In many nations, overcrowding in emergency departments (EDs) is a serious public health issue that threatens the proper operation of health systems. Understanding the connection between overcrowding and delays in ED treatment provides decision-makers with valuable insights into the problem and supports the implementation of timely solutions. This meta-analysis adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards and focuses on evaluating the impact of overcrowding in emergency departments (EDs) on patient care outcomes. Specifically, it synthesizes existing data to identify both the causes of ED overcrowding and its effects on patient outcomes. This review screened 11 articles published between 2010 and 2024, including a total of 3,084,344 patients. Among them, 14.7% were admitted to hospitals, with 49% male and 51% female. The average age was 35.9 years, ranging from 3.9 to 58 years, with a median age of 37.3 years. The minimum waiting time before the first examination was 30 min, with a maximum of 360 min and a mean of 234.0 ± 21.7 min. The total length of stay (LOS) in the ED ranged from 123.5 to 540.0 min, with a mean of 245.8 ± 95.9 min. Most patients were discharged home (67.6%), while 10.9% returned to the ED due to unresolved or worsening conditions. Additionally, 2.31% of patients died, 1.88% eloped, 3.08% left without being seen (LWBS), and 1.27% required ICU admission. This meta-analysis highlights the pervasive impact of ED overcrowding on patient outcomes, healthcare worker well-being, and care quality. Overcrowding prolongs waiting times and LOS, disproportionately affects low-acuity cases, and compromises critical care for high-severity patients. Adverse events, such as LWBS, revisits, and incomplete assessments, are consistently linked to overcrowded conditions. Healthcare workers experience significant stress and burnout, which contributes to medical errors and reduced service efficiency.
Introduction: Epilepsy is one of the most common chronic neurological disorders. The condition is characterized by recurrent epileptic seizures and can negatively impact patients’ quality of life, particularly in its social dimension.
Objective: This study analyzes the influence of clinical factors and social determinants on the quality of life of individuals with epilepsy.
Methods: The study included 89 individuals with a diagnosis of epilepsy. Data were collected using the Quality of Life in Epilepsy Inventory questionnaire, supplemented by items on sociodemographic characteristics and social determinants.
Results: The findings revealed that the overall quality of life of patients with epilepsy was at a moderate level, with the lowest scores observed in the domains of energy/fatigue and seizure-related worry. Overall quality of life was positively correlated with social functioning (p < 0.001), cognitive functioning ( p < 0.001), emotional well-being ( p < 0.001), and perceived medication effects ( p < 0.001). Recent seizures were associated with lower overall Quality of Life in Epilepsy Inventory-31 scores ( p < 0.05).
Conclusion: The quality of life of individuals with epilepsy is influenced by a complex set of clinical, psychological, and social determinants, with social functioning representing a key integrative factor. Comprehensive, patient-centered care is recommended, addressing not only seizure control but also psychological well-being, treatment tolerability, and social participation.
Introduction: Epidemiological studies investigating the relationship between cathepsins and diabetes mellitus (DM) have reported inconsistent results.
Objective: The objective of the study is to evaluate the potential causal relationship between cathepsins and DM using Mendelian randomization (MR) analysis.
Methods: A two-sample MR analysis was conducted using single nucleotide polymorphisms as instrumental variables to examine the effects of cathepsins on DM. Both univariable and multivariable MR analyses were employed to assess the individual and combined effects of cathepsins.
Results: Univariable MR analysis revealed a significant association between cathepsin H and an increased risk of type 1 DM using the inverse-variance weighted method (odds ratio = 1.104; 95% confidence interval = 1.065 – 1.145; p<0.001). Reverse MR analysis and sensitivity analysis supported the robustness of this finding. In the multivariable MR analysis, elevated cathepsin H levels were found to be significantly associated with an increased risk of type 1 DM (odds ratio = 1.090; 95% confidence interval = 1.048 – 1.133; p<0.001), even after adjusting for other cathepsin types. No significant associations were observed between cathepsins and the risk of type 2 DM or gestational DM.
Conclusion: The study highlights a significant causal relationship between cathepsin H and the risk of type 1 DM.
Advancements in diagnostic imaging have improved the detection of brain metastases, which are now recognized as the most common intracranial malignancies. While surgical intervention may be indicated for various reasons – including histopathological confirmation, relief of mass effect, neurological improvement, and survival benefits – evidence suggests that gross total resection is particularly important for enhancing both progression-free and overall survival. However, the management of brain metastases remains largely subjective and controversial. This review aims to critically evaluate existing evidence regarding the role of surgical intervention in the treatment of brain metastases.
