Search Results (4,343)

Objective: The optimal adjuvant therapy for intermediate-risk endometrial cancer remains controversial. Although radiotherapy is commonly used in Western countries, chemotherapy is preferred in Japan; however, its real-world outcomes remain limited. This study evaluated the survival and safety outcomes of three-cycle adjuvant chemotherapy in patients with intermediate-risk endometrial cancer. Methods: We retrospectively analyzed patients who underwent primary surgery for endometrial cancer at a university hospital between 2008 and 2019. Low- and intermediate-risk patients defined by the 2013 Japan Society of Gynecologic Oncology recurrence risk classification were included. Intermediate-risk patients were classified as receiving chemotherapy (Int-Chemo+) or not (Int-Chemo−). The primary endpoint was disease-free survival (DFS); secondary endpoints included cancer-specific survival (CSS), adverse events, and treatment completion. Results: Among 232 patients, 161 were low-risk and 71 intermediate-risk; 49 intermediate-risk patients received platinum-based combination chemotherapy. The 5-year DFS rates were 92.8% (95% CI, 88.6–96.9) in the low-risk group, 89.4% (95% CI, 80.7–98.2) in the Int-Chemo+ group, and 73.5% (95% CI, 53.5–93.6) in the Int-Chemo− group (log-rank p = 0.005). DFS differed between the Int-Chemo+ and Int-Chemo− groups (HR 0.232, 95% CI 0.062–0.867), whereas the DFS outcomes of the Int-Chemo+ group were numerically similar to those of the low-risk group. CSS did not differ significantly among groups (p = 0.052). Treatment completion was 93.8%, and grade ≥ 3 adverse events were mainly hematologic, without severe late toxicities. Conclusions: Three cycles of adjuvant platinum-based combination chemotherapy for intermediate-risk patients may be associated with improved DFS, while maintaining a high treatment completion rate and manageable toxicity. Full article

Farmers’ land transfer-out decisions involve weighing benefits against risks. However, existing studies tend to examine the separate effects of livelihood capital or risk perception on land transfer, overlooking whether and how risk-bearing capacity mediates the relationship between livelihood capital and transfer-out decisions. Moreover, most research treats land transfer-out as a simple binary choice (transfer or not), ignoring that farmers also decide to whom to transfer—a choice that affects both risk and return. This study investigates the effects of livelihood capital and risk-bearing capacity on these decisions, drawing on 2021 China Land Economy Survey data. Logistic regression and mediation models are employed to assess both direct and indirect impacts. The results indicate that natural and financial capital represent the most binding constraints on farmers’ livelihood capital. Higher levels of livelihood capital increase the likelihood of land transfer-out, with this effect operating partly through enhanced risk-bearing capacity. When selecting a transfer object, farmers with greater livelihood capital show a preference for village collectives over other farmers, cooperatives, or enterprises—a choice reflecting a trade-off between expected returns and perceived risks. Risk-bearing capacity partially mediates the effect of livelihood capital on the choice of village collectives and other farmers, but does not play a mediating role in transfers to enterprises or cooperatives. These findings suggest that policies designed to facilitate land transfer-out should consider not only the enhancement of farmers’ livelihood capital endowments but also the strengthening of their risk-bearing capacity. China still needs to strengthen the organizational framework for rural land transfers and improve the rights protection mechanisms for such transfers. This will reduce the risks associated with land transfer-out for farmers, encourage more proactive and market-oriented decision-making, and ultimately improve land transfer efficiency. Full article

Human lifespan is increasing in parallel with the development levels of societies. Consequently, the number of elderly individuals worldwide is also rising day by day. One of the most significant risks these individuals face is falling. In this study, fall and daily activity data were collected from different home environments using a continuous-wave (CW) radar. Micro-Doppler signatures were generated from 700 data samples obtained from 10 individuals. Furthermore, the dataset was expanded by doubling the number of spectrogram images through data augmentation. The YOLO architecture, generally used in vision-based studies for object detection and tracking, was preferred for radar-based fall and activity detection. Classifications were performed with different YOLO structures, and comparative results are presented. At this stage, binary (fall/non-fall) and multi-class (seven different classes) classifications were carried out, achieving 100% accuracy for binary classification and 88.02% for multi-class classification. Additionally, the generalizability of the proposed architecture is demonstrated using the Leave-One-Subject-Out (LOSO) approach on the collected data and through the analysis of a public dataset. These results demonstrate the applicability of YOLO architectures in radar-based fall detection studies. Full article

