Managing diabetes mellitus (DM) and its long-term complications remains a major global health challenge. Dihydromyricetin (DHM), a natural flavonoid abundant in Ampelopsis grossedentata and Hovenia dulcis, has attracted increasing attention for its multi-target anti-diabetic properties. Growing evidence indicates that DHM improves glucose metabolism, alleviates oxidative stress and inflammation, regulates autophagy and cell death, and exerts beneficial effects in DM and a range of related complications, including diabetic nephropathy, cardiomyopathy, cognitive impairment, and wound healing impairment, and other related complications. Overall, this review provides an overview of preclinical research on DHM in DM and its main complications, emphasizing its therapeutic benefits and underlying molecular mechanisms. Although DHM is promising, future research should improve its delivery, clarify its mechanisms, and carry out clinical trials to enable therapeutic use.

Enhanced Recovery After Surgery in the Patient With Cancer: A Narrative Review.

OBJECTIVE: To estimate the effectiveness of patient education and self-management interventions for osteoarthritis (OA) in adults aged ≥ 18 years. DESIGN: Overview of intervention systematic reviews LITERATURE SEARCH: Eight databases (Medline, Cochrane Library, EMBASE, Epistemonikos, Web of Science, Scopus, PEDro, and CINAHL) were searched from inception to June 26, 2024. STUDY SELECTION CRITERIA: We included intervention systematic reviews (SRs), with or without meta-analysis, that evaluated patient education or self-management interventions for adults with OA, reporting pain or functional outcomes. DATA SYNTHESIS: Data were extracted using a standardized template. We extracted intervention effects on pain and function. Methodological quality was evaluated using AMSTAR 2 checklist. We assessed the overlap of studies included in the SRs using the Corrected Covered Area (CCA) method. RESULTS: Nineteen SRs (12 with meta-analysis) encompassing 171 trials were included. Patient education interventions had modest effects on reducing short-term pain (SMD = −0.22 to −0.35). There were no sustained or consistent effects of patient education interventions on function. Self-management interventions yielded small and consistent effects on reducing pain (SMDs ranging approximately from −0.20 to −1.51) and improving function (SMDs up to 1.95), especially over the long term and when combined with patient education. Methodological quality was generally low; 1 SR was rated as high quality. There was slight overlap among included trials (CCA 1.5% for patient education and 4.6% for self-management). CONCLUSION: Self-management interventions, particularly when integrated with patient education or other therapies, may offer more robust and lasting benefits for OA management than patient education alone.

Acute variceal bleeding (AVB) is a known complication of decompensated cirrhosis and carries with it a high mortality rate. Understanding the basic underlying pathophysiologic processes that lead to the development of varices and how to prevent progression of this disease is crucial for an intensivist. Once bleeding occurs, intensivists must be able to navigate a complex presentation of impending respiratory failure and hemorrhagic shock. A multidisciplinary approach to AVB including medical therapies combined with procedural interventions such as endoscopy, balloon tamponade, and emergency surgery must all be considered in severe cases. In this narrative review, we aim to provide an updated and comprehensive overview of the prevention and management of variceal bleeding in patients with cirrhosis.

Background: Point-of-care ultrasound (POCUS) has emerged as a valuable tool for rapid diagnosis, procedural guidance, and real-time clinical decision-making in neonatal and pediatric critical care. Despite its growing use in acute medicine, the evidence describing its implementation, utility, and impact in interfacility and prehospital transport settings remains limited. This scoping review aims to systematically map the current body of evidence on POCUS use during neonatal and pediatric transport and to identify knowledge gaps to inform future research, training, and clinical integration. Methods: A scoping review was conducted following PRISMA-ScR 2020 guidelines, searching PubMed, Embase, Scopus, CINAHL, and Web of Science for studies describing POCUS use during neonatal and pediatric transport. Results: Of 3676 unique articles identified, 20 met inclusion criteria, including 10 cohort studies, 3 case series, 4 case reports, 2 narrative reviews, and 1 textbook chapter. Fifteen studies reported extractable patient-level data and were included in quantitative synthesis, encompassing 4278 patients. Among these, 1153 (27.0%) patients were under 18 years old, and 576 (13.5%) had POCUS performed during transport. POCUS was primarily used for diagnostic assessment—mainly lung and cardiac imaging—with variability in protocols, operator training, and transport characteristics. Eleven studies (73.3%) reported that POCUS altered clinical management, influencing management in 106 (18.4%) patients through diagnostic clarification, resuscitation decisions, medical or ventilator adjustments, and changes in transport destination. Conclusions: Evidence suggests that POCUS supports clinical decision-making and timely intervention during neonatal and pediatric transport, though use remains inconsistent. Future studies should focus on developing structured training frameworks, validating transport-specific protocols, and assessing the impact of POCUS on clinical outcomes and transport safety.