Objectives: Tuberculosis (TB) remains a major global health threat, necessitating accurate, rapid, and cost-effective diagnostic methods to improve early detection and control of the disease. The traditional methods for detecting Mycobacterium tuberculosis (MTB) in clinical testing are fluorescence smear microscopy (FSM) and Lowenstein–Jensen medium culture (LJMC) methods. With the development of molecular diagnostics, the Xpert MTB/rifampicin assay (Xpert) has become increasingly used. This study compared Xpert with traditional FSM and LJMC using sputum specimens to study the application value in the diagnosis of TB.
Methods: A total of 342 examination reports were included. Sputum samples from all study subjects were tested using FSM, LJMC, and Xpert methods.
Results: The Xpert method showed a significantly higher positive rate than FSM, and a slightly higher rate than LJMC.
Conclusion: Among all sputum samples from suspected or confirmed TB patients, Xpert detected all cases that were positive by FSM, while both Xpert and LJMC missed positives found by each other. FSM also detected a small number of positives not detected by LJMC. Overall, Xpert had the highest positive detection rate, and FSM the lowest. Although FSM is the fastest and least expensive (costing only one-seventh of Xpert), it demonstrated the lowest sensitivity, with its positive rate being roughly half that of Xpert or LJMC.
Mevalonate kinase deficiency (MKD) is a rare auto-inflammatory disease caused by mutations in the mevalonate kinase gene. This leads to problems with isoprenoid production and cell function. Individuals with MKD usually experience repeated fever episodes, along with stomach issues, mouth sores, swollen neck lymph nodes, and skin rashes. In addition, the severity of MKD varies markedly among individuals. The most severe and rarest form of MKD is called mevalonic aciduria, while the most typical type is referred to as hyperimmunoglobulinemia-D syndrome. Based on new research and clinical progress, this review explores more treatment options for MKD.
Introduction: Increasing evidence links cardiovascular disorders (CVDs) and related risk factors to neurodegenerative disease development; however, causal mechanisms are poorly defined.
Objective: This study aims to investigate the causal relationships between neurodegenerative diseases, CVDs, and cardiovascular risk factors, as well as the associations between modifiable lifestyle factors and CVDs and their associated risk factors.
Methods: Single-nucleotide polymorphisms demonstrating associations with neurodegenerative disorders, lifestyle factors, and CVDs were extracted from publicly available genome-wide association study databases.
Results: The findings revealed that Alzheimer’s disease (AD) was negatively associated with pulmonary embolism, heart failure, and type 2 diabetes. In addition, Parkinson’s disease (PD) was linked to an increased risk of hypertension and ischemic stroke. Amyotrophic lateral sclerosis (ALS) correlated positively with hypertension and atrial fibrillation; however, it exhibited a negative relationship with peripheral arterial disease. Coffee intake was positively associated with coronary heart disease, peripheral artery disease, and type 2 diabetes. Alcohol intake was linked to elevated risks of coronary heart disease, hypertension, atrial fibrillation, heart failure, myocardial infarction, and type 2 diabetes. In contrast, tea intake demonstrated inverse associations with coronary heart disease and heart failure.
Conclusion: The present study indicates that ALS, PD, coffee intake, and alcohol intake are associated with an elevated risk of CVDs. Conversely, tea intake demonstrated a protective association against the development of CVDs, whereas AD showed inverse associations with certain cardiovascular risk factors.
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and the third leading cause of cancer-related deaths worldwide. Early diagnosis and effective treatment of HCC remain major global health challenges and place a significant burden on healthcare systems. In recent years, significant advancements in radiomics and deep learning (DL) technologies have been made in the field of medical imaging, offering new possibilities for the diagnosis, treatment, and prognostic assessment of HCC. This review summarizes the current applications of radiomics and DL in precision medicine for HCC, with a focus on their roles in diagnosis, pathological grading, prediction of microvascular invasion, post-operative recurrence, and treatment efficacy assessment. By analyzing existing studies, this paper demonstrates both the potential and current limitations of these technologies in HCC management and outlines directions for future development.