Travel companion matching presents unique challenges compared with conventional recommendation domains, as it involves real-world interpersonal interaction, perceived safety risks, and limited historical user data under cold-start conditions. Existing platforms often lack structured multi-factor matching and transparent integration of trust and safety constraints. This study makes three contributions. First, it introduces a methodology for deriving interpretable compatibility weights from user preference data under cold-start conditions. Second, it presents a four-algorithm comparative evaluation framework that identifies user-preferred matching strategies through controlled real-user testing. Third, it proposes a safety-enhanced empirical hybrid algorithm that integrates a hard trust gate (T ≥ 0.7), safety-oriented components (51.3% normalised weight), and empirically derived preference personalisation (48.7%) within a single scoring framework. A three-phase empirical methodology is adopted: Phase 1 (n = 26 survey) derives compatibility weights, revealing safety (69.2%), travel pace (76.9%), and budget (73.1%) as dominant factors; Phase 2 (n = 15) compares four algorithms, with safety-first matching receiving the highest acceptance rate (60.0%, 95% Wilson CI: 35.7–80.2%); Phase 3 (n = 13 journeys) evaluates the hybrid algorithm, achieving an 84.6% selection rate with Precision@6 = 0.333, MRR@6 = 0.554, and NDCG@6 = 0.597. These results provide preliminary evidence that trust-aware constraints can be integrated with empirically derived preference modelling to produce actionable recommendations under cold-start conditions, offering a reproducible approach for peer-to-peer travel platforms prioritising user safety. Full article

Hydrogen refueling stations (HRSs) are a critical enabling infrastructure for fuel cell electric vehicles (FCEVs), yet their deployment in dense metropolitan areas often faces a dual challenge: limited travel-time accessibility for users and low public acceptance driven by perceived safety risks. This study develops an integrated, city-scale framework to quantify HRS accessibility and resident acceptance and to identify expansion priorities for Seoul, South Korea. We combine (i) an online perception survey of 1000 adult residents (October 2024) capturing environmental awareness, perceived safety, siting preferences, and willingness-to-travel distance; (ii) spatial demand data on FCEV registrations by administrative dong (n = 2443 vehicles, 2022); and (iii) network-based travel-time analysis using the Seoul road network and the current HRS supply (n = 10, 2024). Accessibility is evaluated under three travel-time thresholds (10, 15, and 20 min), with service-area delineation and demand-weighted underserved-area diagnosis. Candidate expansion sites are generated and screened using operational and regulatory constraints (e.g., site area and proximity to protected facilities), followed by a p-median location-allocation optimization to select five additional sites that minimize demand-weighted travel impedance. Results indicate that, under the 20 min threshold (7.7 km at an average operating speed of 23.1 km/h), 50 of 425 dongs (11.8%) and 244 of 2443 FCEVs (10.0%) are outside the baseline service coverage. After adding five sites (total n = 15), underserved dongs decrease to 5 (1.2%) and underserved FCEVs to 26 (1.1%) for the 20 min threshold, with consistent improvements across shorter thresholds. Survey responses further reveal that only 12.5% of respondents perceive HRSs as safe, while 46.5% report a maximum willingness-to-travel distance of up to 5 km, underscoring the need for both accessibility enhancement and risk-aware communication. The proposed workflow offers a transparent, reproducible approach to support equitable and risk-informed HRS planning by jointly considering network accessibility, demand distribution, and social acceptance, thereby contributing to sustainable urban mobility, low-carbon transport transition, and socially acceptable hydrogen infrastructure deployment. Beyond local accessibility improvement, the study is framed in the broader context of sustainability, as equitable and socially acceptable hydrogen refueling infrastructure can support low-carbon urban transport transitions and more resilient metropolitan energy-mobility systems. Full article

