Search Results (41,058)

Objectives: Varicella zoster virus (VZV) meningitis is a complication of herpes zoster that causes high rates of residual symptoms. However, prognostic factors and optimal management strategies remain unclear. This study investigated factors affecting functional outcomes, age-related differences, and the impact of prior oral antiviral therapy in VZV meningitis. Methods: This retrospective observational study enrolled patients admitted for aseptic meningitis between 2013 and 2022. The primary outcome was residual symptoms at discharge, defined as a ≥1-point increase in the modified Rankin Scale (mRS) from baseline. Multiple logistic regression identified independent risk factors. Results: Among 176 patients with aseptic meningitis, 60 (34.1%) had VZV meningitis. Patients with VZV meningitis had higher rates of residual symptoms (43.3% vs. 12.9%, p < 0.001). Independent predictors of residual symptoms included delayed intravenous acyclovir initiation (odds ratio [OR] = 1.303, 95% confidence interval [CI] = 1.060–1.601, p = 0.012), corresponding to a 30.3% increase in the odds of residual symptoms for each additional day before treatment initiation, and pre-onset mRS (OR = 2.352, 95% CI = 1.056–5.237, p = 0.036). Patients ≥ 50 years old displayed lower rates of headache (75.0% vs. 96.9%, p = 0.020), neck stiffness (25.0% vs. 62.5%, p = 0.005), and CSF pleocytosis (56/μL vs. 142/μL, p = 0.023). Prior oral antiviral therapy was not associated with a rate of residual symptoms (p = 0.795). Conclusions: Delayed initiation of intravenous acyclovir was independently associated with residual symptoms at discharge, whereas older patients often presented with atypical clinical features, requiring heightened clinical suspicion. Given the lack of observed benefit associated with prior oral antiviral therapy, prompt initiation of intravenous acyclovir should be considered when VZV meningitis is suspected. Full article

Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by a block of differentiation and uncontrolled expansion of myeloid progenitor cells. Standard treatment includes intensive induction chemotherapy, typically with cytarabine and anthracycline, followed by consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. However, these approaches are often associated with relapse and treatment-related toxicity. Accumulating evidence highlights a critical role for epigenetic dysregulation in driving disease initiation, progression, and therapeutic resistance. In this review, we examine an integrated framework of epigenetic regulation in AML, encompassing DNA methylation, histone post-translational modifications, chromatin remodeling, and RNA-mediated epigenetics. We discuss how alterations in key epigenetic regulators, such as DNMT3A, TET2, IDH1/2, EZH2, and histone-modifying enzymes, reshape the transcriptional and epigenetic landscape of leukemic cells. Particular emphasis is placed on epigenetically defined AML subtypes, including NPM1-mutated, DNMT3A-mutated, and KMT2A-rearranged AML, which illustrate distinct mechanisms of transcriptional and epigenetic dysregulation and confer unique therapeutic vulnerabilities. We further summarize current and emerging therapeutic strategies, ranging from conventional chemotherapy to molecularly targeted agents, epigenetic drugs, and immunotherapeutic approaches. Despite these advances, durable responses remain limited, highlighting the need to better understand epigenetic mechanisms to overcome resistance and improve patient outcomes. Full article

Background: Available data indicate that the development of refractory schizophrenia may result from neuroinflammation, dysregulation of neurotrophins and metalloproteinases (MMPs), oxidative stress (OS), and hormonal imbalance. Electroconvulsive therapy (ECT) is an effective therapeutic option for drug resistance, but its impact on brain-derived neurotrophic factor (BDNF) and MMPs remains underinvestigated. This study evaluates the influence of ECT on serum BDNF, MMPs (MMP-7, MMP-9, MMP-14), and tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2, TIMP-3) in patients with treatment-resistant schizophrenia (TRS). Another goal of this study is an assessment of the relationships between these biomarkers and the intensity of schizophrenia symptoms. Methods: Serum concentrations of the aforementioned biomarkers were measured prior to and after ECT in eight patients and 13 healthy controls. The severity of schizophrenia symptoms was evaluated with the Positive and Negative Syndrome Scale (PANSS). Results: Bayesian analysis comparing pre-ECT serum concentrations of BDNF, MMPs, and their inhibitors in TRS patients with a control group showed a significant difference only for MMP-9. Furthermore, convincing evidence of a correlation between MMP-9 and MMP-14 was found in TRS patients. Although the ECT therapy did not result in changes in the serum concentrations of the studied biomarkers, substantial improvement in schizophrenia symptoms on the PANSS was observed. Conclusions: No significant biomarker changes (post- versus pre-treatment) were detected in this small exploratory cohort. Whether these biomarkers are involved in neuroinflammation (as possible contributors to the development of TRS) remains an open question, and therefore, further research on biomarkers in cerebrospinal fluid (CSF) may be suggested. Full article

