Translational Health Reports

Abstract Background: Postpartum depression (PPD) is a prevalent and serious global mental health disorder. Conventional pharmacological treatments like SSRIs have limitations, including side effects and breastfeeding safety concerns, prompting the exploration of alternative therapies.
Objective: This narrative review synthesizes current evidence on the efficacy, mechanisms, and clinical implementation of combined acupuncture and repetitive transcranial magnetic stimulation (rTMS) for PPD.
Methods: A narrative review was conducted to analyze and integrate existing research on the integrative use of acupuncture (a Traditional Chinese Medicine practice) and rTMS (a non-invasive neuromodulation technique) for treating PPD.
Results: Evidence suggests that combined acupuncture-rTMS therapy may produce synergistic effects. Potential benefits include a greater reduction in depressive symptoms, improved neuroendocrine regulation, and enhanced overall quality of life compared to either intervention administered alone.
Conclusion: The combination of acupuncture and rTMS represents a promising integrative approach for PPD. Further research is needed to optimize treatment protocols, identify predictive biomarkers, and evaluate long-term outcomes.

Abstract Background: Stereotactic Body Radiation Therapy (SBRT) represents the standard treatment for inoperable early-stage non-small cell lung cancer (NSCLC) and is increasingly utilized for oligometastatic disease. Its distinct radiobiological profile, involving high doses per fraction, triggers complex tumor-killing effects and systemic biological reactions not fully detectable through conventional imaging.
Objective: This review aims to summarize and critically assess current evidence regarding dynamic alterations in circulating, tissue, and imaging biomarkers after SBRT for lung cancer, and to explore their clinical significance.
Methods: A narrative synthesis of scientific literature from PubMed, Scopus, and Google Scholar was conducted, focusing on studies published between 2005 and 2024. Key search terms included "SBRT," "SABR," "lung cancer," "biomarker," "ctDNA," "immunotherapy," "cytokines," and "radiation pneumonitis."
Results: SBRT prompts a rapid, biphasic shift in tumor-derived biomarkers such as circulating tumor DNA (ctDNA), characterized by an initial post-treatment surge followed by reduction in responders. It significantly influences the immune system, inducing immunogenic cell death, expanding tumor-specific T-cell populations, and increasing checkpoint molecule expression like PD-L1. Additionally, SBRT modifies levels of cytokines (e.g., IL-6, TGF-β) and angiogenic factors (e.g., VEGF), which correlate with both treatment effectiveness and side effects like radiation-induced lung injury. Certain genetic polymorphisms also appear promising for predicting toxicity risk.
Conclusion: SBRT induces a dynamic and multifaceted change in the biomarker profile of lung cancer patients. These biomarkers offer considerable potential for personalizing treatment, predicting outcomes, monitoring response, and rationally planning combination therapies, especially with immunotherapy. Future prospective and validated studies are necessary to integrate these findings into clinical practice.

Abstract Background: Severe adenovirus pneumonia (SAP) in children is a critical illness characterized by a dysregulated hyperinflammatory response. The adjunctive role of early intravenous immunoglobulin (IVIG) and optimized nursing care in modulating this inflammation remains a key area of clinical investigation.
Objective: This review evaluated current evidence on the efficacy of early IVIG administration and nursing process optimization (NPO) in improving clinical and biochemical outcomes for pediatric SAP.
Methods: A comprehensive analysis of clinical studies, including a pivotal randomized controlled trial was conducted. The review focuses on IVIG's immunomodulatory mechanisms and the impact of structured nursing interventions on care delivery.
Results: Early IVIG administration is associated with significant reductions in key inflammatory markers (CRP, PCT, IL-8) and leads to superior clinical outcomes, including shorter hospital stays, fever duration, and mechanical ventilation requirements, alongside lower complication rates. Concurrently, implementing NPO protocols dramatically reduces infusion-related adverse events.
Conclusion: The synergistic application of early IVIG and NPO presents a promising, holistic strategy for managing pediatric SAP by effectively modulating inflammation and enhancing the safety of care delivery. This combined approach warrants broader clinical adoption and further long-term study