Primary head-and-neck squamous cell carcinoma (HNSCC) is a significant global health concern, strongly associated with smoking, alcohol consumption, human papillomavirus infection (particularly in oropharyngeal cancer), and carcinogen exposure. The term “head-and-neck cancer” broadly encompasses malignancies of the head-and-neck region, including nasopharyngeal and oral cancers. Due to its complex anatomy and occult nature, most patients are diagnosed at an advanced local stage (Stage III/IV). Treatment frequently results in recurrence and metastasis, leading to poor 5-year survival rates. Curcumin, an extract from traditional Chinese medicine, exhibits anti-inflammatory, antioxidant, and multitargeted anticancer activities. Compared to conventional formulations, curcumin derivatives demonstrate enhanced stability, solubility, and pharmacokinetics, offering therapeutic potential in HNSCC. This review highlights recent advancements in the antitumor mechanisms of curcumin and its derivatives in primary HNSCC. The objective is to provide innovative insights that could inform the development of more comprehensive and effective treatment strategies for HNSCC. A comprehensive search of the PubMed database was conducted using advanced filters and Boolean logic with relevant Medical Subject Headings terms and keywords, covering publications from 1987 to April 17, 2025. After screening titles and abstracts, 272 publications were selected, including 158 published in the last decade and 85 within the past 5 years. Curcumin and its derivatives demonstrate antitumor properties by disrupting the cell cycle, inducing apoptosis, modulating key signaling pathways, inhibiting invasion and metastasis, regulating epigenetic activities, and inducing oxidative stress and autophagy. They also show synergy with radiochemotherapy, immunotherapy, and photodynamic therapy. Their multifaceted antitumor properties and favorable safety profiles underscore their potential as effective adjuvant therapies in the treatment of HNSCC.
Introduction: Pulmonary hypertension (PH) presents a significant global public health challenge, underscoring the need for novel biomarkers and therapeutic strategies
Objective: This study proposes a lactylation-related diagnostic model for PH, aiming to identify potential therapeutic targets.
Methods: The GSE15197 dataset was analyzed to identify differentially expressed genes (DEGs). Functional enrichment analyses, including Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and gene set enrichment analysis (GSEA), were conducted to explore underlying mechanisms. Weighted gene co-expression network analyses (WGCNA) identified two key gene modules. The intersection of significant WGCNA modules, DEGs, and lactylation-associated genes yielded candidate genes related to lactylation in PH. Machine learning methods, particularly random forest and support vector machine, were employed to identify hub genes, ultimately selecting aryl hydrocarbon receptor (AHR), polyribonucleotide nucleotidyltransferase 1 (PNPT1), and RAS p21 protein activator 1 (RASA1). These were incorporated into a diagnostic nomogram, evaluated through receiver operating characteristic curve and decision curve analyses. Immune cell infiltration was assessed using CIBERSORT and single-sample GSEA, while Enrichr was utilized to identify transcription factors and potential therapeutic agents. Molecular docking was performed to assess drug–gene binding affinities.
Results: A total of 1,504 genes were upregulated and 1,931 downregulated. Functional enrichment analyses revealed clustering of DEGs in pathways associated with cellular transport, protein degradation, DNA repair, and signal transduction. WGCNA identified two critical modules comprising 1,178 genes, from which 33 candidate genes were derived. Machine learning refined this list to three hub genes (AHR, PNPT1, and RASA1), which formed the basis of a novel lactylation-related diagnostic nomogram validated in an external cohort. Immune dysregulation was evident, and friend leukemia integration 1 was recognized as a key TF. Ten potential drugs demonstrated promising binding affinity to the hub genes.
Conclusion: This work introduces a lactylation-based diagnostic model for PH with strong diagnostic potential, though further clinical validation is required.
Many neuropsychiatric disorders arise from impairments in complex higher-order cognitive functions. However, current clinical diagnosis and treatment approaches still rely heavily on subjective rating scales, lacking objective, quantifiable, and reproducible assessment tools. The prefrontal cortex (PFC), as a central hub for executive function, attentional control, and emotional regulation, has been closely linked to a range of neuropsychiatric conditions, including depression, attention-deficit/hyperactivity disorder, schizophrenia, and autism spectrum disorder. This positions the PFC as a promising target for early diagnosis, mechanistic studies, and treatment evaluation. In recent years, functional near-infrared spectroscopy (fNIRS) has gained rapid traction in psychiatric neuroimaging research due to its non-invasiveness, high temporal resolution, portability, and cost-effectiveness. Empirical studies have demonstrated that fNIRS can detect reduced prefrontal activation in patients with depression, distinguish activation patterns among different disorders, and assist in evaluating the effects of neuromodulatory interventions such as transcranial direct current stimulation, transcranial alternating current stimulation, and neurofeedback training. Moreover, fNIRS-derived hemodynamic indicators often correlate with symptom severity. This review provides a comprehensive summary of recent advances in the application of fNIRS in PFC dysfunction-related neuropsychiatric disorders, focusing on activation characteristics, task paradigms, potential biomarkers, and integration with other imaging modalities. The review also discusses the diagnostic and prognostic potential of fNIRS, its current technical limitations, and future directions, aiming to support its clinical translation in the field of psychiatry.
