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Humanin is a mitochondrial-derived peptide with cytoprotective properties, but how it has evolved in response to different oxidative stress levels in mammals is not fully understood. This study examines how Humanin sequences have adapted to species-specific metabolic and environmental pressures. We compared the peptide in several mammalian species categorized by their distinct oxidative stress profiles: small mammals such as shrews with high metabolic rates and elevated endogenous ROS production, cetaceans exposed to hypoxia-reoxygenation cycles during deep diving, and long-lived primates facing cumulative oxidative stress over extended lifespans. Using bioinformatic tools, we analyzed physicochemical traits such as structural stability, the aliphatic index, and oxidation susceptibility. We also used protein-protein docking to estimate binding affinities between Humanin variants and key ligands like BAX and FPRL1. Our results show that Humanin is not a static molecule. Species facing high oxidative stress, such as cetaceans and bats, possess variants that are more stable and chemically robust. In contrast, species with high ROS production but lower antioxidant capacity, like the shrew, have less robust versions of the peptide. Simulation data indicate that variants from mammals living in extreme conditions maintain or improve interactions with proteins involved in cell survival. These findings suggest that evolution has tuned Humanin to optimize mitochondrial protection across different physiological contexts. These natural isoforms provide a structural basis for designing new therapeutic analogs to treat oxidative stress-related diseases in humans.

Seasonal changes, particularly increased daylight exposure, are known to influence dopamine transporter (DAT) availability, potentially affecting mood disorders such as major depressive disorder (MDD). This study aimed to evaluate seasonal variations in the striatum using ¹²³I-FP-CIT SPECT in patients with MDD, and examine associations with specific psychopathological symptoms. In this retrospective study, DAT SPECT scans from 85 patients with MDD were analyzed according to the season of imaging-fall-winter (FW) or spring-summer (SS). Psychometric assessments included the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Snaith-Hamilton Pleasure Scale (SHAPS), and Depression Retardation Rating Scale (DRRS). No overall differences in DAT availability were observed between FW and SS. However, anhedonia levels were higher in FW (p = 0.050). Patients with severe depression (HAMD ≥ 25) showed lower DAT availability in the left putamen, especially during SS (p = 0.014). Patients with marked psychomotor retardation (DRRS ≥ 18) exhibited reduced DAT availability in the left putamen (p = 0.002), with further reductions across all striatal regions during SS. Patients with suicidal ideation showed decreased DAT in the right (p = 0.029) and left putamen (p = 0.015). A negative correlation was found between DRRS scores and left putamen DAT availability (p = 0.034). Reduced DAT availability is associated with key depressive symptoms, notably psychomotor retardation and suicidal ideation. Seasonal effects, especially in the SS period, may exacerbate dopaminergic dysregulation. These findings support integrating seasonal and neurobiological factors in the assessment and management of severe MDD.

Electronic portfolios (e-portfolios) are increasingly used in healthcare professional education (HPE) to support learning, reflection and professional development. Despite their broad adoption, there is limited synthesis on how e-portfolios are structurally designed and pedagogically implemented across healthcare programmes and on the implications for clinical teachers. A narrative review was conducted following the Scale for the Assessment of Narrative Review Articles (SANRA). Literature search was conducted in PubMed, Web of Science, Scopus and CINAHL between January and February 2025. Twelve studies published between 2012 and 2024 were included. Data were analysed to explore e-portfolio structures, educational uses and reported effects on reflection and learning. E-portfolios were implemented in various educational and clinical settings, showing considerable variation in platform design, structural components and curricular integration. Common features included reflective writing, documentation of clinical experiences, feedback mechanisms and assessment rubrics. Studies reported that e-portfolios integrated into structured pedagogical frameworks and supported by training and mentoring promote reflective practice, student engagement and professional identity development. Conversely, inconsistent implementation, technological barriers or checklist-oriented designs were associated with superficial engagement and limited educational value. The educational value of e-portfolios in HPE lies less in the technology itself and more in how these tools are pedagogically designed, supported and contextualised within clinical education. For clinical educators, attention to flexibility, relevance to practice and ongoing guidance may be key to promoting meaningful reflection rather than procedural completion. Further research is needed to identify best practices and improve adaptability in different healthcare education contexts.