Abstract Background: Older patients undergoing thoracoscopic radical resection for lung cancer face considerable risks of postoperative pain, weakened immunity, and malnutrition, which can slow recovery. Multimodal approaches are needed to enhance results. This review explores the combined benefits of preoperative nutritional support and analgesia based on esketamine.
Methods: A narrative literature review was performed using databases including PubMed, Embase, and the Cochrane Library up to 2025. The search targeted clinical trials, randomized controlled trials (RCTs), and meta-analyses on esketamine, preoperative nutrition, and outcomes in thoracic or cancer surgery. Information was combined to assess impacts on pain relief, immune and nutritional indicators, and recovery measures.
Results: Research consistently shows that esketamine notably decreases postoperative pain scores and opioid use while reducing opioid-related side effects. Preoperative immunonutrition lessens the surgery-related drop in immune markers (IgG, IgM, IgA) and nutritional proteins (Alb, TRF, PAB). Together, these approaches work synergistically to speed gastrointestinal recovery, reduce hospital stay, and improve health-related quality of life scores in older surgical patients.
Conclusion: Incorporating preoperative nutritional support and esketamine into Enhanced Recovery After Surgery (ERAS) protocols offers a promising multimodal method to improve perioperative care. This approach effectively manages pain, supports immune and nutritional health, and encourages quicker recovery, supporting broader clinical use and additional large-scale RCTs.

Abstract Background: Patients with end-stage renal disease (ESRD) on maintenance hemodialysis (HD) experience a high psychological burden, with frequent occurrences of alexithymia, anxiety, and depression. These psychological issues are increasingly associated with disruptions in neuroimmune and neuroendocrine pathways. This review examines the basis and supporting data for using a combined approach of Shugan Jieyu Capsule (SJC) and group psychological counseling (GPC) to target both the psychological and biological aspects of this complex condition.
Methods: A synthesis of existing literature was conducted, focusing on the pathophysiology of alexithymia in HD patients, the pharmacological effects of SJC, the therapeutic mechanisms of GPC, and the role of biomarkers such as Orphanin FQ (OFQ), Interleukin-2 (IL-2), Corticotropin-Releasing Hormone (CRH), Neurogranin, and soluble Fractalkine (sCX3CL1).
Results: Recent evidence indicates that a combined strategy of SJC and GPC is more effective than standard care alone. This integrated approach has been found to significantly reduce symptoms of alexithymia, anxiety, and depression; enhance sleep quality, self-care capacity, and social functioning; and improve overall quality of life. Importantly, these psychological improvements are associated with changes in key biomarkers, including decreased serum levels of OFQ, IL-2, CRH, Neurogranin, and sCX3CL1, suggesting a positive effect on stress response, synaptic function, and neuroinflammation.
Conclusion: The combination of Shugan Jieyu Capsule and group psychological counseling represents a promising, multi-targeted strategy for managing the psychosomatic challenges in hemodialysis patients. This method not only improves clinical symptoms but also appears to address underlying neuroimmune and neuroendocrine imbalances, offering a holistic approach to enhancing patient outcomes in ESRD care.

Abstract Introduction: Managing osteoporosis in the elderly, a common issue in aging populations worldwide, demands effective approaches to lower fracture risk and maintain life quality. Although calcium and vitamin D provide basic support, strong anti-resorptive drugs such as zoledronic acid are frequently required. This review compiles evidence on using zoledronic acid together with calcium and calcitriol to treat primary osteoporosis in older adults.
Methods: A narrative literature review was performed. Searches were conducted in electronic databases like PubMed, Scopus, and Web of Science for pertinent clinical trials, meta-analyses, and review articles published through 2024. Important search terms were "zoledronic acid," "senile osteoporosis," "bone mineral density," "bone turnover markers," "calcitriol," and "quality of life." Emphasis was placed on studies involving older populations and combinations of these treatments.
Results: Strong evidence shows that triple therapy (zoledronic acid, calcium, and calcitriol) is more effective than dual therapy (calcium and calcitriol alone) in substantially raising bone mineral density (BMD) at the lumbar spine, femoral neck, and hip. It creates a better bone metabolic state, marked by a significant reduction in resorption markers (CTX-1) and a subtle adjustment of formation markers (PINP, Osteocalcin). This treatment also leads to greater enhancements in quality of life scores (QUALEFFO-41) and shows a tolerable safety profile, with short-lived acute-phase reactions being the most frequent side effects.
conclusion: The combination treatment provides a synergistic, multi-target strategy. Zoledronic acid strongly hinders osteoclast-driven bone resorption, while calcium and calcitriol maintain a positive calcium balance and directly affect bone cell activity. This leads to stronger bones, decreased fracture risk, and better patient well-being. Long-term adherence and uncommon side effects are still factors to consider, but the benefit-risk balance is very positive for high-risk elderly patients.

