Cone-beam computed tomography (CBCT) has expanded from dento-maxillofacial radiology to otorhinolaryngology, being proposed as a low-dose alternative to multidetector computed tomography (MDCT) for evaluating uncomplicated sinonasal disease and for surgical planning. Major guidelines (EPOS, ICAR-RS, ACR) recommend native high-resolution CT for bone and MRI for loco- regional complications, while the role of CBCT remains focused on bone anatomy and the oro-sinusal interface. The objective of this review was to systematically synthesize the evidence on the diagnostic performance, radiation dose, indications/contraindications, and limitations of CBCT in sinonasal pathology, and to propose a practical algorithm for its use. The methodology consisted of searching PubMed/Medline and “gray” literature (professional society positions, guidelines) until September 2025; relevant guidelines/consensuses and original/comparative studies reporting the utility of CBCT for rhinosinusitis (acute/chronic), odontogenic sinusitis, fungal pathology, anatomical variations, pre- and intraoperative planning, doses/technical parameters were included. Papers focused exclusively on non-sinonasal pathology or on contrast-enhanced CBCT were excluded. The synthesis is narrative, oriented towards clinical questions. The key results were: (1) CBCT provides an excellent representation of the bone anatomy of the osteomeatal complex, with superior spatial resolution to MDCT, but with clearly inferior tissue contrast (limiting the evaluation of complications, soft tissues, and perisinusal extension); (2) the effective dose of CBCT for sinuses typically varies ~0.05–0.48 mSv depending on the protocol/FOV, usually below conventional MDCT, but not consistently below ultra-low-dose MDCT or photon- counting CT (PCCT) protocols, which can achieve even lower doses with superior image quality; (3) tor uncomplicated chronic rhinosinusitis (CRS), CBCT correlates well with endoscopy and is adequate for scoring (e.g., LM analog), assessing anatomical variations, and planning FESS; for orbital/intracranial complications, suspected tumors, or invasive fungal rhinosinusitis, CBCT does not replace CT/MRI; (4) In odontogenic sinusitis (ODS), CBCT is the first-line investigation because it finely delineates dental pathology, oro-antral defects, and foreign bodies, and consensus recommendations support its use guided by indications; (5) Intrinsic limitations: poor tissue contrast, uncalibrated/unreliable HU values, metal artifacts, and sometimes restrictive FOV; (6) In the clinical setting, “point-of-care” CBCT shortens the diagnostic pathway and can reduce costs/delays, but careful case selection and adherence to the justification principle are essential. In conclusion, CBCT has robust diagnostic value for uncomplicated rhinosinusal disease and for the dento-sinusal interface, with the advantage of dose and access, but it does not substitute MDCT/MRI in risk/complication scenarios. Responsible implementation, according to guidelines and radioprotection principles, maximizes benefits and minimizes risks.
Background: COVID-19, declared a Public Health Emergency of International Concern, affected hospital operations by increasing the number of patients presenting to hospitals, the necessity to control infections, and the shortage of staff. Through our study, we evaluated the quality and quantity of care and how these changes affected patient experience and outcomes, and we identified actionable methods in order to prepare for the future. Methods: We analyzed data between 2020 and the first half of 2023 from a Romanian tertiary military hospital using patient-reported experience surveys and operational indicators (readmissions, postoperative complications). Associations were assessed using Pearson and Spearman correlation coefficients. We then benchmarked against an ideal surge-ready hospital using a 0-1 Composite Risk Index (CRI) that integrates occupancy, adverse-event density, flow reliability, and readmissions. Results: Overall satisfaction was strongly influenced by satisfaction with medical care (p < 0.001). Higher overall satisfaction was associated with fewer readmissions. Benchmarking showed the highest risk in the ICU, intermediate in Surgery and Internal Medicine, moderate in the ED, and the lowest in the Ambulatory. Satisfaction was highest in the initial period of the COVID-19 pandemic, dropped in 2022, and showed partial recovery at the end of this period. Conclusions: Quality of care is a critical measure of hospital performance, especially in the context of the COVID-19 pandemic. Patient feedback revealed areas of good practice and also the limits of the system, influenced by the burden of multisystem disease and limited resources. Post-COVID-19 disability outcomes are strongly influenced by the quality and continuity of care. Systematic use of patient- reported outcomes, standardized evaluation, and adaptive rehabilitation is essential to preserve the quality of care and reduce long- term functional impairment.
