Osteoarthritis (OA) is now understood as a heterogeneous syndrome driven by diverse biological, biomechanical, metabolic, genetic, and molecular mechanisms. This variability explains differences in disease progression and treatment response, challenging the traditional "one-size-fits-all" approach. This review highlights OA phenotyping as a key step toward precision medicine, focusing on clinical, structural, and molecular classifications that inform individualized care. A narrative review was conducted using a non-systematic search of major databases and Osteoarthritis Research Society International sources (2010-2026). Evidence was thematically synthesized across clinical, imaging, and molecular domains to characterize OA phenotypes and their potential relevance to precision medicine. Multiple OA phenotypes were identified: inflammatory, metabolic, biomechanical, cartilage-subchondral, pain-sensitization, and aging/senescence. These exhibit distinct clinical features, risk factors, and therapeutic responses. Imaging-based phenotypes (e.g., inflammatory, meniscus-cartilage, subchondral bone, atrophic, hypertrophic) and molecular endotypes (low turnover, structural damage, systemic inflammation) further refine stratification. Pain-structure discordance is notable in sensitization phenotypes and may predict poorer surgical outcomes. Joint-specific variations and emerging genomic and epigenetic insights underscore disease complexity. Advances in imaging, biomarkers, and machine learning may enable earlier detection and patient clustering, though clinical application remains limited. Phenotype- and endotype-based classification represents a critical advancement toward precision OA management. Tailored interventions based on stratification hold promise for improving outcomes; however, clinical translation remains limited by overlapping phenotypes, lack of validated biomarkers, and inconsistent results from phenotype-driven trials. Wider clinical adoption requires standardized definitions, validation across joints, and integration of multimodal diagnostic tools into routine practice.

To perform a narrative review of the biomechanics of lumbar pedicle subtraction osteotomies (L-PSO) and associated surgical constructs. A non-systematic literature search was performed. PubMed was queried for investigations published between 2010 and 2025 with the following search terms: "lumbar", "PSO", "biomechanics, "finite element analysis", "cadaver". Studies evaluating biomechanical properties of L-PSO (L1-L5) constructs were included. Clinical studies and non-lumbar level (cervical/thoracic) PSOs were excluded. L-PSOs create a highly destabilized environment, particularly in axial rotation. Two-rod constructs significantly reduce range of motion (ROM) relative to the uninstrumented spine but are associated with high rod stresses. Multi-rod constructs (satellite and accessory rods) consistently reduce ROM and primary rod stresses, although the magnitude of benefit varies across studies and configurations. Rod material (cobalt chrome) and increased rod diameter further enhance construct rigidity but may increase stress shielding. Cross-links may increase rod stress when placed near a L-PSO site, while monoaxial screws increase construct stiffness compared to polyaxial screws. Interbody cages placed adjacent to L-PSOs improve load sharing and reduce posterior rod strains, particularly when used in a "sandwich" configuration. Biomechanical improvements, such as reduced rod strain and ROM, have not been directly linked to clinical outcomes, including fusion rates or rod fractures. While biomechanical studies demonstrate multi-rod constructs and adjunct techniques improve construct stability, the relationship between these biomechanical advantages and clinical outcomes, including osseous healing and rod fractures, remains unclear. In L-PSOs, increasing construct rigidity alone is not the primary goal; instead, optimal load sharing across the osteotomy site is a critical biomechanical consideration. As such, future work should focus on elucidating the optimal balance between protecting posterior instrumentation through construct rigidity and preserving adequate compressive forces across L-PSOs, integrating biomechanical findings with clinical data, and developing patient-specific biomechanical modeling to further refine L-PSO instrumentation techniques.