Abstract Background: Liver cancer, mainly hepatocellular carcinoma (HCC), presents a major global health challenge with high mortality. While established risk factors such as viral hepatitis and alcohol consumption are widely recognized, there is growing interest in modifiable factors like vitamin D (VD) deficiency. Observational studies indicate a link between low serum 25-hydroxyvitamin D (25(OH)D) and increased liver cancer risk, though confounding factors and reverse causality complicate causal conclusions.
Objectives: This review aims to integrate current findings on the relationship between serum 25(OH)D and liver cancer risk, critically assess causality using Mendelian randomization (MR) evidence, and explore mechanistic insights from genetic research.
Methods: A narrative literature review was conducted using PubMed and Google Scholar, focusing on epidemiological studies, MR analyses, and mechanistic research published up to 2025. Search terms included "25-hydroxyvitamin D," "liver cancer," "hepatocellular carcinoma," "Mendelian randomization," and "genetic polymorphisms."
Results: Case-control and cohort studies consistently show that liver cancer patients have significantly lower serum 25(OH)D levels compared to healthy individuals. MR studies, using genetic variants in DHCR7, CYP2R1, and VDR genes as instrumental variables, strongly indicate a causal protective effect of higher 25(OH)D concentrations on liver cancer risk. For example, alleles associated with increased 25(OH)D, such as those in DHCR7 (rs12785878) and VDR (rs2228570), correlate with a 20-30% reduction in liver cancer odds. These findings are supported by biological mechanisms, including VD's anti-proliferative, pro-apoptotic, and anti-inflammatory actions mediated through the VDR receptor in liver cells.
Conclusion: The alignment of epidemiological and genetic evidence reinforces the likely causal, protective role of vitamin D in liver cancer. Genetic polymorphisms offer a means to reduce confounding, providing more robust evidence than observational data alone. Future research should emphasize large-scale randomized controlled trials of VD supplementation in high-risk groups and further investigation of gene-environment

Abstract Background: Colorectal cancer (CRC) remains a major global health issue, with advanced stages difficult to treat. Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway have improved cancer care, but they work well only in a small group of CRC patients with high microsatellite instability (MSI-H). Most CRC cases are microsatellite stable (MSS) and do not respond to ICI treatment alone, highlighting the need for combined therapies.
Methods: This review summarizes recent studies from PubMed, Google Scholar, and clinical trial databases up to 2025 focusing on why CRC resists ICI treatment. It examines ways to modify the immunosuppressive tumor microenvironment (TME), including using immune-boosting agents and targeting proteins like USP2 that regulate PD-L1.
Results: The immunosuppressive TME in MSS-CRC limits the effectiveness of PD-1 blockers. Immune adjuvants, such as the peptide NCL-P2, can reshape the TME by activating immune cells, increasing T cell entry into tumors, and reducing T cell exhaustion. Additionally, recent studies show that USP2 helps stabilize PD-L1 in cancer cells. Blocking USP2 leads to PD-L1 breakdown, improving T cell attack and boosting anti-PD-1 therapy in lab studies.
Conclusion: Combining anti-PD-1 antibodies with treatments that alter the immunosuppressive TME—such as immune adjuvants to strengthen immune responses and USP2 inhibitors to lower PD-L1 levels—offers a promising multi-target strategy. This method could help overcome treatment resistance and extend immunotherapy benefits to more CRC patients.