Background/Objectives: Complex endodontic lesions characterized by significant periapical bone loss, diverse anatomical variations in the root canal system and apical resorption represent a major therapeutic challenge. Biodentine, a calcium silicate-based bioactive dental restorative material, has gained considerable attention because of its potential to promote and sustain the regeneration of bone tissue. This review aims to evaluate current evidence on Biodentine’s regenerative abilities in treatments of diverse endodontic pathology and highlight the clinical and radiographic outcomes. Material and Methods: A systematic review was conducted in accordance with PRISMA guidelines by searching for articles in three electronic databases: Medline (PubMed), Scopus, and Cochrane Library. Studies describing the application of Biodentine in cases of complex endodontic pathology with destruction of apical bone and apical resorption of roots were considered for inclusion in the study. Quality assessment was carried out using the Cochrane risk of bias assessment tool RoB 2.0. Results: The included clinical and radiographic studies demonstrated positive treatment outcomes after using Biodentine in difficult endodontic lesions, including a reduction in lesion size, improvement in symptoms and progression of periapical bone regeneration after 12 months of follow-up. No significant adverse outcomes were reported in the studies included. Conclusions: Biodentine proved to be an efficient biocompatible material in terms of managing complex endodontic lesions. Due to its bioactive properties and high efficiency as an apical plug, Biodentine is capable of inducing bone regeneration within the affected periapical area. Full article

Background and Objectives: Unicameral bone cyst (UBC) is a benign cystic lesion originating from the metaphysis, often extending toward the diaphysis as the individual grows. It is more common in boys aged 5–15 years, typically affecting long bones like the humerus and femur. UBC is usually asymptomatic and found incidentally on imaging, with pathological fractures being a common complication. Treatment options include conservative observation, percutaneous injection, and surgery. This study aims to compare the diagnostic, treatment, and follow-up processes of UBC cases across multiple centers in our country. Materials and Methods: This study reviewed 180 UBC cases in patients aged 0–20 from seven clinical centers in our country. Patient demographics, symptoms, diagnostic methods, treatment approaches, and follow-up data were collected. Radiological and histopathological diagnostic accuracy, treatment methods (conservative, percutaneous injection, surgical), and recovery were analyzed using Musculoskeletal Tumor Society (MSTS) scores and Capanna criteria. Results: Among 180 patients, 50% had pain. Most diagnoses were made through radiographic imaging, with 96.1% diagnostic accuracy. The humerus (44.7%) and femur (30.7%) were the most commonly affected bones. Pathological fractures were found in 35% of cases. Treatment included conservative (19%), percutaneous injection (31.8%), and surgery (49.2%). The average follow-up period was 81 months, with early complications being skin issues and late complications primarily limb shortening. Conclusions: The study highlights the effectiveness of different treatment approaches for UBC, showing that surgical treatment offers the best clinical outcomes, while percutaneous injection is a less invasive option. Treatment should be tailored to individual patient needs. Full article

