic cholecystectomy is now established as the worldwide gold standard for the treatment of benign gallbladder disease. Despite technical advancements, bile duct injury (BDI) remains a major concern, especially in patients with obesity. It is well known that in patients with a Body Mass Index (BMI) ≥ 30 kg/m², identification of Calot’s triangle and the achievement of the Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) are made more challenging due to excessive visceral adiposity and concomitant hepatic steatosis reducing the workspace. Near-Infrared Fluorescence Cholangiography (NIRF-C) with Indocyanine Green (ICG) has emerged as an innovative, safe and effective technique to visualize the biliary anatomy and minimize the risk of iatrogenic BDI. However, its specific benefit in patients with obesity remains under-discussed compared to the general population. The main aim of this narrative review is to evaluate whether the intraoperative use of ICG in patients with obesity may reduce operative times and the risk of BDI. A focused review of the literature is performed on articles from 2010 to 2025 published on PubMed, Scopus and Web of Science. The application of ICG fluorescence in LC for patients with obesity represents a tangible clinical advantage, not only for anatomical identification and significant improvement of procedural efficiency, but also for the reduction in operative time. Full article

The heritagisation of cultural landscapes is often understood as a state-led administrative process. At the same time, the discursive origins and adaptive mechanisms that precede formal designation remain underexplored, especially in relation to cultural sustainability. This study examines the pre-heritagisation of Suzhou’s classical gardens during China’s modern transformation by analysing periodical discourse published between 1870 and 1948. Using a mixed-methods approach that combines quantitative content analysis and Critical Discourse Analysis (CDA), it investigates 699 historical texts from the Index to Chinese Newspapers & Periodicals database. The findings reveal a dual discursive process. On the one hand, reports portrayed the gardens as accessible, multifunctional civic spaces through narratives of public use. On the other hand, literati discourse reinforced their classical value through historical memory and aesthetic preservation. Together, these tendencies show how the gardens were materially refunctioned and symbolically re-anchored under modern conditions. Rather than directly producing later heritage designation, this process helped create the socio-cultural conditions through which the gardens acquired broader public intelligibility, cultural legitimacy, and heritage-like meanings before formal institutional recognition. Full article

This study examines how user-generated content (UGC) is incorporated and negotiated within platformized public service media (PSM) journalism, using the German content network funk as a case study. Based on a qualitative content analysis of selected formats and their social media posts, the study shows that participatory affordances offered by social media platforms (SMPs) are present but rarely foregrounded as central elements of storytelling. Instead, UGC is typically used as illustrative material or selectively embedded within editorial narratives. The analysis investigates how UGC is solicited, incorporated, and visually integrated into editorial storytelling across different formats. The findings identify three recurring patterns of UGC integration that illustrate how audience participation is negotiated within everyday editorial production: (1) illustrative UGC integration, (2) community-oriented UGC integration, and (3) minimalist UGC integration. Overall, the study highlights how platformized PSM journalism integrates UGC in ways that remain strongly editorially moderated rather than fully participatory, demonstrating how participation is enabled, constrained, and strategically applied within platform infrastructures. Full article

Adult neural stem cells (NSCs) maintain lifelong neurogenesis, a fundamental process for neuroplasticity, memory and brain homeostasis. Despite decades of research, translating basic NSC biology into effective clinical therapies remains a central challenge. Here we present a narrative review that provides a comprehensive update on the current landscape of adult NSC research, associating molecular mechanisms with the emerging translational technologies. First, we analyze the biological features and neurogenic sequences within canonical niches such as the subventricular lateral zone and the subgranular zone, emphasizing phylogenetic and migratory differences between rodent models and humans. Second, we integrate these mechanisms with the influence of environmental and pathological modulators, describing how aging, metabolic changes, chronic stress and neuroinflammation disrupt NSC quiescence and lineage progression. Finally, we highlight recent technological advances driving the field toward clinical applications. By examining current NSC isolation strategies, induced pluripotent stem cell modeling, direct somatic reprogramming and the use of CRISPR-Cas9-based gene-editing therapies, this review delineates the pathways to overcome existing methodological limitations. Ultimately, we provide an integrated context that connects the modulation of the neurogenic niches with advanced in vitro technologies, offering new perspectives for regenerative medicine and the treatment of neurological disorders. Full article

