Search Results (16,968)

Background/Objectives: Childhood overweight and obesity represent a major global public health challenge, with increasing prevalence and significant long-term metabolic, cardiovascular, and psychosocial consequences. Standard pediatric weight-management strategies based on lifestyle modification often achieve modest and variable results, highlighting the need for more personalized and scalable approaches. Artificial intelligence (AI) has emerged as a promising tool to enhance prevention, early risk stratification, and management of pediatric overweight and obesity. Methods: This narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science for English-language studies published up to January 2026. The main search terms included “artificial intelligence”, “machine learning”, and “deep learning”, combined with “child”, “adolescent”, “pediatric”, “childhood obesity”, “pediatric overweight”, “body mass index”, “weight management”, “nutrition”, “diet”, “physical activity”, “lifestyle”, and “behavior change”. After title/abstract and full-text screening according to predefined eligibility criteria, the included studies were qualitatively synthesized and grouped by main application domains. The initial database search identified 412 records. After removal of 96 duplicates, 316 records were screened by title and abstract. Full-text assessment was subsequently performed for 175 potentially eligible articles. Following this evaluation, 51 studies met the eligibility criteria and were retained from the database search. Additional relevant articles were identified through manual screening of reference lists and related reviews, resulting in the final set of studies included in the narrative synthesis. Results: The review identified five main domains of AI application in pediatric weight management: risk assessment and prediction, dietary assessment and nutritional support, physical activity and lifestyle monitoring, behavioral and psychological support, and clinical decision support. Across the included literature, AI-based approaches were most frequently applied to predictive modeling using longitudinal BMI or growth trajectories, birth characteristics, parental BMI, sleep duration, physical activity, sedentary behavior, and family or socioeconomic factors. However, the evidence base was largely composed of observational and predictive-modeling studies, whereas interventional studies, real-world implementation studies, and long-term pediatric weight-outcome data remained limited. Conclusions: This narrative review indicates that AI has potential as a complementary tool within multidisciplinary, family-centered pediatric weight-management pathways, particularly for early risk stratification, personalized monitoring, and behavioral support. However, the findings also highlight that current evidence remains mainly exploratory and predictive rather than interventional. Further longitudinal, real-world, and ethically grounded research is required to confirm effectiveness, safety, clinical usefulness, and equitable implementation in pediatric populations. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly transforming cardiology through advanced analytical tools capable of identifying complex patterns across cardiovascular imaging, electrophysiology, and clinical datasets. Machine learning (ML) and deep learning (DL) algorithms are being integrated into echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance imaging (MRI), and electrocardiography (ECG), enabling earlier diagnosis and more personalized cardiovascular care. This narrative review summarizes current clinical and organizational applications of AI in cardiology and discusses emerging concepts related to explainable and trustworthy AI. Methods: A narrative review was conducted according to SANRA recommendations using the PubMed, MEDLINE, Web of Science, and Scopus databases, including peer-reviewed publications from 2015 to 2026 addressing clinical, organizational, and ethical applications of AI in cardiology, with particular emphasis on cardiovascular imaging, electrocardiography, heart failure, digital health, and explainable AI frameworks. Results: Substantial evidence demonstrates that AI-based tools can achieve expert-level performance in cardiovascular imaging interpretation, automated electrocardiographic analysis, and clinical risk prediction. Across multiple cardiovascular settings, AI has been associated with improved diagnostic accuracy, enhanced workflow efficiency, and earlier detection of cardiovascular disease. Predictive models support risk stratification in heart failure and ischemic heart disease, while chatbots and digital health platforms may