Search Results (1,054)

Background: The integration of neoadjuvant and perioperative chemo-immunotherapy (CT-IO) has significantly reshaped the treatment of resectable non-small-cell lung cancer (NSCLC), improving pathological response and survival outcomes. However, its impact on surgical management—particularly robotic-assisted thoracic surgery (RATS)—remains incompletely defined. This review provides a practical overview of current evidence and technical considerations for robotic lung resection following neoadjuvant chemo-immunotherapy. Methods: A narrative review of the literature was performed, focusing on phase III trials, meta-analyses, and surgical series reporting perioperative, oncological, and technical outcomes of minimally invasive—especially robotic—approaches after neoadjuvant or perioperative chemo-immunotherapy. Results: Randomized trials have established CT-IO as a standard treatment option for selected patients with resectable stage II–III NSCLC—although the specific standard varies according to stage, molecular and PD-L1 status, and regulatory approval—significantly improving pathological complete response and event-free survival. However, immune-related fibrosis, nodal scarring, and altered tissue planes increase surgical complexity and intra-postoperative complications. Available evidence, largely retrospective and derived from selected patient populations treated at experienced centers, suggest that RATS is feasible and safe, offering enhanced visualization and dexterity that may facilitate dissection in challenging post-induction settings. Vascular management and lymph node dissection remain critical technical aspects, and early conversion to open surgery, when required, should be regarded as an appropriate safety strategy rather than a complication. Conclusions: RATS after neoadjuvant chemo-immunotherapy appears feasible and promising in selected patients treated at experienced centers, but current evidence does not yet establish it as the preferred approach for all patients. Careful patient selection, adherence to oncological principles, and surgeon experience are essential. Prospective data are needed to define optimal surgical timing and standardize techniques. Full article

Severe bacterial keratitis and endophthalmitis are leading causes of corneal scarring, enucleation, and permanent vision loss, and are increasingly complicated by multidrug-resistant Gram-positive ocular pathogens. In the United States, according to the ARMOR surveillance program (2009–2020), methicillin resistance reached 45.9% of intraocular Staphylococcus aureus and 47.9% of coagulase-negative staphylococci (CoNS), with multidrug resistance exceeding 70% among methicillin-resistant intraocular isolates. While new antibiotics have been approved for systemic infections, vancomycin remains the standard of care for severe Gram-positive ocular infections. However, its ophthalmic use is constrained by limited ocular surface tolerability, physical incompatibility with intravitreal ceftazidime, and an association with hemorrhagic occlusive retinal vasculitis. To address this gap and further stimulate the development of next-generation targeted therapies in ophthalmology, this review focuses on current recommendations and new vancomycin alternative treatments for Gram-positive ocular infections in the antibiotic resistance era. This review details the current antimicrobial recommendations for the most frequent ocular infections, followed by the epidemiology and molecular mechanisms of resistance in S. aureus, CoNS, and S. pneumoniae. Finally, this review discusses new drugs that represent promising alternatives to vancomycin in ophthalmology. Full article

Cardiovascular and vascular diseases remain major causes of morbidity and mortality worldwide, despite substantial advances in prevention, diagnosis, and treatment. In recent years, cardiovascular imaging has moved beyond the traditional assessment of anatomy and morphology toward a multidimensional evaluation of function, tissue composition, haemodynamics, inflammation, and individualized risk. This evolution has been driven by technological progress in echocardiography, cardiovascular magnetic resonance, computed tomography, nuclear imaging, intravascular imaging, and point-of-care ultrasound, together with the rapid development of artificial intelligence, radiomics, and predictive analytics. Advanced echocardiographic techniques, including contrast stress echocardiography and emerging methods for myocardial scar detection, may improve functional and prognostic assessment in patients with suspected or established coronary artery disease. Cardiac magnetic resonance, through tissue mapping, late gadolinium enhancement, and 4D flow imaging, provides unique information on myocardial fibrosis, perfusion, ventricular remodelling, and vascular haemodynamics. Computed tomography, particularly with the introduction of photon-counting technology, is expanding the non-invasive characterization of coronary plaques, vascular calcification, and thromboembolic disease. Hybrid imaging with PET/CT and PET/MR offers additional insight into vascular inflammation, myocardial metabolism, and active disease processes. At the same time, intravascular ultrasound, optical coherence tomography, and augmented-reality-supported imaging are refining interventional guidance, while point-of-care ultrasound is broadening access to rapid bedside cardiovascular and vascular assessment. The integration of imaging findings with circulating biomarkers, clinical scores, lipid profiles, coagulation parameters, and machine-learning models represents a promising strategy for personalized risk stratification, particularly in complex conditions such as coronary artery disease, venous thromboembolism, pulmonary embolism, and bleeding risk during antithrombotic therapy. This review summarizes current advances in cardiovascular imaging, discusses their translational implications, and highlights future directions for integrating imaging, artificial intelligence, and precision medicine into daily clinical practice. Full article