Rosacea is a common chronic inflammatory dermatosis with complex pathophysiology and heterogeneous clinical manifestations. Despite its prevalence, no specific serological biomarkers exist for reliable diagnosis or disease monitoring. Current reliance on subjective clinical assessment underscores the need for objective and quantifiable evaluation methods. This comprehensive review examines the current applications and research progress of non-invasive skin imaging modalities-including computer-aided imaging analyzers, dermoscopy, reflectance confocal microscopy (RCM), optical coherence tomography (OCT), high-frequency ultrasound (HFUS), and laser speckle contrast imaging (LSCI)-in rosacea management. We also discuss the emerging potential of image-based artificial intelligence (AI) for enhancing diagnostic accuracy and clinical decision-making. The integration of multimodal imaging with AI provides a more comprehensive and objective approach to rosacea management, enabling precise subtype classification, accurate severity assessment, and improved treatment monitoring. Multimodal non-invasive imaging combined with AI offers a more objective and comprehensive framework for rosacea diagnosis, subtype stratification, and treatment monitoring, supporting personalized management strategies. However, clinical adoption remains limited by insufficient evidence. Future efforts should focus on large-scale validation, standardization of imaging protocols, and development of AI models that integrate multimodal data to facilitate clinical decision-making.

Marfan syndrome (MFS) is a genetic disorder caused by mutations in the FBN1 gene, which encodes fibrillin-1, a crucial protein involved in the structure of elastic fibers and the regulation of transforming growth factor-beta (TGF-β) bioavailability. Defective fibrillin-1 disrupts these fibers, leading to skeletal, ocular, and cardiovascular abnormalities. A key pathological mechanism in MFS is excessive TGF-β signaling, which has been targeted by angiotensin receptor blocker (ARB) therapies such as losartan, demonstrating potential in restoring normal phenotypes in experimental models. The aim of this narrative review was to highlight findings that demonstrate the potential of ARBs for MFS. Aortic root dilation is a defining feature of MFS. Studies have shown that losartan therapy significantly reduces the dimensions of the aortic root and sinotubular junction in children. However, its long-term efficacy remains uncertain. Beyond its primary effects on the aorta, chronic losartan treatment enhances endothelial function by promoting nitric oxide-mediated vasodilation, which may help prevent aortic root widening. The drug's effects are partly attributed to its metabolites, EXP3174 (an angiotensin II type 1 receptor [AT1] antagonist) and EXP3179 (an NADPH oxidase inhibitor). Overexpression of NADPH oxidase in MFS contributes to vascular dysfunction, and EXP3179 mitigates aortic vasoconstriction. Given these mechanisms, ongoing research explores the potential of AT1 receptor antagonists as therapeutic agents in MFS, aiming to improve vascular health and long-term patient outcomes.

Diverse exercise modalities in alleviating osteoporosis: A narrative review.

Risk Assessment Tools for Mass Gatherings: a Narrative Review.

Nerve-sparing gynecologic surgery has evolved as a critical advancement in the management of deeply infiltrating endometriosis, aiming to reduce postoperative dysfunction while preserving surgical efficacy. Historically, procedures such as radical hysterectomy and excision of deeply infiltrating endometriosis carried high risks of urinary, bowel, and sexual dysfunction due to inadvertent injury to pelvic autonomic nerves. Recent developments in pelvic neuroanatomy, enhanced laparoscopic visualization, and operative technique have enabled surgeons to identify and preserve key neural structures during dissection. This review traces the evolution of nerve-sparing surgery, from early radical oncologic techniques to contemporary minimally invasive approaches guided by functional anatomy. We highlight contributions from key innovators and describe standardized terminology for pelvic nerves, fasciae, and retroperitoneal spaces, which aim to improve surgical reproducibility. Surgical techniques including the laparoscopic neuronavigation technique, the Negrar Method, and hypogastric nerve-based dissection are presented in detail, emphasizing both neuroanatomical precision and practical application. The use of anatomical landmarks in settings without advanced equipment is also discussed. Special attention is given to bowel surgery in endometriosis, balancing radicality with preservation of pelvic nerve function. Collectively, these strategies underscore a shift toward personalized, anatomy-guided surgery that prioritizes both disease control and long-term quality of life. As interest in nerve-sparing approaches continues to grow, education, multidisciplinary collaboration, and ongoing refinement of surgical methods will be essential to broadening access and improving patient outcomes for patients with deeply infiltrating endometriosis.

