Search Results (1,795)

Peripartum depression (PPD) represents a significant public health concern, affecting 10–17% of women globally. Traditional monoaminergic treatments demonstrate limited efficacy and delayed onset of action. The glutamate–GABA imbalance hypothesis provides a novel theoretical framework for understanding depression pathophysiology and developing targeted therapeutic interventions. This review examines emerging pharmacotherapeutic approaches targeting glutamatergic and GABAergic neurotransmitter systems for PPD treatment. Search criteria targeted randomized clinical trials investigating GABA-A-positive allosteric modulators (brexanolone, zuranolone, and ganaxolone) and NMDA receptor antagonists (ketamine and esketamine) in PPD patients. Brexanolone was the first neurosteroid to receive FDA approval for PPD, while zuranolone also shows promise. Ketamine and esketamine are also associated with reduced PPD risk, particularly with perioperative administration during cesarean delivery, though benefits are predominantly short-term. These glutamate–GABA pathway modulators represent novel therapeutic alternatives with rapid onset profiles. Further investigation and research are needed to optimize dosing protocols and patient selection criteria and to establish long-term efficacy before PPD treatment guidelines can be drafted. Full article

Background/Objectives: This systematic review evaluated the efficacy and safety of Emotional Freedom Techniques (EFT) for anxiety disorders, compared with conventional and alternative therapies. Methods: A comprehensive literature search was conducted across nine electronic databases up to February 2025, including only parallel-group randomized controlled trials (RCTs) that investigated EFT as a standalone intervention for anxiety symptoms. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias 2.0 tool. Results: Seven RCTs with 506 participants were included. Populations ranged from clinical to non-clinical groups. EFT interventions varied in duration (1–56 sessions), with control groups including no treatment, supportive interviews, cognitive behavioral therapy (CBT), breathing therapy, and progressive muscle relaxation. All six studies comparing EFT to no intervention reported significant reductions in anxiety symptoms in favor of EFT. Compared to active controls, EFT showed similar or superior effects to breathing therapy and muscle relaxation but no significant difference from CBT. Most studies showed “some concerns” in risk of bias, mainly due to self-reported outcomes and lack of blinding. Conclusions: EFT appears to be a promising and safe complementary intervention for reducing anxiety symptoms, with additional benefits for related psychological outcomes. However, methodological limitations and heterogeneity among studies preclude firm conclusions. High-quality RCTs using standardized protocols and objective outcome measures are warranted to confirm these findings and to explore the effectiveness of EFT as an adjunct to conventional therapies. Full article

Background/Objectives: While the prevalence of depression increases during the peri- and post-menopausal periods, the potential of diet as both a modifiable risk factor and complementary treatment option has received limited research attention in this population. To address this gap, we conducted a scoping review aiming to map and synthesize the existing literature on diet and depression in peri- and post-menopause. Methods: Studies were identified through Medline, EMBASE, PsycINFO, CENTRAL, Web of Science, and Scopus. After deduplication in Covidence, two reviewers independently screened titles, abstracts, and full texts using predefined eligibility criteria. Data were extracted using standardized forms and presented in tables and figures. Methodological quality was assessed using the Cochrane RoB-2 for intervention studies and NHLBI tools for observational studies. Results: Thirty-eight studies met the inclusion criteria, including 29 observational and 9 interventional studies. Dietary patterns showed the most consistent associations with depressive symptoms, whereas findings for foods, nutrients, and other food components were inconsistent. Most observational studies had a moderate to high risk of bias, while over half of experimental studies were rated as low risk. Conclusions: Although limited by volume and poor methodological quality, existing evidence suggests that healthy diets may be protective against depressive symptoms in peri- and post-menopausal women, while unhealthy diets may increase risk. High-quality cohort studies and clinical trials are needed to guide future research and inform professionals working at the intersection of nutrition, psychiatry, and women’s health. Protocol registration: osf.io/b89r6. Full article