facilitate patient engagement, remote monitoring, and continuity of care. Despite these advances, important challenges remain, including algorithmic bias, limited transparency, insufficient external validation, data heterogeneity, and barriers to routine clinical implementation. Emerging explainable AI approaches may improve model interpretability, clinician confidence, and the safe adoption of AI-driven decision support systems. Conclusions: Artificial intelligence is rapidly evolving from a research-oriented technology into a clinically relevant component of cardiovascular care. Current evidence indicates that AI can enhance diagnostic performance, improve risk prediction, streamline clinical workflows, and facilitate more personalized management across multiple cardiovascular domains. However, the successful translation of AI into routine practice will depend on robust external validation, transparent decision-making mechanisms, regulatory oversight, and clinician acceptance. The development of explainable and trustworthy AI frameworks represents a critical step toward the safe, ethical, and sustainable integration of AI into modern cardiology. Full article

This study examines the impact of ESG disclosure, leverage, and profitability on firm value, measured by Tobin’s Q, among 67 non-financial Tadawul-listed companies in Saudi Arabia over the period 2015–2024. ESG disclosure is captured through a manual content-analysis index that scores the proportion of expected environmental, social, and governance items reported by each firm. The study further investigates whether board independence moderates these relationships while controlling for liquidity, firm size, current ratio, capital expenditure, and board size. Methodologically, the study employs the two-step system generalized method of moments (system GMM) estimator, which addresses dynamic persistence, endogeneity, and unobserved heterogeneity. The findings reveal that ESG disclosure has a positive and significant effect on firm value, indicating that the Saudi market increasingly rewards firms that provide broader sustainability-related information. Profitability also exerts a positive influence on Tobin’s Q, while leverage has a negative and significant effect, suggesting that higher debt weakens market valuation. Among the moderating effects, board independence significantly reduces the negative impact of leverage on firm value, although it does not significantly strengthen the positive ESG disclosure–firm value relationship. The results also show that liquidity, firm size, capital expenditure, and board size positively influence firm value. The study’s novelty lies in being the first, to our knowledge, to integrate ESG disclosure, financial structure, profitability, and board independence within a single dynamic firm-value framework over a decade-long panel that brackets the Saudi Exchange’s 2021 ESG disclosure guideline. In doing so, it advances emerging-market ESG research by showing that, under Saudi Arabia’s largely voluntary disclosure regime and concentrated-ownership structure, board independence operates primarily as a risk-monitoring mechanism rather than as an amplifier of disclosure value. The findings imply that regulators should strengthen and progressively mandate ESG reporting frameworks, that investors should treat ESG transparency as value-relevant information, and that firms should view ESG transparency and prudent governance as strategic tools for enhancing market value in line with Vision 2030. Full article

Seawater intrusion presents a significant risk to coastal aquifers, particularly in low-lying locations where groundwater resources are intensively exploited. This study assesses the vulnerability of the Keta Strip aquifer in Southeastern Ghana to seawater intrusion using the GALDIT model; a widely applied index-based approach that evaluates seawater intrusion risk based on six key hydrogeological indicators: groundwater occurrence (G), aquifer hydraulic conductivity (A), groundwater level above sea level (L), distance from the shoreline (D), impact of existing intrusion (I), and aquifer thickness (T). These parameters were analyzed using data from 105 monitoring wells within a Geographic Information System (GIS) environment. The resulting vulnerability index was spatially grouped into four categories: low, moderate, high, and very high vulnerability. Results indicate that very high and high vulnerability regions are predominantly clustered along the coastal margins and central portions of the study area, driven mainly by low hydraulic gradients, proximity to the shoreline, and high hydraulic conductivity. Moderate vulnerability zones dominate inland areas, while low vulnerability zones are limited and confined to northern sections. Sensitivity analysis reveals that hydraulic head (L) and distance from shoreline (D) are the most influential parameters, whereas TDS exhibits relatively low contribution to overall vulnerability. The findings highlight the critical role of hydrogeological controls and anthropogenic pressures in shaping seawater intrusion risk and provide a scientific basis for sustainable groundwater management in the Keta Strip and similar coastal environments. Full article