Background: Currently, there is a lack of biomechanical studies on traditional dual-growing rods (TDGR) combined with apical osteotomy and short-segment fusion (hybrid technique, HT). This study compared the differences in clinical outcomes and biomechanics between TDGR and HT in the treatment of severe early-onset scoliosis (sEOS) via finite element analysis (FEA) and in vitro biomechanical experiments. Methods: Two scoliotic FEA models and 12 in vitro scoliotic models were created. In the FEA, the initial surgeries for TDGR and HT, two subsequent lengthenings, and up to 12 months of physeal spinal growth were simulated. In the in vitro biomechanical experiments, the initial surgeries were simulated. Correction outcomes, spinal height, and stress were compared between the TDGR and HT groups. Results: (1) FEA: Compared with TDGR, HT achieved better correction (62.4% vs. 36.2%) and a greater increase in spinal height (26.43 mm vs. 12.58 mm) after the initial surgery. During follow-up, HT resulted in better correction maintenance and could better sustain spinal growth than TDGR. HT reduced the stress on the proximal and distal instrumented vertebral bodies, junctional intervertebral discs, and instrumentation compared with TDGR. (2) In vitro biomechanical experiment: After the initial surgery, the mean Cobb angle of the main curve (24.58 ± 2.80° vs. 38.97 ± 3.23°) and AVT (8.87 ± 1.64 mm vs. 13.15 ± 3.58 mm) in the HT group were significantly lower than those in the TDGR group (p < 0.05). The increase in spinal height in the HT group was significantly greater than that in the TDGR group (3.83 ± 0.45 cm vs. 1.85 ± 0.72 cm, p < 0.001). Compared with TDGR, HT significantly decreased rod strain (p < 0.05). Conclusions: Compared with TDGR, HT can significantly improve correction outcomes and maintain spinal growth. Apical anchors can effectively disperse stress on the spine and instrumentation, which may reduce the risk of complications and potentially delay intervertebral disc degeneration, although clinical validation is required. Full article

The optimal revascularization strategy for common femoral artery (CFA) atherosclerotic occlusive disease remains debated. This systematic review and meta-analysis compared perioperative and long-term outcomes of endovascular therapy (EVT) and open surgery (OS). Methods: PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched through 15 March 2026 for comparative studies of EVT versus OS in CFA atherosclerotic occlusive disease. Outcomes included perioperative morbidity, wound complications, hospital stay, patency, reintervention, major amputation, and survival. Time-to-event data were pooled as hazard ratios (HRs), reported or reconstructed from Kaplan-Meier curves. Risk of bias and evidence certainty were assessed. Results: Eleven studies with 2835 patients were included. Compared with OS, EVT reduced 30-day morbidity (OR, 0.34; 95% CI: 0.26–0.44), wound complications (OR, 0.14; 95% CI: 0.09–0.23), surgical-site infections, lymphatic complications, myocardial infarction, and hospital stay (mean difference, −4.68 days; 95% CI: −5.49 to −3.86). Distal embolization increased after EVT (OR, 2.45; 95% CI: 1.28–4.70). Follow-up major amputation was higher after EVT in event-rate analyses (OR, 2.42; 95% CI: 1.19–4.93), although amputation-free survival was similar (HR, 1.01; 95% CI: 0.83–1.23). EVT had higher hazards of loss of primary patency (HR, 1.72), loss of secondary patency (HR, 2.03), and reintervention (HR, 1.51). Conclusions: EVT offers fewer early complications and shorter hospitalization, whereas OS provides more durable patency and fewer reinterventions. Given observational, heterogeneous evidence, treatment should be individualized. Full article