Introduction: Thoracoscopic surgery in elderly patients with coronary heart disease (CHD) requires careful anesthetic management to maintain hemodynamic stability. While etomidate is valued for its cardiovascular safety, conventional dosing may not provide sufficient individualization. Evidence on the use of bispectral index (BIS)–guided, stepwise etomidate sedation to optimize outcomes and support enhanced recovery after surgery (ERAS) remains limited.
Objective: This study assessed the efficacy, safety, and impact on ERAS of a BIS-guided sedation protocol using stepwise etomidate injections in elderly patients with CHD undergoing thoracoscopic surgery.
Methods: Ninety patients aged 60–80 years with CHD (classified as American Society of Anesthesiologists physical status I–II) were randomized into three groups (n =30). All received general anesthesia induction with remifentanil through target-controlled infusion plus sevoflurane. The depth of anesthesia was monitored by BIS at thoracic opening and closure. Group I (control) received increased concentrations of sevoflurane; Group II received single intravenous doses of propofol; and Group III received single intravenous doses of etomidate guided by BIS. Hemodynamics, ST-T changes, BIS values, Ramsay sedation scores, post-operative adverse events, and anesthesia costs were compared.
Results: Baseline demographics were similar across groups. At thoracic opening and closure, Group I showed higher blood pressure and heart rate than Group II (p <0.05), but was comparable to Group III. Hemodynamic stability was greater in Group III than in Group II ( p <0.05). ST-T depression was most severe in Group I and least in Group III. BIS values were higher in Group I, indicating lighter anesthesia. Respiratory depression and dizziness were more frequent in Group II, while nausea, vomiting, and agitation were more common in Group I. Anesthesia costs were highest in Group I.
Conclusion: Stepwise etomidate under BIS guidance provides stable hemodynamics, fewer complications, and lower costs, supporting its use in ERAS for elderly CHD patients undergoing thoracoscopic surgery.
Introduction: Cancer-related fatigue is a debilitating symptom among hepatocellular carcinoma (HCC) patients, significantly impacting their quality of life. Emerging evidence suggests that Vitamin D may help alleviate fatigue; however, its causal role remains unclear.
Objective: This study aims to investigate the causal relationship between HCC, Vitamin D, and fatigue by assessing the mediating role of Vitamin D using Mendelian randomization (MR) analysis.
Methods: A two-sample MR analysis was conducted using genome-wide association study (GWAS) data. Genetic instruments for “HCC,” “Vitamin D,” and “fatigue” were obtained from the Integrative Epidemiology Unit OpenGWAS database. Inverse variance weighting, MR-Egger regression, weighted median, simple mode, and weighted mode methods, as well as sensitivity analyses such as the MR-Egger intercept, Cochran’sQ test, leave-one-out analysis, and MR Pleiotropy RESidual Sum and Outlier, were employed to ensure robustness. Finally, a two-step MR analysis was performed to quantify Vitamin D’s mediation effect.
Results: HCC showed a significant causal effect on increased fatigue risk (odds ratio = 1.78; 95% confidence interval: 1.16–2.74; p <0.05) and decreased Vitamin D levels ( β = −12.61; p <0.05). Higher Vitamin D levels were associated with reduced fatigue severity ( β = −0.01; p <0.05). Mediation analysis indicated that 21.74% of the effect of HCC on fatigue was mediated by Vitamin D. Sensitivity analyses confirmed the robustness of these findings.
Conclusion: Vitamin D may partially mediate the HCC–fatigue relationship inferred from genetic proxies for chronic fatigue syndrome, highlighting its potential, albeit preliminary, role as a therapeutic target for cancer-related fatigue management. Future clinical trials should evaluate the efficacy of Vitamin D supplementation in alleviating fatigue among HCC patients.