ABSTRACT Communities in rural areas face a diverse range of challenges. How these challenges are addressed is crucial for achieving sustainability. Nature-based Solutions provide opportunities to address multiple community challenges. However, their application in rural communities is limited. Hence, this study employed a combination of secondary (non-systematic literature search) and primary data (focus group discussions and AEIOU framework) to identify multiple challenges in the rural community of Guptapada, India, understand their causes and impacts, explore their interlinkages, and propose Nature-based Solutions to promote grassroots sustainability. This was achieved through a three-step Codefine-Understand-Create conceptual framework that co-defined settings, understood challenges, and created visions and scenarios, all grounded in the principles of Nature-based Solutions. Three prevailing challenges of low livelihood standard, low access to clean cooking and cyclone vulnerability were identified. This study revealed the causes and consequences of these challenges in the community. Also, the interlinkages were explored. Given these and the observed resources in the community, a nature-based solution (Tree-based Agroforestry System model) was strategically and systematically proposed to address all the identified challenges. The implementation plan was also drawn based on community needs and incorporates co-design approaches to ensure long-term sustainability. This contributes directly to Sustainable Development Goals 1, 3, 7, 8, 11, 13 and 15.

Mechanical and adhesive properties of monolithic zirconia and their clinical implications: a narrative review.

To provide an overview of the biological mechanism and pattern of oligoprogression in renal cell carcinoma (RCC) and the most updated role of surgery in this setting, highlighting scientific gaps and informing future implications. A non-systematic search of PubMed/MEDLINE was performed in August 2025 including guidelines, reviews, and original studies. Additional sources were identified through manual reference screening. Oligoprogression in RCC likely arises from clonal evolution dynamics, with spatially confined subclone mutations and microenvironmental niches yielding differential responses to treatment. Complete metastasectomy may offer a survival benefit, spare patients toxic side effects of systemic therapy, and offers the possibility of histopathological and molecular characterisation of residual disease. Surgery is also particularly important in delayed cytoreductive nephrectomy as the site of oligoprogression. However, this must be weighed against non-negligible surgical morbidity and complication rates. International guidelines recognise the role of surgical resection in the metastatic setting but emphasise low evidence levels and careful patient selection requirements. Limited evidence derived from the oligometastatic context constrains optimal patient selection and timing strategies in oligoprogressive RCC. Following the establishment of consensus over definitions and research gaps, future research integrating molecular biomarkers, novel imaging tracers, and multicentre collaborative studies will be essential to develop evidence-based surgical management protocols for this increasingly common clinical scenario.

Understanding how endogenous hormonal fluctuations and exogenous hormonal modulation influence exercise-related outcomes in women is essential for developing individualized and evidence-informed training and nutritional strategies. This narrative review summarizes the endocrine physiology of the eumenorrheic menstrual cycle and hormonal contraceptive (HC) use and critically examines their implications for athletic performance, neuromuscular function, injury risk, and metabolic regulation in physically active women. A non-systematic literature search was conducted in PubMed, Scopus, and Web of Science for articles published up to January 2026. Search terms combined menstrual cycle-related, hormonal contraceptive, performance, and metabolic/nutritional keywords, and relevant studies were selected based on their relevance to the scope of this narrative review. Estradiol and progesterone fluctuations may modulate substrate utilization, connective tissue properties, central fatigue regulation, and symptom expression; however, evidence indicates that performance-related effects across menstrual phases are generally small and inconsistent, reflecting both the modest magnitude of physiological effects and the methodological heterogeneity in menstrual cycle phase classification and verification across studies. Similarly, although HC use suppresses endogenous hormonal variability, current findings do not support consistent benefits for performance, injury prevention, or metabolic outcomes, and responses remain heterogeneous. From a nutritional perspective, the endocrine context may contribute to modest changes in energy expenditure, insulin sensitivity, appetite regulation, inflammation, and recovery-related processes. Importantly, symptom burden-including pain, fatigue, sleep disturbances, gastrointestinal discomfort, and fluid retention-emerges as a practical driver of day-to-day training tolerance. We propose an integrative framework in which sex hormones define a physiological context rather than deterministic performance regulators, while nutrition acts as a key modifiable factor influencing metabolic responses, symptom severity, and performance consistency.

