Hemorrhoids are a common problem. It's diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this AGA Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease. This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice (BPA) statements were drawn from a review of the published literature and from expert opinion. Since systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. BPA 1: The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist. The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient. Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse. Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure. BPA 2: Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet are reasonable first-line therapies for symptomatic hemorrhoids. The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised but scientific data is limited. BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids and vasoactive agents can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy. Topical steroids should not be used for more than two weeks at a time. BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment to ensure accurate diagnosis. BPA 5: Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short-term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1-3 hemorrhoids. BPA 6: As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evaluation, if indicated. BPA 7: In patients with active Crohn's disease or ulcerative colitis, hemorrhoid disease management should be delayed until complete remission is achieved. BPA 8: Hemorrhoids occur in up to two thirds of women during pregnancy. Treatment should generally involve conservative management, including fiber, treatment of constipation and topical ointments. If symptoms persist postpartum, or if a woman is planning further pregnancies, standard treatment such as banding or infrared coagulation can be considered. BPA 9: Acute thrombosed hemorrhoids are often extremely painful. They are best treated surgically with incision and drainage. BPA 10: Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids. Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids. Grade 4 internal hemorrhoids require surgical hemorrhoidectomy. BPA 11: Patients with cirrhosis and hemorrhoids should be carefully examined so as not to confuse hemorrhoids with rectal varices. Hemorrhoids in patients with cirrhosis can be treated with banding or infrared coagulation. In patients with significant coagulopathy, infrared coagulation is preferred to banding. Concomitant portal hypertension should not alter this approach. For most clinicians, significant coagulopathy means a platelet count of less than 50,000 per microliter or INR greater than 2.0. The presence of concomitant portal hypertension should not alter this approach.
The Team Emergency Assessment Measure (TEAM) questionnaire is widely used to assess non-technical skills (NTS) in emergency care. An updated and culturally adapted version is needed to ensure continued relevance, particularly for Spanish-speaking professionals working in emergency care settings. To translate, culturally adapt, and validate the TEAM questionnaire for Spanish-speaking emergency teams in a high-fidelity simulated environment. A back-translation and cross-cultural adaptation process was conducted. Twelve Emergency Medical Services (EMS) professionals (nurses, physicians, and Emergency Medical Technicians (EMT)) participated in high-fidelity simulation scenarios. Two evaluators used the translated tool to assess team performance, generating 700 ratings. Psychometric analyses included internal consistency, exploratory factor analysis, inter-rater reliability, and Bland-Altman plots. The Spanish TEAM (s-TEAM) questionnaire showed acceptable psychometric performance in this pilot sample. Four factors explained 80.8% of the variance. Internal consistency was high (α and ω > 0.90). Item 6 showed poor performance; its removal improved reliability. Inter-rater agreement exceeded 80%, though some items had lower ICC and kappa values. The updated s-TEAM shows promising preliminary validity and reliability for assessing NTS in Spanish-speaking emergency teams under simulated conditions. Removing items 6 and 12 and using a standardised 1-10 scale may enhance precision and usability. However, these findings should be interpreted as preliminary pilot evidence, and further validation in real-world emergency settings is required before broader clinical implementation.
Thin melanoma (TM, ≤1.0 mm Breslow thickness) and Melanoma In Situ (MIS) constitute the majority of melanoma diagnoses worldwide and are responsible for melanoma-related deaths in these early-stage tumors. Despite their favorable prognosis, MIS and TM represent an opportunity for improving patient outcomes through early detection, accurate risk stratification, and long-term surveillance for metastasis and new skin neoplasms. Provide an update of current evidence regarding epidemiology, risk factors, prognostic indicators, genetic background, and clinical management of MIS and TM. A comprehensive review of the literature and international guidelines was conducted, integrating epidemiologic data, clinical prognostic parameters, and molecular insights relevant to MIS and TM. MIS and TM account for over 80% of all melanomas, with increasing incidence and relatively stable mortality rates. Prognosis is primarily determined by Breslow depth and ulceration, while factors such as mitotic rate, anatomic site, and age further refine risk assessment. Genetic alterations contribute to tumorigenesis but are not yet integrated into routine management. Long-term dermatological surveillance is needed, as new neoplasms, recurrence, and metastasis can develop during follow-up. MIS and TM are increasingly diagnosed, and dermatologists need to be a part of early detection, multidisciplinary management, and lifelong surveillance, which remain the cornerstone of reducing melanoma-related mortality. The substantial heterogeneity among the included studies limits direct comparison and quantitative synthesis of the available data.