Introduction: Cancer is a major global health challenge, responsible for one in six deaths worldwide, with 19.3 million new cases and 10 million deaths recorded in 2020. Iraq has witnessed a steady rise in cancer incidence, and Basra, in southern Iraq, is particularly vulnerable due to extensive oil extraction and petrochemical activity.
Objective: This study aimed to estimate cancer prevalence in northern Basra and describe the distribution of cancer types across age and sex.
Methods: A descriptive, cross-sectional, community-based survey was conducted in northern Basra, covering an area of 3,822 km2 with a population of 948,489. Using the Basra Health Directorate family registry, 560 families (0.35% of households) were randomly selected. Data were collected from 3,866 participants through structured questionnaires administered by trained fieldworkers. Cancer diagnoses were verified using medical documentation. Statistical analyses included descriptive statistics, chi-square tests, and odds ratios, with prevalence expressed per 100,000 population.
Results: The overall cancer prevalence was 1.6% (1,600 per 100,000). Prevalence was higher in females than males (2,360 vs. 990 per 100,000; p < 0.001). Cancer prevalence increased with age, from 230 per 100,000 in children to 28,090 per 100,000 in those over 80 years. The most common cancers were breast (24.2%), gastrointestinal (22.6%), lymph node (14.5%), and hematologic (11.3%) malignancies.
Conclusions: Cancer prevalence in northern Basra exceeds official registry estimates. Breast cancer predominates in women and hematologic cancers in men. The findings call for enhanced cancer surveillance, early detection programs, and environmental health interventions in oil-producing areas of Iraq.
Introduction: High-risk (HR) human papillomavirus (HPV) is the main cause of cervical cancer and a substantial proportion of oropharyngeal cancers, making early and accurate detection critical for effective screening and prevention, particularly in low-resource settings
Objective: This study aims to compare the diagnostic accuracy of point-of-care and rapid testing methods for HR-HPV detection.
Methods: We conducted a scoping review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework. PubMed/MEDLINE, ScienceDirect, and Scopus were searched for English-language studies published from 2010 through July 2025. Fifteen studies met the inclusion criteria, with eight included in the meta-analysis.
Results: Recombinase polymerase amplification combined with clustered regularly interspaced short palindromic repeats/Cas12a achieved the highest pooled diagnostic performance, with a sensitivity of 0.94 and specificity of 0.97. Polymerase chain reaction-based analyses also showed high accuracy (sensitivity = 0.85; specificity = 0.97) but exhibited considerable heterogeneity across platforms and sample types. Loop-mediated isothermal amplification demonstrated moderate performance (sensitivity = 0.60; specificity = 0.91), while p16 immunohistochemistry offered good sensitivity (0.91) but lower specificity (0.73), supporting its use as a confirmatory rather than primary screening tool. In situ hybridization and next-generation sequencing provided broader genotyping capability but were limited by higher cost and technical complexity.
Conclusion: Polymerase chain reaction remains the clinical gold standard for HR-HPV detection, whereas recombinase polymerase amplification/clustered regularly interspaced short palindromic repeats–Cas12a emerges as a promising alternative for decentralized, low-resource screening. Future multi-center studies should standardize reporting, expand genotype coverage beyond HPV-16 and HPV-18, and assess cost, turnaround time, and operational feasibility to ensure that advances in
Introduction: Gastrointestinal neuroendocrine tumors (GI NETs) represent 1–2% of malignancies arising in the digestive tract, and the incidence has increased in recent years due to greater use of diagnostic tools. However, institution-level patterns in GI NET case counts and survival remain undercharacterized
Objective: This study aims to evaluate demographic and site-specific case count patterns and survival outcomes across a large multi-hospital healthcare system.
Methods: We conducted a retrospective cohort study of 1,813 patients diagnosed with GI NETs across MedStar Health from November 2012 to September 2024. Cases were identified using the International Classification of Diseases (ICD) codes. Tumors were categorized as benign, malignant, or mixed coding history based on ICD patterns. Case counts were stratified by sex, race, age, and tumor site. Survival analyses used unadjusted Kaplan–Meier curves and log-rank tests to compare tumor categories and six anatomical sites (appendix, large intestine, pancreas, rectum, small intestine, stomach).
Results: GI NET case counts increased over the study period, with higher counts observed among women and individuals aged 51–74 years. Most diagnoses occurred in White (45.8%) and Black (40.7%) patients. Small-intestinal and rectal NETs were the most frequently identified. Survival patterns showed that female sex, White race, younger age, and benign tumors were associated with the most favorable outcomes. Among all anatomical sites, rectal NETs demonstrated the highest long-term survival.