Renal cell carcinoma (RCC) is a biologically heterogeneous malignancy characterized by variable clinical behavior and diverse molecular phenotypes. Although immune checkpoint inhibitors and targeted therapies have transformed the treatment landscape of advanced RCC, clinically validated biomarkers capable of improving risk stratification, therapeutic-decision making and disease monitoring remain lacking. Kidney injury molecule-1 (KIM-1), also known as hepatitis A virus cellular receptor-1 (HAVCR1) or T-cell immunoglobulin and mucin domain-containing protein-1 (TIM-1), has emerged as a biologically compelling investigational biomarker e because of its close relationship to proximal tubular epithelial injury and renal carcinogenesis. KIM-1 is a transmembrane glycoprotein minimally expressed in normal kidney tissue but markedly upregulated in dedifferentiated proximal tubular epithelial cells following injury, and in clear cell RCC, where its extracellular domain can be shed into plasma and urine. Beyond its role as a marker of tubular injury, KIM-1 participates in immune regulation, phagocytosis, inflammatory signaling and tissue remodeling, supporting its potential relevance to tumor biology. Clinical studies have demonstrated associations between elevated circulating KIM-1 levels and RCC diagnosis, recurrence risk, and survival outcomes, particularly in localized and postoperative disease settings. KIM-1 has additionally been investigated as a therapeutic target through antibody–drug conjugate approaches. Despite promising translational data, important limitations yet remain. Current evidence is predominantly prognostic rather than predictive, and substantial analytical and biological challenges continue to limit implementation. Assay standardization, clinically meaningful cutoffs, specimen selection, timing of sampling, and confounding by chronic kidney disease or nonmalignant renal injury remain incompletely resolved. Furthermore, evidence supporting incremental value beyond established clinicopathologic models remains limited. This review critically evaluates the biological rationale, analytical considerations and clinical evidence supporting KIM-1 in RCC. Particular emphasis is placed on distinguishing prognostic, predictive, pharmacodynamic, and therapeutic applications, as well as defining the evidentiary gaps that must be addressed before clinical implementation. Current evidence is derived predominantly from retrospective and exploratory analyses, and important limitations remain regarding assay standardization, biological specificity, chronic kidney disease-related confounding, and prospective validation. The review concludes with a summary of the evolving landscape of KIM-1-directed biomarker strategies in RCC, which may ultimately contribute to improved biologic risk stratification and biomarker-driven clinical investigation in RCC. Full article

Background: Anti-amyloid monoclonal antibodies represent the first disease-modifying therapeutic strategy targeting amyloid-β pathology in early Alzheimer’s disease (AD). Although several agents have demonstrated the ability to reduce cerebral amyloid burden, their clinical efficacy and safety remain subjects of substantial scientific and regulatory debate. This study aimed to synthesize randomized evidence evaluating the benefit–risk profile of anti-amyloid monoclonal antibodies in biomarker-confirmed early AD. Methods: A systematic review and classical pairwise meta-analysis of randomized controlled trials (RCTs) was conducted following the PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for phase III placebo-controlled trials evaluating lecanemab, donanemab, aducanumab, and gantenerumab in patients with mild cognitive impairment due to AD or mild AD dementia with biomarker confirmation of amyloid pathology. The primary outcome was change from baseline in the Clinical Dementia Rating–Sum of Boxes (CDR-SB) at the longest available follow-up. Safety outcomes included amyloid-related imaging abnormalities with edema or effusion (ARIA-E), amyloid-related imaging abnormalities with hemorrhage (ARIA-H), serious adverse events, and treatment discontinuation. Random-effects