We hope to update the reader on recent literature investigating the use of regional anesthesia for laparoscopic and robotic surgery. These peripheral nerve blocks are now supported by evidence in robotic or laparoscopic surgery: (1). transversus abdominis plane (TAP) block for robotic prostatectomy, (2) paravertebral block (PVB) for robotic mitral valve repair, (3) SAPB for robotic thymectomy, (4) TAP or erector spinae plane block (ESPB) for laparoscopic cholecystectomy, (5) quadratus lumborum block (QLB), ESPB, or PVB for percutaneous nephrolithotomy, (6) QLB or ESPB for partial or full nephrectomy, and (7) TAP or QLB for laparoscopic colectomy.
Global population growth and economic development have driven a rapid increase in agricultural production, leading to a substantial rise in the application of pesticides such as phenylurea herbicides (PUHs). However, the large-scale and extensive use of PUHs has led to their widespread occurrence and persistent residues across ecosystems, posing potential long-term environmental hazards. Given the complex metabolic behavior, cumulative toxicity, and high systemic transport characteristics of PUHs, this paper provides a comprehensive update and summary of the occurrence, distribution, degradation pathways, and removal strategies of PUHs in various environmental matrices. We systematically compare the strengths, limitations, and applicability of mainstream removal technologies (e.g., advanced oxidation, bioremediation, adsorption). Furthermore, we highlight recent advances in novel functional materials and synergistic treatment systems, and propose feasible optimization directions and future development pathways for current technologies. This work is expected to offer a scientific basis and valuable insights for the environmental monitoring, risk control, and remediation of PUH contamination.
Leydig cells (LCs) are primary for testosterone production and the preservation of male reproductive function; however, their activity is highly susceptible to oxidative stress (OS)-induced damage. Accumulating evidence indicates that excessive reactive oxygen species (ROS) disrupt redox homeostasis, impair mitochondrial function, and interfere with key steroidogenic processes, ultimately promoting cellular senescence in LCs. This review provides an updated synthesis of the molecular mechanisms underlying OS-induced LC dysfunction, with particular emphasis on mitochondrial impairment, DNA damage response, and major signaling pathways, including SIRT1/Nrf2, PI3K/Akt/mTOR, MAPK, and FOXO. In addition, we highlight the impact of senescence-associated secretory phenotype and inflammatory mediators on amplifying LC dysfunction and contributing to male subfertility. Emerging therapeutic strategies are also discussed, including antioxidant-based compounds, nanoformulations, and targeted pharmacological agents that modulate redox balance, inflammation, apoptosis, and steroidogenesis. Collectively, these insights deliver a mechanistic framework for emerging novel interventions directed at preserving LC function and improving male reproductive health.