Abstract Introduction: The length of stay in the emergency department (ED) starts from entering the unit and does not end until the patient is discharged home, admitted to the hospital or until transferred to another department or other treatment center. This period of time indicates the optimal management of beds in the ED. It is used as a performance index to evaluate the quality of care in the ED and the evidence shows that a stay in the ED of more than 6 hours is associated with an increase in mortality and morbidity. Therefore, the present study aims to investigate the causes of long-term stay (more than 12 hours) patients in the ED of Ayatollah Rouhani Babol educational and treatment center is designed.
Research method: This research was cross-sectional-retrospective. The study population consisted of all patients who referred to the ED of Rohani Babol Hospital in 2022. Sampling was done in the form of the entire census of the studied community. Data was collected using a checklist from Rouhani Hospital in Babol city. The collection tool was a pre-made checklist that included basic and demographic information of the patients. If a file did not have the desired information, or was incomplete, it was excluded from the study.
Results: This study was conducted on 400 patients who referred to the ED of Ayatollah Rouhani and Shahid Beheshti hospitals, who stayed in the emergency ward for more than 12 hours. In this study, the average duration of hospitalization until the assignment of the patient by the emergency medicine specialist was 57.8±82.6 minutes. The average time from entering to leaving the ED was 31.8 ± 21.8 hours for men and 33.8 ± 24.4 hours for women. The average time from entering to leaving the ED in patients with a history of hypertension was 38.9 ± 27.1 hours, with a history of diabetes 37.6 ± 27.3 hours, and with a history of heart disease 36.5 ± 24.3 hours. It was statistically significant (p=0.001), (p=0.007) and (p=0.040) respectively). The difference between the average time of entering and leaving the ED with the way the patient left the emergency ward was not statistically significant (p=0.636). However, a statistically significant difference was observed between the average time of entering and exiting the ED with the level of triage (p=0.004) and the type of disease (p=0.001). The results of the one-way analysis of variance test showed that the difference in the average duration of hospitalization in the emergency medicine service until leaving the emergency medicine service, the difference in the average duration of assignment by emergency medicine to the visit of the specialist assistant (p=0.814) and the difference in the average duration of required tests From the request to the answer to the test (p=0.454), no significant statistical difference was observed in the age groups. However, the difference in the average time between entering and leaving the ED in the age groups was found to be statistically significant (p=0.001).
Conclusion: The length of stay is influenced by various demographic and clinical factors. Therefore, it is possible to predict the length of stay by applying data mining techniques on hospital admission data. This work can be a suitable tool for planning and optimal allocation of hospital resources.

Abstract Background: Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disease with an incompletely understood etiology. Observational studies suggest dysregulated immunity, but confounding and reverse causation have hindered causal inference. Mendelian randomization (MR) uses genetic variants as instrumental variables to assess causality and has recently been applied to investigate immune involvement in AIH.
Objective: To summarize and interpret findings from a recent bidirectional two-sample MR study evaluating the causal effects of 731 immune cell traits on AIH risk, contextualizing them within existing immunological knowledge.
Methods: This narrative review focuses on a key MR investigation using genome-wide association study (GWAS) summary statistics for 731 immunophenotypes and AIH. The primary analysis method was inverse variance weighting, supplemented by sensitivity analyses (MR-Egger, weighted median) and reverse MR to assess robustness and directionality of causal relationships.
Conclusion: The MR analysis provides genetic evidence supporting a causal role for specific innate and adaptive immune cell subsets in AIH pathogenesis. These findings highlight the therapeutic potential of targeting pathways involving myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), dendritic cells, NKT cells, and the PD-1/PD-L1 axis, offering a foundation for future mechanistic and translational research.
 

Abstract Background: Renal peripelvic (parapelvic) cysts cause hydronephrosis, pain, and obstruction when exceeding 4-5 cm due to hilar compression, with elevated IL-6, TNF-α, and creatinine reflecting inflammation and impaired function.​
Objective: This narrative review synthesizes evidence on pathophysiology, diagnosis, and minimally invasive management, emphasizing retroperitoneoscopic decortication versus ureteroscopic drainage outcomes.​
Methods: Literature from 2011-2025 (PubMed, Scopus, Web of Science) was reviewed, prioritizing comparative studies, case series (n≥20), and biomarker data; a key 100-patient cohort provided head-to-head analysis.​
Results: Retroperitoneoscopic decortication shows superior outcomes versus ureteroscopy: shorter operative time (78±18 vs 112±24 min), less blood loss (25±15 vs 55±30 mL), faster recovery (hospital stay 2.8±0.9 vs 5.1±1.4 days), lower complications (8% vs 18%), and greater IL-6/TNF-α decline; recurrence rates similar (8-10%).​
Conclusion: Retroperitoneoscopic decortication is optimal for symptomatic peripelvic cysts, balancing efficacy, safety, and biomarker recovery over ureteroscopy

