Background/Objectives: Orthodontic mini-implants have become an essential source of temporary skeletal anchorage because of their versatility, minimal invasiveness, and reduced dependence on patient compliance. However, their clinical success relies on maintaining adequate primary and secondary stability throughout orthodontic treatment. Photobiomodulation (PBM) with diode lasers has been proposed as a non-invasive adjunctive therapy capable of enhancing bone healing and remodeling, thereby improving mini-implant stability. Despite encouraging findings, the available evidence remains limited and heterogeneous. The objective was to systematically evaluate the effect of diode laser photobiomodulation on the stability of orthodontic mini-implants. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in the PubMed, EBSCO, Scopus, and ScienceDirect databases to identify randomized clinical trials published in the last 10 years. Five randomized controlled trials involving 89 participants and 178 orthodontic mini-implants fulfilled the eligibility criteria. Mini-implant stability was assessed using objective methods, including resonance frequency analysis (ISQ) and Periotest values, while one study also evaluated insertion and removal torque. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and the certainty of the evidence was evaluated using the GRADE approach. Results: Three of the five included studies reported improvements in orthodontic mini-implant stability following diode laser photobiomodulation, whereas two studies found no significant differences compared with the control group. Considerable heterogeneity was identified regarding laser wavelength (618-940 nm), irradiation protocols, energy parameters, timing of force application, and stability assessment methods. Most studies presented a low risk of bias, although some concerns remained regarding allocation concealment and blinding. According to the GRADE assessment, the overall certainty of the evidence was considered moderate, mainly because of inconsistency across studies and methodological heterogeneity. Conclusions: Current evidence suggests that diode laser photobiomodulation may improve the stability of orthodontic mini-implants. Nevertheless, the small number of randomized clinical trials and the substantial variability in PBM protocols and outcome assessment methods preclude definitive clinical recommendations. Future well-designed randomized controlled trials using standardized irradiation parameters and uniform stability assessment methods are required to establish evidence-based clinical protocols.
Carpal tunnel release (CTR) is a highly effective surgical procedure, but differences in exposure (conventional open, mini-open, endoscopic) may influence outcomes. Contemporary CTR reporting prioritizes patient-reported outcomes such as the Disabilities of the Arm, Shoulder and Hand (DASH) and the Boston Carpal Tunnel Questionnaire (BCTQ), while peripheral-nerve-specific quality-of-life measures remain largely under-reported in CTR. Is modified mini-open carpal tunnel release (mMOCTR) non-inferior to standard open carpal tunnel release in terms of clinical and patient-reported outcomes? We describe a single-center case series of adults treated with mMOCTR using a short palmar incision, no tourniquet, meticulous bipolar hemostasis, and tactile "crisp snap" guided stepwise division of the transverse carpal ligament. Primary outcomes were DASH, BCTQ and Peripheral Nerve Surgery Quality of Life (PNSQoL) results, while the secondary outcomes were surgical complications. Out of 224 patients (291 hands) operated for CTR during the study period, 115 patients (166 hands) fulfilled the inclusion criteria. All patient reported outcomes improved significantly. Recurrence occurred in 8 hands (2.7%), and two cases of persistent pillar pain and two wound dehiscences were noted. No vascular or neural injury was noted. mMOCTR delivered substantial symptom, function, disability, and QoL gains, non-inferior to those of the conventional open and mini-open techniques. As a single-center, noncomparative case series, comparative multicenter studies and technical standardization across mini-open variants are warranted to confirm these findings.