The Wilkins score evaluates mitral valve morphology and predicts percutaneous balloon mitral valvuloplasty (PBMV) success in rheumatic mitral stenosis (MS). The 2021 European Society of Cardiology guidelines recommend considering 5 clinical and 2 anatomical factors when selecting PBMV candidates. The authors aimed to update the Wilkins score by integrating clinical variables and compared its performance with the conventional score. We studied 1,128 patients with rheumatic MS who underwent PBMV in 4 hospitals. PBMV success was defined as postprocedural mitral valve area (MVA) ≥1.5 cm2, irrespective of percentage increase, mitral regurgitation ≤ grade 2, with no more than a 1-grade increment in severity and without in-hospital complications. The Wilkins-Integrated Clinical PBMV score was developed from a multivariable logistic regression predicting PBMV success, incorporating age, prior commissurotomy, NYHA functional class IV, atrial fibrillation, right ventricular systolic pressure, pre-PBMV MVA, severe tricuspid regurgitation, and Wilkins score. The median age was 45 years and 82.2% were female. Prevalence of prior commissurotomy, NYHA functional class IV, atrial fibrillation, and pulmonary hypertension was 4.3%, 1.5%, 48.4%, and 44.5%, respectively. The median Wilkins score was 8 and 65.8% and 4.2% had very small MVA and severe tricuspid regurgitation. The procedural success rate was 48.6%. C-statistic of the Wilkins score and the Wilkins-Integrated Clinical PBMV score was 0.543 (95% CI: 0.477-0.608) and 0.658 (95% CI: 0.595-0.721), respectively. The Wilkins-Integrated Clinical PBMV score showed good calibration and clinical utility on decision curve analysis. The Wilkins-Integrated Clinical PBMV score better predicts procedural success in patients with rheumatic MS who underwent PBMV.
Perform an updated meta-analysis of RCTs that evaluated survival and recurrence in patients with clinically node-negative breast cancer with sentinel lymph node metastasis who underwent sentinel lymph node dissection (SLND) alone compared to axillary lymph node dissection (ALND). A systematic search was conducted in PubMed, Embase, and Cochrane databases for studies on clinical T1-T3, N0, M0 primary breast cancer patients with pSLN undergoing SLND or ALND. The primary outcomes of interest are disease-free survival, overall survival, and recurrence rate; surgical adverse effects and mortality rate are evaluated as secondary outcomes. We included eight RCTs, in which 3952 patients underwent SLND, and 3871 underwent ALND in the presence of sentinel lymph node metastasis. We observed that overall survival and disease-free survival were non-inferior in the experimental group. When analyzing recurrence rates, axillary recurrence was the only type for which ALND appeared to have a protective effect. In contrast, local and distal recurrence were more common in the group undergoing complete axillary dissection. In terms of morbidity, patients who underwent SLND alone had fewer adverse surgical effects. The reduction in lymphedema was statistically significant only at the 5-year endpoint after randomization. However, the occurrence was lower in the experimental group at all time points analyzed in the studies. Our findings show that SLND reduces surgical complications associated with ALND and improves quality of life without decreasing local control and overall survival in patients with T1-T2/T3 breast cancer with clinically negative nodes and the presence of 1-2 pSLN.
MoonProt 4.0 (http://moonlightingproteins.org) is an updated open-access database storing manually-curated annotations for moonlighting proteins. Moonlighting proteins exhibit two or more physiologically relevant distinct biochemical or biophysical functions performed by a single polypeptide chain. Here we describe an expansion in the database since our report published in 2021. With the assistance of five undergraduate annotators, we have added approximately 200 protein entries to give a total of over 700 moonlighting proteins. The new entries include more examples from plants, more transmembrane proteins and additional combinations of functions. The MoonProt Database collection of proteins with multiple functions serves as a resource for developing algorithms for predicting protein functions and provides examples of the evolution of new functions on a protein scaffold that can be valuable in developing novel methods for designing proteins with added functions.