meta-analyses were performed. Results: Six randomized comparisons derived from four phase III trials involving 7695 participants met the eligibility criteria. Anti-amyloid monoclonal antibodies were associated with a statistically significant slowing of clinical progression compared with placebo (pooled mean difference in CDR-SB: −0.42 points; 95% CI −0.59 to −0.25; I² = 78%). The observed effect was primarily driven by trials of lecanemab and donanemab, whereas aducanumab demonstrated discordant results across trials and gantenerumab showed no clinically meaningful benefit. Despite statistical significance, the magnitude of the pooled effect approached the lower boundary of the minimal clinically important difference reported for CDR-SB in early AD. Treatment was associated with a markedly increased risk of ARIA-E (pooled risk ratio 10.1; 95% CI 7.8–13.0), with moderate heterogeneity across studies. Most ARIA-E events were asymptomatic and detected through protocol-mandated MRI monitoring. Conclusions: In biomarker-confirmed early Alzheimer’s disease, anti-amyloid monoclonal antibodies produce a statistically significant but modest slowing of clinical decline accompanied by a substantially increased risk of ARIA. The benefit–risk profile appears heterogeneous across individual antibodies and may reflect pharmacological differences in amyloid targeting and clearance mechanisms. These findings support cautious, individualized use of anti-amyloid therapies and highlight the need for longer-term studies to determine whether short-term slowing of decline translates into clinically meaningful disease modification. Full article

Landfill tire fires are complex environmental disasters generating toxic pollutants with severe health risks. This study quantified emission dynamics and toxicological consequences of a large-scale tire fire in an urban ecosystem. A comprehensive source-to-receptor approach was applied, integrating Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) atmospheric dispersion modeling with comparison against air quality monitoring data. Soil samples collected from the fireground and surrounding urban allotment gardens were analyzed for tire-specific tracers (Zn) and 16 priority polycyclic aromatic hydrocarbons (PAHs). Human health risks were assessed using Incremental Lifetime Cancer Risk (ILCR), Toxic Equivalency Quotient (TEQ), and Mutagenic Equivalency Quotient (MEQ) metrics. Fire emissions were dominated by particulate matter (PM₁₀: 1.34 t) and PAHs (17.7 kg). Soil at the fire site showed severe contamination (Σ PAHs: 148.9 mg/kg), with benzo[a]pyrene as the primary carcinogen. The cumulative ILCR for children reached 9.7 × 10⁻⁴, exceeding the commonly used upper regulatory benchmark of 10⁻⁴. Dermal contact was identified as the dominant exposure pathway for pyrogenic PAHs. Elevated risk levels persisted at distal residential sites (ILCR: 10⁻⁵–10⁻⁴), indicating long-term environmental contamination Ecological risk quotients (RQ) exceeded unity for PAHs across all fire-impacted locations and for Zn and Cu in the immediate vicinity of the fire scene. These findings demonstrate that acute tire fire events can evolve into persistent terrestrial health hazards, highlighting the critical role of dermal exposure in PAH uptake and the need for long-term environmental monitoring and adaptive land-use management strategies to mitigate chronic health risks in urban populations. Full article

Background: The management of diabetic foot disease and knee osteoarthritis (OA) with smart orthotics holds significant importance during the early stages of these conditions, given their potential consequences, including functional impairment, chronic pain, and economic burden. Real-time monitoring of plantar foot pressure enables early detection of abnormal force distribution and gait biomechanics, allowing for the redirection of forces away from affected ulcers or arthritic joints. This is the first systematic review to synthesise clinical evidence for smart orthotics technology with real-time plantar pressure sensor biofeedback across both diabetic foot ulcer prevention and knee osteoarthritis management simultaneously. A search of the PROSPERO register confirmed no existing registration covers this specific combination. Objectives: To examine the clinical evidence for the use of standard and smart orthotics in the prevention and management of diabetic foot ulcers (DFUs) and knee OA, and to evaluate their impact on plantar pressure redistribution, ulcer recurrence, pain, biomechanics, and economic burden. Eligibility criteria: Studies published in English involving human adult participants (≥18 years) with a clinical diagnosis of