Background: Chronic respiratory disease is currently a global health problem. Secondary problems, such as skeletal muscle disorders, among which cervical spine and diaphragm dysfunctions are two of the most common, can affect the lung function of these subjects. Manual therapy could be a suitable treatment for these problems. However, although this is a very broad area of research, there is no consensus on its usefulness. Objectives: To investigate the effects of the diaphragmatic stretch technique and the high-speed, low-amplitude C3–C4 rotational thrust technique, applied alone or in combination, on respiratory function in healthy adults. Peak expiratory flow (PEF) was the primary outcome; forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were secondary outcomes included to assess safety. Methods: A randomized, sham-controlled clinical trial with blinded outcome assessment with 152 healthy participants distributed in four groups was conducted: Group 1 subjects underwent the Diaphragmatic Stretch Technique, Group 2 subjects underwent the high-speed, low-amplitude thrust technique in C3–C4 rotation, Group 3 underwent both techniques, and Group C (control group) received a simulation of one of the two techniques. The three outcome variables were recorded immediately after the intervention and 5 min after. Study registered on ClinicalTrials.gov (NCT03732222). Results: The results show a significant increase in PEF for Group 1, visible in the immediate post-intervention and at 5 min post-intervention. Group 3 also showed a significant increase in PEF, although only at 5 min post-intervention. Conclusions: High-speed, low-amplitude C3–C4 rotation thrust technique and Diaphragmatic Stretch Technique can improve the PEF in healthy subjects. Full article

Background/Objectives: High-viscosity glass hybrid restorative systems (GHRS) were developed to improve the mechanical limitations of conventional glass ionomer cements while preserving their bioactive properties. This scoping review aimed to map and synthesize the currently available evidence regarding the clinical performance of high-viscosity glass hybrid restorative systems in posterior teeth. Methods: A literature search was conducted in PubMed/MEDLINE, Web of Science and Google Scholar using MeSH terms and free-text keywords related to glass hybrid restorative systems and posterior restorations. After screening and eligibility assessment, 39 studies were included in the review. Results: The reviewed studies indicated that GHRS exhibited better wear resistance, higher fracture resistance, improved surface durability, and superior marginal integrity compared with conventional high-viscosity glass ionomer cements. Equia Forte HT (GC Corporation, Tokyo, Japan), combined with nano-filled resin coatings, was the most frequently investigated system and showed favorable short- and medium-term clinical performance in small-to-moderate posterior restorations. Discussion: Glass-hybrid restorative systems have demonstrated considerable potential in minimally invasive dentistry, atraumatic restorative treatment, and pediatric restorative applications, particularly in patients with increased caries susceptibility. Their sustained fluoride release, chemical adhesion to dental tissues, and improved moisture tolerance may contribute to favorable clinical outcomes in challenging operative conditions. Conclusions: Within the limitations of the available evidence, high-viscosity glass-hybrid restorative systems may represent a promising restorative option for selected posterior restorations. Nevertheless, the available evidence remains heterogeneous, and further high-quality long-term randomized controlled trials are required to confirm their clinical performance and indications. Full article

Background: Heritable thoracic aortic disease (HTAD) encompass a heterogeneous spectrum of conditions characterized by increased susceptibility to developing thoracic aortic aneurysm and life-threatening complications, including aortic dissection and rupture. Despite distinct underlying mechanisms involving extracellular matrix integrity, vascular smooth muscle cell function, and dysregulation of signaling pathways, these disorders converge on a shared vulnerability of the aortic wall. Although acute events typically occur in adulthood, the disease process often begins early in life, making HTAD highly relevant in pediatric practice, where early recognition and longitudinal management are essential. Aims: This narrative review provides a biology- and genetics-oriented, translational complement to current consensus recommendations, framing pediatric HTAD as a developmentally shaped disorder of the aortic wall in which genotype increasingly informs diagnosis, surveillance, and treatment. Methods: Relevant studies were identified through a comprehensive PubMed search, with particular focus on pathogenic mechanisms, current clinical guidelines, follow-up strategies and emerging genetic perspectives. Results: Genetic testing is emerging as a key tool for the management of HTAD, although its clinical utility remains limited by provisional genotype–phenotype correlations and inconclusive results. Current risk stratification is still mainly based on aortic diameter surveillance, while pharmacological strategies are predominantly extrapolated from Marfan syndrome trials, highlighting important gaps in evidence. Conclusions: Genetic advances are expanding management opportunities in HTAD, but their clinical translation remains challenging. Disease-specific risk models integrating genetic and clinical data may improve individualized risk stratification, treatment strategies and clinical outcomes. Full article