Background/Objectives: Shoulder disorders are among the most prevalent musculoskeletal conditions, with lifetime prevalence reaching 67% and substantial associated disability and economic burden. Geographic barriers and workforce shortages impede access to optimal rehabilitation. This narrative review aims to synthesize current evidence on tele-diagnostics and tele-rehabilitation in shoulder disorders, evaluate clinical outcomes and implementation factors, and explore models for integrating these complementary approaches. Methods: A structured but non-systematic literature search was conducted across PubMed, Scopus, and Web of Science covering publications from January 2010 through December 2025, using terms related to telehealth, tele-rehabilitation, tele-diagnostics, and shoulder disorders. Priority was given to randomized controlled trials, systematic reviews, feasibility studies, and clinical practice guidelines in adult populations. A total of 97 articles were included in the final narrative synthesis. Results: Tele-diagnostic approaches demonstrate acceptable reliability for range-of-motion assessment and general diagnostic classification, though glenohumeral instability evaluation remains challenging remotely. Multiple randomized controlled trials suggest non-inferior outcomes for tele-rehabilitation compared to conventional physiotherapy across rotator cuff repair, shoulder arthroplasty, and conservative management, with generally high patient satisfaction. Certainty of evidence is currently low to moderate due to short follow-up durations, modest sample sizes, and heterogeneous protocols. Key implementation barriers include the digital divide, inability to deliver manual therapy, and insufficient long-term outcome data. Conclusions: Current evidence supports telehealth as a viable complement to conventional shoulder care, with the strongest evidence base for postoperative tele-rehabilitation. Hybrid care models appear clinically feasible, though widespread adoption requires standardized outcomes, longer-term trials, and strategies addressing health equity barriers.

Background: Vitamin B12 deficiency is a recognized but frequently under-integrated cause of global developmental delay (GDD) in infancy and early childhood. Early diagnosis is critical because neurological impairment may be partially or completely reversible with timely treatment. Objective: This narrative review aims to synthesize current evidence on the role of vitamin B12 deficiency in the diagnostic evaluation of GDD, with a focus on clinical phenotype, risk factors, biomarkers, treatment outcomes, and practical integration into contemporary diagnostic algorithms. Methods: A structured, non-systematic search of PubMed/MEDLINE, Embase, and Web of Science was performed to identify clinical studies, case series, reviews, and guideline documents addressing pediatric vitamin B12 deficiency and neurodevelopmental delay. Results: Vitamin B12 deficiency in early childhood is most commonly associated with maternal deficiency and exclusive breastfeeding without adequate supplementation. Evidence from recent clinical and observational studies indicates that vitamin B12 deficiency may present with nonspecific neurological symptoms, including developmental regression, hypotonia, and feeding difficulties. Incorporating vitamin B12 assessment-using serum vitamin B12, holotranscobalamin, methylmalonic acid, and homocysteine-into early diagnostic algorithms for GDD may facilitate timely identification of a treatable cause of neurodevelopmental impairment. The proposed diagnostic framework emphasizes early biochemical evaluation in infants with unexplained developmental delay, thereby supporting prompt treatment during a critical window of neurological reversibility. Conclusions: Targeted assessment of vitamin B12 status in children with GDD, together with evaluation of maternal status, represents a clinically relevant approach to identifying a potentially preventable and treatable cause of neurodevelopmental impairment. Integration of functional biomarkers into diagnostic pathways and the development of pediatric-specific reference standards are key priorities for future research and clinical practice.