Importance: Triple-negative breast cancer (TNBC) is characterized by high tumor mutation burden and frequent programmed cell death ligand 1 (PD-L1) expression, making immune checkpoint inhibitors (ICIs) a promising therapeutic approach. However, randomized trials of chemoimmunotherapy (Chemo-IO) in locally recurrent unresectable or metastatic TNBC have shown inconsistent results, necessitating a clearer understanding of efficacy and patient selection. Objective: The aim of this study was to evaluate the efficacy and safety of chemotherapy combined with immunotherapy vs. chemotherapy alone in patients with locally recurrent unresectable or metastatic triple-negative breast cancer and to identify beneficiary populations to guide optimal treatment selection. Data Sources: PubMed, Embase, and the Cochrane Library were searched from database inception through 23 August 2025. Study Selection: Randomized clinical trials (RCTs) comparing chemotherapy combined with ICIs vs. chemotherapy with placebo or control in patients with locally recurrent unresectable or metastatic TNBC were selected. Data Extraction and Synthesis: Two investigators independently performed data extraction and assessed risk of bias using the Cochrane Risk of Bias 2 tool (RoB 2). Heterogeneity was evaluated using the I² statistic. Data were synthesized using random-effects meta-analysis models to calculate hazard ratios (HRs) for time-to-event outcomes and risk ratios (RRs) for dichotomous outcomes according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Results: Seven RCTs comprising 3485 patients (2085 in the Chemo-IO group, 1400 in the control group) were included. The median age across trials ranged from 52 to 57 years. Chemo-IO significantly improved PFS (HR, 0.82 [95% CI, 0.76–0.89]; p < 0.01) and OS (HR = 0.88; 95% CI: 0.81–0.96; p = 0.004) in the intention-to-treat (ITT) population, with PFS benefit particularly evident in PD-L1-positive patients (HR = 0.68, 95% CI: 0.59–0.79). However, OS improvement in the PD-L1-positive subgroup was not statistically significant. CBR did not differ significantly in the intention-to-treat population (RR, 1.11 [95% CI, 0.99–1.25]; p =  0.08) but was higher in PD-L1-positive patients (RR, 1.15 [95% CI, 1.01–1.31]; p = 0.04). Safety analyses revealed no significant differences in overall AE (RR, 1.01 [95% CI, 0.99–1.02]; p = 0.35), TEAE (RR, 1.01 [95% CI, 0.99–1.03]; p = 0.19), or grade ≥ 3 TEAE (RR, 1.00; [95% CI, 0.93–1.07]; p =  0.98). However, serious AE (RR, 1.32 [95% CI, 1.11–1.57]; p = 0.001) and irAE (RR, 1.86 [95% CI, 1.41–2.45]; p <  0.01) were more frequent with Chemo-IO. Conclusions and Relevance: Chemotherapy combined with immunotherapy significantly improved PFS and OS in patients with locally recurrent unresectable or metastatic TNBC, without substantially increasing chemotherapy-related toxicities. However, the OS benefit in PD-L1-positive patients was not statistically significant, and the combined regimen was associated with higher rates of serious and immune-related adverse events. These findings support the use of Chemo-IO as a treatment option, highlighting the importance of PD-L1 status and careful monitoring of immune-mediated toxicities in clinical practice. Full article

Genetically modified (GM) lactic acid bacteria (LAB) are gaining attention as tools for innovation in the food sector, health applications, and industrial processes. LAB have long been used safely due to their GRAS/QPS status, making them suitable for improving fermentation and synthesizing specific and beneficial metabolites. Advances in genomics and gene editing have significantly expanded the available tools, ranging from classical mutagenesis to site-specific recombination, homologous recombination in non-coding regions, CRISPR-based systems, and food-grade chromosomal integration. These approaches enable the insertion of desired genes and the development of engineered strains with tailored functionalities. GM-LAB are also being studied as live delivery systems for therapeutic molecules, including cytokines, hormones, antimicrobial peptides, and vaccine antigens. Engineered strains of Lactococcus lactis and Lactobacillus spp. have yielded promising outcomes in applications such as mucosal immunization, modulation of inflammatory and metabolic responses, and inhibition of pathogenic microorganisms, including multidrug-resistant bacteria. From an industrial perspective, several studies highlight their potential for cost-effective recombinant protein production and the synthesis of high-value metabolites through fermentation. However, within the European Union, their use is subject to stringent regulatory oversight, requiring comprehensive molecular and environmental risk assessments, careful evaluation of horizontal gene transfer, and a preference for markerless chromosomal integrations. Despite these constraints, GM-LAB offer significant potential to improve food quality, sustainability, and human health. Full article