Conclusion: This large institutional study highlights meaningful demographic and site-specific variation in GI NET case counts and descriptive survival patterns. These findings underscore the need for future research addressing access-related and sociodemographic contributors to GI NET outcomes.
Introduction: Human cerebral organoids (COs) are sophisticated three-dimensional (3D) models that successfully replicate the 3D cytoarchitecture of human brain development in its early stages. Co-cultivation of COs obtained from human-induced pluripotent stem cells with 3D U-87 MG glioblastoma cell spheroids (glioblastoma–CO assembloid [GCOA]) represents a robust strategy for modeling brain cancer behavior
Objectives: This study aims to evaluate the feasibility of using GCOAs and 3D U-87 MG glioblastoma cell spheroids as in vitro cell models to evaluate the cytotoxic effect of the oncolytic recombinant vaccinia virus-granulocyte–macrophage colony-stimulating factor (VV-GM-CSF)-Lact compared to the VV-GMCSF-del virus.
Methods: To assess the cytotoxicity of two virus strains, we used fluorescent and confocal microscopy, spectrophotometry, the MTT assay, and real-time polymerase chain reaction
Results: Glioblastoma cells died faster in the presence of VV-GMCSF-Lact virus, and 3D spheroids infected with this virus contained more caspase-3-positive cells. On the 10th day in GCOA, glioblastoma cells began to invade the interior of the CO. Under conditions of 3D spheroid and GCOA infection with recombinant viruses, three differentially expressed genes – FSCN1, SCUBE2, and TNFRSF9 – associated with invasion were analyzed.
Conclusion: These 3D models of glioblastoma can be used in the development of antitumor drugs to study their cytotoxic effects.
Introduction: Hypertension in children is an emerging public health concern that has traditionally received limited attention, particularly in developing countries such as South Africa
Objective: This study addresses a methodological gap by modeling pediatric hypertension in South Africa using panel quantile regression analysis, aiming to uncover the heterogeneous effects of key predictors across the blood pressure distribution over time.
Methods: Data were obtained from the South African National Income Dynamics Study Household Surveys conducted in 2014–2015 (Wave 4) and 2017 (Wave 5). We constructed a balanced panel of 103 adolescents (<18 years) who participated in both Waves 4 and 5. Panel quantile regression was applied to examine predictors of blood pressure over time.
Results: The prevalence of child hypertension based on abnormal systolic blood pressure increased slightly from 16.5% in 2014–2015 to 21.4% in 2017. Age, body mass index, gender, exercise frequency, cigarette use, depression, and perceived health status were identified as significant predictors of elevated systolic blood pressure or diastolic blood pressure over time. Fixed-effects and random-effects specifications produced identical point estimates.
Conclusion: These results underscore the importance of targeted interventions that consider modifiable lifestyle and psychosocial factors when addressing hypertension among South African children.
Introduction : Parkinson’s disease (PD) is increasingly correlated to gastrointestinal disturbances and intestinal microbiota alterations. Growing evidence suggests that shifts in gut microbial communities may influence immune activation and metabolic pathways relevant to PD.
Objective: This systematic review examines microbial changes in PD and their clinical relevance.
Methods: A systematic search of PubMed, Scopus, and Web of Science identified 819 records. After removing duplicates and screening, 521 full-text articles were evaluated. Ten studies met the inclusion criteria, focusing on human subjects and original data on gut microbiota composition, function, or modulation in PD.
Results: The microbiome profile most frequently reported in PD includes a drop in overall diversity and in bacterial taxa associated with short-chain fatty acid production, alongside a shift toward taxa commonly associated with inflammatory states (e.g., Enterobacteriaceae). Most studies reported associations between dysbiosis and motor severity, constipation, autonomic dysfunction, and neuropsychiatric symptoms. Interventions such as resistant starch supplementation and acupuncture improved microbial profiles and some clinical outcomes. Machine-learning approaches showed promising diagnostic potential based on microbial signatures.
Conclusions: Gut dysbiosis is significantly associated with PD clinical features. Although early evidence suggests potential therapeutic and diagnostic applications, methodological heterogeneity and small sample sizes highlight the need for standardized, longitudinal research.