Myelofibrosis (MF) is a chronic myeloproliferative neoplasm characterized by progressive cytopenias, splenomegaly, and constitutional symptoms. The hallmark of MF pathophysiology is constitutive activation of JAK/STAT signaling, which, in the majority of cases, is associated with an acquired mutation in one of three driver mutations, JAK2, CALR, or MPL. Our growing understanding of the molecular biology of MPNs has resulted in regulatory approval of four JAK inhibitors (JAKi), which have demonstrated efficacy in improving symptom burden and reducing spleen size. Despite clear benefits of JAKi therapy, including evidence of improved survival, these therapeutic interventions have not established an ability to modify disease in terms of resolution of bone marrow fibrosis or molecular remissions. Therefore, recent emphasis has been on the development of novel therapies with informed targets outside of the JAK/STAT signaling pathway. Moreover, combination approaches utilizing JAK and non-JAK targeting agents underscore the potential for disease modification along with deeper and more durable clinical responses. Emerging combination strategies and their clinical development will be reviewed here, including investigations that pair JAKi therapy with BCL-2 family inhibitors, BET inhibitors, restored p53 cell death signals, telomerase inhibitors, PIM1 kinase inhibitors, and mutant CALR targeted therapies. While several combination clinical trials suggest improved spleen and symptom responses and the possibility of disease modification, toxicity profiles and optimal sequencing remain areas of active investigation.
Small cell lung cancer (SCLC) is an aggressive pulmonary neuroendocrine carcinoma characterized by rapid progression and early metastasis. Despite recent therapeutic advances, including immune checkpoint inhibitors and emerging targeted agents, survival outcomes remain poor. Recent molecular insights have identified four transcription factor-driven subtypes-SCLC-A, SCLC-N, SCLC-P, and the inflamed subtype SCLC-I-providing a framework for precision and immunotherapy-based strategies. This review summarizes the evolving scope of imaging in SCLC and highlights emerging approaches that support personalized medicine. Conventional imaging with CT, MRI, and fluorine 18 fluorodeoxyglucose PET/CT remains essential for diagnosis, staging, and treatment response assessment. Semiquantitative, volume-based PET/CT metrics, such as metabolic tumor volume and total lesion glycolysis, correlate with tumor proliferation and provide stronger prognostic value than maximum standardized uptake value. Emerging imaging approaches, including radiomics, radiogenomics, and machine learning, may further enable noninvasive tumor characterization and outcome prediction. Recent advances in molecular imaging, including delta-like ligand 3- and somatostatin receptor-targeted immune-PET, represent key steps toward biomarker-guided and personalized therapy. Together, integration of structural, functional, and molecular imaging with biologic insights is expected to shape the next phase of precision oncology in this highly aggressive malignancy. Keywords: Lung, Imaging Modality, PET, MRI, Molecular Imaging, Oncology, Neoplasms-Primary, CT, MR Imaging, Diagnosis, PET/CT, Small Cell Lung Cancer, Radiogenomics, Machine Learning, Radiolabeled Tracer, Personalized Medicine Supplemental material is available for this article. © RSNA, 2026.
To systematically review and meta-analyze COVID-19 vaccine hesitancy among individuals with epilepsy. Following PRISMA 2020 guidelines, we searched Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS, PsycINFO databases, and grey literature through February 6, 2026. We included studies addressing COVID-19 vaccination hesitancy in adults with epilepsy, with no date or language restrictions. Two reviewers independently screened articles, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS). Meta-analyses were conducted using random-effects models, with heterogeneity assessed using I² statistics. The certainty of evidence was evaluated using the GRADE criteria. Fourteen studies comprising 4230 participants were included. Overall vaccination willingness was 51.7% (95% CI: 36.6-68.8%, I²=98%). Among unvaccinated individuals, 44.2% (95% CI: 26.6-61.8%, I²=95%) expressed willingness to be vaccinated. Well-controlled epilepsy was associated with higher vaccination rates (OR 1.91, 95% CI: 1.49-2.46, I²=0%). Conversely, frequent seizures (daily/weekly) were associated with lower vaccination likelihood (OR 0.52, 95% CI: 0.35-0.76, I²=0%). The primary reasons for vaccine hesitancy were fear of seizure worsening (23.8-88.5% across studies) and concerns about side effects (13.0-53.0%). Methodological quality was generally poor, with only one study rated as "satisfactory" using NOS criteria. GRADE assessment indicated very low certainty of evidence due to serious risk of bias, inconsistency, and imprecision. COVID-19 vaccine hesitancy remains present in people with epilepsy, primarily driven by concerns about seizure exacerbation. Individuals with well-controlled epilepsy show higher vaccination acceptance. Healthcare providers should address specific concerns about seizure control while emphasizing vaccine safety data. High-quality prospective studies using validated instruments are recommended.