Background: Neoadjuvant therapy (NAT) is increasingly investigated in operable pancreatic ductal adenocarcinoma (PDAC), yet its role in strictly resectable disease remains controversial. Randomized trials have been conducted both in borderline resectable and resectable PDAC and have demonstrated survival advantages, while evidence in strictly resectable tumors remains poor. We conducted an umbrella review of systematic reviews and meta-analyses (SRMAs) to comprehensively evaluate the highest level of available evidence on NAT versus upfront surgery in operable PDAC. Methods: We performed an umbrella review of completed SRMAs assessing neoadjuvant chemotherapy (NAC) and/or chemoradiotherapy (NACRT) in resectable and borderline resectable PDAC. MEDLINE/PubMed, Embase, and Cochrane Library were searched from inception through November 2025. Eligible SRMAs reported at least one clinical outcome, including overall survival (OS), disease-free/event-free survival (DFS/EFS), resection rate, R0 resection, nodal status, or perioperative outcomes. Methodological quality was appraised using AMSTAR-2 and ROBIS tools. Overlap among SRMAs was quantified using the Corrected Covered Area (CCA), and RCT-only evidence was prioritized for causal inference. Evidence credibility was graded using an Ioannidis-style classification framework. Results: Thirty-four SRMAs published between 2010 and 2025 were included. In strictly resectable PDAC, RCT-only meta-analyses showed no definitive OS benefit for NAT compared with upfront surgery (pooled HR approximately 0.85, 95% CI 0.68–1.05), although a significant improvement in EFS was observed (HR approximately 0.77, 95% CI 0.65–0.90). Trial sequential analyses suggested insufficient information size for conclusive OS benefit in resectable disease. Conversely, in pooled resectable and borderline resectable populations, NAT significantly improved OS (HR approximately 0.66, 95% CI 0.52–0.85), with subgroup analyses indicating that the survival advantage was primarily driven by borderline resectable tumors. NAT consistently increased R0 resection and node-negative (pN0) rates and reduced non-curative explorations. However, neoadjuvant strategies were associated with treatment-related attrition and, in some analyses, lower overall resection rates. Comparative evidence suggested improved pathological outcomes with chemoradiotherapy versus chemotherapy alone, without a consistent survival advantage. Conclusions: Current high-level evidence supports NAT as the preferred strategy for borderline resectable PDAC, demonstrating consistent survival and pathological benefits. In strictly resectable disease, NAT improves disease-control endpoints and pathological surrogates, but a definitive OS advantage has not been consistently demonstrated in RCT-only syntheses. This should not be interpreted as evidence of equivalence between NAT and a surgery-first strategy, given the heterogeneity, limited power, and therapeutic-era effects of the available literature. Treatment decisions in resectable PDAC should therefore be individualized, balancing potential oncologic benefits against attrition risk. Future adequately powered randomized trials employing contemporary multi-agent regimens are needed to clarify the survival impact of NAT in strictly resectable disease. Full article

Coal gasification slag (CGS) is rich in Si-Al-Ca components and thus has potential for ceramic utilization, but associated heavy metals may pose environmental risks. In this study, CGS from Yili (Xinjiang, China) was used as the major raw material (80 wt%), with clay and waste glass as additives, to prepare ceramsite by firing green pellets (8–12 mm) at 1000–1200 °C. The phase evolution, microstructure, and heavy-metal migration were characterized, and the leaching safety was evaluated. Increasing temperature leads to progressive quartz consumption, enrichment of feldspar-type crystalline phases, and liquid-phase sintering, which together enhance densification. The apparent density and single-particle compressive strength exhibit an “increase-then-decrease” trend with temperature and reach maxima at 1150 °C, where the compressive strength is 15.38 MPa. Heavy-metal behavior is element-specific: As and Zn show stronger volatilization, whereas Mn, Ba, Ni, and Cu are largely retained in the solid phase; Cr shows intermediate, temperature-dependent volatilization. After firing at ≥1150 °C, the leached concentrations of Cr, Mn, Ni, Cu, Zn, As, and Ba under the sulfuric acid–nitric acid test (HJ/T 299-2007) are below the Class III limits of the Chinese Groundwater Quality Standard (GB/T 14848-2017). Considering phase/structure evolution, mechanical performance, and short-term heavy-metal leaching, 1150 °C is identified as the preferred firing temperature in this work. Full article