Abstract Backgrounds: Early-stage laryngeal squamous cell carcinoma (LSCC), which includes stage I and II disease, has a high cure rate. The main treatment approaches are definitive radiotherapy (RT) and transoral surgery (TOS), which includes transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). Selecting the optimal treatment involves balancing oncologic effectiveness with functional results and quality of life.
Objective: To review and compare current evidence on overall survival (OS), disease-specific survival (DSS), laryngeal preservation (LP), and functional outcomes in early-stage LSCC treated with primary RT or TOS.
Methods: A narrative literature review was performed, identifying relevant studies from PubMed and Scopus. The focus was on peer-reviewed articles from the last two decades, including retrospective cohort studies, prospective trials, systematic reviews, and meta-analyses that directly compared RT and TOS.
Results: Recent large-scale analyses and meta-analyses show similar overall and disease-specific survival rates for T1 and T2 tumors treated with modern TOS or RT. The main differences are seen in patterns of oncologic control. TOS is linked to lower local recurrence but a higher incidence of second primary tumors, whereas RT shows higher local recurrence but a lower need for salvage laryngectomy, resulting in comparable long-term laryngeal preservation rates. Functionally, TOS offers advantages in treatment duration, voice outcomes for select T1a lesions, and cost-effectiveness, but may lead to poorer swallowing outcomes for larger resections. RT may provide better voice quality for more extensive T1 and T2 lesions but carries risks of long-term dry mouth and tissue scarring.
Conclusion: Both RT and TOS are effective treatments for early-stage LSCC, with similar long-term survival outcomes. Treatment selection should be individualized, based on tumor characteristics, patient health, institutional experience, and patient preferences regarding functional trade-offs and treatment burden.

Abstract Background: In the context of modern healthcare, surgical interventions are essential yet pose inherent risks, including postoperative infections. Antibiotic prophylaxis plays a pivotal role in mitigating these risks, aiming to prevent surgical site infections (SSIs) and associated complications. This study focuses on the consumption patterns of antibiotic prophylaxis regimens among patients admitted to the surgical wards at Bu Ali Sina Medical and Educational Services Center in Sari, Iran.
Methods: This retrospective cross-sectional study involved 970 participants undergoing clean or clean-contaminated surgical procedures. The research employed a researcher-made questionnaire covering demographic information, antibiotic details, side effects, duration of administration post-operation, adherence to guidelines, and compliance with ASHP 2013 antibiotic prophylaxis guidelines. Statistical analyses included central tendency and dispersion indicators, Chi-squared test, Fisher's exact test, one-sample Kolmogorov-Smirnov, Mann-Whitney U test, and T-test.
Results: The predominant antibiotic categories were cephalosporins, with ceftriaxone and cefazolin accounting for 65.2% and 61.8% of prescriptions, respectively. Comparison between orthopedic and ENT surgery groups did not reveal significant differences in antibiotic regimens (P=0.085). However, a noteworthy difference emerged in the duration of antibiotic prophylaxis, with a significant distinction between orthopedic and ENT surgery groups (P=0.650). Compliance with ASHP 2013 guidelines was observed in 84% of cases regarding the timing and type of prescribed antibiotic prophylaxis regimen.
Conclusion: This study provides crucial insights into the consumption patterns of antibiotic prophylaxis among surgical patients, emphasizing the prevalence of cephalosporins and revealing distinctions in duration between orthopedic and ENT surgery groups. The findings contribute to optimizing patient outcomes and addressing antimicrobial resistance challenges. As the healthcare community navigates the delicate balance between prophylactic benefits and resistance concerns, these results offer valuable information for policy-making and clinical practices.

