Deep brain stimulation (DBS) remains one of the most effective advanced therapies for Parkinson’s disease (PD), yet considerable heterogeneity persists in clinical outcomes, patient selection, and long-term neuropsychiatric effects. This narrative review synthesizes recent evidence on the mechanisms, efficacy, and evolving applications of DBS, integrating findings from neurophysiology, neuroimaging, genetics, and computational modeling. Current data indicate that stimulation of the subthalamic nucleus (STN) and globus pallidus internus (GPi) reliably improves cardinal motor symptoms and reduces dopaminergic medication requirements, with sustained benefits over time. However, axial symptoms, including gait disturbance, postural instability, and speech, demonstrate variable or limited responsiveness, underscoring the complexity of the underlying neural circuits. Non-motor outcomes also show substantial variability: sleep and gastrointestinal functions often improve, whereas apathy, impulsivity, and speech disturbances may emerge or worsen in selected patients. Emerging biomarkers, including evoked cortical responses, oscillatory signatures, radiomic features, and gray matter morphometry, show promise in refining patient-specific predictions, although external validation remains limited. Genetic variants, particularly in GBA and LRRK2, further modulate cognitive trajectories and long-term outcomes. Advances in imaging-guided “asleep” DBS, directional leads, and personalized programming strategies have improved precision and safety. Concurrently, machine learning and adaptive DBS paradigms represent major future directions, enabling real-time, biomarker-driven modulation tailored to disease dynamics. By integrating multidomain evidence, this review highlights both the established therapeutic value and the persistent challenges of DBS, emphasizing the need for mechanistically informed, precision-based approaches. These developments collectively outline a path toward more individualized and circuit- specific neuromodulation strategies in PD.
Background: Artificial intelligence (AI) is increasingly investigated for radiographic assessment of peri-implant bone conditions, although radiographic marginal bone loss does not alone establish a clinical diagnosis of peri-implantitis. This narrative review aimed to critically synthesize current evidence on AI-assisted radiographic assessment of peri-implant marginal bone levels and bone loss. Methods: A structured literature search was conducted in PubMed/MEDLINE and Scopus. Eligible original studies applying AI or machine-learning methods to human dental radiographs for peri-implant bone assessment were included in a qualitative synthesis. Results: Seventeen studies were included. Periapical radiographs were the predominant imaging modality, while panoramic radiographs and CBCT were less frequently investigated. AI applications included implant and landmark localization, marginal bone-level measurement and quantification, bone-loss severity and defect-morphology classification, and prediction using imaging-derived features. Reported performance was generally promising, although substantial heterogeneity was observed in datasets, target tasks, reference standards, validation strategies, and performance metrics. Conclusions: Current radiograph-based AI systems show potential for image analysis, quantitative assessment, and clinical decision support. However, radiographic AI performance should not be interpreted as autonomous diagnostic accuracy for peri-implantitis. External validation, longitudinal assessment, and integration with relevant clinical parameters remain priorities for future research.
Biological data have grown exponentially due to single-cell multi-omics, high-content imaging, and large-scale clinical records; this has transformed modern biology. The landscape has shifted to one of data abundance, and the current approaches to computational analysis are not up to the task of dealing with the scale and complexity of this change. The information in big biological data can be characterized by the volume it occupies, velocity, variety, veracity, and value, and each of these features presents its own challenges to the researcher. Artificial intelligence (AI), including machine learning (ML), deep learning (DL), and natural language processing (NLP), has progressively turned into a requirement in tackling these issues. This chapter discusses how AI can be used to curate, represent, learn, and model the analysis of big biological data. Questions include data curation via methods to compress, represent, and outline big biological data, how to learn representations, how to model with big biological data, and how to translate into clinical problems. Using the conversation of genomics, proteomics, transcriptomics, structural biology, imaging, and electronic health records, this chapter reveals how AI is transformative in bioinformatics. In conclusion, the chapter points to enduring challenges, namely interpretability, data governance, and reproducibility, and provides a step into the future of explainable, trustworthy, and reproducible AI in biology.