Global societies are currently facing a significant demographic challenge characterized by progressive aging and an increase in age-related pathological processes. One of the fundamental mechanisms underlying biological aging and the development of modern non-communicable diseases is the accumulation of harmful metabolic by-products. Particular importance is attributed to advanced glycation end products, which are formed through the non-enzymatic glycation of proteins. This process occurs when reducing sugars, primarily glucose, react with free primary amino groups of N-terminal amino acids or lysine residues. This chemical pathway, known as the Maillard reaction, results in the formation of permanent, pathological cross-links between proteins. These modifications not only alter individual protein structures but also significantly alter the physicochemical properties of the extracellular matrix, leading to tissue stiffness and loss of physiological function. Scientific evidence indicates that glycation plays a critical role in the pathogenesis of a wide spectrum of chronic conditions, including Alzheimer’s disease, atherosclerosis, diabetic nephropathy, heart failure, sarcopenia, and chronic lung diseases. Understanding the dynamics of these molecular interactions is essential for developing novel therapeutic strategies aimed at slowing down the aging process and mitigating metabolic complications in geriatric patients.
Monoamine oxidase B (MAO-B) is a flavin enzyme on the outer mitochondrial membrane that produces hydrogen peroxide during amine deamination and has been implicated as a pro-tumorigenic redox driver in several cancers. Hepatocellular carcinoma (HCC) represents a mechanistic exception: in hepatocytes, MAO-B also catalyzes the oxidation of geranylgeraniol to geranylgeranoic acid (GGA), an acyclic retinoid-like metabolite that, in experimental models, has been shown to eliminate premalignant hepatocyte clones via apoptosis, autophagy, or pyroptosis-like inflammatory cell death. It is hypothesized that the loss of MAO-B expression in aging and chronic liver disease may contribute to a state of relative “GGA insufficiency,” only partially buffered by alternative oxidases, thereby enabling dysplastic hepatocytes to escape elimination and progress to HCC. This perspective reframes MAO-B as a context-dependent metabolic switch and outlines testable implications for biomarker development and chemoprevention in high-risk liver disease.
Introduction: Radiotherapy remains the primary therapeutic option for nasopharyngeal carcinoma (NPC). The choice of technique, however, directly influences tumor control and the preservation of healthy tissues.
Objective: This study aims to evaluate the dosimetry outcomes of three approaches: three-dimensional conformal radiation therapy (3D-CRT), 3D-CRT with electron boost (3D-CRT+E), and volumetric-modulated arc therapy (VMAT), as implemented at the National Oncology Center in Nouakchott, Mauritania.
Methods: Sixty-seven patients with NPC were included. For each patient, three plans (3D-CRT, 3D-CRT+E, and VMAT) were available or retrospectively reconstructed from archived CT datasets, yielding 201 plans for paired dosimetric comparison. Treatment planning was performed using Eclipse 3.0, with delivery on the Clinac 2100 for 3D-CRT and 3D-CRT+E, and Halcyon 3.0 for VMAT. Dosimetric parameters, including dose coverage (D95%), conformity index, homogeneity index, and doses to organs at risk (OARs), were evaluated. Isodose volumes (ISO30, ISO20, ISO10) were also assessed. Statistical analyses were performed using the Wilcoxon test.
Results: VMAT exhibited significantly higher dose coverage (D95%, p = 0.01) and demonstrated optimal homogeneity and conformity (p < 0.001) compared to 3D-CRT and 3D-CRT+E. It also reduced radiation exposure to critical OARs ( p < 0.008) and lowered isodose volumes (ISO30, ISO20, ISO10, p = 0.0187), thereby enhancing healthy tissue sparing.
Conclusion: The findings confirm that VMAT offers clear dosimetric advantages over 3D-CRT and 3D-CRT+E, consistent with international evidence. The novelty of this study lies in its demonstration, for the first time in Mauritania, that VMAT can be successfully implemented in routine practice. By validating global standards in a local context, this study supports the integration of VMAT into national treatment protocols and highlights its potential to improve clinical outcomes for patients with NPC.