Background/Objectives: Therapeutic education for children and adolescents with Type 1 Diabetes Mellitus (T1DM) is a continuous and essential process in the effective management of the disease. These programs consider the unique characteristics and developmental needs of each child or adolescent, aiming to empower them to take responsibility for their disease self-management, improve quality of life, and prevent complications. The purpose of this systematic review was to evaluate the impact of therapeutic education in children and adolescents with T1DM on self-management of their disease. Methods: International bibliography was reviewed using electronic databases such as PubMed, Cochrane Library, and Scopus. Key words such as “Therapeutic Education”, “Type 1 diabetes”, “children”, “self-management”, “glycemic control”, and “educational programs” in combination with Boolean operators (AND, OR) were used in English language to search for studies conducted during 2014–2024. Results: A total of 23 studies met the inclusion criteria. Most reported improvements in glycemic control, though not all showed statistically significant reductions in glycated hemoglobin (HbA1c). Enhanced treatment adherence and increased diabetes-related knowledge were common outcomes. Combined educational approaches incorporating psychoeducational interventions demonstrated greater effectiveness in promoting self-management. Digital tools, such as Continuous Glucose Monitoring (CGM), further supported adherence. Quality-of-life improvements were noted but were not always sustained long-term. Parental involvement appeared to improve children’s confidence in disease management. The critical role of interdisciplinary diabetes care teams, particularly nurses’ role, was also highlighted. Conclusions: Therapeutic education appears to support self-management among children and adolescents with T1DM, particularly when programs are individualized, family-centered, multidisciplinary, and supported by psychosocial or technological components. However, effects on glycemic control were not consistent across studies, and further research is needed to confirm long-term outcomes. Full article

Sickle cell disease (SCD) and thalassemia are genetic disorders that necessitate accurate diagnosis for effective management and improved patient outcomes. The advent of nanotechnology has paved the way for innovative, precise detection methods, offering enhanced sensitivity and specificity. The present systematic review aims to assess the analytical performance of nanotechnology-based detection methods for SCD and thalassemia, with a focus on evaluating the analytical performance and identifying the most sensitive nanotechnology-based techniques. An extensive literature search was conducted across five databases (ScienceDirect, PubMed, Embase, Google Scholar), yielding 23 studies that met the inclusion criteria. These studies showcased the potential of nanotechnology-based methods for detecting SCD and thalassemia. The studies utilized diverse samples, including blood, serum, genomic DNA, and purchased oligonucleotides, with most reporting limit of detection (LOD) values. Specifically, gold nanoparticles (AuNPs) exhibited exceptional sensitivity, with detection limits ranging from 2.6 aM to 0.035 pM. Surface modification and functionalization of AuNPs significantly enhance their detection capabilities. Other nanostructures, including silver nanoparticles, quantum dots, and graphene quantum dots, also demonstrate promising diagnostic capabilities. The results showed that nanotechnology-based methods demonstrated improved analytical sensitivity, with LOD ranging from 2.6 aM to 50 nM. This systematic review provides a comprehensive overview of the analytical performance of nanotechnology-based detection methods, shedding light on their potential to revolutionize diagnosis and treatment. Overall, it highlights the transformative potential of nanotechnology in improving molecular diagnostic accuracy for SCD and thalassemia. Full article

Gestational diabetes (GDM) is a frequent health problem associated with both short- and long-term adverse outcomes for mother and child. Standard management includes lifestyle interventions and, when necessary, pharmacologic therapy. However, the effectiveness and timely initiation of pharmacological therapy depend on accurate glucose monitoring. Continuous glucose monitoring (CGM) systems have emerged as valuable tools in diabetes care, providing real-time information on glycemic variability and enabling more individualized therapeutic interventions. In this narrative review, we explore the role of CGM in the early detection of dysglycemia, its diagnostic and prognostic value, and its ability to identify specific glycemic patterns during pregnancies complicated by GDM. We also assess its role in optimizing lifestyle interventions and guiding pharmacotherapeutic strategies. Current evidence suggests that CGM supports clinical decision-making and patient engaging by providing real-time glucose data. This facilitates earlier identification of hyperglycemic patterns, more precise treatment changes and improved glucose control. Furthermore, CGM use has been associated with improved neonatal and maternal outcomes. Despite these promising findings, barriers such as cost and limited access persist. Although the existing evidence remains relatively limited, it supports the integration of CGM into routine care of women with GDM as part of a comprehensive and personalized treatment strategy. Larger clinical trials are needed to fully understand the benefits and optimal use of CGM in GDM, as well as its impact on pregnancy outcomes, glycemic control and psychological well-being. Full article