Post-stroke fatigue is a prevalent sequela of stroke that substantially impairs patients' quality of life and rehabilitation progress, yet its mechanisms and management remain heterogeneous. This narrative review synthesizes current evidence on neuroimmune pathways implicated in post-stroke fatigue and appraises emerging mechanism-targeted interventions. Studies published between 2003 and 2025 were included; all were sourced from PubMed, Web of Science, or Scopus. Search terms included "post-stroke fatigue", "neuroinflammation", "pharmacological interventions", "neuromodulation", and related terms. Only full-text, English-language articles were considered; studies were selected according to their focus on post-stroke fatigue mechanisms or interventions. Convergent data implicate low-grade, cytokine-mediated inflammation; dysregulation of the monoaminergic system - particularly dopamine and serotonin; and hyperactivity of the hypothalamic-pituitary-adrenal axis. Interventions aligned with these pathways show promise, including immunomodulation with interleukin-1 receptor antagonists; neuromodulation with transcranial direct current stimulation and repetitive transcranial magnetic stimulation; pharmacotherapy with selective serotonin reuptake inhibitors or modafinil; and non-pharmacological strategies such as aerobic exercise and cognitive behavioral therapy. A neuroimmune-informed, mechanism-targeted approach may improve outcomes in post-stroke fatigue. Priorities include standardized definitions, harmonized outcome measures, and adequately powered trials to confirm effectiveness across phenotypes.

Processed electroencephalogram (EEG) indices, such as the Bispectral Index, have markedly influenced anesthesia practice as they translate brain activity into simple numerical indices. Nevertheless, as the manufacturing algorithms are not disclosed, the underlying neurophysiology remains obscured. Additionally, these indices are often affected by electromyographic contamination, pharmacological variability, and patient-specific EEG heterogeneity. In contrast, an EEG spectrogram, or density spectral array, preserves the frequency- and time-resolved structures of cortical oscillations. This information is presented in a form that is both physiologically meaningful and clinically interpretable. In this review, we trace the evolution of anesthesia from an index-based to a spectrogram-guided approach, and summarize the clinical rationale for adopting the latter. Key applications of this approach include the use of frontal alpha power as a biomarker of cortical stability and postoperative brain health, the identification of nociceptive arousal through alpha dropout and beta or delta arousal patterns, and individualized titration of multimodal or age-specific anesthetic management. Although current devices lack standardized quantitative alpha metrics and have limited sensitivity for low-frequency brain wave components, structured EEG education programs have proven to be effective in terms of fostering spectrogram literacy among anesthesiologists. By combining neurophysiological precision with bedside practicality, the EEG spectrogram represents a pivotal advance toward individualized, mechanism-based, and brain-protective anesthesia, transforming anesthetic monitoring from mere algorithmic abstraction to cortical insight.

Cancer-associated venous thromboembolism (CA-VTE) is a leading, severe, and potentially life-threatening complication in patients with malignancy. Low-molecular-weight heparin has historically been the standard of care; however, direct oral anticoagulants, particularly direct factor Xa inhibitors, have emerged as effective alternatives. These agents offer the convenience of oral administration, predictable pharmacokinetics, elimination of routine laboratory monitoring, and improved adherence. Despite the expanding role of direct oral anticoagulants in CA-VTE management, concerns regarding bleeding risk-particularly in patients with gastrointestinal and genitourinary malignancies-remain central to clinical decision-making. In this narrative review, we evaluate the efficacy, safety, and clinical applicability of apixaban for the treatment and prophylaxis of CA-VTE. Current evidence from randomized controlled trials, including CARAVAGGIO and AMPLIFY, demonstrates that apixaban has noninferior efficacy compared with low-molecular-weight heparin and conventional anticoagulation strategies, with comparable or lower rates of recurrent venous thromboembolism. In addition, apixaban appears to have a favorable safety profile, with no statistically significant increase in major bleeding in selected cancer populations, including those without active gastrointestinal lesions. Apixaban's pharmacokinetic properties, including limited renal clearance and stable drug exposure, further enhance its clinical utility in oncologic populations. However, evidence supporting apixaban use across all cancer subtypes remains limited and heterogeneous, highlighting the need for additional comparative and real-world studies.