Epilepsy is a chronic neurological disease affecting more than 3.5 million Americans. Epilepsy requires lifelong self-management, the most important predictor of epilepsy-related outcomes. There is a lack of epilepsy self-management interventions that comprehensively address psychological motivations underlying self-management: autonomy, competency, and relatedness. Most existing interventions specifically focus on autonomy and competence via self-efficacy and/or patient activation; while somewhat effective, their effects wane over time. A more comprehensive intervention that addresses all 3 components of motivated behavior, including relatedness, is needed. We developed an intervention targeting autonomy, competence, and relatedness-in the form of intimate relationship satisfaction-to improve epilepsy self-management in people with epilepsy. Because no similar interventions exist, we implemented a mini-Delphi technique to garner perspectives on our intervention from invested parties before formal testing. The Delphi technique gathers evaluations on a new method through repeated rounds of discussion with experts or other invested parties. These repeated discussions lead to gradual improvement until all participants agree that the method is satisfactory. We established 2 advisory boards of invested parties: 1 with professionals (eg, a Clinical Nurse Specialist) and 1 with people with epilepsy. Advisory boards reviewed the intervention and provided qualitative and quantitative feedback. Advisory board members' feedback provided guidance on inclusion criteria, participant compensation, intervention timelines, and content structure. After iterative revisions and rounds of feedback over a 3-month period, all members gave the finalized version of the intervention a highly positive evaluation. Guidance from the advisory boards allowed us to refine intervention content, delivery structure, and implementation strategies. The mini-Delphi technique provided a practical advantage in our development process, offering a low-cost, efficient way to obtain meaningful feedback from a diverse group of people with varied expertise and lived experience.
The therapeutic landscape for lung cancer has been transformed by the introduction of molecular targeted therapies, immune checkpoint inhibitors (ICIs), and antibody-drug conjugates (ADCs). However, this expansion of treatment options has been accompanied by an increasing incidence of drug-induced interstitial lung disease (DIILD), which can significantly impact clinical outcomes. This review provides a comprehensive overview of DIILD in lung cancer management. Distinct clinical features and management strategies for various classes of antineoplastic agents are discussed. A high incidence of epidermal growth factor receptor-tyrosine kinase inhibitor-associated ILD in the Japanese population and emerging risks associated with sequential therapy using osimertinib following ICIs are highlighted. Unique "off-target" pulmonary toxicities of newer ADCs and the complex "two-hit" interactions between systemic therapies and local interventions like pleurodesis are also examined. Furthermore, a standardized five-step diagnostic approach based on systematic exclusion and multidisciplinary team consensus is proposed. Vigilant monitoring, early detection, and integrated management involving patient education and shared decision-making remain essential for optimizing patient safety in the era of precision oncology.
Peroxisome proliferator-activated receptors (PPARs) are nuclear receptors that regulate metabolic homeostasis and represent important therapeutic targets for conditions such as type 2 diabetes, dyslipidemia, and cardiovascular disease. While classical modulators often rely on carboxylic acid moieties to anchor receptor binding through hydrogen bonding, such groups are associated with suboptimal pharmacokinetic profiles, including poor bioavailability, rapid metabolism, and limited tissue penetration. This review explores the strategic use of bioisosteres, such as thiazolidinediones, tetrazoles, oxadiazolones, sulfonamides, and acetamides, as alternative polar headgroups in the design of PPAR ligands. We provide an overview of several aspects, highlighting how structural modifications to polar headgroups influence binding modes, receptor selectivity, and agonist profiles in the development of safer and more effective PPAR modulators. Emphasis is placed on synthetic approaches that prioritize convergent, high-yield, and late-stage diversification to facilitate parallel structure-activity relationship (SAR) exploration. Together, these bioisosteric strategies highlight the synergy between medicinal chemistry and synthetic innovation in the pursuit of next-generation PPAR modulators. Future efforts aimed at partial, biased, or tissue-selective agonists will benefit from continued exploration of novel headgroups, enabling safer and more effective therapies for metabolic and inflammatory diseases. Overall, a comparison of the different bioisosteric classes underscores the pivotal role of polar headgroup design in tuning potency, selectivity, and safety, guiding the rational development of future PPAR-targeted therapeutics.