Background: Post-burn neck contractures continue to represent a complex reconstructive problem, with significant functional limitations and a marked impact on patients’ appearance and quality of life. This systematic review and meta-analysis aimed to assess surgical outcomes in adult patients undergoing reconstruction for post-burn neck contractures. Methods: A comprehensive search of Medline, Web of Science, and Scopus was performed up to January 2025. Studies reporting surgical management of post-burn neck contractures were included. Primary outcomes were functional and aesthetic improvement, while secondary outcomes included complications, recontracture, and disfiguring scarring. Results: In total, 46 studies comprising 1636 patients were included. Flap-based reconstruction was the most frequently applied approach. Overall, functional improvement was achieved in 92% of cases (95% CI: 89–94%), while satisfactory aesthetic outcomes were reported in 90% (95% CI: 85–93%). The pooled complication rate was 15% (95% CI: 11–20%), with higher rates observed following free flap reconstruction. The incidence of recontracture and disfiguring scarring remained relatively low, about 6%. Although functional outcomes were comparable across flap types, regional flaps appeared to offer the most favorable balance between aesthetic results and complication rates. In contrast, skin grafts and dermal substitutes showed less consistent outcomes and a higher tendency toward recurrence. Conclusions: Flap-based reconstruction remains the cornerstone of treatment for post-burn neck contractures. Surgical planning should be individualized, taking into account defect severity, tissue availability, and surgical expertise. Further prospective studies using standardized outcome measures are needed to strengthen current evidence. Full article

Pulmonary fibrosis (PF) is a progressive lung condition characterized by irreversible scarring and high mortality, with limited effective treatments. Mitochondrial dysfunction has emerged as a critical factor in fibroblast activation in PF, although approaches to restore mitochondrial function remain underexplored. The present study investigated whether mitochondrial transfer from alveolar type II epithelial cells (A549) to patient-derived fibroblasts could restore mitochondrial function and bioenergetics. Histological analysis of fibrotic lungs reveals increased collagen deposition and elevated profibrotic markers, accompanied by reduced expression of mitochondrial biogenesis and respiratory proteins compared to non-fibrotic controls, indicating mitochondrial impairment. Freshly isolated donor mitochondria were functionally validated before mitoception using Seahorse analysis and patient-derived fibroblasts were confirmed by qRT-PCR using fibroblast-specific markers. In vitro transfer of mitochondria to diseased patient-derived fibroblasts exhibited a modest, dose and time-dependent increase in mitochondrial membrane potential compared to normal fibroblasts. Gene expression analysis revealed decreased fibrosis-associated markers and increased expression of mitochondrial and antioxidant genes following mitoception. Seahorse analysis after mitoception revealed enhanced ATP-linked respiration and improved selected mitochondrial bioenergetic parameters, whereas maximal respiration and spare respiratory capacity demonstrated variable responses. In contrast, normal fibroblasts displayed minimal changes. Collectively, these findings indicate that mitochondrial transfer modulates fibroblast bioenergetics and profibrotic signaling, supporting its potential as a therapeutic strategy for pulmonary fibrosis. Full article