Cervical lymph node metastasis (CLNM) remains the principal determinant of survival in oral squamous cell carcinoma (OSCC), conferring significant reductions in disease-specific and overall survival even in early-stage disease. Despite advances in imaging and surgical staging, accurate identification of occult nodal involvement in clinically node-negative patients continues to represent a major clinical challenge. This narrative review synthesizes contemporary evidence on clinicopathological and molecular predictors of CLNM in OSCC, with emphasis on biological determinants that may refine risk-adapted neck management. A structured literature search of PubMed, Scopus, and Web of Science was conducted, prioritizing high-quality cohort studies, meta-analyses, and translational investigations evaluating histopathological parameters, molecular alterations, tumor microenvironment features, and integrative predictive models. Among clinicopathological factors, depth of invasion, lymphovascular invasion, perineural invasion, tumor budding, and infiltrative invasion patterns consistently demonstrate strong associations with nodal metastasis. Molecular drivers include epithelial–mesenchymal transition, activation of the phosphoinositide 3-kinase/protein kinase B/mechanistic target of rapamycin signaling pathway, hypoxia-mediated angiogenesis and lymphangiogenesis, immune checkpoint upregulation, and dysregulated non-coding RNAs. Emerging multivariable models that integrate pathological and molecular determinants demonstrate improved predictive performance compared to conventional tumor–node–metastasis staging. Collectively, CLNM reflects a coordinated biological process involving invasive tumor architecture and molecular reprogramming. Incorporation of validated biological predictors into routine pathological assessment may support precision-based neck management and enhance oncologic stratification in OSCC.
Introduction: Acute heart failure (AHF) is a multifaceted clinical syndrome that commonly necessitates urgent hospitalization and remains associated with considerable in-hospital mortality. Despite improvements in emergency care, AHF continues to account for a significant proportion of admissions at Saigon General Hospital
Objective: This study sought to characterize the clinical and paraclinical profiles of patients admitted with AHF and identify factors associated with unfavorable in-hospital outcomes, to facilitate early risk stratification and improve therapeutic strategies.
Methods: A prospective cross-sectional study was conducted, including 177 patients with AHF admitted to the Emergency and Intensive Care Department of Saigon General Hospital from April 1 to October 31, 2025. Data collected included demographic characteristics, clinical manifestations, underlying comorbidities, laboratory parameters, imaging findings, and echocardiographic measurements. Statistical analysis was conducted to evaluate clinical patterns and associated outcomes.
Results: The mean age of participants was 72.1 years, with male predominance. Dyspnea was the most prevalent presenting symptom (88.6%), whereas a third heart sound was infrequently detected (23.8%). Mean systolic and diastolic blood pressures were 113 ± 34 mmHg and 67 ± 15 mmHg, respectively. Chest radiography most frequently demonstrated cardiomegaly (51.0%), pulmonary congestion (13.7%), and pleural effusion (6.1%). The mean N-terminal pro-B-type natriuretic peptide concentration was 7,539.02 ± 491.53 pg/mL, and the mean left ventricular ejection fraction was 41.5 ± 6.9%. Ischemic heart disease was identified as the principal etiology (58.2%), followed by cardiomyopathy (14.7%), while congenital heart disease (1.1%) and myocarditis (0.6%) were uncommon causes. The leading precipitating factors were medication non-adherence (19.2%), infections (17.5%), and acute coronary syndrome (17.5%).
Conclusion: Ischemic heart disease emerged as the predominant cause of AHF. Medication non-adherence, infections, and acute coronary syndrome were the most common triggers of decompensation. These findings underscore the necessity for early recognition of high-risk individuals and emphasize the role of patient education and optimized management in improving in-hospital outcomes.
Metabolic dysfunction-associated steatotic liver disease (MASLD), commonly associated with obesity and type 2 diabetes mellitus, is characterized by excess intrahepatic fat and is accompanied by at least one metabolic risk factor, without significant alcohol consumption. It is a major etiology of chronic liver disease-including metabolic dysfunction-associated steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma-contributing substantially to liver-related morbidity and mortality. Accumulating evidence supports the notion that MASLD is a systemic condition with an increased risk of extrahepatic outcomes, including incident type 2 diabetes mellitus, cardiovascular disease, and various extrahepatic cancers. This review critically examines recent advances in key MASLD topics, including evolving clinical trial endpoints, novel insights into pathogenesis, genetic and non-genetic disease modifiers, cancer risk, and emerging pharmacological therapies. The review concludes that advances in disease stratification, biomarkers, and artificial intelligence may enhance patient care and research. With the rapid global rise in metabolic disorders, MASLD and metabolic dysfunction-associated steatohepatitis should be prioritized in health policy agendas. These conditions pose a challenge for clinical trial recruitment and patient management and should be integrated into the broader noncommunicable disease framework to prevent millions of avoidable cases and support goals to reduce premature noncommunicable disease deaths by 2030.