Emery–Dreifuss muscular dystrophy (EDMD) is a rare inherited neuromuscular disorder within the spectrum of nuclear envelope diseases, classically characterized by early musculo-tendinous contractures, slowly progressive myopathy, and cardiac involvement dominated by conduction disease and arrhythmias, with variable evolution toward cardiomyopathy and heart failure. This narrative review provides a comprehensive and clinically actionable synthesis of cardiovascular manifestations across EDMD genotypes and phenotypes, outlining pragmatic diagnostic and therapeutic pathways for real-world care. A targeted literature search was performed in PubMed, Embase, and Web of Science, focusing on studies addressing cardiovascular involvement in EDMD. Relevant original studies, case series, registries, guideline documents, and high-quality reviews were selected and synthesized narratively, with particular emphasis on diagnostic strategies, risk stratification, and management approaches. Cardiac involvement in EDMD encompasses a broad and heterogeneous spectrum, including atrial disease and conduction disturbances, ventricular arrhythmias, dilated cardiomyopathy, thromboembolic complications, and sudden cardiac death. Phenotypic expression varies according to the underlying genetic substrate, with distinct atrial- and ventricular-dominant trajectories. Early recognition and structured cardiovascular surveillance are essential to guide timely intervention, including anticoagulation, device therapy, and heart failure management. Despite growing awareness, significant gaps remain in risk prediction and standardized management strategies. EDMD represents a paradigmatic model of cardiomyopathy characterized by prominent electrical instability and systemic involvement. A structured, genotype- and phenotype-informed approach centered on early surveillance, proactive arrhythmia and thromboembolic risk management and timely device therapy may improve clinical decision-making in real-world settings. Future perspectives include the integration of precision medicine and the development of gene- and pathway-targeted therapies, with the potential to shift from symptomatic management toward disease-modifying strategies. Full article

In contemporary scholarship, pilgrimage is increasingly analysed as a practice associated with personal transformation, spiritual reflection, and psychological well-being. Among the most popular contemporary pilgrimage routes, the Camino de Santiago attracts hundreds of thousands of participants each year, many of whom describe their journey in explicitly therapeutic terms. This article examines the Camino experience through the theological category of penance understood as a form of spiritual therapy within the Christian tradition. The main argument of the study is that the early Christian understanding of penance as spiritual medicine provides a meaningful interpretative framework for analysing the therapeutic experiences reported by contemporary pilgrims. Early Christian authors such as Hermas, Tertullian, and Cyprian described sin as a spiritual illness and penance as a process of healing and restoration. Within this perspective, practices involving physical effort, repentance, prayer, and moral transformation functioned as forms of spiritual therapy (gr. θεραπεία). The article combines theological and empirical approaches. Analyses the concept of penance as spiritual healing in early Christian sources and traces its historical connection with penitential pilgrimage. Presents qualitative research based on semi-structured interviews conducted with pilgrims on the Camino de Santiago. While the participants rarely framed their experiences explicitly in penitential terms, their testimonies reveal recurring themes of inner purification, emotional reconciliation, coping with illness or personal crisis, and the search for meaning. The findings suggest that these experiences can be meaningfully interpreted through the lens of the Christian understanding of penitential practice, particularly as a process of transformation and restoration. Rather than demonstrating a direct continuity, the study proposes an interpretative perspective that highlights structural similarities between historical theological models and contemporary experiential narratives. By integrating theological reflection with empirical data, the article contributes to debates on how historical religious concepts can illuminate contemporary experiences of healing, meaning, and well-being. Full article

Background: Magnesium regulates neuronal excitability, NMDA receptor activity, and cerebrovascular tone. Dysmagnesemia is common in patients with acute brain injury (>65%), yet large randomized trials of magnesium neuroprotection have been neutral despite strong physiological rationale and consistent observational associations with outcomes. A key limitation may be diagnostic misclassification: the total serum magnesium poorly reflects the biologically active ionized fraction and may misclassify magnesium status in 20–85% of ICU patients during critical illness. Purpose: This narrative review synthesizes current evidence on magnesium physiology, measurement limitations, and clinical implications in neurocritical care. Overview: We discuss the mechanisms of magnesium depletion, outline the conceptual “two-hit” model (chronic deficiency plus acute ICU losses), and highlight the potential value of ionized magnesium for improved patient evaluation. Emerging syndrome-specific data suggest that magnesium disturbances are associated with prognostic signals. Improved phenotyping may help explain prior trial neutrality and support stratified approaches to magnesium monitoring and repletion. Future studies should evaluate magnesium-guided strategies and phenotype-driven trials to clarify the therapeutic role of magnesium in neurocritical care. Full article