Background: Lumbar foraminal canal stenosis (LFS) is typically multifactorial: disk height loss and bulging, facet hypertrophy/osteophytes, ligamentous thickening, and post-inflammatory or post-interventional scarring. Methods: To develop and implement a structured system for surgical care in chronic vertebrogenic pain with radicular features attributable to LFS, integrating population-based MRI morphometrics and interventional therapy response profiling, we conducted a single-center, multi-cohort observational study to develop, operationalize, and internally evaluate a quantitative, volume-integrated diagnostic and treatment stratification framework for LFS. Results: A retrospective evaluation of 351 surgically treated patients (2017–2023) was performed to identify structural and clinical drivers of persistent or recurrent pain. Following selective blockades and radiofrequency denervation, radiculopathy regressed in 44.7% of patients, facet-mediated pain improved in 44.0%, and the median pain relief duration was 3–6 months. Oswestry Disability Index (ODI) dynamics after interventional therapy showed significant improvement at 6 months (all p < 0.001). Both groups demonstrated significant improvement in VAS, ODI, and SF-36 scores over time. Endoscopic decompression achieved faster early leg pain relief (VAS leg, p < 0.001 at 6 and 12 months). ALIF resulted in superior long-term back pain control (VAS back, p < 0.001 at 12 and 24 months). At 24 months, pain levels were clinically equivalent between groups, indicating that procedure selection influences pain profile rather than absolute outcome. Conclusions: By integrating quantitative foraminal volume, nerve occupancy, and segmental stability, we demonstrated that treatment success in LFS is not determined by the magnitude of decompression alone, but by the precision of phenotypic matching. Indirect decompression, endoscopic foraminotomy, microsurgical decompression, and fusion-based stabilization each have a rational role when aligned with the biomechanical context rather than applied reflexively. Full article

The skin is the largest organ of the human body and, due to its direct contact with the external environment, is one of the most vulnerable tissues. Traditional medical bandages and gauze exhibit limited efficacy in wound management, often neglecting the control of wound inflammation and the promotion of skin regeneration. Hydrogels, as an emerging material, possess appropriate swelling capacity, oxygen permeability, and the ability to absorb wound exudates, thereby facilitating wound healing, making them an ideal choice for functional applications in skin tissue engineering. In this study, dual-treated balsa wood (BWSM) was used as the hydrogel substrate, with polyvinyl alcohol (PVA), chitosan (CS), and zinc gluconate (ZnG) used as the primary raw materials. The BWSM/PVA/CS/ZnG hydrogel was prepared via gamma-ray irradiation. Balsa wood treated with alkaline solutions, hydrogen peroxide solutions, and microwave treatment processing exhibited enhanced transparency, increased porosity, improved thermal stability and swelling rates, while retaining adequate mechanical strength. Gamma-ray irradiation of the BWSM/PVA/CS/ZnG hydrogel wound dressing demonstrated sustained drug release and antibacterial efficacy through release and antimicrobial tests. Animal experiments showed that the BWSM/PVA/CS/ZnG composite hydrogel promoted wound healing in mice and effectively prevented scar formation. The aforementioned results demonstrate that the PVA/CS/ZnG composite hydrogel loaded with balsa wood exhibits durable antibacterial properties and high mechanical strength and promotes wound healing, making it suitable for applications in biomedical materials such as wound dressings. Full article

Background: HS is a chronic inflammatory skin disease in which inflammatory nodules and abscesses coexist with tunnels, fibrosis, and scarring. This dual biology explains why medical therapy often improves inflammatory dissease activity without fully addressing fixed tissue damage, whereas surgery can achieve durable local control but does not treat diffuse inflammatory burden. Contemporary international guidelines increasingly endorse multimodal and medicosurgical care. Objective: To critically compare the evidence supporting medical and surgical management of HS, with emphasis on outcomes, indications, limitations, and clinical decision-making relevant to contemporary practice. Methods: A structured review was undertaken using PubMed/MEDLINE, the Cochrane Library, and major dermatology guideline sources, with searches updated to 7 May 2026. Priority was given to clinical guidelines, systematic reviews and meta-analyses, randomized controlled trials, and higher-quality observational studies. Evidence was synthesized narratively because endpoints, populations, and follow-up intervals differed markedly across medical and surgical studies. Results: Medical evidence is strongest for biologic therapy in moderate-to-severe inflammatory HS. Weekly adalimumab improved week-12 HiSCR in the phase 3 PIONEER trials; secukinumab improved week-16 and week-52 outcomes in SUNSHINE/SUNRISE; and bimekizumab improved week-16 HiSCR50 in BE HEARD I/II. Surgical evidence is strongest for wide excision in structurally advanced disease, particularly when compared with local excision or incision and drainage. Meta-analytic data consistently show lower recurrence after wide excision than after local excision, and lower recurrence after flap or graft reconstruction than after primary closure. Combined therapy is increasingly supported: peri-operative adalimumab improved outcomes in SHARPS, and surgery plus adalimumab outperformed adalimumab alone in a pragmatic 12-month RCT. Conclusions: HS is best managed by matching treatment to disease phenotype. Medical therapy is essential for inflammatory control; surgery is essential for persistent tunnels, fibrosis, and scarred regional disease. The strongest overall clinical position is an integrated, multidisciplinary model in which systemic therapy reduces inflammatory load and surgery definitively treats irreversible tissue damage. Full article