Treatment for patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has shifted from chemoimmunotherapy (CIT) to targeted therapies, administered as continuous treatment until progression or in fixed-duration regimens. Fixed-duration regimens with targeted therapies (usually in combination regimens with venetoclax and a Bruton tyrosine kinase inhibitor [BTKi] and/or an anti-CD20 monoclonal antibody) are of increasing interest, and recent phase3 trial results support this approach. Fixed-duration treatment offers a pre-defined treatment stopping point and may provide patients with a treatment-free interval, potentially reducing the burden of long-term therapy while minimizing cumulative toxicity and costs. Here, we review the currently approved fixed-duration regimens and some investigational combinations in ongoing registrational clinical trials. The registrational fixed-duration studies CLL14 (venetoclax plus obinutuzumab), GLOW (ibrutinib plus venetoclax), CAPTIVATE (ibrutinib plus venetoclax), AMPLIFY (acalabrutinib plus venetoclax with or without obinutuzumab), and MURANO (venetoclax plus rituximab) along with the investigator-initiated CLL17 study, which may impact treatment guidelines, demonstrated extended treatment-free intervals. Generally, targeted fixed-duration regimens in patients with unmutated immunoglobulin heavy chain variable region or TP53 and/or del(17p) demonstrated greater efficacy than CIT, but outcomes were typically poorer than in patients without these high-risk features. Cardiovascular toxicity and death remain a significant concern with ibrutinib plus venetoclax, which was also associated with high rates of diarrhea and atrial fibrillation. Successful fixed-duration regimens in CLL should achieve deep remission (i.e., undetectable minimal residual disease), sustain long-term progression-free survival, decrease the burden of treatment-related adverse events, and allow for re-treatment with minimal risk of drug resistance. Although fixed-duration treatment represents a positive step forward for most patients with CLL/SLL, the currently approved regimens often fall short in patients at high risk of progression. Continued research and development of next-generation drugs is essential to enhance efficacy and safety, ultimately improving outcomes in all patients with CLL/SLL.

Patients with hepatocellular carcinoma (HCC) often sit at the crossroads of malignancy and chronic liver disease, where impaired hepatic reserve, systemic inflammation, and treatment-related stress accelerate loss of skeletal muscle mass and function. In this narrative review, we synthesize current evidence on the two-way relationship between sarcopenia and HCC management across curative and palliative settings. We outline key biological pathways—altered energy substrate use, amino acid imbalance, hyperammonemia-related signaling, and inflammatory and hormonal perturbations—that promote progressive muscle wasting, and we summarize how sarcopenia influences tolerance, complications, and outcomes of surgery, locoregional therapies, and systemic agents. We then translate the literature into practical supportive-care principles, including adequate energy and protein delivery, optimized meal distribution (including late-evening snacks), and selected supplementation alongside hepatic rehabilitation/exercise. Potential adjuncts discussed include branched-chain amino acids, L-carnitine, vitamin D, zinc, and other micronutrients. Because the available data are heterogeneous and largely derived from observational cohorts or extrapolated from cirrhosis populations, HCC-specific randomized trials and standardized intervention protocols remain limited. Therefore, nutritional and exercise recommendations should be individualized according to tumor stage, hepatic function, comorbidities, and treatment goals, and viewed as supportive guidance that requires confirmation in well-designed prospective studies.

Cardiovascular adverse effects of drugs has significant practical implications for patient management. While cardiovascular adverse effects have commonly been associated with oncologic therapeutics, a growing body of evidence suggests that non-oncologic medications can also be associated with significant cardiovascular harm. These adverse effects range from arrhythmias, conduction abnormalities, QT prolongation, heart failure, myocardial infarction, or structural cardiomyopathy. Non-oncologic drugs that have been implicated include antibiotics (e.g., macrolides, fluoroquinolones), antidiabetics (e.g., thiazolidinediones), non-steroidal anti-inflammatory drugs (NSAIDs), drugs for gastrointestinal and urological conditions, and most importantly, cardiovascular drugs. In this narrative review, we focus on the most common non-oncologic drugs that cause cardiovascular adverse effects, their proposed underlying mechanisms with particular emphasis on their clinical manifestations and clinical implications for everyday cardiovascular practice.

