This study aims to conduct a comprehensive bibliometric analysis to evaluate the scope and progression of Artificial Intelligence (AI) and Machine Learning (ML) applications in Chronic Rhinosinusitis (CRS) within the field of otorhinolaryngology. Specifically, the objective is to analyse publication trends, collaboration networks, and thematic focus areas in the relevant literature, providing insights into the current state and future directions of AI and ML in managing CRS. A comprehensive literature search was conducted in Scopus and PubMed databases for studies published between 1987 and 2024, focusing on AI and ML in CRS. The bibliometrix package in R was utilized for data analysis, including performance assessment, science mapping, and network analysis to identify key contributors, collaboration patterns, and emerging themes within the research landscape. The analysis of 102 documents shows a consistent annual publication growth of 5.78
Primary cutaneous adnexal adenocarcinoma not otherwise specified (PCAANOS) is a rare malignant neoplasm derived from adnexal structures, often posing diagnostic challenges due to nonspecific morphology and immunohistochemical overlap with metastatic adenocarcinomas. We describe a case of PCAANOS and review key diagnostic considerations, including histopathology, immunohistochemistry, and radiologic evaluation, emphasizing the necessity of excluding cutaneous metastasis. PCAANOS commonly affects older adults and may recur or metastasize. Accurate diagnosis requires comprehensive evaluation. Therapeutic guidelines remain undefined; management typically involves complete surgical excision. Multidisciplinary management is essential given the rarity and therapeutic complexity of PCAANOS.
BACKGROUND:Albeit the numerous guidelines on pre-operative fasting in pediatric patients, clinical practice varies. Prolonged fasting can result in several complications, hypoglycemia being one of them. This systematic review and meta-analysis (SRMA) was conducted to assess the effect of prolonged pre-operative fasting on the incidence of hypoglycemia in pediatric patients posted for elective surgery. MATERIALS AND METHODS:Relevant studies (observational and randomized controlled studies [RCTs]) with fasting duration and incidence of hypoglycemia were identified from data sources (Medline, Scopus, Cochrane Library, Google Scholar) using a systematic search strategy. A pooled relative risk (RR) of hypoglycemia and ketosis due to prolonged fasting was calculated from the RCTs. RESULTS:This SRMA included 42 studies (15 RCTs and 27 observational studies) involving 5121 patients. There was a wide variation in the definition of hypoglycemia, fasting duration, and incidence of hypoglycemia across the studies. The pooled RR for hypoglycemia was 2.0 (95% CI: 0.57-7.03, I2 = 0.00%, p = 0.28) in the prolonged fasting group compared to the non-prolonged fasting group. Although statistical significance was not reached, the direction and magnitude of the pooled effect suggest a clinically meaningful trend toward a lower risk of hypoglycemia with adherence to recommended fasting durations compared with prolonged fasting. CONCLUSION:The findings of the review revealed the need for standardized outcome definitions and fasting protocols to enable comparisons across future studies. The meta-analysis revealed a variable relationship between fasting duration and hypoglycemia incidence. Structured interventions to facilitate the implementation of guidelines in clinical practice may mitigate the problem.
Background:CAR T-cell therapy represents a substantial advance for relapsed/refractory hematologic cancers, but toxicities still limit its benefits. A particular concern is immune effector cell-associated neurotoxicity syndrome (ICANS), whose mechanisms remain only partly resolved. In parallel, work across immunology and neurogastroenterology shows that gut microbial communities can shape systemic inflammation and show correlations with brain function. Together, these strands suggest-without yet proving-that microbiome features could bear on both CAR T efficacy and ICANS risk. Objectives:We examined human clinical evidence at three touchpoints: how CAR T and the gut microbiota interact; how gut profiles relate to brain function; and which signals accompany CAR T-related neurotoxicity. The aim was to locate areas of overlap, not to claim a single causal chain. Methods:Following PRISMA, PubMed, Scopus, and Embase were searched from 2015 to 11 April 2025. We included randomized trials, prospective cohorts, and retrospective series reporting gut microbial composition, inflammatory or neurobiological markers, CAR T outcomes, or ICANS. Study quality was appraised with the Newcastle-Ottawa Scale and certainty graded with GRADE. Results:Twenty-five studies were included (four CAR T-gut, eleven gut-brain, ten CAR T-neuro). Recurrent signals were (i) reduced microbial diversity, (ii) loss of short-chain fatty-acid producers, and (iii) prior antibiotic exposure-each linked to poorer clinical outcomes and higher or more severe ICANS. Candidate markers (e.g., C-reactive protein, interleukin-6, neurofilament light chain) and imaging findings, including PET abnormalities, were reported but remain exploratory and variably measured. Included studies are small and methodologically varied, and results should be interpreted with caution. Conclusion:Taken together, the data support a convergence model: the gut microbiota may correlate with both treatment efficacy and neurotoxicity in CAR T recipients. The signal is consistent yet preliminary. Microbiome interventions such as probiotics and FMT are investigational and not yet recommended for CAR T recipients. Prospective, mechanism-rich studies-ideally pairing longitudinal stool profiling with inflammatory panels and neuroimaging-are needed before clinical translation. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42024548645.
BACKGROUND:In advanced Parkinson's disease (PD), the clinical response to oral levodopa diminishes over time, leading to dyskinesia and unpredictable "off" periods. In PD patients with dementia, those with a Ryle's tube in situ, or those who decline existing levodopa delivery routes such as intraduodenal, subcutaneous, or oral inhalation, alternative approaches are required. This study evaluates a novel maxillofacial route and platform as a clinically viable alternative to conventional levodopa delivery methods. OBJECTIVE:This study evaluates the feasibility and safety of low-dose levodopa administered using a maxillofacial platform in a PD patient and assesses systemic exposure and its relationship to clinically meaningful motor outcomes over a 24-hour period following dosing at regular intervals. METHODS:A PD patient received four cycles of 5 mg levodopa (one-twentieth of the patient's usual oral dose) through a maxillofacial route at regular 3.5-hour intervals. Levodopa was administered using a maxillofacial platform designed to enable controlled, repeated dosing through this route. The patient was monitored over a 24-hour period. Motor outcomes were assessed using the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III: Motor Examination (ME). Clinically meaningful improvement was evaluated using Minimal Clinically Important Difference (MCID) thresholds. Plasma levodopa concentrations were quantified using high-performance liquid chromatography (HPLC). Local and systemic adverse events were monitored throughout the study period. RESULTS:MCID-level improvement was observed in 16 (94%) post-dose MDS-UPDRS assessments. Robust improvement was observed in 13 (76%) post-dose assessments. The median improvement from baseline was nine points, the interquartile range (IQR) was eight points (5-13), and the observed range was fourteen points (2-16). Clinically meaningful benefit was detected within 30-60 minutes, peaked at 1-2 hours, and persisted for approximately 3 hours per dose. Robust motor responses occurred across a wide range of systemic exposures, demonstrating a temporal and quantitative dissociation between plasma levodopa area under the concentration-time curve (AUC) and clinical effect. No local or systemic adverse events were observed. CONCLUSION:Low-dose levodopa administered at regular intervals through the maxillofacial platform yielded reproducible and clinically meaningful improvement. The platform was safe, effective, and well tolerated over the 24-hour study period.