In the decade since the landmark Relative Motion (RM) scoping review was published, literature volume has tripled, alongside expanded applications across three categories: protective, exercise and adaptive. To provide an overview of published evidence since 2016 relating to RM orthoses and integrate these findings with the 2016 review. Scoping review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guided this study. Four databases were searched: CINAHL, Embase, MEDLINE and PubMed. Studies investigating RM use in adults with hand conditions were included. Data extracted included demographic, intervention and outcome details. Quantitative and qualitative studies were appraised using the Structured Effectiveness Quality Evaluation Scale and Standards for Reporting Qualitative Research respectively. The Template for Intervention Description and Replication checklist evaluated intervention reporting, informing a narrative synthesis. Twenty-two studies involving 386 participants met inclusion criteria. Quantitative studies were categorized as protective (n = 19 studies, 346 participants) and exercise-based (n = 1 study, 20 participants). Qualitative studies explored adaptive use (n = 1 study, four participants) or combined protective and exercise applications (n = 2 studies, 16 participants). Study designs included randomized control trials (n = 6), retrospective case series (n = 6), prospective case series (n = 1), clinical audit (n = 1), case reports (n = 4), qualitative studies (n = 2) and mixed-methods (n = 1). Three studies comparing RM extension with alternative approaches for zones V-VI extensor tendon repairs reported equivalent or superior outcomes. Randomized control trials found no significant difference between RM and metacarpophalangeal blocking orthoses for trigger finger management. Multiple randomized control trials support RM orthoses without a wrist component to adequately protect extensor tenorrhaphy in zones V-VI. Since 2016, RM literature has expanded to include a broader range of hand conditions. Further research is required to evaluate the orthosis' use in flexor tendon injuries, boutonniere deformity and sagittal band injuries.
Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare and aggressive primary liver cancer. Liver resection (LR) has long been the standard treatment for cHCC-CCA, but it is associated with high recurrence rates and poor long-term prognosis. The significance of liver transplantation (LT) remains controversial. This systematic review and meta-analysis aimed to compare the long-term survival and recurrence outcomes between LT and LR for cHCC-CCA to assess the potential benefit of LT. A systematic search of Web of Science, Medline Ovid, Scopus, and Cochrane CENTRAL was conducted using predefined terms related to cHCC-CCA. Records were screened according to PRISMA. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcome was 5-year Overall Survival (OS). Recurrence-free survival (RFS) was a secondary outcome. Meta-analysis was performed using random-effects models. Six retrospective studies met inclusion criteria. NOS scores ranged from 7 to 9. For OS, pooled analyses yielded ORs of 0.67 (95% CI: 0.39-1.15, p = 0.15) at 1 year, 0.70 (95% CI: 0.42-1.17, p = 0.15) at 3 years, and 0.55 (95% CI: 0.38-0.81, p = 0.002) at 5 years. For RFS, pooled analyses yielded ORs of 0.48 (95% CI: 0.30-0.78, p = 0.003) at 1 year and 0.40 (95% CI: 0.27-0.59, p < 0.001) at 5 years. LT may be associated with favorable long-term survival and recurrence outcomes compared with LR for cHCC-CCA. These findings suggest that LT could be considered in carefully selected patients.