diabetes mellitus (at risk of DFU or with peripheral neuropathy) or knee OA, where the intervention involved any orthotic device or smart/intelligent insole with clinical outcomes reported, were included. Studies on healthy individuals only, those not reporting participant age, and non-weight-bearing protocols not differentiated from weight-bearing were excluded. Information sources: Five databases were searched: CINAHL (EBSCO Information Services, Ipswich, MA, USA), PubMed Advanced (National Library of Medicine, Bethesda, MD, USA), Wiley Online Library (John Wiley & Sons, Hoboken, NJ, USA), Cochrane Library (Cochrane Collaboration, London, UK), and Google Scholar (Google LLC, Mountain View, CA, USA). Searches were completed in May 2026. Methods: We conducted a comprehensive literature review. This review was structured and reported with reference to the PRISMA 2020 statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis; University of Ottawa, Ottawa, ON, Canada) to guide transparency of reporting. It does not constitute a full Cochrane-style systematic review; risk of bias assessment was applied to key included studies and GRADE (Grading of Recommendations Assessment, Development and Evaluation; McMaster University, Hamilton, ON, Canada) certainty ratings were applied informally and narratively rather than as formal per-outcome evidence profiles. Five databases were searched yielding 92,637 records. After removal of 398 duplicates by Rayyan, 92,239 records remained. A subsequent automated keyword-based relevance filter applied within Rayyan (Rayyan AI, Doha, Qatar), prior to human screening, excluded 84,572 records that did not contain any terms related to orthotics, diabetic foot, or knee osteoarthritis, yielding 7667 records for human title/abstract screening. A narrative synthesis approach was adopted owing to the heterogeneity of study designs and outcome measures across included studies, which precluded meta-analysis. This review was not prospectively registered. A complete list of all 78 included studies, including those not individually discussed in the results and discussion. Results: The available clinical studies report promising findings for orthotics and smart orthotics in pain reduction, ulcer prevention, and potential reduction in economic burden, though conclusions are limited by small sample sizes, heterogeneity, and predominantly open-label designs. Recent research found that orthotics can be used to alter the gait pattern that influences knee OA by reducing excessive force on the affected joint. A randomised controlled trial demonstrated an 80% relative risk reduction in DFU recurrence (RR = 0.20; 95% CI: 0.06–0.79; p = 0.022), with absolute event rates of 6.3% in the intervention group versus 30.8% in controls (ARR = 24.5%); a second trial reported a 71% reduction in ulcer incidence over 18 months; and a third randomised controlled trial demonstrated statistically significant plantar pressure reduction (p < 0.01) in patients with diabetic neuropathy. Conclusions: The available evidence suggests that orthotics may be associated with improved pressure redistribution, reduced ulcer incidence, and benefit in the management of knee OA. Although the number of studies directly comparing smart orthotics with standard orthotics remains limited, the limited comparative studies suggested that smart orthotics showed promising results in reducing ulcer incidence, providing the patient with real-time feedback to offload via their electronic devices. These findings, while preliminary, highlight the potential of smart orthotic technology as an adjunct to standard orthotic care in reducing the overall burden of diabetic foot disease and knee osteoarthritis. Limitations: The primary methodological limitation of this review is the open-label design of all included smart orthotic trials, which precludes participant blinding and introduces performance bias. However, this limitation is structural and inherent to the wearable technology field—analogous to surgical trials—and is substantially mitigated by the use of objective primary outcome measures (plantar pressure and ulcer recurrence) across the three included RCTs, the consistency of effect direction across independent RCTs conducted in different countries, and a narrative sensitivity analysis confirming robustness of findings (Risk of Bias Across Studies Section). Formal per-outcome GRADE evidence profiles were not produced; overall certainty of evidence was assessed narratively with reference to GRADE domains and is judged to be low to moderate for smart orthotics in DFU prevention and low for knee OA management, consistent with the Level 2–3 evidence base and open-label study designs. Future adequately powered, multi-site RCTs with standardised outcome reporting, minimum 24-month follow-up, and integrated health economic modelling are the highest priority to extend these preliminary findings. Registration: This review was not prospectively registered. Full article

