Gastric cancer (GC), often diagnosed at advanced or metastatic stages, remains a significant clinical challenge requiring novel biomarkers for early detection, risk stratification, and effective, personalized treatment optimization. Emerging evidence underscores a strong association between gut microbiome dysbiosis and GC initiation, progression, and therapeutic outcomes. This review explores the potential of the advanced/metastatic gastric microbiome as a source of diagnostic and targetable biomarkers and its role in modulating responses to immunotherapy. Although Helicobacter pylori (H. pylori) is the most significant risk factor for GC, several other gastrointestinal taxa-including Fusobacterium nucleatum (F. nucleatum)-have been implicated in advanced GC (AGC). At its inception, microbial dysbiosis contributes to chronic inflammation and immune evasion, thereby influencing tumor behavior and treatment efficacy. Integrating microbiome-based biomarkers into risk stratification, GC staging, and targetable treatment frameworks may enhance early detection, inform immunotherapy strategies, and improve patient-specific treatment responses. Bifidobacterium and Lactobacillus rhamnosus GG have the potential to change the immunotherapy framework with their direct influence on dendritic cell (DC) and cytotoxic T cell (CTL) activity. However, clinical translation is impeded by methodological heterogeneity, causality limitations, and a lack of clinical trials. Nonetheless, the integration of microbiome profiling and the development of therapeutic microbiome modulation strategies, such as personalized probiotics regimens and fecal microbiota transplantation, hold substantial potential for improving clinical outcomes and reducing treatment-related toxicity in GC management.
Sex-related differences in outcomes after catheter ablation for atrial fibrillation (AF) remain incompletely understood, particularly regarding long-term arrhythmia recurrence and procedural safety. Current guidelines do not provide sex-specific recommendations. This systematic review and meta-analysis aimed to evaluate sex-based differences in efficacy, safety, and long-term outcomes following AF catheter ablation. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines and the Cochrane Handbook, with prospective registration in PROSPERO (CRD420251168422). PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2025. Only studies adjusting for baseline differences using propensity score–based methods were included. Risk ratios (RRs) with 95
Lumbar laminectomy is one of the most common spinal procedures, yet the extent of bone removal remains highly operator-dependent, resulting in significant variability in decompression outcomes. Insufficient decompression risks symptom persistence, while over-resection of the facet joints causes iatrogenic instability, and uncontrolled instrument passes near the inner lamina cortex carry well-documented risk of dural injury and cerebrospinal fluid (CSF) leak. A standardized, stepwise technique that reduces these risks, promotes operative efficiency, and provides a teachable framework for neurosurgical residents has not been widely described. We present a reproducible six-step lumbar laminectomy technique centered on bilateral troughing with a 3-mm matchstick burr, progressive eggshell thinning with a 5-mm diamond burr, and en bloc lamina removal, with intraoperative navigation used at defined checkpoints to confirm the medial facet border, pedicle proximity, trough depth, and final decompression extent. The technique is illustrated with a case of a 70-year-old man with multilevel lumbar stenosis (Schizas grade C-D at L3-5) and a prior L4-5 discectomy who underwent L3-L5 laminectomy using this approach; the estimated blood loss was 30 mL, the troughing and en bloc removal were completed in approximately 15 minutes, and the patient was discharged on postoperative day three without complication. The staged matchstick-to-diamond burr sequence reduces the risk of inadvertent dural injury while maintaining operative efficiency, and navigation serves as a confirmatory adjunct rather than a primary guide. The technique is designed to be learned by neurosurgical residents, with each step building anatomical understanding and safeguarding against dural injury and facet violation, and merits prospective evaluation in larger cohorts.
This narrative review examines recent literature of artificial intelligence (AI) in child and adolescent psychiatry. With increasing mental health disorders in young people along with persistent workforce shortages, AI has emerged as a potential tool to improve efficiency and support clinical decision making. However, using AI raises important ethical concerns which are summarized in our review. Most AI applications in child and adolescent psychiatry remain early in development and are not ready for routine clinical use. AI scribes are likely impractical in many child psychiatry settings because of multiparty visits, consent concerns, and sensitive clinical discussions. Many multimodal diagnostic tools using machine learning still require further testing and can be impractical when relying on costly diagnostics like neuroimaging. Similarly, AI-assisted therapeutics requiring physical hardware like robotics and virtual or augmented reality devices can also be prohibitively expensive. One of the few exceptions includes AI-enabled video and eye-tracking approaches for autism diagnosis. Chatbots and robot companions may provide modest improvements for depression, but evidence remains limited in the pediatric population with risk of serious harm. Concerns of AI include misinformation, algorithmic biases, privacy risks, crisis mismanagement, and excessive emotional attachments to chatbots. AI may eventually support child and adolescent psychiatry, but current evidence supports cautious, supervised use rather than broad clinical adoption. Clinicians should help families understand AI’s limits, encourage digital literacy, and ensure that AI remains an adjunct to human care rather than a substitute.