Adipose tissue micrografts (ATM) and dermis micrografts (DMG) have emerged as promising autologous therapies in regenerative wound care, leveraging mechanically disaggregated cell–matrix constructs to modulate the wound microenvironment and promote tissue repair. This scoping review systematically analyzed clinical studies investigating ATMs and DMGs in acute and chronic wounds. Eight studies, comprising randomized controlled trials, observational studies, and case series, were identified, involving diverse wound types such as burns, ulcers, surgical dehiscence, and posttraumatic defects. All interventions utilized mechanical disaggregation (Rigenera^® system) to produce micrografts, which were applied via perilesional injection, scaffold-assisted delivery, or topical administration. Outcomes consistently demonstrated accelerated re-epithelialization, enhanced angiogenesis, improved scar remodeling, and low complication rates. In select studies, micrografts were combined with platelet-rich fibrin or stromal vascular fraction, suggesting potential synergistic effects. While one randomized trial showed superior healing outcomes with DMGs over collagen scaffolds, others yielded mixed results, likely reflecting heterogeneity in methodology and outcome measures. Overall, the available clinical evidence supports the safety, feasibility, and biological activity of micrograft-based therapies. However, larger, standardized, and mechanistically driven studies are required to validate their efficacy and define optimal protocols across wound etiologies. Full article

Background and Objectives: Endocrowns have emerged as a minimally invasive restorative option in dentistry, aiming to preserve as much of the original tooth structure as possible. This scoping review investigates the success rates, biomechanical performance, and material efficacy of endocrowns for restoring molars, in comparison to conventional post-and-core crowns. Materials and Methods: A comprehensive literature review was conducted to identify relevant studies using PubMed and Scopus databases. The search covered publications up to March 2025. All study types focusing on molar restorations were included, except for case reports. Data extraction and screening were performed independently by two reviewers. Results: A total of 37 studies fulfilled the eligibility criteria. Eleven systematic reviews examined comparisons between endocrowns and post-and-core crowns, as well as differences in material selection, survival and success rates, and outcomes between molars and premolars. The remaining 26 studies addressed the clinical performance and longevity of endocrowns, with an emphasis on preparation design, adhesive protocols, and mechanical behavior related to material selection. Conclusions: Endocrown restorations present a conservative and predictable alternative to post-and-core crowns for molars with extensive coronal damage. However, due to variability in reported outcomes, high-quality randomized clinical trials are crucial for confirming their clinical effectiveness. The development of novel, standardized treatment guidelines would provide clinicians with adequate information to effectively restore endodontically treated teeth (ETT). Full article

Background and Objectives: Early ambulation and timely detection of postoperative complications are cornerstones of colorectal Enhanced Recovery After Surgery (ERAS) programmes, yet the traditional bedside checks performed every 4–8 h may miss clinically relevant deterioration. The consumer wearables boom has spawned a new generation of wrist- or waistband-mounted sensors that stream step count, heart-rate and temperature data continuously, creating an opportunity for data-driven early-warning strategies. No previous systematic review has focused exclusively on colorectal surgery. Methods: Three databases (PubMed, Embase, and Scopus) were searched (inception—1 May 2025) for prospective or retrospective studies that used a consumer-grade or medical-grade wearable to collect objective physical-activity or vital-sign data during the peri-operative period of elective colorectal resection. Primary outcomes were postoperative complication rates, length-of-stay (LOS) and 30-day readmission. Two reviewers screened records, extracted data and performed risk-of-bias appraisals with ROBINS-I or RoB 2. Narrative synthesis was adopted because of the heterogeneity in devices, recording windows and outcome definitions. Results: Nine studies (n = 778 patients) met eligibility: one randomised controlled trial (RCT), seven prospective cohort studies and one retrospective analysis. Five studies relied on step-count metrics alone; four combined step-count with heart-rate or skin-temperature streams. Median wear time was 6 d (range 2–30). Higher day-1 step count (≥1000 steps) was associated with shorter LOS (odds ratio 0.63; 95% CI 0.45–0.84). Smart-band–augmented ERAS pathways shortened protocol-defined LOS by 1.1 d. Pre-operative inactivity (<5000 steps·day⁻¹) and low “return-to-baseline” activity on the day before discharge independently predicted any complication (OR 0.39) and 30-day readmission (OR 0.60 per 10% increment). A prospective 101-patient study that paired pedometer-recorded ambulation with daily lung-ultrasound scores found fewer pulmonary complications when patients walked further (Spearman r = –0.36, p < 0.05). Conclusions: Continuous, patient-worn sensors are feasible and yield clinically meaningful data after colorectal surgery. Early postoperative step-count trajectories and activity-derived recovery indices correlate with LOS, complications and readmission, supporting their incorporation into digital ERAS dashboards. Standardised outcome definitions, open algorithms for signal processing and multicentre validation are now required. Full article