Objective: To analyze the psychological impact of exposure to conflict zones on active-duty soldiers and to evaluate the role of physical activity as a mitigating factor against stress-related effects. Background: Combat exposure is associated with increased psychological stress, sleep disturbances, and reduced well-being among military personnel. Understanding modifiable protective factors like physical activity is crucial for improving resilience and mental health in operational settings. Method: A total of 261 male Colombian Army personnel participated in the study. Standardized psychological scales (STAI, LES, UCLA Loneliness Scale, AAQ-II, PSS-14) and custom questionnaires assessing sleep, happiness, and physical activity were used. Statistical analyses included t-tests and ANOVAs to examine group differences and correlations. Results: Soldiers exposed to traumatic events or prolonged time in red zones reported significantly lower sleep quality and happiness levels. Those engaging in more than 120 minutes of physical activity per day reported significantly lower perceived stress scores compared to less active peers. Conclusion: Exposure to conflict zones adversely affects psychological well-being, particularly in sleep quality and happiness. However, increased physical activity is associated with lower perceived stress, suggesting its protective role. Application: These findings support the integration of structured physical activity programs as a practical and scalable intervention to promote resilience and reduce stress among active- duty military personnel.
Background: The COVID-19 pandemic exposed substantial shortcomings in emergency hospital systems, demonstrating that conventional linear models fail to accurately depict the intricate interdependencies among clinical, operational, and infrastructural components. This research employs nonlinear and fractal analytical frameworks to characterize and forecast the dynamic behavior of the principal emergency clinical hospital in Iași, Romania, for the years 2020–2022. Methods: The study employed a mixed-methods approach, combining retrospective analysis of hospital risk factors (infection rates, staff absenteeism, and ICU occupancy) with computational simulations. We analyzed time-series data using several nonlinear metrics, including the Higuchi fractal dimension, Lyapunov exponents, Shannon entropy, and multifractal detrended fluctuation analysis (MF-DFA). A modified Lotka–Volterra system was utilized to simulate feedback mechanisms between clinical and operational stressors. Results: The analyzed variables demonstrated nonlinear dynamics and fractal self-similarity across temporal scales (Hurst exponent = 0.73 ± 0.04; D_H = 1.35–1.49). Positive Lyapunov exponents (λ > 0) indicated deterministic chaotic behavior, whereas the multifractal spectrum width (Δα ≈ 0.62) indicated heterogeneous scaling patterns across hospital departments. Increasing fractal complexity was closely associated with diminished clinical efficiency and staff availability. Conclusions: The progression of pandemic-related risk followed a trajectory consistent with self-organized criticality, transitioning from stable to oscillatory and ultimately to chaotic phases as system load intensified. Adding nonlinear markers such as fractal dimension, Lyapunov exponents, entropy, and multifractal parameters to hospital monitoring systems could improve early warning systems and make it easier for healthcare organizations near critical thresholds to manage risk
Background: Although CBCT was introduced in dentistry, it has a specific role in rhinology for assessing uncomplicated maxillary sinusitis. CBCT offers valuable information on anatomy and pathology with a low irradiation dose. Methods: We performed a systematic search on PubMed on the use of CBCT in detecting maxillary sinus pathology and the relation between dental lesions and maxillary sinusitis. Results: Specific findings, such as mucosal thickening, retention cysts, or antroliths, have been found to be associated with dental problems. These alterations can be incidental findings during the management plan for patients with dental problems, but can also be the reason that prompts the patient to perform the imaging investigation. Conclusions: The literature on the topic is quite comprehensive and clarifies percentages and the correct use of CBCT. As a minimally invasive procedure, CBCT finds its utility in assessing patients with dental problems, as they are more prone to accepting this fast, pain-free, and non- claustrophobic method. There are several limitations, such as the not-so-large target area and the less-than-average, limited pictures. However, CBCT remains a valuable tool that can be used for patients with suspected sinus problems that require dental treatment to ensure there are no future sinus complications.
Mental health stigma (MHS) among military personnel requires a complex approach, as it is influenced by ethical challenges and organizational norms distinct from those in civilian milieus. Stigmatization encompasses multiple dimensions -including social, self, anticipated, cultural, and structural stigma- that must also be examined within military settings. This article presents a conceptual analysis of key research directions in the field of MHS, based on a literature review conducted across three electronic databases (PubMed, Google Scholar, and Clarivate/Web of Science), from the inception of each database up to June 2025. The review focuses on active-duty service members and veterans, and identified six major domains involving MHS: (1) structural stigma within military contexts, (2) risk factors and consequences associated with MHS, (3) self-stigma among active-duty personnel and veterans, (4) the role of military healthcare providers in mitigating stigma, (5) military sexual trauma and its relationship to stigma, and (6) interventions aimed at decreasing MHS among military personnel. Although relevant primary and secondary studies were identified across these domains, significant research gaps remain, particularly in the last three areas. Addressing MHS in military populations is essential not only for improving quality of life, psychological well-being, and daily functioning, but also for maintaining combat readiness, unit cohesion, and peer acceptance.