Artificial intelligence (AI) has emerged as a pivotal tool in enhancing the management of gestational diabetes mellitus (GDM). With its rising global prevalence, there is a pressing need for more precise, timely, and personalized strategies for diagnosis and treatment. This review highlights the role of AI in reshaping GDM management, providing actionable insights for researchers, clinicians, and policymakers. Relevant literature was identified through a non-systematic search of databases including PubMed, Scopus, and Google Scholar. Articles published up to August 2025 were considered. Studies were selected based on their relevance to the topic. Key findings were organized thematically to highlight current trends, challenges, and future directions. The application of stacking-based machine learning models including random forest, AdaBoost, decision tree, support vector machine, naïve bayes, K-nearest neighbor, CatBoost, and XGBoost have facilitated the early detection of high-risk patients and achieved high precision and accuracy (88.8%) in reducing unnecessary diagnostic tests. Additionally, machine learning-based decision support systems have demonstrated promising capabilities in predicting insulin requirements and treatment failure with oral hypoglycemic drugs. The integration of AI in mobile applications and wearable devices has significantly encouraged proactive patient participation through real-time glucose monitoring and individualized feedback. Furthermore, these technologies are used to assess the long-term risk of developing type 2 diabetes postpartum, expanding the potential for innovative preventive strategies. While challenges such as data heterogeneity, narrow applicability, and ethical concerns persist, there is an increasing body of evidence indicating that AI can play a revolutionary role in GDM management by providing personalized, cost-efficient, and scalable solutions. The online version contains supplementary material available at 10.1007/s40200-025-01817-z.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by immune dysregulation and systemic inflammation, with the cardiovascular (CV) system representing a major yet frequently under-recognized target. Cardiac involvement spans from subclinical myocardial inflammation to overt pericardial disease, myocarditis, valvular abnormalities, coronary microvascular dysfunction, and accelerated atherosclerosis. Given that CV disease remains a leading cause of morbidity and mortality in SLE, early detection of silent cardiac injury is crucial. Aim: This review aims to provide a comprehensive and clinically oriented overview of CV involvement in SLE, focusing on the role of multimodal cardiac imaging in the detection, characterization, and risk stratification of cardiac abnormalities, as well as its potential implications for clinical management and preventive strategies. Methods: This narrative review is based on a structured, non-systematic search of PubMed (2013-2026), combining the term "systemic lupus erythematosus" with imaging-related keywords including "transthoracic echocardiography," "cardiac magnetic resonance," and "cardiac computed tomography." English-language studies in adult populations were screened and selected according to clinical relevance, methodological robustness, and contribution to understanding SLE-related cardiac involvement. Discussion: Multimodal cardiac imaging plays a central role in the evaluation of SLE-related cardiac disease. Transthoracic echocardiography (TTE) represents the first-line modality for the assessment of ventricular function, pericardial disease, and valvular abnormalities, while deformation imaging enables the detection of subtle myocardial dysfunction. Cardiac magnetic resonance (CMR) provides comprehensive tissue characterization, allowing differentiation between active inflammation and chronic fibrosis. Cardiac computed tomography (cCT) identifies subclinical coronary atherosclerosis and high-risk plaque features, whereas nuclear imaging techniques offer insight into inflammatory activity and microvascular dysfunction. Conclusions: An integrated, imaging-based approach enables early diagnosis, refined CV risk stratification, longitudinal monitoring, and personalized therapeutic strategies. Multimodal imaging thus represents a key pillar of precision medicine in lupus-associated CV disease.

Parenteral nutrition (PN) is fundamental in the management of premature infants hospitalized in neonatal intensive care units (NICUs). Traditionally, standardized PN (SPN) has been recommended for most newborns due to safety, faster initiation, and reduced risk of prescribing errors. However, individualized PN (IPN) remains necessary in cases of metabolic instability or prolonged PN. Recently, AI-based models, such as the TPN2.0 algorithm, have emerged as potential tools to enhance precision, safety, and clinical outcomes in PN by combining standardization and personalization. The aim of this review is to summarize and critically discuss current evidence regarding standardized, individualized, and AI-based approaches to PN in premature infants hospitalized in NICUs. Despite guidelines, practice varies, and the emerging evidence for AI needs critical synthesis. This narrative review is based on a focused, critical appraisal of the available literature. A nonsystematic search of PubMed/MEDLINE, Wiley Online Library, ScienceDirect, and Google Scholar was conducted to identify relevant articles. Additional sources included international clinical guidelines and consensus statements. The search focused on publications addressing standardized, individualized, and AI-supported PN in neonatal and pediatric intensive care settings. Selected studies were analyzed qualitatively with emphasis on clinical outcomes, nutritional adequacy, safety profiles, and practical implementation aspects. Due to the heterogeneity of study designs and outcomes, a formal systematic review methodology and meta-analysis were not performed. Across multiple studies, SPN has been found to provide adequate macronutrient and electrolyte intake for most NICU patients, enabling faster initiation of PN and reducing prescribing errors. SPN often resulted in improved early protein, glucose, calcium, and phosphate delivery compared with IPN, with fewer electrolyte disturbances and comparable or better growth outcomes. Evidence supporting IPN benefits has been inconsistent and limited primarily to metabolically unstable or complex cases. AI-based PN (TPN2.0) demonstrated promising results, with physicians rating its recommendations higher than standard prescriptions. In infants whose clinically prescribed PN differed most from AI recommendations, higher morbidity, including NEC, was observed compared with AI-guided formulations. The algorithm reduced formulation subjectivity, streamlined workflow, and enabled rapid, guideline-adherent PN prescription. Early evidence suggests a potential association with reduced rates of mortality, cholestasis, sepsis, and NEC with the use of AI-supported PN strategies. SPN remains the safest and most efficient first-line approach for most premature infants, ensuring rapid initiation and reducing prescription-related risks. IPN continues to be essential for selected high-risk patients with complex metabolic needs. Emerging AI-based systems such as TPN2.0 may bridge these approaches by delivering personalized yet SPN formulations, improving safety, efficiency, and potentially clinical outcomes. Further high-quality prospective trials are needed to validate these findings and support the integration of AI into routine NICU nutritional practice.