Abstract Antimicrobial resistance (AMR) poses a significant global health challenge, with children being particularly vulnerable to its consequences (World Health Organization, 2015; Science 353(6302):874–875, 2016). This narrative review examines antibiotic stewardship practices within pediatric emergency and primary care settings, emphasizing gaps and opportunities within the healthcare framework of Oman. Relevant publications from 2013 to 2023, including clinical guidelines such as those from the American Academy of Pediatrics (2021) and the WHO AWaRe classification (2023), along with national Omani data (Oman Med J 36:e287, 2021, J Infect Public Health 15:322–329, 2022), were reviewed to evaluate patterns of antibiotic utilization and stewardship interventions. A thematic synthesis—guided by the identification of recurring themes across sources rather than formal qualitative coding—was used to combine findings from different types of evidence (BMC Med Res Methodol 8:45, 2008). Despite comprehensive guidance, both international and local studies consistently report that 30–40% of pediatric antibiotic use is unnecessary (Pediatrics 132(6):1146–1154, 2013, JAMA 315(17):1864–1873, 2016), with Omani audits indicating that 37% of prescriptions were inappropriate, often involving broad-spectrum agents (Oman Med J 36(4):e287, 2021). Practical strategies to reduce this inappropriate use include delayed prescriptions, shorter treatment durations, and electronic decision-support tools (Cochrane Database System Rev (9):CD004417, 2017, JAMA 309(22):2345–2352, 2013). In Oman, stewardship initiatives have demonstrated measurable benefits, including a reduction in multidrug-resistant organisms (from 2.8 to 0.6 per 1000 patient-days) and annual cost savings ranging from USD 70,000 to 80,000 (J Infect Public Health 15(3):322–329, 2022). Embedding evidence-based strategies and integrating stewardship into health systems are essential for sustaining progress and regional impact.

Introduction: Programmatic assessment (PA) has emerged as a transformative framework in medical education, emphasizing longitudinal evaluation, meaningful feedback, and data-informed decision-making to enhance learner development. Its role extends beyond competency measurement, contributing to broader educational goals such as strengthening health literacy and health promotion competencies—core attributes for future healthcare professionals. This bibliometric and narrative review aimed to map global research trends, influential contributors, and thematic patterns in programmatic assessment while synthesizing evidence on its potential to advance health literacy and health promotion competencies in medical education. Methods: A comprehensive search was conducted in Scopus database for articles published between 1977 and 2025. Inclusion criteria of eligible studies were those addressing programmatic assessment in medical or health professions education—including portfolios, decision processes, or programmatic feedback—and explicitly linking these approaches to health literacy or health promotion competencies. The dataset comprised 822 records and a final sample of 166 publications eligible for bibliometric analysis. Bibliometric indicators were analysed using VOSviewer, including publication trends, author networks, organizational and country contributions, and keyword co-occurrence. Narrative synthesis integrated empirical findings on PA implementation and its educational outcomes. Results: A total of 1092 authors, 502 organizations, and 44 countries contributed to 1737 indexed keywords, of which 167 met inclusion thresholds. Thematic clustering identified four dominant domains: feedback and learning analytics, competency-based assessment, digital and AI-supported assessment, and professional identity formation. Recent literature emphasizes PA’s capacity to cultivate reflective practice, communication skills, and health advocacy—key components of health literacy and promotion. Conclusion: Programmatic assessment represents an integrative and evidence-driven approach that not only enhances learning and assessment quality but also fosters essential competencies in health literacy and promotion, aligning medical education with 21st-century public health priorities.

Bibliometric analysis is a systematic process of reviewing and evaluating relevant sources through a literature survey on a specific topic. Bibliometric analysis is frequently employed to examine scale development and adaptation studies in music, enabling researchers to determine current trends and key research in this field. This study aims to evaluate the last decade (2014–2024) by presenting scale development and adaptation studies in music published in the TR Dizin database through various sub-problems (publication year, journal, keywords, sample group, publication type, citation count, etc.). The goal is to contribute to future scientific research in scale adaptation and development in music education. Within the study’s scope, articles on scale development and adaptation in music published in the TR Dizin database between 2014 and 2024 were screened (n=312), and eligible articles (n=30) were included. The results were analyzed bibliometrically and presented via descriptive tables, including content analysis and percentage-frequency distributions. Findings indicate that the highest number of studies were conducted in 2020 (n=8), the most cited study had 11 citations, scale development studies were more common than adaptations, and most publications appeared in university journals.

Like any other medical field, physiotherapy has changed dramatically over time. Rapid access to healthcare, increased efficiency, consideration of cost-effectiveness and cost-utility, and shorter wait times are all becoming more and more necessary as a result of demographic shifts. As a result, advanced clinical experts who work at a level higher than entry-level for a variety of healthcare professions now require education. The aim of the study is to substantiate the content of the professional training process for future specialists on physical rehabilitation on using advanced rehabilitation tools, within global and Ukrainian context. Based on narrative and integrative review methodology, the study identifies key principles for structuring educational content both in global and Ukrainian perspective: consistency, interactivity, modularity, and adaptability. The role of specialized training courses in physical rehabilitation is emphasized in fostering a health-oriented educational environment. These courses are distinguished by their informativeness, incorporation of current scientific research, diverse conceptual approaches, and innovative perspectives on health-related problems. Additionally, a list of knowledge and competencies expected of university graduates upon completion of the training program is provided in a holistic perspective plane.