Background/Objectives: Hydroxychloroquine is widely used in the treatment of autoimmune and dermatologic diseases; however, it may rarely induce severe cutaneous adverse reactions. Acute Generalized Exanthematous Pustulosis is an uncommon, acute pustular eruption most frequently associated with antibiotics. Hydroxychloroquine-induced AGEP remains relatively rare and diagnostically challenging due to its atypical and prolonged clinical course. Case presentation: We report the case of a 45-year-old woman with rheumatoid arthritis and a complex medical history who developed generalized urticarial and pustular dermatosis following re-exposure to hydroxychloroquine. Notably, the patient had experienced a similar cutaneous reaction after previous exposure to the same medication several years earlier. Ten days after completing a treatment course of hydroxychloroquine, she developed rapidly progressive pruritic erythematous and urticarial plaques that evolved into generalized annular lesions with peripheral scaling and grouped sterile pustules. Laboratory evaluation demonstrated leukocytosis, intermittent eosinophilia, and elevated IgE levels, while the infectious workup was negative. Histopathological examination revealed subcorneal pustules with neutrophilic infiltration, mild spongiosis, and scattered individual eosinophils, perivascular inflammatory infiltrates, findings consistent with AGEP. Retrospective assessment using the EuroSCAR scoring system classified the reaction as probable AGEP, while the Naranjo adverse drug reaction scale supported a probable causal relationship with hydroxychloroquine. Clinical improvement was achieved after withdrawal of the drug and treatment with systemic corticosteroids and supportive therapy. Conclusions: This case highlights the importance of recognizing atypical presentations compatible with hydroxychloroquine-induced probable AGEP and emphasizes the diagnostic value of a positive rechallenge as supportive evidence of drug causality. Early recognition and prompt discontinuation of the offending agent are essential to prevent severe complications and recurrence. Full article

Odontogenic cutaneous sinus tracts represent an uncommon clinical manifestation of chronic dental infection and are frequently misdiagnosed due to the absence of dental symptoms and their resemblance to dermatologic lesions. This case report describes the nonsurgical endodontic management of a cutaneous sinus tract of dental origin in a 13-year-old patient. The patient presented with a persistent extraoral lesion in the mandibular region, initially evaluated by non-dental specialists. Clinical and radiographic examination revealed a necrotic mandibular first molar associated with a periapical radiolucency and intraoral sinus tract. Nonsurgical root canal treatment was performed using chemomechanical debridement with sodium hypochlorite irrigation and calcium hydroxide as an intracanal medicament. Complete obturation was achieved following resolution of intracanal exudation. No surgical intervention of the cutaneous lesion was undertaken. Progressive healing of the periapical lesion and spontaneous resolution of the extraoral sinus tract were observed over a 6-month follow-up period. This case is noteworthy because it combines a prolonged diagnostic delay, an atypical extraoral manifestation in a child, and successful resolution by nonsurgical endodontic therapy alone without surgical excision of the cutaneous lesion. The 6-month follow-up confirms sustained clinical and radiographic healing, underscoring the importance of early recognition and conservative management in pediatric patients. Early identification and elimination of the dental source can prevent unnecessary surgical procedures and minimize the risk of permanent scarring. Full article