Background: Hormone receptor-positive (HR+), HER2-negative breast cancer accounts for the majority of breast cancer diagnoses. While outcomes have improved with neoadjuvant and adjuvant therapies, the risk of late recurrence persists, and there remains a critical need for reliable biomarkers to guide prognosis and post-treatment surveillance. Circulating tumor DNA (ctDNA), detectable via liquid biopsy, has emerged as a promising tool for monitoring minimal residual disease and predicting survival outcomes. This systematic review evaluates the association between ctDNA detection during neoadjuvant or adjuvant treatment and survival outcomes in early-stage HR+/HER2− breast cancer. Methods: This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive literature search of Ovid MEDLINE and Embase was conducted to identify studies published through 3 May 2024 that evaluated ctDNA as a prognostic biomarker in stage I–III HR+/HER2− breast cancer. We included studies reporting recurrence-free survival, invasive disease-free survival, or overall survival and excluded non-original studies, conference abstracts, and non-English articles. Data extraction and qualitative synthesis were performed, and the risk of bias was qualitatively assessed across studies. No review protocol was registered. Results: Eleven studies comprising 1644 patients met the inclusion criteria. In the neoadjuvant setting, ctDNA positivity prior to treatment initiation was associated with inferior survival outcomes. In the adjuvant setting, detection of ctDNA during or after treatment was consistently linked to poorer recurrence-free and invasive disease-free survival. Across studies, ctDNA detection was a significant negative prognostic marker. Conclusions: This systematic review supports the prognostic value of ctDNA in HR+/HER2− early-stage breast cancer. Limitations include small sample sizes, observational study designs, and heterogeneity in ctDNA assays. Standardization of ctDNA testing methods and further prospective trials are needed to validate its clinical utility and explore its potential role in guiding therapeutic interventions. Full article

Background/Objectives: Phage therapy is gaining attention as a potential alternative to antibiotics. This study investigates the potential use of a phage cocktail as a preventive measure against ventilator-associated pneumonia (VAP) in children. Methods: Sixty patients were selected from the pediatric intensive care units for this double-blind clinical trial. The inclusion criteria involved patients requiring invasive mechanical ventilation for more than two days. This, however, excluded newborns and children with bacterial pneumonia. The intervention group received the standard country protocol drugs in addition to 5 mL of phage cocktail suspension administered every 24 h through an in-line mesh nebulizer for 7 days. The two groups were compared in terms of the incidence of VAP, survival rate, and duration of hospitalization. Results: The intervention with phages had a significant impact on reducing the occurrence of VAP compared to the group receiving a placebo. The data showed that there was a significant difference in the occurrence of VAP between the two groups, with a lower percentage of VAP in the phage cocktail group (p < 0.05). Additionally, the cultures of specific bacterial strains did not yield positive results. Notably, there were no significant differences between the intervention and placebo groups in terms of mortality rates and duration of hospitalization (p > 0.05). Conclusions: Inhalation of a phage cocktail shows a promising effect in preventing VAP in PICU patients at a tertiary hospital in Iran with no observed side effects. However, further, larger clinical trials are necessary to validate its efficacy. Full article

Perfusion assessment is critical in clinical oncology, particularly in tumor characterization, intraoperative decision making, and postoperative outcome predictions. Hyperspectral imaging (HSI) has emerged as a promising, non-contact, non-invasive, and contrast-free modality capable of capturing spatial and spectral information related to tissue oxygenation and hemoglobin distribution. This study provides an up-to-date review of recent advances in the use of HSI for perfusion monitoring in clinical oncological applications, with a special focus on its adoption in laparoscopic surgeries, brain tumor delineation, and head and neck cancer interventions. The integration of HSI into surgical workflows and its potential to reduce complications are discussed. Overall, while HSI is emerging as an appealing, real-time, quantitative perfusion imaging modality, a lack of standardized protocols and interpretation guidelines pose the most significant challenges. Addressing these gaps through multicenter clinical trials is essential for advancing the routine use of HSI in oncological surgery. Full article