Background: Keloid scarring is a fibroproliferative disorder driven by a complex interplay of genetic, epigenetic, and environmental factors, resulting in significant cosmetic and functional impairment. Despite its high prevalence in African, Asian, and Hispanic populations, the molecular mechanisms underlying ancestry-dependent susceptibility remain incompletely understood. Methods: This narrative review synthesizes current genomic, epigenetic, and multi-omic evidence related to keloid scarring. Relevant literature was identified through a targeted, structured, non-systematic search of PubMed, Scopus, Web of Science, SciELO, and Google Scholar up to August 2025, focusing on genetic susceptibility loci, epigenetic regulation, and ancestry-related differences. PRISMA-ScR guidelines were used as a reporting framework to enhance transparency, without implying a formal systematic review methodology. Results: This synthesis identifies recurrent susceptibility loci at 1q41, 3q22.3, and 15q21.3 across multiple populations. Variants in NEDD4 and regulatory regions near BMP2 emerge as key modulators of profibrotic signaling pathways, including TGF-β/SMAD and NF-κB. Additionally, epigenetic reprogramming and long non-coding RNA networks, such as CACNA1G-AS1, appear to sustain fibroblast hyperactivation. A persistent limitation is the marked underrepresentation of Latin American populations in current genomic studies. Conclusions: Integrating ancestry-specific genomic variation with epigenetic markers is essential for advancing precision diagnostic and therapeutic strategies in keloid scarring. Future research should prioritize diverse, multicenter cohorts and integrative multi-omics approaches to improve risk stratification and enable targeted interventions for this disfiguring condition.

Proximal Humerus Fractures (PHFs) are increasingly common, particularly in elderly patients with osteoporotic bone. Surgical and anesthetic management significantly influence outcomes, yet evidence guiding optimal strategies remains limited. Regional Anesthesia (RA) offers effective analgesia, opioid sparing, and the potential to avoid general anesthesia in frail or high-risk patients. This narrative review summarizes current knowledge, highlights diaphragm-sparing approaches, and integrates expert clinical insights to provide practical recommendations for anesthesiologists managing PHF surgery. A narrative review was conducted using a structured non-systematic search of PubMed, Embase, and Scopus (January 2000–November 2025). Eligible studies included adults undergoing PHFs surgery with RA and reporting clinical outcomes; case reports, purely anatomical studies, non-surgical analgesia, and non-PHF procedures were excluded. Nine studies met inclusion criteria. Additional references provided anatomical, surgical, and anesthetic context. Orthopedic data were reviewed to contextualize anesthetic strategies, and an “Expert Opinion” section integrated multidisciplinary insights. Among the nine PHF-specific studies, evidence was limited and heterogeneous, focusing mainly on analgesic efficacy, technical feasibility, and respiratory safety rather than long-term outcomes. Interscalene Brachial Plexus Block (ISBPB) provided effective analgesia but was frequently associated with phrenic nerve involvement. Diaphragm-sparing approaches—such as Superior Trunk Block (STB), infraclavicular techniques, and selective suprascapular and axillary nerve blocks—may reduce respiratory impairment while maintaining acceptable analgesia. Only a minority of studies evaluated continuous RA, reporting prolonged postoperative pain control and opioid sparing in small cohorts. Additional literature supported tailoring block selection to fracture pattern, surgical approach, and patient comorbidities. Expert perspectives emphasized pragmatic, patient-centered strategies, particularly for high-risk or frail patients. RA is an important component of PHFs surgery, although PHF-specific evidence remains limited. Integrating available data, contextual literature, and expert experience supports an individualized approach balancing analgesic efficacy with safety. Diaphragm-sparing and selected continuous techniques may be considered in patients at increased respiratory risk. Further well-designed studies are needed to refine patient selection and evaluate functional and long-term outcomes.