Waste cooking oil (WCO) is generated globally in large quantities, and improper disposal contributes to significant environmental problems. Recently, WCO has attracted increasing attention as a sustainable base fluid for lubricating grease due to its biodegradability, low cost, and favorable physicochemical properties after thermal degradation. This study presents a systematic review conducted with reference to the PRISMA 2020 guidelines of WCO-based grease and lubrication systems published between 2000 and 2025. Scopus was systematically searched, resulting in 22 peer-reviewed studies meeting the inclusion criteria. The review shows that thermal degradation increases WCO viscosity, polarity, and the relative proportion of saturated fatty acids, thereby enhancing boundary lubrication behavior. Tribological performance was found to depend more strongly on formulation strategy than feedstock variability, provided that appropriate pre-treatment is applied. Optimized WCO-based greases achieved coefficient of friction (COF) values as low as 0.0253 and wear scar diameters (WSD) of 467 µm, demonstrating performance comparable to conventional mineral oil greases. Non-soap thickeners exhibited thermal stability exceeding 350 °C, while additives such as molybdenum disulfide (MoS₂) improved friction and wear performance. Overall, this review establishes a structure–property–performance framework linking thermal degradation chemistry, formulation design, and tribological behavior in WCO-based lubrication systems while highlighting challenges related to standardization, long-term stability, and industrial validation. Full article

Background: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder associated with recurrent febrile urinary tract infections, renal scarring, hypertension, and potential long-term renal morbidity. Postoperative outcomes after ureteral reimplantation may be influenced by reflux grade, reflux etiology, bladder function, renal status, operative technique, surgeon experience, and follow-up intensity. However, real-world evidence from low- and middle-income healthcare settings remains limited, particularly for surgically treated children with high-grade VUR. Objective: To describe postoperative outcomes after ureteral reimplantation in children with Grade III–V VUR and to explore the association of VUR grade and surgical approach with reflux resolution, recurrence, and reintervention in a surgically selected pediatric cohort. Methods: We conducted a retrospective cohort study at a tertiary pediatric referral center in Ecuador. The study included 90 children aged 0 to 15 years with Grade III–V VUR confirmed by voiding cystourethrography who underwent open or laparoscopic ureteral reimplantation between January 2019 and January 2024. Demographic, clinical, imaging, and surgical variables were extracted from medical records. Postoperative outcomes included reflux resolution, recurrence, and reintervention. Logistic regression models were used as exploratory analyses only. Because the cohort included only operated patients, treatment allocation was nonrandomized, event numbers were limited, and several relevant prognostic variables were incompletely documented, adjusted estimates were interpreted cautiously and were not used to infer causality. Results: Overall reflux resolution was achieved in 68 of 90 patients (75.6%), recurrence occurred in 12 patients (13.3%), and reintervention was required in 8 patients (8.9%). Resolution rates were similar after open and laparoscopic surgery (44/59, 74.6% vs. 24/31, 77.4%; p = 0.766). Recurrence was numerically lower after laparoscopic than open reimplantation, but the difference was not statistically significant (2/31, 6.5% vs. 10/59, 16.9%; p = 0.164). Reintervention rates were also similar between groups (3/31, 9.7% vs. 5/59, 8.5%; p = 0.849). In exploratory multivariable analysis, Grade V VUR was associated with lower odds of reflux resolution (OR, 0.06; 95% CI, 0.01–0.40; p = 0.003) and higher odds of recurrence (OR, 16.69; 95% CI, 1.88–148.32; p = 0.012) compared with Grade III VUR. Surgical approach was not independently associated with resolution, recurrence, or reintervention. The small Grade V subgroup, the limited number of recurrence and reintervention events, and the wide confidence intervals indicate substantial statistical imprecision. Conclusions: In this surgically treated pediatric cohort from a tertiary referral center in Ecuador, ureteral reimplantation was associated with reflux resolution in approximately three-quarters of patients. Higher reflux grade, particularly Grade V disease, was associated with less favorable postoperative outcomes in exploratory analyses, but these findings should not be interpreted as causal or definitive because of the small subgroup size, limited event numbers, selection bias, and incomplete documentation of reflux etiology, bladder dysfunction, renal scarring, renal function, surgeon experience, and follow-up duration. Open and laparoscopic approaches showed comparable resolution and reintervention rates, while the lower recurrence observed after laparoscopy did not reach statistical significance. Future prospective studies should standardize outcome definitions, distinguish imaging-confirmed from clinically documented resolution, report follow-up duration, and account for reflux etiology, bladder function, renal status, surgical experience, and healthcare access. Full article