Abstract Background: Coronary Heart Disease (CHD) is a widespread health challenge characterized by intricate pathophysiological mechanisms such as chronic inflammation, endothelial impairment, and metabolic irregularities. Exercise-focused Cardiac Rehabilitation (CR) is a key element of secondary prevention, known to decrease mortality and improve health outcomes. Examining its impact on a diverse range of biomarkers offers deeper insight into the biological mechanisms behind these benefits.
Objective: This systematic review consolidates current research on the effects of structured exercise training within CR on biomarkers related to critical pathological areas in CHD patients, including inflammation, lipid metabolism, vascular function, myocardial stress, and metabolic health.
Methods: A systematic search of PubMed, Scopus, and the Cochrane Central Register of Controlled Trials was conducted from January 2000 to May 2024. Randomized controlled trials, meta-analyses, and prospective cohort studies evaluating the impact of exercise-based CR on biomarkers in adults with confirmed CHD were included.
Results: Analysis of 40 high-quality studies shows that exercise-based CR consistently produces beneficial changes across multiple biomarker pathways. Notable findings include significant decreases in high-sensitivity C-reactive protein (median reduction of 32%), interleukin-6, and tumour necrosis factor-alpha; improved lipid profiles (increase in HDL-C of 5–10%, reduction in triglycerides of 15–20%); better endothelial function (increase in Flow-Mediated Dilation of 1.5–3.0%); lower myocardial stress (NT-proBNP reduction of 25–40%); and enhanced insulin sensitivity (HOMA-IR reduction of 15–30%).
Conclusion: Exercise training within CR exerts extensive, multisystem biological effects that directly address core CHD pathophysiological processes. The consistent favorable changes in biomarkers provide a strong mechanistic rationale for the known clinical benefits of CR and support the use of biomarker assessment to tailor risk stratification and improve secondary prevention approaches.

Abstract Background: Nosocomial infections remain a significant challenge in intensive care units (ICUs), contributing to increased morbidity, mortality, and healthcare costs. Emerging evidence suggests that structured risk assessment strategies may not only improve infection control but also modulate inflammatory and immune responses.
Methods: A comprehensive literature review was conducted, querying PubMed, Cochrane Library, EMBASE, and Web of Science for studies published through 2025. Eligible studies evaluated risk assessment tools or protocols in ICU settings and reported on outcomes including infection incidence, clinical parameters, and biomarker levels (e.g., inflammatory cytokines).
Results: The integration of structured risk assessment frameworks into ICU infection prevention protocols is associated with substantial benefits. These include reduced infection rates, improved clinical outcomes, and favorable alterations in key biomarker profiles, indicating a potential systemic immunomodulatory effect.
Conclusion: Implementing risk assessment in ICU infection control is advantageous for both clinical outcomes and biomarker patterns. Future research should focus on longitudinal biomarker monitoring and the development of personalized, dynamic risk assessment models to further optimize prevention strategies.




 
 
 
 
 

Abstract Background: Esophageal cancer (EC) is a highly aggressive malignancy with increasing global prevalence, especially esophageal adenocarcinoma (EAC). Late-stage detection significantly contributes to its unfavorable outcomes, highlighting an urgent demand for non-invasive early diagnostic approaches. Metabolomics, the comprehensive study of small-molecule metabolites, provides a valuable strategy for discovering biomarker patterns that mirror the pathophysiological condition of cancer.
Objective: This review seeks to consolidate and critically assess existing research on the utility of plasma metabolites as diagnostic, prognostic, and predictive biomarkers in EC.
Methods: A systematic search of PubMed, Scopus, and Web of Science was performed for literature published between January 2000 and March 2024. Keywords such as "esophageal cancer," "metabolomics," "plasma," "serum," "biomarkers," "mass spectrometry," and "NMR" were employed. Studies were chosen based on their focus on plasma or serum metabolomic analysis in human EC patients.
Results: EC patients exhibit consistent changes in plasma metabolomic profiles compared to healthy individuals. Major disrupted pathways involve amino acid metabolism (e.g., increased branched-chain amino acids, reduced glutamine), energy metabolism (including the Warburg effect and disturbances in the TCA cycle), and lipid metabolism (alterations in phospholipid and sphingolipid concentrations). Panels comprising multiple metabolites show strong diagnostic performance, often with area under the curve (AUC) values above 0.90. Additionally, certain metabolic patterns may be useful for predicting patient outcomes and evaluating responses to neoadjuvant treatments.
Conclusion: Plasma metabolomics offers considerable potential to transform the clinical approach to EC through non-invasive methods for early diagnosis, risk assessment, and therapy evaluation. Validation through extensive, multi-center prospective studies is needed to implement these advances in clinical settings.