Measurable residual disease (MRD) is the most powerful predictor of relapse and long-term survival in adult acute lymphoblastic leukemia (ALL), consistently outperforming traditional clinical and cytogenetic risk factors. The advent of high-sensitivity next-generation sequencing (NGS) capable of detecting MRD at 10⁻⁶ has transformed monitoring, reclassifying a substantial proportion of patients previously deemed negative by multiparameter flow cytometry (MFC) or quantitative PCR (qPCR), and revealing clinically relevant disease persistence at ultra-low levels. This review synthesizes current MRD detection platforms and their clinical applications across frontline therapy, allogeneic hematopoietic cell transplantation, and relapsed/refractory disease with specific focus on B-ALL. We integrate the 2024 European LeukemiaNet (ELN) and the 2025 US expert panel recommendations, highlighting important differences in preferred methodologies and decision thresholds. Particular attention is given to the emerging role of early deep NGS negativity in guiding transplant deferral among selected standard-risk patients, including some with Ph+ ALL treated with chemotherapy-free regimens, and to the challenges of interpreting persistent low-level positivity (10⁻⁴–10⁻⁶). Despite technological advances, key questions remain: when should deeper detection trigger therapeutic escalation, and how should discordance between modalities, peripheral blood monitoring, and subtype-specific variability be interpreted? Addressing these issues through prospective validation, platform harmonization, and broader global access will be essential to ensure that increasing sensitivity translates into evidence-based, equitable clinical benefit. Full article

Cross-reactivity among nonsteroidal anti-inflammatory drugs (NSAIDs) creates a significant clinical difficulty, especially in patients with NSAID hypersensitivity. These reactions are based on cyclooxygenase-1 (COX-1) inhibition and non-immunoglobulin E (IgE)-mediated reactions. COX-1 inhibition leads to dysregulation of arachidonic acid metabolism, with decreased prostaglandin synthesis and increased leukotriene production. Clinically, cross-intolerant reactions manifest in different phenotypes, including NSAID-exacerbated respiratory disease (NERD), NSAID-induced urticaria/angioedema (NIUA), and NSAID-exacerbated cutaneous disease (NECD). In contrast, true allergic reactions—such as single-NSAID-induced urticaria/angioedema and anaphylaxis (SNIUAA) and single-NSAID-induced delayed hypersensitivity reactions (SNIDHR)—are immunologically mediated and drug-specific. These phenotypes differ in underlying conditions, clinical manifestations, and patterns of NSAID tolerance. Paracetamol is generally considered a safer alternative due to its weak COX-1 inhibition; however, reactions may still occur, particularly at higher doses. Selective COX-2 inhibitors are usually better tolerated, however their safety should be confirmed, preferably through controlled drug provocation testing due to sporadic reactions in cross-intolerant patients. Understanding the distinction between pharmacologically mediated cross-intolerance and true allergic reactions is essential for accurate diagnosis, risk stratification, and therapeutic decision-making. This review summarizes current evidence on the mechanisms underlying NSAID hypersensitivity, analyzes the tolerability of paracetamol and alternative analgesics, and discusses practical management strategies to reduce the risk of adverse reactions. Full article

Background: The clinical benefit of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains controversial, particularly regarding left ventricular (LV) functional recovery. Global longitudinal strain (GLS) has emerged as a more sensitive marker of myocardial function than left ventricular ejection fraction (LVEF). This study aimed to evaluate the effect of CTO revascularization on LV function using GLS. Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. A comprehensive literature search was performed in the PubMed/MEDLINE database from inception through March 2026 using predefined search terms and Boolean operators. Reference lists of relevant articles were also screened to ensure completeness. Studies evaluating GLS before and after PCI for CTO and reporting quantitative strain data were included. Pooled effect estimates were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity and assess the robustness of the findings. Results: Six studies involving 376 patients were included. Successful CTO-PCI may be associated with an improvement in GLS (MD = 1.69; 95% CI: 1.09–2.29; p < 0.001), with substantial heterogeneity (I² = 81%). Subgroup analysis demonstrated greater GLS improvement in studies with longer follow-up durations. Sensitivity analyses confirmed the robustness of the results. Conclusions: CTO revascularization may be associated with an improvement in LV myocardial function as assessed by GLS, even in the absence of marked changes in conventional parameters such as LVEF. These findings support the clinical utility of GLS as a sensitive imaging biomarker for detecting early myocardial recovery and for guiding risk stratification in patients undergoing CTO-PCI. Full article