Vernal keratoconjunctivitis (VKC) is a chronic condition that causes remodeling of the cornea and conjunctiva through recurring episodes of allergic inflammation of the ocular surface. This can lead to corneal scarring, keratoconus, and chronic conjunctival papillae. However, the details of the immunopathological processes behind these remodeling changes are not completely understood. Despite involving IgE-modulated mechanisms, about half of patients with VKC test negative on systemic allergy tests. This calls for the need to understand the common and novel inflammatory mediators involved in the pathogenesis of VKC development and severity levels. Eye rubbing stimulates the release of inflammatory cytokines TNF-alpha, IL-4, IL-5, and IL-13 and remodeling enzymes MMP-1, MMP-3, MMP-9, and MMP-10, which drive a dysregulated cycle of stromal tissue remodeling that leads to progressive ectasia. Eosinophilic activity is driven by CCL11 and ICAM-1 and eye rubbing, which leads to degranulation and the release of EMBP, ECP, and MMP-9. These inflammatory mediators drive the remodeling changes that lead to corneal scarring and ectasia. The purpose of this comprehensive review paper is to shed light on common and novel immunological mediators that help us further understand VKC and eventually lead to the discovery of more effective and targeted treatment options. Full article

Background: Acne vulgaris affects up to 80% of individuals aged 11–30 years and frequently results in permanent scarring with significant psychosocial impact. This prospective single-arm case series evaluated the safety and high-frequency ultrasound-assessed morphological changes in a combined protocol integrating subcision, PEGDE-crosslinked hyaluronic acid supplemented with calcium hydroxyapatite (CaHA), and fractional 1470 nm diode laser therapy in patients with facial atrophic acne scars. Methods: Twenty patients (aged 18–42 years, Fitzpatrick phototypes I–II) with moderate-to-severe atrophic acne scars underwent subcision of fibrotic adhesions using a 22G cannula combined with a single subcutaneous injection of 2 mL PEGDE-crosslinked hyaluronic acid with CaHA microparticles on day 0, followed by two sessions of fractional 1470 nm diode laser therapy on days 7 and 28. Scar depth and diameter were assessed using high-frequency ultrasound (48 MHz) at baseline and on days 28, 49, 77, and 139. Results: All participants completed the protocol without serious adverse events. High-frequency ultrasound demonstrated progressive reductions in mean scar depth (from 0.35 to 0.05 mm; −86%) and scar diameter (from 4.27 to 1.06 mm; −75%) by day 139, with reductions continuing beyond the active treatment phase. In linear mixed-effects models accounting for within-patient clustering of the two lesions assessed per participant, the reductions in both depth and diameter were statistically significant at every follow-up timepoint relative to baseline (all p < 0.001). These ultrasound findings were not corroborated by a control group, blinded assessment, validated clinical grading, or patient-reported outcomes. Conclusions: In this single-arm case series, the combined subcision, PEGDE-crosslinked HA–CaHA filler, and fractional 1470 nm diode laser protocol was well tolerated and associated with progressive, sustained reductions in high-frequency ultrasound-measured scar depth and diameter. As an uncontrolled, unblinded study without validated clinical grading or patient-reported outcomes, these findings are preliminary and require confirmation in larger, controlled trials. Full article

Posterior urethral valves (PUV) cause congenital urinary tract obstruction and often lead to chronic kidney disease (CKD) despite treatment; however, DNA methylation remains underexplored in PUV. This cross-sectional study aimed to compare peripheral-blood global DNA methylation, measured as 5-methylcytosine content (5-mC%), between boys with PUV and age-matched male controls, and to assess its association with kidney function, CKD stage, and kidney scarring. The study included 45 boys with PUV and 45 age-matched boys as controls. Peripheral-blood global 5-mC% was quantified using an ELISA-based assay. Glomerular filtration rate and kidney scarring were assessed by nuclear scintigraphy, and PUV patients were categorized according to CKD stage and scarring status. Statistical comparisons were performed using the Kruskal–Wallis test followed by Dunn’s test, with exploratory trend analysis used to evaluate the association between global 5-mC% and CKD severity. Global 5-mC content was significantly higher in PUV patients than in controls (median 5-mC%: 0.4336 vs. 0.3732, p < 0.001). Within the PUV cohort, global 5-mC% increased with CKD severity (p < 0.05) and showed a logarithmic association with CKD stage (R² = 0.8012). Patients with kidney scarring also had significantly higher global 5-mC% than controls (p < 0.001), although differences across individual CKD stages and scarring subgroups were not statistically significant. These findings suggest altered systemic global 5-mC content in boys with PUV and support larger, longitudinal studies incorporating locus-specific methylation profiling. Full article