Erythroderma is a severe dermatologic condition with a broad differential diagnosis encompassing inflammatory, drug-induced, neoplastic, and infectious etiologies. Scabies is the most common neglected tropical disease (NTD) and can manifest in two common forms: classic and crusted types. Although rare, crusted scabies is an important and frequently underrecognized cause of erythroderma (accounting for <0.5% of cases) that poses diagnostic challenges due to its clinical overlap with other dermatoses associated with erythroderma. We report the case of a 70-year-old man with a history of psoriasis who developed generalized erythroderma with pruritus and crusted, hyperkeratotic plaques on the face, scalp, and trunk. Skin biopsy demonstrated psoriasiform changes without detectable mites, whereas skin scrapings confirmed the presence of Sarcoptes scabiei, establishing the diagnosis of crusted scabies (erythrodermic crusted scabies). Differential diagnoses included psoriasis, adverse drug reaction, and seborrheic dermatitis. Treatment with oral ivermectin and topical scabicidal therapy resulted in marked clinical improvement. A review of the literature identified 16 reported cases of erythroderma secondary to scabies and highlighted the frequent misdiagnosis of this condition due to overlapping clinical and histopathological features, potentially delaying appropriate treatment and increasing the risk of complications. This case highlights the importance of considering crusted scabies in patients presenting with erythroderma, pruritus, and hyperkeratotic or scaly lesions and supports the integration of clinical assessment with parasitological examination, particularly skin scrapings, to reduce the risk of misdiagnosis and facilitate timely management. This is particularly relevant in primary care and general practice settings, where initial management decisions are often made. Knowledge of various scabies manifestations, especially its erythrodermic presentation, could further improve disease management and control, particularly in endemic and resource-limited areas.
Cancer and neurodegenerative disorders remain major public health challenges worldwide. Increasing incidence across age groups, together with persistently high mortality in many settings, contributes to substantial socioeconomic burdens on individuals, families, and healthcare systems. Histone Deacetylases (HDACs) are enzymes that remove acetyl groups from lysine residues on histone tails. As a key post-translational modification, histone deacetylation modulates chromatin organization and gene transcription. In many contexts, HDACmediated deacetylation is associated with increased chromatin compaction, which may limit transcription-factor accessibility and reduce transcriptional output. Beyond chromatin regulation, HDACs have been implicated in cell-cycle progression, apoptosis, inflammation, immune responses, redox homeostasis, and neuronal development. Given their involvement in disease mechanisms, Histone Deacetylase Inhibitors (HDACis) have attracted attention as potential epigenetic therapeutics with pleiotropic effects. By counteracting aberrant deacetylation, HDACis may help restore acetylation-dependent transcriptional programs and reactivate genes implicated in disease. They may also affect dysregulated signaling pathways and have been reported to exhibit antiproliferative, anti-inflammatory, neuroprotective, and anticancer effects. Accumulating preclinical and emerging clinical evidence suggests that HDACis are being evaluated for therapeutic activity in a range of malignant and neurodegenerative diseases. This review summarizes recent advances in HDACis, with emphasis on structural classification, key chemical features, molecular mechanisms, and clinical translation in oncology and neurodegeneration. By integrating these aspects, the article aims to provide a conceptual reference for targeted drug discovery and rational combination strategies for these challenging conditions.
As a crucial component of plant architecture, shoot branching significantly enhances photosynthetic efficiency and optimizes the source-sink allocation of photosynthetic products, which directly impacts crop productivity. The formation of lateral branches is co-regulated by various internal and external factors, including genetic factors, phytohormones, metabolic, and environmental factors. In this review, we provide a mechanistic overview of the key regulatory events involved in axillary meristem (AM) formation and lateral branch development, emphasizing the significant regulatory roles of phytohormones (such as auxins, cytokinins, strigolactones, brassinosteroids, gibberellins, abscisic acid, and other phytohormones) in this process. Furthermore, we highlight the transcription factors SHOOT MERISTEM-LESS (STM) and BRANCHED1 (BRC1) as central hubs that integrate multiple hormonal signals to control AM initiation and lateral branch development, respectively. By elucidating the regulatory mechanisms of these key nodes, we propose future research directions that can provide a foundation for shaping ideal crop plant architecture through genetic engineering and breeding strategies.