Salivary gland cancers (SGCs) are rare and heterogeneous tumours, making the identification of reliable prognostic biomarkers challenging. MicroRNAs (miRNAs) regulate post-transcriptional gene expression and may play important roles in tumour progression and treatment response. This systematic review aims to identify and summarize the current evidence on miRNA dysregulation in SGCs, with a particular focus on their prognostic relevance and therapeutic potential. A systematic search of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library was conducted up to 3 December 2025, following PRISMA guidelines and a pre-registered protocol (CRD420251231827). Observational cohort and cross-sectional studies reporting microRNA dysregulation in human salivary gland tissues with prognostic assessment were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Due to considerable heterogeneity, a narrative synthesis was conducted. Twenty studies published between 2013 and 2025 that fulfilled the search criteria were further analyzed. Based on the currently available evidence, dysregulation of miRNAs associated with prognosis has been identified only in adenoid cystic carcinoma (AdCC) and mucoepidermoid carcinoma (MEC). Most studies originated from Asia and used qRT-PCR for miRNA assessment. Most researchers focused on the evaluation of selected candidate miRNAs, rather than conducting comprehensive miRNA profiling approaches in relation to prognosis. Several distinct dysregulated miRNAs were identified across the studies. Among them, miR-9, miR-21, miR-24 miR-29, miR-34c-5p, miR-125a-5p, miR-143, miR-145 and miR-205 were reported in more than one study and linked to clinicopathological advancement and a more aggressive disease course, thus leading to a poorer outcome. MiRNAs appear to represent promising prognostic biomarkers, either as independent predictors or in combination with established clinicopathological features. However, current evidence remains limited to selected histological subtypes and relatively small patient cohorts. Further well-designed studies with long-term follow-up are required. Moreover, comprehensive miRNA profiling with prognosis assessment is necessary before specific miRNAs could be reliably established as biomarkers and utilized in daily clinical practice. Full article

To evaluate the clinical applicability of the 2023 ACR/EULAR serologic classification criteria for antiphospholipid syndrome (APS) in a cohort of pregnant women across the APS spectrum, and to assess the association between serologic burden and clinical manifestations, obstetric outcomes, and treatment response, a retrospective cohort study was conducted including 190 pregnant women with persistent antiphospholipid antibody (aPL) positivity. Patients were classified according to the ACR/EULAR serologic criteria into two groups: high serologic burden (≥3 points) and low serologic burden (≤2 points). Clinical, obstetric, therapeutic, and reproductive variables were compared between groups. Nearly one-third of women did not meet the 2023 ACR/EULAR serologic threshold. Although most patients with thrombotic or obstetric APS fulfilled the ACR/EULAR serologic threshold, 28% of women with obstetric APS and 35.3% of those with pregnancy-related morbidity had ≤2 serologic points. Baseline demographic characteristics were similar between groups. Obesity (23.9% vs. 10%; p = 0.04) and obstetric comorbidity (17.9% vs. 5.4%; p = 0.02) were more frequent among patients with higher serologic burden. Rates of obstetric complications were comparable between groups. The most commonly prescribed treatment was low-dose aspirin combined with low-molecular-weight heparin, with no differences according to serologic classification. Live birth rates and adverse pregnancy outcomes were comparable between groups, with favorable outcomes observed in treated pregnancies. Serologic burden as defined by the 2023 ACR/EULAR criteria does not reliably predict obstetric complications, nor identify a clinically more severe subgroup. These findings highlight that clinical judgment beyond formal classification frameworks remains essential when managing pregnant women with antiphospholipid antibodies. Full article