Background: Structurally active phospholipoproteomic formulations that lack pharmacodynamic targets or systemic absorption present unique challenges for validation. Designed for immune compatibility or structural modulation—rather than therapeutic effect—these platforms cannot be evaluated through conventional clinical or molecular frameworks. Methods: This study introduces a standardized, non-invasive ex vivo protocol using real-time kinetic imaging to document biological behavior under neutral conditions. Eight human tumor-derived adherent cell lines were selected for phenotypic stability and imaging compatibility. Phospholipoproteomic preparations were applied under harmonized conditions, and cellular responses were recorded continuously over 48 h. Results: Key parameters included signal continuity, morphological integrity, and inter-batch reproducibility. The system achieved high technical consistency without labeling, endpoint disruption, or destructive assays. Outputs included full kinetic curves and viability signals across multiple cell–fraction pairings. Conclusions: This method provides a regulatorily compatible foundation for functional documentation in non-pharmacodynamic programs where clinical trials are infeasible. It supports early-stage screening, batch comparability, and audit-ready records within SAP, CTD, or real-world evidence (RWE) ecosystems. By decoupling validation from systemic exposure, the protocol enables scalable, technically grounded decision-making for structurally defined immunobiological platforms. Full article

Objective: This systematic review and meta-analysis aimed to evaluate the effects of moisture control strategies (including wet-bonding techniques, universal adhesives, and etching type) on dentin bonding performance in restorative dentistry. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar, following PRISMA guidelines. Only in vitro and ex vivo studies comparing wet- and dry-bonding protocols, using human dentin substrates, and reporting microtensile bond strength (μTBS) were included. The data were synthesized using a random-effects meta-analysis and the methodological quality was assessed using the MINORS tool. Certainty of evidence was evaluated using the GRADE framework. Results: Nine studies met the inclusion criteria, eight of which were included in this meta-analysis. The moisture control strategies significantly influenced the bonding outcomes, with ethanol and acetone wet bonding yielding higher μTBS and enhanced hybrid layer morphology. The universal adhesives performed effectively under both moist and dry conditions, although their performance varied by the adhesive composition and solvent system. The meta-analysis revealed a statistically significant advantage for hydrated dentin (SMD = +1.20; 95% CI: 0.52 to 1.86; p < 0.001), with the moist and ethanol-treated substrates outperforming the dry and over-wet surfaces. The long-term durability was better preserved with ethanol and acetone pretreatments and the adjunctive use of chlorhexidine. Conclusions: Moisture conditions influence dentin bond strength, but modern universal adhesives show consistent bonding performance across different moisture conditions. Solvent-wet-bonding protocols, particularly with ethanol or acetone, enhance the immediate and long-term performance. While the current evidence is limited by the in vitro designs and heterogeneity, the findings demonstrate protocol flexibility and highlight strategies to optimize adhesion in clinical practice. Future clinical trials are necessary to validate these approaches under real-world conditions. Full article

Although the dosimetric advantages of rectal spacers in prostate cancer radiotherapy have been demonstrated in selected clinical trials, real-world data from routine clinical practice remain limited—particularly within the Portuguese healthcare system. This study offers a detailed dosimetric comparison of Volumetric Modulated Arc Therapy (VMAT), with and without rectal spacer use, in a real-world patient cohort, aiming to assess the clinical relevance of spacer insertion under standard treatment protocols. A retrospective dosimetric evaluation was performed on 80 prostate cancer patients treated at a radiotherapy centre in southern Portugal. Patients were equally divided into two matched groups (n = 40): one receiving VMAT alone, the other receiving VMAT with hydrogel rectal spacer placement. Dose-volume histograms (DVHs) were analysed for the planning target volume (PTV) and key organs at risk (OARs). Standard dosimetric metrics, such as V50–V75 for the rectum and bladder, V50 for femoral heads, and mean dose for the penile bulb, were assessed. PTV coverage was evaluated using conformity and homogeneity indices. Spacer use significantly decreased rectal dose exposure across all evaluated parameters without compromising PTV coverage or increasing dose to other OARs. These findings support routine rectal spacer applications to enhance treatment safety and patient outcomes. Full article