Primary signet ring cell carcinoma (SRCC) of the urinary bladder is an exceptionally rare and aggressive malignancy. We report a case of a 60-year-old man presenting with painless gross hematuria, urinary frequency, and dysuria. Imaging and cystoscopy revealed a bladder lesion, while histopathology demonstrated diffuse signet ring cell infiltration with detrusor muscle invasion, confirming muscle-invasive disease. Extensive investigations, including upper and lower gastrointestinal endoscopy, chest radiography, and prostate biopsy, excluded secondary malignancies. Despite the lack of immunohistochemistry, diagnosis was established through clinicopathologic correlation. This case highlights the importance of thorough evaluation for accurate diagnosis and appropriate management.
ObjectiveThis study evaluates the performance of large language models (LLMs)-ChatGPT-4.0, Gemini 2.0 Pro, o3-mini, Doctor GPT and DeepSeek-V3-in a national orthopaedic proficiency examination and explores their implications for health informatics and medical education. The responses of these models were analysed to assess accuracy rates and differences between models.MethodA total of 100 multiple-choice questions from the 2024 TOTEK examination were administered to each AI model under identical conditions. Correct and incorrect responses were recorded, and differences in performance were evaluated using chi-square testing and frequency analysis. Question categories were also compared to identify domain-specific variations.Resultso3-mini achieved the highest accuracy rate (79%), while Gemini 2.0 showed the lowest (68%); all models exceeded the 60% pass threshold. A statistically significant difference between models was identified in the Surgical Procedures category, in which Gemini 2.0 answered fewer questions correctly (23/36) than the other models (30-32/36) (χ2 = 9.87, df = 4, p = 0.043). No significant differences were observed in the remaining categories (all p > 0.05), and the overall difference in accuracy between models did not reach statistical significance (χ2 = 4.01, df = 4, p = 0.405). Clinical decision-making and visual content-based questions were the most challenging for all models.ConclusionAI models demonstrate generally high accuracy in medical examinations; however, they struggle with interpreting clinical context, recognising atypical medical scenarios and answering questions involving visual content.
Esketamine, an intranasally administered N-methyl-D-aspartate (NMDA) receptor antagonist, represents a significant advancement in the treatment of Major Depressive Disorder (MDD), particularly among patients with Treatment-Resistant Depression (TRD). Its therapeutic effects are associated with rapid enhancement of glutamatergic neurotransmission and downstream activation of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor-Brain-Derived Neurotrophic Factor (BDNF)-mechanistic Target Of Rapamycin (mTOR) signaling pathway, which is implicated in synaptic plasticity. This mini-review aims to synthesize current clinical and translational evidence on intranasal esketamine in TRD. This mini-review provides an integrative overview of clinically relevant and translational studies on intranasal esketamine, based on a focused search of the PubMed and Scopus databases. Peer-reviewed clinical trials, meta-analyses, mechanistic studies, and regulatory documents were included. Evidence from randomized controlled trials demonstrates a rapid onset of antidepressant effects, often within hours of administration, with consistent reductions in depressive symptom severity. Effects on clinician-rated suicidality were variable across studies. The most common adverse events include transient dissociation, dizziness, and modest increases in blood pressure, which are generally self-limiting. Overall, the available evidence supports intranasal esketamine as an effective rapid-acting treatment for TRD, with a favorable benefit-risk profile under supervised clinical use. However, important considerations remain regarding optimal patient selection, maintenance strategies, and long-term outcomes. Esketamine offers a clinically meaningful option for patients unresponsive to conventional monoaminergic treatments. Key unresolved issues include the development of predictive biomarkers, optimization of maintenance regimens, integration with psychotherapy, and evaluation of long-term cognitive and functional outcomes.