Abstract Background: The established first-line treatment for newly diagnosed Glioblastoma Multiforme (GBM) involves maximal surgical removal of the tumor, followed by a regimen of radiotherapy (RT) together with concurrent and maintenance temozolomide (TMZ) chemotherapy. Patient response to this combined approach varies widely and is closely associated with the tumor's molecular characteristics.
Objective: This analysis compiles current research on how the RT/TMZ combination modifies crucial GBM biomarkers over time, focusing on therapy-induced alterations rather than their initial prognostic significance.
Methods: A systematic review of literature from January 2000 to July 2024 was performed using PubMed, Scopus, and Web of Science. Search keywords included "glioblastoma," "radiotherapy," "temozolomide," "MGMT," "IDH," "biomarker," and related terms. Emphasis was placed on clinical trials and key preclinical studies.
Results: The RT/TMZ protocol imposes significant selective pressure, dynamically influencing GBM biomarkers. MGMT promoter methylation is the primary predictor of TMZ efficacy, but treatment often leads to the expansion of MGMT-active, resistant tumor clones at recurrence. IDH1/2 mutations are strong prognostic indicators, and their associated metabolic changes may increase tumor sensitivity to DNA-damaging therapies. Treatment substantially reshapes the tumor immune microenvironment; RT can stimulate anti-tumor immune responses but also increase PD-L1 expression, while TMZ often causes severe lymphocyte depletion. Additionally, therapy promotes the selection of cells with enhanced DNA damage repair mechanisms and activates survival pathways such as EGFR, fostering treatment resistance.
Conclusion: RT and TMZ induce continuous, adaptive changes in GBM biomarkers. Recognizing this dynamic process is essential for personalizing treatment, assessing response, and developing new combination therapies to combat resistance.

Abstract Background: Acute pain is one of the most frequent presenting complaints in emergency departments (EDs). In the context of the global opioid crisis, there is increasing interest in effective non-opioid and opioid-sparing analgesic strategies. Ketamine, at subanesthetic doses, has emerged as a valuable option for acute pain management due to its unique pharmacologic profile.
Objectives: This narrative review aims to synthesize current evidence on the mechanisms of analgesia, clinical efficacy, dosing protocols, and safety considerations of ketamine for acute pain management in adult ED patients.
Methods: A comprehensive narrative review of the literature was conducted using recent randomized controlled trials, systematic reviews, meta-analyses, and international guidelines focusing on ketamine use for acute pain in emergency settings. Studies from diverse geographic regions and healthcare systems were included to provide a global perspective.
Results: Evidence consistently demonstrates that subdissociative-dose ketamine provides analgesia comparable to opioids for acute pain in the ED. Typical intravenous doses of 0.1–0.35 mg/kg, administered as a bolus or infusion, achieve rapid pain relief while preserving respiratory drive and airway reflexes. Ketamine is associated with higher rates of transient neuropsychiatric effects, such as dizziness and emergence reactions, but lower risks of respiratory depression compared with opioids. Alternative routes of administration, including intranasal and subcutaneous, offer additional flexibility in selected patients.
Conclusion: Ketamine is a safe and effective alternative or adjunct to opioids for acute pain management in the emergency department when used at appropriate subanesthetic doses. With proper patient selection, monitoring, and adherence to established protocols, ketamine can play a central role in multimodal ED analgesia strategies aimed at improving pain control while reducing opioid exposure.

Abstract Background: Chemoradiation therapy (CRT) is fundamental for treating locally advanced and high-risk breast cancer. Although effective, it significantly impacts systemic physiology, which can be tracked through fluctuations in serum biomarkers. This review consolidates existing research on how CRT affects circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), inflammatory cytokines, and tissue injury markers, assessing their value for predicting outcomes and guiding treatment.
Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted for studies to 2025. Keywords included "breast cancer," "chemoradiation," "serum biomarker," "ctDNA," "CTC," and related terms. Eligible studies reported serum biomarker levels in breast cancer patients before, during, or after CRT and linked them to clinical results.
Results: Analysis of studies indicates that CRT causes a predictable but individualized alteration in serum biomarkers. A swift decrease in CTCs and ctDNA levels during neoadjuvant or definitive CRT strongly correlates with pathological complete response (pCR) and better survival. In contrast, detectable ctDNA after treatment is a powerful indicator of minimal residual disease (MRD) and impending relapse. Inflammatory markers such as IL-6 and CRP generally increase during therapy; prolonged elevation is linked to poorer prognosis and greater toxicity. Additionally, biomarkers like high-sensitivity Troponin I and TGF-β1 enable early identification of subclinical cardiotoxicity and radiation-induced skin damage, respectively.
Conclusion: Serum biomarkers offer a real-time, dynamic reflection of tumor response and host toxicity during CRT. Incorporating liquid biopsy components (CTCs, ctDNA) and host-response markers into clinical practice shows great potential for personalizing treatment, facilitating early intervention, and enhancing long-term results. Prospective studies are urgently required to standardize testing methods and confirm their clinical utility in guiding treatment strategies.