The process of aging population is increasing the relevance of comprehending age-related changes in skin structure and function, as well as their implications for clinical care. This narrative review explores aspects of the intrinsic and extrinsic mechanisms of skin aging, their molecular and morphological consequences, and their clinical expression, with particular attention to chronic cutaneous insufficiency. The intrinsic aging process is reflecting declining cellular functionality, impaired tissue homeostasis, and endocrine changes, especially regarding estrogen deficiency after menopause. These processes are reducing collagen synthesis, hydration, and elasticity and thus contributing to epidermal and dermal atrophy and barrier dysfunction. On the other hand, extrinsic aging is driven mainly by cumulative ultraviolet exposure, with additional contributions from pollution, smoking, diet, and behavioral and psychosocial factors. Processes such as oxidative stress, inflammation, DNA damage, glycation, and increased matrix metalloproteinase activity promote extracellular matrix degradation, linking the environmental exposure to the photoaging and cutaneous carcinogenesis. Main clinical manifestations include xerosis, chronic pruritus, pigmentary changes, benign lesions, actinic keratoses, and basal cell and squamous cell carcinomas. Inflammatory, allergic, autoimmune, and drug-induced dermatoses, including psoriasis, lichen planus, and bullous pemphigoid, are complicating healthcare in older adults, while systemic comorbidities and medication use are influencing clinical presentation and treatment. Dermatoporosis is characterized by cutaneous atrophy, purpura, pseudoscars, and susceptibility to injury after minor trauma. Reduced hyaluronic acid availability and CD44 expression contribute to impaired hydration and mechanical resilience, potentially leading to ulceration and deep dissecting hematomas. Management measures are emphasizing the role of photoprotection, skin hydration, trauma prevention, and reduction of modifiable exposures, with corticosteroid use warranting reassessment in secondary dermatoporosis. Other discussed approaches are topical hyaluronic acid, retinoids, alpha-hydroxy acids, and vitamin C, but the proposed interventions have limited supporting evidence. Therefore, it is considered that early recognition of these interconnected changes may be supportive for planning prevention, a timely diagnosis, and individualized care, based on considerations like skin fragility, associated disease, and treatment burden in older patients.
Background: Patent foramen ovale (PFO) is an anatomical variant in which the normal fetal interatrial passage persists after birth. It is estimated to be present in approximately 25% of adults. Furthermore, it appears to be involved in 50% of cryptogenic strokes. A cryptogenic stroke means the etiology remains unknown despite a thorough assessment (including arterial imaging, echocardiography, rhythm monitoring, and relevant laboratory testing, such as lipid profile and hemoglobin A1c). Secondary prevention options after a PFO-associated stroke consist of antiplatelet therapy, anticoagulant therapy, or percutaneous closure of the PFO, and it is still debatable which option is better. Objective: To critically review the available evidence regarding PFO closure vs. medical therapy as the optimal therapeutic option for secondary prevention after PFO-associated cryptogenic stroke, and to discuss relevant factors for patient selection. Methods: We conducted a focused review and searched the PubMed database for relevant literature on the subject. We included records about patients with PFO and a history of stroke. We chose to include only the free full-text sources. On the other hand, studies regarding children, studies comparing different devices or techniques, and observational studies on long-term complications and recurrence predictors were excluded. Results: Eight records were included, comprising 3750 participants, all diagnosed with PFO and stroke, to compare different therapeutic strategies for preventing stroke recurrence (PFO closure versus medical therapy). Conclusions: The results indicated that closure of PFO may provide greater protection against recurrent stroke than medical therapy alone in adequately selected patients with PFO-associated cryptogenic stroke. Additionally, given the lack of recent studies, further research is warranted to improve patient selection and evaluation of medium- and long-term prognosis.
Dental implants have risen as the gold standard for oral rehabilitation, offering predictable outcomes and improved quality of life for patients with missing teeth. However, postmenopausal women constitute a distinct patient population due to the systemic effects of estrogen deficiency, particularly on bone metabolism. The decline in estrogen levels following menopause can negatively impact bone remodeling, potentially influencing osseointegration and the long-term success of dental implants. This review aims to evaluate the current evidence regarding implant outcomes in postmenopausal women, examine the biological implications of hormonal changes on bone physiology, quality, and quantity, and provide evidence-based clinical recommendations to enhance treatment planning and optimize outcomes in this demographic segment.
Introduction: Athletes generally seek alternatives for muscle recovery after exercise in order to alleviate the resulting pain and accelerate muscle recovery. One of the commonly used procedures is the intermittent pneumatic compression (IPC) method. Objective: Analyze the effects of IPC on muscle pain and physical recovery after fatigue. Methods: A systematic review with meta-analysis registered in the PROSPERO platform (CRD42024530298) was conducted, following the PRISMA guidelines, using the PICOS approach. Eligible studies focused on individuals who used IPC as an intervention method and its effects on the components of physical conditioning and recovery. Quality, certainty of evidence, and completeness of descriptions were assessed using different tools. Results: 10 articles met the eligibility criteria. Meta-analysis data showed that interventions through IPC had a significant effect in favor of the experimental group in the outcome flexibility (SMD = -0.30; CI = 95%; -0.56 to -0.05), subjective perception of recovery (SMD = -0.22; CI = 95%; -0.40 to -0.05) and delayed onset muscle soreness (SMD = - 0.34; CI = 95%; -0.51 to -0.17). Conclusion: IPC can become a superior option to passive recovery. In turn, the meta-analysis suggested a beneficial effect of IPC on flexibility, PSR, and DOMS after intervention.