Mycotoxin contamination of cereal crops poses escalating food safety risks across the Central and Balkan European (CBE) corridor under climate change, yet no PRISMA 2020-compliant synthesis of remote sensing (RS) and machine learning (ML) evidence for this region exists. We conducted an AI-augmented systematic review applying a four-stage automated pipeline—PICO domain scoring, SBERT semantic deduplication, and Thompson-sampling reinforcement learning—to 36,038 corpus records (2010–2025), yielding 156 included studies (inter-rater κ = 0.81 (95% CI: 0.74–0.88)). Logistic growth modelling identified a 56-fold corpus expansion with inflection at t₀ = 2024.8 (R² = 0.981). Satellite multispectral imaging dominated the literature (91.7% of studies); random forest and gradient boosting models achieved R² = 0.74–0.80 for aflatoxin B1 and deoxynivalenol prediction in CBE maize and wheat when integrating vegetation indices, land surface temperature, and precipitation covariates. Deep learning surpassed classical ML in annual study count from 2021, reaching ~60% relative share by 2025, though the performance advantage narrows at field scale relative to laboratory hyperspectral benchmarks (98–99% accuracy). A five-percentage-point CBE–global performance gap is largely consistent with differences in sample size and multi-toxin design scope rather than algorithmic access. The country × mycotoxin gap matrix identifies zero eligible studies for four CBE nations and for T-2/HT-2 toxins across the Balkan states. Climate-driven satellite mycotoxin prediction emerges as the field’s active research frontier. Full article

Rapid detection of heavy metals is vital for monitoring surface water contamination and preventing environmental and health risks. Traditional detection methods for metals such as lead and copper often require sophisticated, costly instrumentation, limiting their use in routine analyses. To address this challenge, we developed a cost-effective fluorescence-based approach using semiconductor quantum dots (QDs) as nanosensors for metal ion detection. The QDs were synthesized directly in aqueous medium through a reflux-assisted process employing cadmium precursors, selenium, thioglycolic acid (TGA), and branched polyethyleneimine (PEI, Mw ~25,000) as stabilizing agents. Structural analysis revealed nanoparticles with diameters below 5 nm, spherical morphology, and a zinc blende (face-centered cubic) crystalline structure. Optical characterization by UV–Vis, photoluminescence (PL), and FTIR spectroscopy confirmed effective surface functionalization and strong quantum confinement. PEI-capped QDs exhibited enhanced colloidal stability and showed pronounced fluorescence quenching in the presence of Pb²⁺ ions, indicating high sensitivity and selectivity toward lead. Both TGA- and PEI-capped QDs also demonstrated moderate responses to Co²⁺ but negligible interaction with Sn²⁺, confirming ion-specific detection. Overall, this study demonstrates that surface-engineered QDs constitute a simple, accessible platform for selective detection of toxic metals, with promising applications in environmental monitoring and water quality assessment. Full article

The agricultural and environmental application of Miscanthus × giganteus biomass ash (MBA) as a soil amendment requires a thorough assessment of its properties, nutrient potential, and associated risks. This study characterizes the elemental composition, pH, cation exchange capacity (CEC), and polycyclic aromatic hydrocarbons (PAHs) content of MBA in comparison with other common biomass ashes (crops, wood, and sewage sludge) referred to the international regulatory standards. The ash exhibits a strong alkaline pH (11.03), suggesting potential to improve soil pH in acid soils, but requires careful controlled application to prevent excessive alkalization. The main nutrients detected include K (5.54%), Ca (2.07%), Mg (0.37%), and P (0.86%), indicating its potential as a soil amendment, though long-term use may cause nutrient imbalances. Micronutrients such as Zn (240.67 mg·kg⁻¹), Mn (297 mg·kg⁻¹), and Cu (33.5 mg·kg⁻¹) are found in concentrations suitable for agricultural use, while potentially toxic elements (PTEs), including Cd, Cr, Ni, and Pb, are below detection limits, thereby reducing the risk of pollution. As (8.3 mg·kg⁻¹) and ΣPAHs (1.63 mg·kg⁻¹) remain within safety thresholds, suggesting a low environmental toxicity of MBA. The low Na content (0.12%) indicates a minimal risk of salinity accumulation, distinguishing MBA from high-sodium biomass ashes. Soil alkalization, disruptions in nutrient balance, and element leaching are risks to be considered. Despite these concerns, its composition is in agreement with established safety guidelines, supporting its feasibility for valorization as a sustainable soil amendment and remediation material. To maximize agronomic benefits and mitigate environmental risks, it is important to utilize the ash, considering site conditions and carry out regular monitoring of the soil. Full article