Patients undergoing total pharyngo-laryngectomy with anterolateral thigh (ALT) free-flap neopharyngeal reconstruction require prolonged voice rehabilitation, yet whether preoperative psychological characteristics predict postoperative voice and quality-of-life (QoL) outcomes in this surgical population has not been examined. We aimed to characterize changes in voice and QoL after this surgery and to explore associations between baseline psychological characteristics and depressive somatic symptoms and these postoperative outcomes. In this preliminary, single-center prospective study, 12 adult male patients undergoing primary or salvage total pharyngo-laryngectomy with simultaneous ALT free-flap neopharyngeal reconstruction were enrolled. Health-related QoL (EORTC QLQ-C30 and QLQ-H&N35), personality (Big Five Inventory, BFI), and depressive somatic symptoms (Depression and Somatic Symptoms Scale, DSSS) were assessed at baseline, 3 months, and 6 months postoperatively; the structured psychiatric interview (Mini International Neuropsychiatric Interview, MINI) was administered at baseline. Voice intelligibility (word correct rate), maximum phonation time, and speaking rate were assessed at baseline, 3 months, and 6 months postoperatively. Within-participant changes were analyzed with the Friedman test, and associations were examined using Spearman correlation. Cancer diagnoses included hypopharyngeal (n = 6) and laryngeal (n = 6) cancer; 10 of 12 participants underwent salvage surgery. EORTC QLQ-H&N35 speech problem scores decreased at 6 months (p = 0.036) and dry mouth scores at 3 months (p = 0.044) relative to baseline, while QLQ-C30 cognitive functioning decreased (p = 0.048) and sense problem scores increased (p = 0.011) over follow-up. Higher baseline neuroticism (r = -0.928, p = 0.008) and DSSS total scores (r = -0.928, p = 0.008) were negatively correlated with the 3-to-6-month change in word correct rate. Higher baseline DSSS was associated with poorer 6-month cognitive (r = -0.678, p = 0.031) and social functioning (r = -0.786, p = 0.007), and with higher pain scores (r = 0.663, p = 0.037). In this preliminary cohort, voice intelligibility and several QoL domains improved relative to baseline after pharyngo-laryngectomy with ALT free-flap neopharyngeal reconstruction, while patient-reported cognitive function and sense problems declined. Higher baseline neuroticism and depressive somatic symptoms were associated with smaller postoperative gains. Given the small sample size and the absence of a comparator group, these exploratory findings require confirmation in larger studies before preoperative psychological screening can be recommended for routine clinical use.
(1) Background: Clinical trial data extraction from registries such as ClinicalTrials.gov remains labor-intensive and error-prone, often missing critical details hidden in unstructured protocol descriptions. Large Language Models (LLMs) offer potential to automate this process, yet systematic multi-model comparisons on real clinical trial data remain scarce. (2) Methods: Four LLMs (OpenAI o4-mini-high, Anthropic Claude-Sonnet-4, Google Gemini 2.5-Pro, and Meta Llama-4-Maverick) extracted brain stimulation parameters from 67 transcranial direct current stimulation (tDCS) trials in Parkinson's disease via a structured JSON schema. Pairwise inter-model agreement was quantified with Cohen's Kappa and percentage agreement across binary, categorical, and multi-component task tiers. (3) Results: Under exact-string matching, agreement was near-perfect for binary classifications (non-invasive classification: 100%; brain stimulation presence: 99.3%, κ = 0.50) and substantial for categorical extractions (primary stimulation type: 96.4%, κ = 0.70), but fell to 48.6% (κ = 0.43) for complex anatomical targets. Numeric parameters revealed model-specific strengths: o4-mini-high and Claude-Sonnet-4 achieved perfect duration agreement (r = 1.000, n = 19) while Llama-4-Maverick diverged substantially (r < 0.12). Validation against an expert gold standard (100% inter-annotator agreement on a 20-trial overlap) confirmed high extraction accuracy across all features (mean 93.7-98.9%). Crucially, the low agreement on anatomical targets proved to be an artifact of exact-string scoring: under the same semantic matching used to measure accuracy, inter-model agreement rose to 97.0%, coinciding with the 95.5% expert accuracy. Inter-model agreement therefore tracks accuracy once both are measured on a common basis. (4) Conclusions: Exact-string inter-model agreement decreases with task complexity, but this decline largely reflects interchangeable free-text wording rather than reduced accuracy. Evaluated semantically, agreement and expert accuracy are both high and closely aligned. A residual risk is not low accuracy but the rare error shared across all models, which agreement cannot detect, and which overall accuracy can itself mask when one class dominates. These findings inform hybrid human-AI systematic review pipelines in which targeted expert oversight focuses on shared-error and minority-class detection.