Carbon dioxide is a key determinant of cerebral blood flow and is needed to prevent secondary damage in neurocritical care; however, optimal targets across the heterogeneous spectrum of acute brain injury (ABI) remain to be elucidated. The aim of this study was to evaluate the association between arterial hypocapnia and mortality and neurological outcomes in adult patients with ABI. Six electronic databases were systematically searched from inception to January 2025. Observational and randomized controlled trials comparing exposure to hypocapnia, defined as an arterial partial pressure of carbon dioxide (PaCO2) lower than 35 mmHg, and no-hypocapnia in adult patients with ABI-related conditions (including traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, central nervous system infections, brain tumors, and post-cardiac arrest encephalopathy) were included. Random-effects meta-analyses were conducted using the restricted maximum likelihood (REML) method to pool unadjusted odds ratios (ORs). The primary outcome was all-cause mortality, and the secondary outcome was the occurrence of poor neurological outcomes defined using validated scales. Prespecified subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. A total of 8,637 records were identified after duplicate removal, of which 37 studies met inclusion criteria for the systematic review. Twenty-seven studies (51,373 patients) were included for mortality outcomes, and thirteen studies (3,814 patients) were included for neurological outcomes. Hypocapnia was associated with higher odds of mortality in adult patients with ABI (OR 1.29, 95% CI 1.05-1.59). Subgroup analyses demonstrated variability across ABI types, with stronger associations observed in subarachnoid hemorrhage and ischemic stroke populations. Hypocapnia was also associated with increased odds of poor neurological outcomes (OR 2.09, 95% CI 1.24-3.54), particularly in the traumatic brain injury population. Subgroup analyses suggested that the association with neurological outcomes was more consistent in studies defining exposure as severe hypocapnia (PaCO2<32 mmHg). Arterial hypocapnia was associated with increased mortality and poor neurological outcomes in adults with acute brain injury, although the evidence is predominantly observational and limited randomized data are available. These findings underscore the need for cautious, individualized PaCO2 management and further high-quality prospective research.
The adrenal cortex is responsible for the synthesis of glucocorticoids, mineralocorticoids, and adrenal androgens, all derived from cholesterol through a series of enzymatic reactions. This process is known as steroidogenesis. Deficiency of various enzymes required for steroid synthesis causes congenital adrenal hyperplasia (CAH), a group of inherited disorders characterized by impaired cortisol synthesis often accompanied by mineralocorticoid deficiency and abnormalities in androgen synthesis, depending on the specific enzyme defect. The most common type of CAH is 21-hydroxylase deficiency. Management of all CAH types typically requires glucocorticoid therapy.
Digital dietary assessment tools are highly beneficial for nutrition research and personalized interventions. This paper describes the development and evaluation of eNutriFFQv2.0, an updated online food frequency questionnaire designed to reflect current diets in the United Kingdom (UK). Updates included modernized food lists based on recent UK population surveys, food composition tables, and food portion photos to improve accuracy and user experience. To assess reproducibility, UK adults completed the FFQ twice, 14 days apart; validity was evaluated against a 3-d weighed food record in a sub-sample. Multiple statistical methods were used. After excluding participants with unfeasible energy intakes, 87 participants completed the reproducibility and 53 the evaluation. The final eNutriFFQv2.0 captured 164 items and estimated intake for 56 nutrients and 6 food groups. Agreement with the WFR was acceptable to good for 25 out of the 29 nutrients analyzed (weighted kappa 0.21-0.77), with ≤10% misclassification into opposite quartiles for most nutrients. Bland-Altman plots showed good agreement for energy (176 kcal/d higher in FFQ1) and macronutrient estimates. Reproducibility was good for 24 out of the 29 nutrients analyzed (weighted kappa 0.58-0.85) with <5% misclassification. Mean bias for estimates of carbohydrate, fat, and protein was small (0.0-0.7). Energy estimates were 209 kcal/d (10.7%) higher in the first compared with the second completion of the FFQ. These findings demonstrate that eNutriFFQv2.0 is a valid and reliable tool for assessing nutrient intake in UK adults, offering a practical, scalable solution for research and public health in the context of digital health and personalized dietary interventions.