The efficacy of polymer-based nanopesticides (NPs) is strongly governed by carrier concentration and surface charge, which affect shell thickness, drug release kinetics, and photostability. However, the influence of these two factors in pesticide release and delivery performance remains unclear. This study introduces a NIR-II fluorescence dye-tracing strategy to enable high-resolution monitoring of NP behavior in model plants. By systematically varying polymer concentration and copolymer blocks, we investigate their impact on release behavior, photostability, and stem uptake. As the polymer concentration increased, NPs demonstrated a controlled slow release and better photostability, yet a lower pesticide loading capability. In model plants, PISNPs transport quickly and can accumulate at wound sites, effectively offering antifungal properties. This work provides experimental evidence for optimizing polymer carrier design to achieve efficient, controlled release while minimizing photodegradation risks, offering practical guidelines for developing high-performance, low-risk nanopesticide formulations. Full article

Background and Objectives: Right heart failure is a life-threatening complication of pulmonary hypertension (PH), with limited treatment options. Although recombinant human brain natriuretic peptide (rhBNP) is widely used in left heart failure, its effectiveness in right heart failure associated with varying groups of PH (Groups 1, 2, and 4) is unknown. Materials and Methods: 763 patients with varying groups of PH (PH Groups 1, 2, and 4) were enrolled and received both conventional therapy and rhBNP treatment. Therapeutic efficacy and adverse event incidence were evaluated among the PH groups. Results: Significant reductions in variables reflecting cardiac congestion, including NT-proBNP, total bilirubin, and body weight, were observed in all PH subgroups (all p < 0.001). The median percentage changes were −47% (IQR −76 to −24), −21% (IQR −33 to −1), and −3% (IQR −7 to −1), respectively. Alanine transaminase levels presented a decreasing trend (p < 0.001), whereas creatinine levels remained unchanged (p > 0.05), with consistent trends across PH subgroups. The hemodynamic response was heterogeneous, with marked decreases in the mean arterial pressure in Groups 1 and 4 (p < 0.001) but not in Group 2. Improvement in dyspnea and edema of the lower limbs was observed in 49.9% and 66.6% of cases, respectively. The overall incidence of adverse events was 0.66%, with 0.26% (2/763) being serious, all of which were in Group 1 PH. Conclusions: Findings from this exploratory analysis indicated that rhBNP treatment was associated with favorable changes in congestive status and clinical symptoms across different PH subgroups, as well as stable end-organ function. Of note, all patients received comprehensive conventional background therapy; thus, these improvements cannot be exclusively attributed to rhBNP alone. Given the observed hemodynamic fluctuations, close blood pressure monitoring should be considered throughout the treatment course, particularly for patients in Groups 1 and 4, and most notably for high-risk PAH patients (Group 1 PH). Full article

Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction, characterized by a substantial symptom burden, impaired quality of life, and increased healthcare use. Despite advances in diagnostic criteria and treatment strategies, many patients feel dismissed, inadequately informed, or uncertain about the nature and meaning of their symptoms; these experiences may undermine trust and reduce engagement with healthcare professionals. The aim of this narrative review is to synthesize clinical and ethical considerations and propose a patient-centered ethical framework for IBS management, positioning communication as a core therapeutic intervention. We highlight how validation, clear and non-stigmatizing explanations, transparency about uncertainty, and recognition of patient values can strengthen the therapeutic alliance, support relational autonomy, and enable shared decision-making. These elements can