Health literacy, representing the ability to understand and apply health information, is a key determinant of public health. In Eastern Europe, decades of underinvestment in health education, socioeconomic disparities, and institutional mistrust have contributed to persistently low levels of health literacy. Objective: This review synthesizes evidence on the social consequences of inadequate health literacy in Eastern Europe, focusing on behavioral, structural, and policy-related outcomes. Methods: A narrative literature review was conducted using PubMed, Scopus, Web of Science, Google Scholar and institutional reports. Studies were included if they examined health literacy, public medical education, and social outcomes in Eastern European populations. Results: The synthesis of evidence identified four major thematic domains through which inadequate health literacy is associated with negative outcomes in Eastern European populations. Low health literacy is consistently associated with preventable disease, poor health behaviors, limited uptake of preventive services, and reduced adherence to medical advice. Vulnerable groups bear a disproportionate burden. Inadequate health knowledge is also associated with increased and inappropriate healthcare utilization, delayed care-seeking, and higher rates of avoidable mortality. Furthermore, low health literacy is plausibly linked to the proliferation of health misinformation, erosion of trust in healthcare systems, and has contributed to excess mortality during public health crises such as the COVID-19 pandemic. Discussion: The observed patterns are shaped by historical and structural factors, including the postcommunist legacy of under-resourced health systems and the persistent under-prioritization of preventive care. Eastern Europe is a heterogeneous region, and the availability of health literacy data varies considerably across countries, limiting the generalizability of findings. At the clinical level, healthcare providers play a key role in identifying low health literacy, adapting communication strategies, and addressing vaccine hesitancy and misinformation. Addressing these challenges requires coordinated strategies, investment in education, culturally tailored communication, and cross-sectoral collaboration. Improving public health literacy can enhance health outcomes, reduce system costs, and strengthen societal resilience. Conclusions: This review underscores the challenges associated with health literacy in Eastern Europe, illustrating how insufficient health literacy contributes to detrimental behaviors, undermines trust in healthcare systems, exacerbates misinformation, and ultimately imposes a significant societal and systemic burden on public health.
Background: Health promotion and prevention are becoming increasingly important in the context of the growing prevalence of chronic diseases, population aging, and the shift towards patient-centered care. Objective: This review examines the relationship between health promotion, lifestyle medicine, and medical prevention, with particular emphasis on the convergence between general medicine and dentistry and on the positioning of the conceptual framework of Individual Health–General Health– Primordial Health–Total Health. Methods: A narrative review with a conceptual component was conducted. Relevant literature was identified through thematic searches in PubMed and Google Scholar. Sources were selected according to their relevance to the objectives of the review. The quality and applicability of the evidence were considered in relation to the type and authority of the source, its relevance, and its consistency with the literature and reference frameworks used. Results: The literature identifies several risk factors shared by oral and systemic health, including diet, smoking, obesity, chronic inflammation, and stress. These interrelationships support the integration of prevention, health education, and interventions targeting modifiable behaviors into both medical and dental practice. Conclusions: Closer collaboration between general medicine, dentistry, and public health may facilitate a more coherent framework for preventive care. The proposed conceptual model may provide a starting point for future research.
Introduction: Operational cardiology is an emerging field of military medicine focused on cardiovascular risk assessment and maintaining mission fitness. Military activities involve intense physical exertion, operational stress, sleep deprivation, and occupational exposures that can trigger acute cardiovascular events, including in apparently healthy individuals. The aim of this review is to synthesize data on cardiovascular risk in the military population and its implications for determining mission fitness. Materials and Methods: This review included 52 studies published between 2000 and 2026, identified in PubMed/MEDLINE, Web of Science, and Scopus. The papers were analyzed thematically: cardiovascular epidemiology, sudden cardiac death, specific risk factors, impact of exertion and operational stress, cardiovascular screening, and physiological monitoring. Results: Cardiovascular events occur predominantly during intense exertion and are frequently associated with previously undiagnosed pathology. Traditional risk factors coexist with operational stressors, increasing cardiovascular load. Cardiovascular screening and cardiorespiratory fitness assessment allow risk stratification and identification of overload. Conclusions: Integration of cardiovascular screening, fitness assessment, and physiological monitoring may reduce the risk of cardiovascular events and optimize operational safety. Standardized protocols adapted to the military environment are needed.