The relative contributions of pleural intervention and surgical access to long-term recurrence after surgery for recurrent primary spontaneous pneumothorax remain uncertain. In this single-center retrospective cohort study, 315 patients younger than 35 years who underwent surgery for recurrent primary spontaneous pneumothorax after a second ipsilateral episode were included. Surgical treatment consisted of wedge resection combined with pleural abrasion or pleurectomy, performed through uniportal video-assisted thoracoscopic surgery or muscle-sparing mini-thoracotomy. The primary endpoint was recurrence-free survival. Kaplan-Meier analysis and Cox proportional hazards models were used to identify factors associated with postoperative recurrence. Overall recurrence occurred in 31 of 315 patients (9.8%) during a median follow-up of 64 months (IQR, 62-66); all included patients had at least 5 years of available follow-up. Recurrence was more frequent after pleural abrasion than after pleurectomy (14.4% vs. 4.7%, p = 0.004). In multivariable analysis, pleurectomy was independently associated with a lower hazard of recurrence than pleural abrasion (hazard ratio 0.255, 95% confidence interval 0.108-0.598; p = 0.002), whereas surgical access was not independently associated with recurrence-free survival (hazard ratio 1.023, 95% confidence interval 0.487-2.146; p = 0.953). Larger bullae, multiple bullae, and lower body mass index also remained independently associated with recurrence. Minimally invasive access was associated with more favorable perioperative recovery. In recurrent primary spontaneous pneumothorax, long-term recurrence appears to be more strongly associated with the pleural intervention strategy and baseline disease burden than with the route of surgical access. Pleurectomy was associated with lower recurrence, whereas minimally invasive access was associated with more favorable perioperative recovery.
BackgroundAge-related hearing loss is strongly associated with cognitive decline and dementia. Cochlear implantation (CI) has emerged as an effective intervention for severe-to-profound hearing loss and may influence cognitive and psychosocial outcomes in older adults. This systematic review and meta-analysis aimed to evaluate the cognitive, audiological, psychological, and quality-of-life outcomes following CI in the elderly.MethodsA systematic search of four databases was conducted for studies published up to February 2026. Studies including adults aged ≥55 years with bilateral hearing loss who underwent CI and reported pre- and post-implantation outcomes were eligible. The primary outcome was change in global cognitive function, assessed using multiple validated cognitive instruments - the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the hearing-adapted Repeatable Battery for the Assessment of Neuropsychological Status (RBANS-H) - with no single test treated as a reference ("gold-standard") measure of cognition. Secondary outcomes included domain-specific cognitive measures, audiological and speech perception performance, psychological outcomes (depression and anxiety), and patient-reported quality of life and subjective hearing ability. Pooled analyses were conducted using random-effects models, and results were expressed as mean differences (MD) with 95% confidence intervals (CI).ResultsA total of 31 studies involving 1,210 participants were included. Findings for global cognition differed by instrument. Scores on the MMSE, a verbally administered screening tool, showed no statistically significant change following CI (MD = 0.20, 95% CI: -0.75 to 1.15, p = 0.68). By contrast, global cognition assessed using the hearing-adapted RBANS-H and the MoCA improved significantly. Significant improvements were also observed in audiological performance and speech perception measures. Significant reductions were also observed in anxiety and depressive symptoms assessed using the Hospital Anxiety and Depression Scale, alongside substantial improvements in patient-reported hearing-related quality of life and subjective hearing ability. In contrast, no statistically significant improvements were observed in several executive function and working memory measures, including tests assessing cognitive flexibility, inhibition, and short-term memory. Depressive symptoms assessed using the Geriatric Depression Scale also showed no significant change.ConclusionCI in older adults provides substantial benefits in auditory performance and hearing-related quality of life. Cognitive benefit, drawn from the totality of cognitive testing rather than from the MMSE alone, was evident as improved global cognition on the hearing-adapted RBANS-H and the MoCA, with particular gains in memory and attention; by contrast, the MMSE - a verbally administered screening tool - together with executive function and working memory measures, did not change significantly. Considered across this full range of measures, the findings support CI as an effective intervention that may help alleviate the cognitive and psychosocial consequences of severe hearing loss in the aging population. Because recipients may under-recognise their own social gains, future studies should also incorporate family-perceived benefit and social-interaction outcomes as additional patient-centred measures, using parallel family- or caregiver-reported instruments rather than recipient-reported speech outcomes alone.