Sentinel lymph node biopsy (SLNB) has transformed the management of cutaneous melanoma, emerging as a cornerstone in evaluating regional lymphatic spread while minimizing surgical morbidity. From its theoretical foundation laid by Cabanas to its refinement and clinical validation through landmark trials, SLNB has evolved into a standard of care with significant prognostic value. This review traces the historical trajectory of SLNB, analyzes current guidelines and controversies and explores future directions. Novel imaging technologies, such as indocyanine green fluorescence and augmented reality-assisted mapping, promise to enhance accuracy and reduce invasiveness. Furthermore, the advent of effective systemic therapies and neoadjuvant protocols is reshaping the therapeutic landscape, potentially redefining the role of SLNB in melanoma management. As precision medicine advances, SLNB remains an essential procedure, with its utility continually redefined by technological innovation and evolving oncologic strategies. Full article

Background/Objectives: Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes, often leading to infection, amputation, and reduced quality of life. Platelet-rich plasma (PRP) therapy has emerged as a promising treatment due to its potential to accelerate wound healing through growth factors and cytokines. Despite growing interest, evidence on PRP’s efficacy and safety in DFU management remains variable. This article critically reviews recent studies to evaluate the effectiveness of PRP in promoting ulcer healing, while examining methodological rigor, ethical considerations, and research parameters to provide a comprehensive, evidence-based assessment for clinical application. Materials and Methods: This review explores the biological mechanisms underlying platelet-rich plasma (PRP) as an adjunctive therapy for DFUs, focusing on its regenerative capabilities. PRP is an autologous concentration of platelets containing growth factors and bioactive molecules that promote angiogenesis, cellular proliferation, and extracellular matrix remodeling. Various application methods—topical, injectable, gel-based, and PRP-enhanced dressings—are examined. The review also evaluates the efficacy of PRP as monotherapy and in combination with other interventions such as debridement and split-thickness skin grafting. Results: Clinical studies suggest that PRP, particularly when used alongside surgical debridement or skin grafting, significantly enhances healing outcomes in patients with non-healing DFUs. It provides a biologically favorable environment for tissue regeneration while reducing inflammation and potentially exhibiting antimicrobial properties. However, variability in PRP preparation techniques, application protocols, and patient selection criteria presents challenges to standardization and broader clinical adoption. Conclusions: While PRP therapy demonstrates significant potential in the management of diabetic foot ulcers, further randomized controlled trials with standardized methodologies are essential to establish optimal treatment protocols and confirm long-term benefits. PRP offers a minimally invasive, autologous, and biologically active treatment modality that may serve as a vital component in the multidisciplinary approach to DFU management. Full article

Background: Physical exercise can improve certain musculoskeletal conditions, but adherence remains low due to intimidating environments, limited government support, and financial constraints faced by many individuals. Home-based exercise is a potential strategy to treat that population. Objective: Discuss the main home-based resistance exercise protocols that have been studied and implemented for six highly prevalent musculoskeletal disorders. Methods: A narrative literature review was conducted, using the PubMed database to search for six highly prevalent musculoskeletal conditions: shoulder impingement syndrome (SIS), nonspecific low back pain (NSLBP), greater trochanteric pain syndrome (GTPS), knee osteoarthritis (OA), patellofemoral pain syndrome (PFPS), and Achilles tendinopathy (AT). The strategy included the listed pathologies and the keywords “physical exercise” or “physiotherapy”. Clinical trials, reviews, and retrospective studies from the last 30 years published in English, Portuguese, or Spanish were included. Only studies with sufficient details on the training protocols used and outcome measures were included in the analysis. Results: In SIS, exercise protocols have been more effective in the long term than in the short term. In PFPS and GTPS, strengthening the quadriceps and hip muscles helps reduce pain and improve function. For NSLBP, exercises like Pilates and core training demonstrate pain relief. In knee osteoarthritis, physical exercise improves pain, function, and quality of life both immediately and over time. Eccentric training promotes type I collagen formation in the tendons of patients with Achilles tendinopathy. Conclusions: Home-based resistance exercises studied and implemented in this review offer several general health benefits, including pain reduction, improved functionality, increased muscle strength, and enhanced motor control. Full article