This study examines the evolution of the scientific literature on mining and heavy metals, with a particular focus on biosanitary risks associated with childhood exposure. The research integrates a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, combined with a bibliometric analysis of Scopus-indexed publications, international epidemiological data, and an evaluation of the socio-environmental context in Ecuadorian mining regions. The PRISMA-based screening process was applied to identify, filter, and select relevant peer-reviewed studies, enabling the delimitation of a focused corpus of literature, with particular attention given to scientific contributions produced by Latin American researchers and institutions. The results reveal a significant concentration of knowledge production among a limited number of countries and institutions, the dominance of English as the main language of scientific communication, and the centrality of journals in environmental sciences and toxicology. While notable progress has been made in identifying contaminants and exposure pathways, governance structures, territorial disparities, and policy implementation processes remain insufficiently explored. In Ecuador, the rapid growth of mining concessions in ecologically sensitive zones presents potential threats to children’s neurocognitive development, highlighting the urgent need for ongoing surveillance, biomonitoring programs, and preventive public health measures. The study emphasizes the importance of strengthening regional research capacity and fostering more equitable international scientific collaborations to ensure that knowledge production is responsive to local contexts and effectively safeguards vulnerable populations. Full article

Carbapenem-resistant Acinetobacter baumannii infections pose a significant challenge due to their severity and the poor prognoses they often result in, particularly in cases where there are risk factors present. The United States (US) Centers for Disease Control and Prevention (CDC) identified carbapenem-resistant Acinetobacter baumannii (CRAB) infections as a threat to human health. The World Health Organization (WHO) has classified it as a top priority for research. In 2023, the US FDA approved sulbactam–durlobactam for treating certain A. baumannii infections. As of 2024, this combination is designated as the preferred treatment strategy by the Infectious Diseases Society of America (IDSA) for infections due to carbapenem-resistant A. baumannii. In this therapeutic review, the preclinical and clinical data relevant to this regulatory decision were analyzed. This in-depth analysis will provide a comprehensive overview of the complex subject matter. It should be observed that carbapenem-based combination therapy is indicated for carbapenem-resistant A. baumannii. Full article

Background and Objectives: The joint study of cerebral asymmetries and bipolar disorder (BD) has long attracted the interest of researchers and clinicians. Nevertheless, despite the increasing awareness of hemispheric asymmetries in BD, the combined investigation of these two constructs constitutes a relatively recent area of inquiry. The main objective of the present systematic review is to systematically examine the existing literature in order to identify, integrate and critically discuss evidence of hemispheric asymmetry in BD patients in terms of brain anatomy, physiology and neuropsychological function. The initial hypotheses support the presence of atypical cerebral asymmetry and differential hemispheric activation as a function of mood states in BD. Materials and Methods: Following the collection and analysis of numerous research papers through several databases and search engines, specific papers were identified and screened according to specified inclusion and exclusion criteria. Research papers on the adult bipolar population were included, while papers including comorbidity with other disorders, lesions, or an underage or elderly population, as well as meta-analyses and reviews, were excluded. This paper aligns with the procedures in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines, and was assessed for risk of bias according to the Cochrane guidelines by the Newcastle–Ottawa Scale (NOS). Results: A total of 56 papers were identified as eligible in this review. Despite inconsistent findings across the included studies, an emerging pattern suggests the presence of atypical hemispheric asymmetry in BD, both in terms of specific brain structures and functional activity. Moreover, several studies associate depressive states with increased activation of the right hemisphere, whereas manic states appear to be linked with increased activation of the left hemisphere. Conclusions: These findings support the aforementioned hypotheses and partly align with the theoretical framework of emotional laterality theories. However, although certain patterns were observed, a comprehensive understanding of functional hemispheric asymmetry in BD has not yet been achieved. The presence of contradictory findings highlights the need for further extensive and systematic research to improve understanding of this topic. Full article