This study compared the clinical outcomes of the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations for the management of acute midsubstance Achilles tendon ruptures (AMATR). A retrospective analysis was conducted on 63 AMATR patients (54 men and 9 women, with a mean age of 39.84 ± 10.40 years (range, 21-62 years). All patients underwent Achilles tendon repair using the modified Bunnell suture configuration using the all-inside endoscopic repair (n = 31) or a minimally invasive repair (n = 32). The primary endpoint was postoperative functional outcome, assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS) at 6, 12, and 24 months. Secondary endpoints included perioperative and short-term recovery parameters, including operative time, incision length, postoperative pain assessed by the Visual Analog Scale (VAS) on postoperative days 1 and 3, wound complications, and time to return to work and sports activities. There were no intraoperative complications, and all patients in the endoscopic group achieved primary wound healing. At the 6-, 12-, and 24-month follow-up, both groups demonstrated significant improvement in AOFAS and ATRS scores over time, with no significant differences between groups. Regarding secondary endpoints, the all-inside endoscopic group had a significantly longer operative time but a significantly shorter incision length compared with the minimally invasive group (p < 0.05). VAS pain scores on postoperative days 1 and 3 were significantly lower in the endoscopic group (p < 0.05). No wound infections occurred in the endoscopic group, whereas three superficial infections were observed in the minimally invasive group; however, the difference was not statistically significant. Patients in the endoscopic group returned to work one week earlier (p < 0.05), while the time to return to sports was comparable between groups. Both the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations provide reliable repair for AMATR and support a successful return to occupational and athletic activity. While the all-inside endoscopic procedure was associated with a longer operative time, it offered advantages in terms of reduced early postoperative pain, smaller incisions, and earlier return to work, without compromising functional recovery at the 2-year follow-up.

Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses. Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword 'orthopaedic'. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates. Larger author teams were associated with higher citation rates (β = 0.108 citations/year per additional author, 95% confidence interval [CI] 0.103-0.114, p < 0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p = 0.001). Title length in characters correlated positively with citation rate (β = 0.023 per character, p < 0.001), whereas title length in words showed a negative association (β = -0.183 per word, p < 0.001). The presence of a colon (+0.314 citations/year, p < 0.001) or dash (+0.187, p = 0.001) increased citation performance, while question marks (-0.476, p < 0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p < 0.0001). In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more critical than citation metrics.

Background/Objectives: Oral mucositis (OM) is a common complication in onco-hematological patients undergoing chemotherapy and hematopoietic stem cell transplantation, negatively affecting comfort, nutrition, and quality of life. Despite existing assessment tools and recommendations, OM management-particularly non-pharmacological approaches-remains inconsistent, and evidence on nurses' perspectives and contextual factors is limited. This study explored nurses' perceptions and experiences regarding non-pharmacological treatments for OM, including educational needs and barriers and facilitators to implementation in clinical practice. Methods: A qualitative descriptive study using inductive content analysis was conducted. Semi-structured interviews were carried out with nurses working in onco-hematological settings in Italy. Data were analysed according to the Elo and Kyngäs framework. Results: Twelve nurses with extensive experience in onco-hematology and transplant care participated in the study. Five main themes emerged: (1) education and training pathways; (2) approaches to mucositis management; (3) nursing competence in OM care; (4) interprofessional collaboration; and (5) governance of practice, including protocols and guidelines. Findings highlighted strong experiential competence, high levels of nursing autonomy in assessment and patient education, and effective interprofessional collaboration, particularly in specialised settings. However, training pathways were predominantly informal, and the availability and use of protocols varied widely across clinical contexts. Conclusions: Non-pharmacological management of OM appears to be sustained primarily by advanced nursing competence and a specialised clinical culture rather than by structured education and standardised governance. Addressing educational gaps and promoting shared protocols may enhance the consistency, quality, and equity of supportive care while ensuring that the findings are clearly reflective of nurses' experiences.