Periodontitis is a highly prevalent, chronic inflammatory disease that progressively destroys tooth-supporting structures, significantly impacting systemic health and patient quality of life. Given its global public health implications, a current, evidence-based understanding of periodontitis management is essential, particularly as therapeutic strategies have evolved rapidly. This paper critically traces the evolution of periodontitis management from historical paradigms to modern, evidence-based practices, highlighting how shifting conceptual frameworks have reshaped clinical decision-making and patient care. A structured narrative literature review was conducted, analysing recent clinical studies, systematic reviews, updated classification systems, and internationally recognised treatment guidelines. This review highlights emerging paradigm shifts in the aetiopathogenesis, risk factors, and treatment of periodontitis. Advances in diagnostic tools and classification systems now enable refined, risk-informed, and personalised care pathways. Despite these improvements, the global prevalence of periodontitis remains high. Given that periodontitis is largely preventable, this work aims to re-engineer current therapeutic strategies to prioritise robust preventive measures. This approach is combined with updated, validated clinical protocols for curative treatment, aiming to drastically reduce the global burden of disease and its systemic impact. Current evidence-based guidelines underscore a shift toward personalised periodontal care, emphasising tailored, patient-specific management over 'one-size-fits-all' protocols. Future research must prioritise refining diagnostic precision and validating innovative, preventive strategies to bridge the gap between scientific advancements and everyday clinical practice.
Plasma inflammatory biomarkers linked to cardiovascular risk have been associated with asymptomatic apical periodontitis. However, it remains unclear whether endodontic treatment can reverse these alterations. This review evaluated the effect of endodontic treatment on inflammatory markers in individuals with asymptomatic apical periodontitis. A comprehensive search was conducted in PubMed/Medline, Embase, Web of Science, Scopus, VHL, gray literature, and reference lists between October and November 2022, with an update in September 2025. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence using the GRADE approach. Random-effects meta-analysis estimated pooled mean differences (MD) and 95% confidence intervals (95%CI) for serum inflammatory markers concentrations between treated individuals and controls (α = 5%). The search identified 6,295 records; sixteen studies were assessed and eight included in the quantitative synthesis. All studies showed moderate risk of bias, and evidence certainty was very low. Meta-analysis suggested possible reductions in C-reactive protein (CRP) [MD = 0.76 (95% CI: - 0.15, 1.67)] , interleukin-6 (IL-6) [MD = 0.81 (95% CI:-0.27, 1.90)], and tumor necrosis factor-alpha (TNF-α) [MD = 1.04 (95% CI:-0.38, 2.46)] after endodontic treatment, with levels similar to control groups. Evidence, although limited, suggests endodontic treatment may lower serum CRP, IL-6, and TNF-α levels in asymptomatic apical periodontitis patients. Endodontic treatment of asymptomatic apical periodontitis may help reduce systemic inflammatory biomarkers associated with cardiovascular risk, reinforcing its potential role beyond local infection control.
Over the past several decades, the management of nonmetastatic nonsmall cell lung cancer (NSCLC) has centered on identifying patients eligible for upfront surgical treatment. This selection has traditionally relied on multidisciplinary assessments of clinical operability and oncologic resectability, with the latter depending primarily on mediastinal lymph node evaluation, a key prognostic factor in determining whether patients should be directed toward upfront surgery or definitive chemoradiotherapy. The recent incorporation of immune checkpoint inhibitors (ICIs) into standard neoadjuvant therapy has transformed this paradigm. By significantly enhancing pathologic response and improving survival across the full spectrum of N2 disease, neoadjuvant ICI therapy is reshaping the prognostic weight traditionally assigned to mediastinal nodal involvement, challenging long-standing staging practices. Rather than serving primarily to exclude patients from surgery, mediastinal assessment in the immunotherapy era may play a more selective role in baseline risk stratification while also potentially gaining new roles, such as in the evaluation of treatment response and nodal downstaging, which could support broader refinements in clinical decision-making. This update synthesizes emerging evidence and evolving clinical concepts to re-examine mediastinal assessment in the immunotherapy era, with implications for clinical decision-making and future trial design in nonmetastatic NSCLC.