Background and purpose: Colorectal cancer is one of the most prevalent cancers globally, representing a significant public health challenge. Treatment methods include surgery, chemotherapy, and targeted therapies, selected based on disease stage and patient status. Common cancer treatments, such as chemotherapy and radiation therapy, often induce considerable side effects, including fatigue, nausea, hair loss, and blood disorders, which can impact patients' quality of life. Consequently, researchers are focusing on developing novel drugs and targeted therapies aimed at reducing side effects while enhancing treatment efficacy. Innovative therapies, including bacterial and oncolytic viruses, can specifically target cancer cells while sparing healthy tissues. The present study aims to compare the cytotoxic effects of Lactobacillus casei extract with Newcastle disease virus on human colorectal cancer. Materials and methods: Human colorectal cancer cells were cultured and treated with various concentrations of Lactobacillus casei extract and Newcastle disease virus to determine the IC50. Cell viability and apoptosis rates were then assessed using MTT assay and acridine orange/propidium iodide staining. Statistical significance was set at P<0.05 for all evaluations. Results: The results demonstrated that both Lactobacillus casei extract and Newcastle disease virus significantly reduced cell viability and increased apoptosis in a concentration- and time-dependent manner. Caspase-8 and -9 activity measurements indicated that Newcastle disease virus and Lactobacillus casei extract activated both the mitochondrial and extrinsic apoptotic pathways. Conclusion: Based on the findings, it appears that bacterial and oncolytic viruses could be considered as complementary therapeutic options alongside chemotherapy and radiotherapy, following clinical trials.
[¹⁸F]FDG PET/CT enables in vivo quantification of cerebral glucose metabolism, revealing functional abnormalities before morphological changes on CT or MRI. This review summarizes major clinical indications, methodological aspects, and key metabolic patterns. In cognitive impairment, [¹⁸F]FDG PET is a core biomarker within the amyloid/tau/neurodegeneration (A/T/N) framework, predicting conversion from mild cognitive impairment (MCI) to Alzheimer’s disease (AD) and differentiating AD, dementia with Lewy bodies (DLB), frontotemporal lobar degeneration (FTLD), vascular dementia, and atypical parkinsonian syndromes (APS). In movement disorders, it distinguishes Parkinson’s disease (PD) from APS – including multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS) – and supports prognosis in amyotrophic lateral sclerosis (ALS) and Huntington’s disease (HD). In epilepsy, interictal hypometabolism aids localization of the epileptogenic zone, especially in MRI- negative cases, while in neuro-oncology, [¹⁸F]FDG PET assists in primary central nervous system lymphoma (PCNSL), glioma grading, and recurrence assessment. The review also highlights roles in inflammatory and infectious diseases, such as autoimmune encephalitis, neurosarcoidosis, and post-coronavirus disease 2019 (COVID-19) sequelae. Standardized preparation, glucose control, and statistical comparison with normal databases remain essential for accurate interpretation.
Knee osteoarthritis (KOA) is a chronic, degenerative disease that affects not only the bone and cartilage but also all periarticular soft tissues. Transcriptomic investigations in osteoarthritis have recently advanced due to the introduction of RNA sequencing, which has been used to elucidate significant molecular differences between groups of patients with KOA. A total of 29 patients with knee pain were selected and divided into two groups. Group 1 comprised 26 patients, who were diagnosed with stage four KOA according to the Kellgren and Lawrence (KL) classification and were scheduled for total knee arthroplasty. Group 2 consisted of three patients who constituted the control group. The main objective of this study is to analyze gene expression in suprapatellar synovial tissue using the RT-PCR technique in patients with knee osteoarthritis. The promising results of gene expression analysis highlight the complex transcriptomic profile of synovial tissue in patients with stage IV KL KOA who required TKA after conservative treatments failed. The analysis of the expression of four genes indicates that compensatory mechanisms are either insufficient or exhausted due to the chronic proinflammatory status. Pro-inflammatory transcription factors (JUN, MYC) and feedback regulators (DUSP1, NFKBIA) require extensive clinical trials for the use of disease-modifying drugs.
Loneliness is receiving more and more attention for being an important psychosocial contributor to the deterioration of quality of life, psychological well-being, onset of mental health disorders, but also to the increased mortality and morbidity, through the mediation of general health problems and suicide. While studies on the impact of loneliness in the civilian population have been steadily increasing in number over the past decade, research on the same phenomenon in military settings has progressed at a comparatively slower pace. This article is a two-stage analysis of the perceived lack of social connectedness among active-duty and former military personnel, including (1) a conceptual exploration and literature review based on searches in three electronic databases (PubMed, Google Scholar, and Web of Science/Clarivate), and (2) a pragmatical set of recommended strategies to reduce the impact of loneliness in these populations. Based on the review of 42 primary and secondary sources, the paper explores the prevalence, risk and protective factors, characteristics, and consequences of loneliness, with particular attention to various minorities, female military personnel experiencing motherhood during active duty, civilian spouses of deployed service members, and other significant subgroups. Recommended directions of interventions are threefold, i.e., screening for loneliness and its risk factors, initiation of prophylactic strategies and therapeutic interventions targeting this phenomenon in vulnerable categories. In conclusion, further research on loneliness in both active and former military personnel is strongly warranted, given its significant consequences for multiple dimensions of health and overall functioning.