Background/Objectives: Cognitive impairment, frailty, and systemic comorbidity burden are common in elderly patients with glaucoma and may influence both visual field (VF) performance and glaucoma severity. This study investigated the associations of comprehensive geriatric assessment (CGA) parameters, including Mini-Cog, G8, and Age-Adjusted Charlson Comorbidity Index (ACCI), with VF sensitivity and VF reliability indices in glaucoma patients. Methods: This retrospective cross-sectional study included 1125 eyes of 622 glaucoma patients who underwent Humphrey VF testing and CGA at a tertiary referral center. Associations between CGA parameters and VF indices, including mean deviation (MD), pattern standard deviation (PSD), foveal sensitivity, fixation loss rate (FL), false-negative rate (FN), and false-positive rate (FP), were evaluated. Generalized linear mixed models were used to assess independent associations after adjustment for demographic, systemic, and ocular covariates. Results: In univariate analyses, lower Mini-Cog and G8 scores and higher ACCI scores were associated with several VF sensitivity and reliability indices. After multivariable adjustment, ACCI remained independently associated with lower MD (estimate = -0.52, p = 0.004), higher PSD (estimate = 0.27, p = 0.04), and lower foveal sensitivity (estimate = -0.36, p = 0.01). Lower G8 scores and higher ACCI scores were independently associated with increased FN rates, whereas higher G8 scores were associated with increased FP rates. Conclusions: Systemic comorbidity burden, assessed using ACCI, was independently associated with both glaucomatous functional impairment and selected VF reliability indices. Frailty, assessed using G8, was associated with VF reliability but not VF sensitivity. Although cognitive function measured by Mini-Cog was associated with VF parameters in univariate analyses, these associations were not retained after multivariable adjustment. Consideration of systemic health status and geriatric vulnerability may improve interpretation of VF results in patients with glaucoma.
Temporary anchorage devices (TADs) are considered an essential and reliable component of orthodontic fixed appliance therapy, providing stable skeletal anchorage with minimal dependence on patient compliance. This study aimed to evaluate the success rate of orthodontic mini-implants and to assess the influence of patient- and treatment-related factors on their stability and success rate. A retrospective analysis of 60 patients was conducted with a total of 121 inserted TADs. Patient sex, age, orthodontic diagnosis, insertion site, and bone quality were analyzed, and descriptive statistics were calculated for all variables. Associations between categorical variables were evaluated using Pearson's chi-square test. Variables showing potential association were further analyzed using multivariate binary logistic regression to identify independent predictors of mini-implant success. No statistically significant associations were found between implant success and patient sex (p = 0.240), age (p = 0.819), or insertion site (p = 0.069); however, a trend toward higher failure rates in palatal-placed implants was noted. Logistic regression analysis did not identify any independent predictors of success (p = 0.284), and the model explained only a small proportion of outcome variability (5.9-12.0%). The high success rate of the TADs demonstrated high clinical reliability in this study, although patient-related factors such as age and sex did not significantly influence the success rate. Bone quality and soft tissue characteristics may contribute to TAD stability; however, these factors were not directly quantified in the present analysis.