Franco Basaglia (1924–1980) was a psychiatrist who played an important role in transforming mental health care in Italy during the 1960s and 1970s. Current mental health debates focus on community care, recovery, and co-production. Against this background, the paper describes theoretical references used by Basaglia and colleagues to psychiatric phenomenology, Jean-Paul Sartre, and Michel Foucault, and the role of psychiatrists as professionals and intellectuals, with a view to their relevance to current mental health care issues. The paper is based on a non-systematic search and meta-narrative review of sources in Italian, French. and German, including the Archivio Basaglia in Venice, Italy. Basaglia and colleagues were influenced by phenomenology, Sartre, and Foucault. The tradition of psychiatric phenomenology helped in focusing on the ‘person’, the ‘body’, and the deprivation of individual rights among mental hospital patients. Sartre’s concepts of a ‘personal ontology of freedom’ evolving towards collective action found an echo in Foucault’s archaeology of madness which highlighted the societal construction of madness and emphasized the knowledge-power link in professional practice. Basaglia insisted on linking theory to anti-institutional work and psychiatric reform practice. Basaglia’s thinking helped mobilize forces toward reform, and his focus on co-production of psychiatric knowledge with experts by experience was ahead of its time. This could help sharpen the concept of recovery during the current crisis of European mental health reform, moving in the direction of more pronounced attention towards the (non-market) economic concepts of social choice and common goods, and towards more user-controlled services.

Digital technology is embedded in daily life, and growing evidence suggests that evening and bedtime screen engagement may disrupt sleep in young adults. Associations appear stronger for bedtime exposure and problematic or addiction-like patterns of use than for total screen time alone. This review aims to synthesize current evidence on the relationship between smartphone and social media use and sleep outcomes in young adults, with particular attention to the timing of device use, problematic digital engagement, and psychological or behavioral factors that may influence sleep.A narrative literature review was conducted using a broad, non-systematic search of PubMed, Scopus, Web of Science, and Google Scholar. Observational, longitudinal, experimental, or interventional studies and higher-level syntheses were included when they contributed to conceptual understanding of the screen-sleep relationship. Evidence was organized thematically across domains, including overall associations, bedtime and in-bed use, problematic and addictive behaviors, bedtime procrastination, psychological mediators (rumination and fear of missing out), chronotype, objective exposure and sleep measures, content versus duration, and cross-cultural consistency. Across diverse populations and study designs, digital media use was consistently associated with poorer sleep outcomes, including reduced sleep quality, delayed sleep onset, shorter sleep duration, and daytime dysfunction. Bedtime and nighttime use showed stronger associations than general daily exposure, supporting sleep displacement and circadian disruption as key pathways. Problematic smartphone and social media use demonstrated particularly robust links with poor sleep and insomnia-related symptoms, and longitudinal evidence suggested bidirectional relationships between problematic phone use, impaired sleep, and depressive symptoms. Bedtime procrastination emerged as a central behavioral mediator, while rumination and fear of missing out contributed to cognitive-emotional arousal that sustains sleep disruption. Objective smartphone tracking and wearable sleep measures generally supported associations between nighttime phone activity and worse sleep, although short-term panel studies assessing brief exposure windows reported largely null effects. Experimental studies of short-term social media abstinence and structured digital detox interventions showed improvements in sleep quality and psychological well-being. Evidence indicates that sleep dysregulation in young adults is most strongly linked to bedtime screen exposure and problematic or compulsive digital engagement rather than screen time alone. Digital sleep hygiene strategies that reduce in-bed use and address problematic smartphone behaviors may improve sleep and well-being. Future research should prioritize longitudinal and intervention designs, clearer exposure definitions capturing habitual bedtime behaviors, and greater use of objective tracking to strengthen causal inference.