Abstract Background: Pediatric kidney transplantation is the optimal therapy for end-stage kidney disease in children, yet long-term allograft survival remains inferior to adults due to heightened immunological reactivity, subclinical inflammation, and progressive fibrosis. Conventional monitoring with serum creatinine and protocol biopsies is limited by poor sensitivity and invasiveness.
Methods: This comprehensive narrative review synthesizes evidence on native T1-mapping MRI—a non-contrast technique quantifying renal parenchymal microstructure via elevated cortical T1 and reduced corticomedullary differentiation, reflecting inflammation, oedema, and interstitial fibrosis/tubular atrophy (IFTA)—and its mechanistic interplay with serum cytokine/chemokine profiles capturing alloimmune response phenotypes.
Results: Emerging data show strong pathophysiological/statistical correlations between pro-inflammatory cytokines (especially IL-6, TNF-α, CXCL10) and T1 prolongation, as cytokine-driven inflammation alters tissue relaxation properties detectable by MRI. Native T1-mapping demonstrates high diagnostic performance for IFTA (sensitivity 81-89%, specificity 78-85%), predicts graft dysfunction (HR 3.8 per 100 ms T1 increase), and tracks treatment response. Combined with cytokines, it identifies subclinical rejection with 94% specificity, outperforming eGFR/creatinine.
Conclusions: Native T1-mapping offers robust prognostic value in pediatric renal allografts. Integrated with targeted cytokine panels, it enables biopsy-sparing monitoring, early injury detection, and personalized strategies to improve outcomes. Multicenter trials with standardized protocols are needed.

Abstract Post-stroke upper limb spasticity (PULS) is a disabling condition that severely limits motor function and quality of life. While botulinum toxin A (BTX-A) injection is a standard treatment, its benefits are often partial and temporary. Traditional Chinese acupuncture (TCA) is increasingly used as an adjunct therapy. Concurrently, there is growing interest in identifying objective biomarkers to monitor recovery and elucidate treatment mechanisms.Combining acupuncture with BTX-A is more effective than BTX-A monotherapy for PULS rehabilitation. The therapy induces favorable changes in biomarkers related to muscle repair, neural plasticity, and neuroendocrine adaptation, providing a molecular basis for the observed clinical synergy. This integrated, biomarker-informed approach offers a promising direction for personalized neurorehabilitation in stroke survivors.

Abstract Backgrounds: Hyperlipidemic acute pancreatitis (HLAP) is a growing and serious subtype of acute pancreatitis, involving a complicated interaction of metabolic imbalance, widespread inflammation, and clotting irregularities. The potential of low molecular weight heparin (LMWH) and early enteral nutrition (EEN) as supplementary treatments has attracted considerable attention for their ability to influence central disease mechanisms.
Methods: This detailed review integrates findings from clinical research, randomized controlled trials, and meta-analyses released between 2010 and 2024, gathered via systematic searches of PubMed, Embase, and Cochrane Library databases. Emphasis was placed on studies assessing how LMWH and EEN affect immune markers (IgA, IgG, IgM), clotting factors (PT, TT, APTT, FIB), inflammatory mediators (TNF-α, IL-6, IL-8, CRP), and nutritional indicators (TP, ALB, TRF) in HLAP patients.
Results: Current data suggest that using LMWH together with EEN produces better patient results than traditional care alone. Notable outcomes involve a marked decrease in inflammatory markers, better clotting function, higher antibody levels, and improved nutritional measures. This combined method is linked to reduced hospitalization time, quicker return of digestive function, and fewer complications like multiple organ failure.
Conclusion: The complementary actions of LMWH and EEN tackle the diverse causes of HLAP. LMWH enhances blood flow in the pancreas while lowering excessive clotting and inflammation, whereas EEN protects intestinal lining and helps regulate immunity. Subsequent studies should aim to establish consistent treatment guidelines and determine which patients would gain the most from this dual therapy.