Autoimmune diseases are chronic inflammatory disorders characterized by loss of immune tolerance, activation of autoreactive immune cells, and progressive tissue injury. Despite advances in immunosuppressive and biologic therapies, treatment responses remain heterogeneous and long-term therapy is frequently associated with adverse effects and economic burden. These limitations have stimulated increasing interest in complementary immunomodulatory strategies, including naturally occurring bioactive compounds. Genistein, a soy-derived isoflavone belonging to the phytoestrogen family, has emerged as a promising candidate due to its pleiotropic anti-inflammatory, antioxidant, and immunoregulatory properties. At the molecular level, genistein functions as a tyrosine kinase inhibitor and modulates several signaling pathways implicated in immune regulation, including NF-κB, MAPK, and estrogen receptor-dependent pathways. Through these mechanisms, genistein influences cytokine production, lymphocyte activation, T-cell differentiation, and cellular redox homeostasis. A body of preclinical evidence supports the immunomodulatory potential of genistein in multiple autoimmune disease models, including systemic lupus erythematosus, rheumatoid arthritis, experimental autoimmune encephalomyelitis, type 1 diabetes, Sjögren's syndrome, autoimmune thyroid disease, and autoimmune blistering skin disorders. In these models, genistein administration has been associated with attenuation of inflammatory responses, reduced disease severity, and modulation of autoimmune pathways. Although precision medicine represents a major contemporary direction in autoimmune disease therapeutics, many patients continue to experience suboptimal clinical responses. In this context, multi-target compounds such as genistein may represent a potential adjunctive therapeutic approach. Clinical evidence remains limited; however, preliminary studies suggest potential immunomodulatory effects in humans. This mini review summarizes mechanistic, preclinical, and emerging clinical evidence regarding the role of genistein in autoimmune diseases.
Beach sediments may contain natural radionuclides, fallout-derived radionuclides, naturally occurring radioactive material (NORM) or technologically enhanced naturally occurring radioactive material (TENORM), but their radiological significance depends on sediment dynamics and exposure scenario as much as on bulk activity concentration. RadSed-INT is introduced as a tiered field-laboratory protocol for assessing radioactivity in dynamic beach sediments. The protocol links in situ gamma screening, statistically designed transects, primary/confirmatory A/B sampling, high-purity germanium (HPGe) gamma-ray spectrometry, grain-size and heavy-mineral partitioning, vertical mini-core radiostratigraphy, and triggered dust, radon/thoron and ingestion pathway modules. Its central requirement is radiometric mass closure between directly measured bulk activity and the mass-weighted reconstruction from sediment fractions. External and internal doses are evaluated only for explicitly defined material status, exposure pathways, occupancy assumptions and regulatory domains; construction-material and NORM indices are retained as context-specific comparators, not universal beach-sediment limits. RadSed-INT defines escalation triggers from reconnaissance to confirmatory spatial, grain-size, vertical or aerosol investigations. This article is methodological and does not report new primary field data. Extended notation, a date-sensitive regulatory matrix, confounder checklists, implementation tables and a minimal worked example are included to support transparent and reproducible application of the core protocol logic.
This study examined the prevalence of fear of cancer recurrence (FCR) and its related factors among cancer survivors in South Korea. Between August 2021 and November 2022, 345 cancer survivors were recruited from the National Cancer Center, regional cancer centers, university hospitals, and local communities in South Korea. Participants completed self-report questionnaires, including the Korean version of Fear of Cancer Recurrence Inventory-Short Form (K-FCRI-SF) via mobile platforms, and underwent structured diagnostic interviews using the Korean version of the Mini-International Neuropsychiatric Interview (K-MINI). Logistic regression analyses were conducted to identify key predictors of clinical FCR (K-FCRI-SF of ≥ 22). Overall, 60.87% of participants had elevated FCR, including 31.01% who met the threshold for clinical FCR. Younger age was independently associated with clinical FCR, whereas cancer-related clinical characteristics were not. Across domain-specific multivariable analyses, psychiatric comorbidities (illness anxiety disorder and somatic symptom disorder), psychological factors (thought suppression and catastrophizing), and cancer-related factors (symptom focusing, anxious preoccupation with cancer, negative illness perception, and illness-related ambiguity) were independently associated with clinical FCR. These findings suggest the potential value of greater clinical attention to health anxiety and maladaptive cognitive responses as modifiable correlates of clinical FCR, alongside clearer and more consistent medical communication to address illness-related uncertainty. In comprehensive cancer survivorship, multidisciplinary approaches integrating cognitive-behavioral strategies with accurate medical guidance could be considered a promising avenue for reducing FCR; however, further longitudinal and intervention studies are needed to confirm these preliminary observations.