The biological effects of dietary polyphenols have gained increasing attention due to their roles in regulating oxidative stress, inflammatory processes, and mitochondrial function. Human studies suggest that polyphenol intake may support aspects of post-exercise recovery, neuromuscular function, and selected aspects of physical performance. However, most investigations have been conducted in young or metabolically healthy populations, limiting direct clinical translation to older adults. This narrative review aims to synthesize current mechanistic and human evidence on the physiological and recovery-related effects of dietary polyphenols in the context of exercise adaptation and skeletal muscle function, and to examine their potential relevance to muscle aging and sarcopenia. A structured, non-systematic literature search was conducted to integrate findings from human intervention trials, preclinical studies, and mechanistic research addressing polyphenols, exercise adaptation, muscle recovery, and muscle aging. Evidence was synthesized narratively with emphasis on shared physiological pathways and functional outcomes. Human intervention studies suggest that polyphenol intake may attenuate biomarkers of exercise-induced muscle damage, modulate inflammatory responses, and accelerate recovery of muscle strength and functional performance. Mechanistic evidence supports the involvement of redox homeostasis, mitochondrial regulation, and inflammatory signaling as central mediators of these effects. While clinical data in older populations remain limited, converging evidence suggests biological overlap between recovery-related pathways and mechanisms implicated in age-related muscle decline. Current evidence is consistent with a biologically plausible role for polyphenols in modulating exercise-related physiological and recovery processes. By aligning recovery-focused evidence with pathways central to muscle aging, this review proposes a translational framework that may inform the design of future targeted clinical trials in older and clinical populations.

Finite element analysis (FEA) is increasingly used in conservative and restorative dentistry to investigate the mechanical behavior of adhesive direct and indirect polymer-based restorations. Despite the growing number of FEA-based studies, the literature currently lacks a dedicated critical synthesis specifically addressing the methodological validity and clinical interpretability of FEA in adhesive restorative dentistry. This narrative review critically examines the current literature on the application of FEA in adhesive restorative dentistry, with particular attention to class I to class V cavities in anterior and posterior teeth restored with direct or indirect polymeric materials, including inlays, onlays, overlays, and tabletop restorations. A structured, non-systematic search of major databases was conducted, and selected studies were qualitatively appraised with emphasis on modeling assumptions, stress distribution, and clinical meaning. Unlike previous broad overviews of dental biomechanics, this review provides a clinically oriented framework for interpreting FEA findings across restorative strategies. FEA consistently identifies trends related to cavity configuration, cuspal support, restoration design, material stiffness, polymerization shrinkage, and adhesive interface behavior, helping to explain clinically observed failure patterns and supporting minimally invasive approaches. However, simplified material models, idealized bonding conditions, and static loading protocols limit prediction of long-term performance. When interpreted within these constraints and integrated with experimental and clinical evidence, FEA remains a valuable complementary tool for rational restorative decision-making.

Nearly 1% of the global population suffers from epilepsy. There are over 65 million people worldwide with epilepsy and approximately 10.5 million of those are children. One third of these people have drug-resistant epilepsy (DRE). Neuromodulation is an adjunct treatment option for these patients. This manuscript aims to describe the history, patient/parent perspective, current use, and future directions of neuromodulation in the management of pediatric DRE. We conducted a nonsystematic search of the literature through different databases as part of the Pediatric State of The Art Symposium at the 2025 American Epilepsy Society meeting in Atlanta. Three neuromodulation therapies, all using implanted devices and electrodes, have been approved by the Food and Drug Administration (FDA) to treat DRE, namely, vagus nerve stimulation (VNS) (1997 and lately 2017), deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) in 2018 (2010 in Europe), and responsive neurostimulation (RNS) in 2013. Only VNS is approved in pediatric patients. Emerging noninvasive neuromodulation modalities such as noninvasive VNS and transcranial magnetic stimulation showed mild adverse effects and exhibit the most encouraging seizure and neurocognitive outcomes to date, but larger multicenter studies are essential before these modalities can be offered and integrated into standard pediatric epilepsy care.