Acute coronary syndromes (ACS) remain time-critical clinical emergencies in which early diagnosis and accurate risk stratification determine management and outcomes. Although symptoms, electrocardiography, and high-sensitivity cardiac troponin (hs-cTn) provide a reliable framework for detecting myocardial injury, they offer limited insight into plaque instability, thromboinflammatory activity, vascular repair, and post-infarction remodeling. In this narrative review, we examine the biological rationale and current clinical evidence supporting brain-derived neurotrophic factor (BDNF) as a candidate biomarker in ACS, with particular attention to pre-analytical, analytical, and phenotypic sources of heterogeneity. Available studies show that circulating BDNF concentrations vary substantially according to biological matrix, timing of sampling, ACS subtype, and assay methodology, which likely contributes to inconsistent findings across cohorts. Overall, current evidence does not support BDNF as a diagnostic alternative to hs-cTn in rule-in or rule-out pathways. However, BDNF may have value in biological phenotyping and risk stratification by reflecting platelet activation, endothelial dysfunction, inflammatory signaling, and remodeling processes after ACS. Further progress will require standardized pre-analytical procedures, separate assessment of mature BDNF and proBDNF, serial sampling, and validation in large multicenter studies. Full article

Background/Objectives: Dental caries is one of the most prevalent chronic diseases in childhood, disproportionately affecting socially vulnerable populations. This scoping review aimed to analyze the clinical effects of selected minimally invasive materials and approaches, specifically mouthrinses, fluoride varnishes, silver diamine fluoride, and glass ionomer-based interventions, for the prevention and management of dental caries in pediatric patients, with emphasis on public health and community-based settings. Methods: This scoping review followed the Population, Concept, and Context (PCC) framework. Electronic searches were conducted up to 23 January 2026, using tailored strategies for mouthrinses, fluoride varnishes, silver diamine fluoride (SDF), and glass ionomer cements (GICs). Randomized clinical trials (RCTs) were included. Data extraction and qualitative synthesis focused on clinical outcomes and applicability in public health contexts. Results: Fifty-five RCTs were included. Fluoride- or chlorhexidine-based mouthrinses showed potential in controlling cariogenic biofilm, with evidence primarily based on microbiological outcomes. Fluoride varnishes were associated with enamel remineralization and control of early white spot lesions, particularly in supervised programs. SDF was reported to achieve high caries’ arrest rates in cavitated dentin lesions of primary teeth, while its preventive effect on sound surfaces appeared comparable to other fluoride-based interventions. GICs were associated with acceptable clinical performance as pit-and-fissure sealants and in atraumatic restorative treatment. Conclusions: Minimally invasive dentistry (MID) approaches show promise for the prevention and management of childhood dental caries in public health and community-based settings. However, these findings should be interpreted with caution due to the heterogeneity of interventions and outcome measures, the predominance of short-term and surrogate (microbiological) outcomes, and the absence of a formal risk-of-bias assessment. As a scoping review, the synthesis is narrative in nature, which limits the ability to draw definitive conclusions. Further studies with standardized clinical outcomes and longer follow-up are needed to strengthen the evidence. Full article

The digital preservation and dissemination of historical and cultural heritage is a pivotal area at the intersection of digital humanities and geographic information science. To address the challenges of multi-source heterogeneity, limited dimensionality, and inadequate public engagement, this study designed and implemented an interactive visualization platform using modern Web technologies. Taking the Leshan Confucian Temple (religious heritage) and the former site of Wuhan University (educational heritage) as case studies, the platform integrates four types of heterogeneous data (geospatial coordinates, architectural attributes, visitor behavioral records, and multimedia imagery) into a unified spatiotemporal information model. Core technical implementations are built upon a lightweight front-end stack including the Gaode Map JavaScript API for geographic visualization, ECharts for dynamic statistical charting, and the Tailwind CSS framework for a fully responsive front-end interface. Key interactive features encompass linked map markers with contextual information windows, user-driven chart filtering, and paginated loading of cultural relic cards. Evaluation results demonstrate that the platform achieves cross-device response delay ≤3 s, supports spatially grounded, dynamic, and presentation of cultural heritage information, and attains a System Usability Scale (SUS) score of 82.5. This work offers a lightweight, scalable technical solution for advancing digital recording and public communication of historical and cultural heritage, while contributing to the theoretical discourse on spatial narrative and multi-source data integration in digital humanities. Full article