The performance of breast MRI (bMRI) depends on image quality, varying due to patient-related or technical/protocol factors. The resulting artifacts can heavily reduce sensitivity and specificity. We developed a bMRI quality scoring system (bMRI-QUAL) for the bMRI standard protocol. Two independent readers with 3 years of experience evaluated 133 consecutive 1.5-T examinations (sample size calculated to ensure reproducibility). Each sequence was rated on a 4-point scale: 0 = not diagnostic; 1 = relevant artifacts with conserved diagnostic value; 2 = slight artifacts with conserved diagnostic value; 3 = excellent image quality. Each score was weighted in the following formula: (T2-weighted * 1) + (diffusion weighted imaging with b = 0 * 0.5) + (apparent diffusion coefficient maps * 0.5) + (T1-weighted-precontrast * 1) + (T1-weighted-postcontrast * 2) + (T1-weighted-subtracted * 3). This sum was divided by 2.4, obtaining a 0-to-10 global score (GS), with < 6 considered insufficient. The average GS between the two readers was 8.3 ± 1.0, with 102/133 examinations (76.7%) receiving a score ≥ 7 from both readers. Only one case (0.8%) was scored < 6 by both readers. The Bland-Altman analysis showed bias of -0.12, with limits of agreement ranging from -2.52 to +2.29. The difference in GS between the two readers (coverage probability) was 72/133 (54.1%) within ±1 and 123/133 (92.5%) within ±2. Coverage probability within ±1 point ranged from 94.0% to 99.2% across sequences. Average evaluation time/examination was 3 min. bMRI-QUAL is a reproducible quality scoring system. Breast MRI image quality at a tertiary cancer center was good to excellent in approximately 80% of cases. QuestionBreast MRI image quality varies widely and can compromise diagnostic accuracy. A standardized, clinically weighted scoring system is needed to guide repeat-scan decisions and facilitate quality assurance. FindingsIn 133 breast MRIs, the bMRI-QUAL 0-to-10 scoring system proved to be reproducible. Readers assigned a good-to-excellent mean score (8.3) with a 3-min evaluation time. Clinical relevancebMRI-QUAL provides a relatively fast and reproducible evaluation of breast MRI image quality, with each sequence weighted according to its clinical relevance for lesion detection/characterization. It can support decision-making regarding insufficient image quality and facilitate quality assurance protocols.

The aim of the study was to assess the effect of titanium scanbody (Ti ISB) repeated use on the accuracy of complete-arch implant impression in vitro. A mandibular resin model with four conical connection implant analogues was digitized using an extraoral scanner to achieve a reference file. Thirty-eight test files were obtained with an intraoral scanner (IOS) and superimposed to the reference file. Screw-retained sand-blasted Ti ISB were screwed and unscrewed between each test scan. Implant positions (n=152) were analyzed through linear (∆X, ∆Y and ∆Z- axis) and angular deviations (∆ANGLE). Three-dimensional (3D) deviation was calculated as Euclidean distance (∆EUC) from the linear deviations. Effect of implant position was also calculated. A significative reduction of ∆EUC over time (p=0.001, b=-0.00099) was noticed, with position 4.5 as the least accurate with a significant difference compared to 3.2. Considering ∆ANGLE a significant reduction was noticed over time (p=0.041, b=-0.0031), with position 4.5 as the least accurate with a significant difference compared to 3.2 and 4.2. Conclusions: Ti ISBs repeated use didn’t show a significant negative effect on complete-arch IOS implant impression accuracy both in terms of angular and 3D deviation. Implant position showed a significant effect on accuracy with posterior tilted identified as most critical positions.

Neurodegenerative disorders (NDs), such as Alzheimer's disease and Parkinson's disease (PD), represent a significant challenge for ageing populations, with their prevalence increasing worldwide. Elevated human Monoamine Oxidase B (hMAO-B) activity has been related to neurodegenerative progression, where it contributes, among others, to oxidative stress and neuroinflammation. The identification and optimization of selective hMAO-B inhibitors is therefore pivotal in addressing the progression of NDs. In this work we introduced 2-aroylbenzothiophene analogues as promising agents to mitigate neurodegeneration. The synthesized compounds were screened against hMAO-A and hMAO-B, identifying compounds 4, 11, and 12 as the most promising. In vitro studies in hGF and SH-SY5Y cells revealed distinct toxicity profiles, with compound 4 being the least tolerated at 100 µM. ROS generation was investigated as a possible mechanism underlying this toxicity. Compounds 4 (12.5 µM), 11, and 12 (100 µM) were further evaluated for neuroprotective effects against 6-hydroxydopamine (6-OHDA)-induced toxicity in SH-SY5Y cells, showing a modest neuroprotective effect after 72 h at a sub-toxic 6-OHDA concentration (250 µM), comparable to the clinically used hMAO-B inhibitor (R)-(-)-Deprenyl at 100 µM. Finally, molecular modelling studies revealed that compound 4 establishes key stabilizing interactions within hMAO-B, accounting for its high inhibitory potency and selectivity over hMAO-A.