Artificial intelligence (AI) promises to significantly impact daily radiology practices. Numerous studies have already been conducted that anticipate this potentially disruptive innovation. So far, these studies have mainly focused on single topics, such as "trust," or investigating perspectives of single stakeholder groups, such as "radiologists." This study aims to explore future directions for AI in radiology by incorporating perspectives of a heterogeneous group of stakeholders on a broad spectrum of moral and economic topics. It also aims to cocreate and reflect with a broad range of stakeholders on viable implementation scenarios for scalable AI applications in radiology in the Netherlands, thereby identifying potential opportunities and frictions, with a focus on moral and economic considerations. To inform the workshop design, a nonsystematic narrative literature search was performed to deepen our understanding of key moral and economic considerations at play in the field of radiology and AI. Workshop participants, representing a wide range of actors including radiologists, innovators, and patient representatives, were selected using purposive sampling. Data were collected in a cocreation workshop. In 3 subsequent rounds, mixed over 3 breakout groups, a total of 17 participants were asked to (1) map what they considered important moral and economic considerations, (2) envision possible future scenarios for AI in radiology, and (3) discuss opportunities, frictions, and routes to success. Transcribed recordings were coded and cross-checked. Workshop participants envision future AI-driven scenarios, ranging from extramural imaging departments for increased accessibility to health care, to multimodal data integration for human-centered AI-enhanced diagnostics. Seven themes emerge from the discussions during the workshop: (1) trust and efficiency of AI technologies, (2) responsibilities in clinical decision-making when AI is involved, (3) diagnosis as a one-off versus an iterative process, (4) regulations as a requirement or a restriction, (5) economic benefits or drawbacks, (6) trade-off between amount of information required and patient privacy, and (7) environmental considerations. Reflecting on the 7 emerging themes, we identify three overarching topics: (1) human-AI collaboration and trust, (2) governance, regulation, and ethical safeguards, and (3) value creation and sustainability. These topics highlight the need to balance technological advancements with ethical responsibility, institutional accountability, and societal benefit. They also underscore the importance of designing AI systems that not only perform well but are also trusted and aligned with clinical workflows and patient values. These overarching themes offer a lens through which future research and policy can navigate the complex interplay between innovation, regulation, and real-world implementation. Future research is needed to validate the generalizability of the results across various countries and health care settings.

Introduction: Lithium carbonate plays an essential function in the management of mood disorders, standing out for its robust mood-stabilizing efficacy and its well-established protective effect against suicide. Nevertheless its application in emergency situations necessitates prudence owing to its low therapeutic index, very gradual initiation of action, coupled with the necessity for ongoing clinical and laboratory surveillance. Objective: To critically analyze the use of lithium carbonate in psychiatric emergencies, focusing on clinical indications, associated risks, management of intoxication, and implications for the organization of health services. Method: This is a narrative literature review based on a non-systematic search of the PubMed/MEDLINE, Scopus, and SciELO databases, complemented by international clinical guidelines, consensus statements from scientific societies, and classical psychiatric texts. Original studies, narrative and systematic reviews, clinical trials, observational studies, and normative documents relevant to the use of lithium in urgent and emergency contexts were included. Results: Lithium has well-established efficacy in acute mania, relapse prevention, and reduction of suicide risk. In emergency settings, its prescription should be limited to situations involving adequate clinical assessment, demonstrated capacity for adherence, absence of a recent history of intoxication or medication-related suicide attempts, and assurance of outpatient follow-up with appropriate laboratory monitoring. Lithium intoxication is potentially severe, requiring early recognition and prompt, appropriate clinical management. Conclusion: Despite its substantial benefits, the use of lithium carbonate in psychiatric emergencies must be judicious, individualized, and integrated into a comprehensive care plan that ensures continuity of treatment, with the goal of maximizing therapeutic benefits while minimizing preventable risks.