promote supported self-management and improve adherence to individualized dietary, behavioral, and pharmacologic strategies. In response to the central role of nutrition in IBS care, we further integrate dietary management into the ethical framework, addressing dietary assessment, first-line dietary advice, soluble fiber, the structured low-FODMAP approach, and the risks of excessive or unsupported food restriction. We further discuss how the incorporation of patient-reported outcomes (PROs) can translate patient priorities into measurable outcomes, monitor clinically meaningful changes over time, and reduce discrepancies between clinical assessment and patients’ lived experiences. Finally, we underscore the impact of stigma and uncertainty and provide practical communication approaches to support a stronger therapeutic alliance in IBS care. The integration of ethical communication, PROs, and nutrition-sensitive self-management may improve patient experience, strengthen adherence, and support individualized therapeutic strategies in IBS care. Full article

Background: Dental ankylosis (DA) in growing patients leads to progressive infraocclusion and alveolar ridge deformities, compromising future implant rehabilitation. Decoronation has been proposed as a biologically driven alternative to extraction for preserving alveolar bone during growth. Objective: We aimed to evaluate the clinical outcomes of decoronation—alveolar ridge preservation, infraocclusion progression, implant site development, and the influence of treatment timing—in growing patients with ankylosed permanent anterior teeth. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of MEDLINE (EBSCO), EMBASE, Scopus, and Web of Science was performed (January 2006–May 2026), supplemented by grey literature screening. Eligible studies included clinical investigations reporting outcomes of decoronation in patients ≤18 years. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) checklist. Certainty of evidence was evaluated using the GRADE framework. Lastly, an inter-rater agreement was quantified using Cohen’s kappa coefficient. Results: Five studies (two retrospective cohorts and three case series) comprising 140 decoronated teeth with follow-up periods ranging from 1 to 30 years were included. A total of 78 records were identified across four databases; five studies met the eligibility criteria after duplicate removal and screening. Inter-rater agreement at the full-text eligibility stage was good (κ = 0.70). The overall risk of bias was low to moderate, and the certainty of evidence was rated as low using the GRADE framework. Vertical alveolar bone preservation or gain was consistently observed, particularly when decoronation was performed during the prepubertal or pubertal growth phases. The largest cohort (n = 103) reported substantial vertical bone gain when intervention occurred at a mean age of 13.0 years in girls and 14.6 years in boys. Infraocclusion stabilisation or improvement was reported across all studies. In contrast, horizontal ridge reduction persisted, with the only quantitative study reporting a mean bucco-palatal loss of 1.67 ± 1.12 mm (p = 0.004). No included study directly assessed implant placement outcomes. Overall, the certainty of evidence was low due to observational study designs, heterogeneity in outcome assessment, and absence of controlled comparators. Conclusions: Decoronation appears to be a promising strategy for preserving vertical alveolar bone and stabilising infraocclusion in growing patients with ankylosed teeth, particularly when performed before or during the pubertal growth phase. Evidence showed considerable bone height preservation, though horizontal ridge reduction persisted across cases. However, the certainty of evidence remains low because available studies are observational, heterogeneous, and lack direct extraction comparators. Therefore, high-quality prospective studies with standardised outcome measures and controlled comparisons are required to establish definitive clinical protocols. Participants underwent decoronation during childhood or adolescence (≤18 years); reported follow-up periods of up to 30 years reflect monitoring that extended into adulthood. Clinical significance: For clinical decision-making, decoronation should be considered once ankylosis with progressive infraocclusion is confirmed during active growth, ideally before the pubertal spurt; the decision should be guided by growth stage rather than chronological age, and clinicians should anticipate likely horizontal ridge reduction by planning for possible augmentation at implant placement and coordinating multidisciplinary follow-up until skeletal maturity. Full article