The human virome, comprising eukaryotic viruses, bacteriophages, and viral genetic material, is a dynamic component of the microbiome with growing relevance in infectious diseases. This narrative review is structured to: (i) summarize the general composition of the human virome and methodological challenges, including the fraction of unclassified viral “dark matter”; (ii) describe virome alterations in chronic infections; and (iii) explore site-specific virome dynamics across respiratory, intestinal, and genito-urinary tracts in both chronic and acute infections. In chronic viral infections such as HIV, HBV, HCV, and HPV, a recurrent feature is the expansion of Anelloviridae—particularly torque teno virus—reflecting impaired immune surveillance rather than direct pathogenicity, suggesting their potential as surrogate biomarkers of immune competence. Evidence on virome changes in chronic bacterial and parasitic infections remains limited, highlighting a critical knowledge gap. Acute infections are associated with compartment-specific shifts in eukaryotic viruses and bacteriophage communities, often paralleling changes in bacterial populations and inflammatory responses, with implications for disease severity. Despite advances in metagenomic approaches, a substantial proportion of viral sequences remains unclassified, limiting functional interpretation. Nevertheless, virome profiling provides an ecosystem-level perspective, offering insights beyond single-pathogen detection and supporting emerging applications in diagnostics, immune monitoring, prognosis, and infectious disease surveillance. Full article

Background: H1-antihistamines are widely used for allergic and upper respiratory conditions; however, several agents included in this class have been associated with cardiac electrophysiological adverse effects, including QT interval prolongation and torsades de pointes (TdP). These effects are largely exposure-dependent and mechanistically linked to inhibition of cardiac ion channels. Chlorpheniramine maleate (CPM), a first-generation H1-antihistamine, has been implicated in arrhythmic events primarily under conditions of increased systemic exposure, prompting interest in whether alternative routes of administration may lower cardiac risk. Methods: This narrative review integrates mechanistic, preclinical, clinical, pharmacokinetic, and regulatory evidence. Information was extracted from PubMed, Google Scholar, and Scielo using search terms such as cardiotoxicity, chlorpheniramine, QT prolongation, intranasal administration, and cardiac arrhythmias, with no language restriction. Results: Comparative pharmacokinetic evidence shows that, on a dose-normalized basis, intranasal and oral chlorpheniramine exhibit comparable bioavailability; however, in a clinical context, intranasal doses (1.12–2.24 mg) are lower than oral daily doses (4–12 mg/day), resulting in a lower systemic exposure (Cmax and AUC) with intranasal administration. Available pharmacovigilance or epidemiological data have not specifically evaluated intranasal chlorpheniramine, and the number of dedicated safety trials remains limited. Conclusions: Preclinical, in vitro, mechanistic studies suggest that intranasal administration of chlorpheniramine should confer superior cardiac safety compared to the oral route. However, clinical data from human studies directly comparing the cardiac safety of intranasal chlorpheniramine versus systemic chlorpheniramine is extremely limited. More data from clinical trials, case–control studies, and regulatory databases are needed to validate these theoretical claims. Full article

Clear cell renal cell carcinoma (ccRCC) is characterized by marked biological heterogeneity, which limits the prognostic accuracy of conventional clinicopathological models. Increasing attention has therefore focused on identification of biomarkers that can enhance risk stratification throughout all stages of the disease. Starting from the current state of the art, this narrative review summarizes and critically appraises the evidence published over the past decade regarding prognostic biomarkers in ccRCC. The analysis is structured into four overarching domains: (i) genomic biomarkers, covering somatic alterations and transcriptomic signatures; (ii) tissue-based biomarkers, including immunohistochemical surrogates and immune microenvironment features; (iii) circulating biomarkers, such as systemic inflammation parameters and indices; and (iv) integrated predictive models, represented by emerging multi-omic approaches. Going through the broad framework of potential prognostic biomarkers, emphasis is placed on their individual and integrative value in relation to classic clinical-pathological factors and survival parameters. At the tissue level, chromosome 3p-related alterations constitute a central molecular feature of ccRCC. Among these, BAP1 loss has emerged as one of the most consistently validated indicators of aggressive tumor behavior. Disruption of the SETD2/H3K36me3 axis and immune-related biomarkers, including PD-L1 expression, have demonstrated prognostic associations in selected settings, although with variable and context-dependent performance. In the circulating compartment, plasma KIM-1 has shown prognostic relevance following nephrectomy, while postoperative detection of circulating tumor DNA (ctDNA) may identify patients at increased risk of recurrence. However, limited analytical sensitivity and methodological heterogeneity currently restrict the broader clinical applicability of ctDNA-based strategies. Systemic inflammatory indices, such as the neutrophil-to-lymphocyte ratio, show reproducible associations with outcomes but largely reflect host inflammatory status rather than tumor-specific biology. However, no single biomarker currently supports routine prognostic implementation in ccRCC. Future progress will likely depend on integrative models combining genomic, tissue-based, immune, and circulating parameters with established clinical variables. Prospective validation and clear demonstration of incremental clinical utility will be essential before such strategies can meaningfully inform therapeutic decision-making. Full article