Neurodevelopmental, psychiatric, and neurodegenerative disorders are traditionally studied as distinct disease categories, yet they show overlapping disturbances in systems that regulate neural function and resilience. This article proposes maladaptive brain-state locking (MBSL) as a lifespan framework for examining whether otherwise distinct disorders may converge, in some contexts, on impaired biological-state reversibility. MBSL is defined as a failure of adaptive state-transition or recovery dynamics in which a maladaptive state becomes insufficiently reversible and the nervous system loses its normal capacity to terminate, recalibrate, or transition away from that state. Locking is therefore distinguished from persistence alone: an abnormal state maintained solely by a continuing pathological driver does not, by itself, constitute MBSL. Candidate operational features include abnormal persistence, impaired transition toward an adaptive state, delayed or incomplete recovery after perturbation reduction or removal, and history-dependent loss of flexibility. Lifespan timing, regional context, disease stage, severity, duration, and resilience are proposed to modify phenotypic consequences rather than assign disorder classes exclusively to specific age periods. Existing evidence is compatible with components of the hypothesis, but direct demonstration of MBSL will require longitudinal or perturbational evidence of impaired recovery or state-transition dynamics. Major limitations include etiological and pathological heterogeneity, nonspecific biomarkers, unresolved causality, and challenges in operationalizing multiscale state dynamics. If validated, the framework could support research focused on measurable reversibility, longitudinal monitoring, and interventions designed to restore adaptive state regulation rather than symptom improvement alone.

Watertight-intent dural reconstruction may reduce incisional cerebrospinal fluid (CSF) leakage after decompressive craniectomy but may prolong surgery. We aimed to evaluate whether watertight-intent reconstruction, compared with non-watertight management, was associated with direct postoperative incisional CSF leakage and operative time.

Five databases were searched through August 1, 2026. Comparative studies with explicit watertight or sealing-intent reconstruction and non-watertight comparators were included. The primary outcome was direct incisional CSF leakage; secondary outcomes included operative time, wound or surgical-site infection, hydrocephalus, mortality, and functional outcomes. Binary outcomes were expressed as risk ratios (RRs), and continuous outcomes as mean differences. Random-effects meta-analysis used restricted maximum likelihood estimation with Wald 95% confidence intervals (CIs); randomized and observational studies were examined as subgroups, with Hartung–Knapp sensitivity analyses. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.

Twelve studies were included; nine (1,314 participants) reported direct incisional CSF leakage. Watertight-intent reconstruction was associated with fewer reported leaks (RR, 0.54; Wald 95% CI, 0.34–0.86; I² = 23.3%), although the prediction interval included the null value (0.24–1.20). The randomized subgroup was imprecise (RR, 0.75; 95% CI, 0.32–1.73), whereas the observational subgroup favored reconstruction (RR, 0.43; 95% CI, 0.20–0.90); its Hartung–Knapp interval (0.14–1.32) crossed 1. Infection and hydrocephalus estimates were imprecise; mortality and function were not pooled. Reconstruction was associated with longer operative time (mean difference, 39.85 minutes; 95% CI, 25.14–54.56; I² = 97.4%). Certainty was very low for all key outcomes.

Watertight-intent reconstruction is associated with fewer reported incisional CSF leaks and longer operations, although certainty is very low. Limited study and event numbers, imprecise design subgroups, and multicomponent techniques preclude causal or universal treatment conclusions. Effects on infection, hydrocephalus, mortality, and function remain uncertain.

Epithelial-myoepithelial neoplasms of the breast are biphasic tumors composed of both epithelial and myoepithelial cell populations. Their rarity, broad morphologic spectrum, and evolving molecular characterization pose substantial diagnostic challenges, underscoring the need for an integrated review of their diagnostic and molecular features. This review aims to provide a comprehensive overview of epithelial-myoepithelial neoplasms of the breast, emphasizing their morphologic spectrum, diagnostic challenges, and emerging molecular features.

This narrative review is based on a review of the pertinent English-language literature and the author’s firsthand experience as a practicing breast pathologist.

Benign epithelial-myoepithelial tumors include pleomorphic adenoma and classic adenomyoepithelioma. Pleomorphic adenoma of the breast closely resembles its salivary gland counterpart as well as the benign mixed tumor of the skin. In contrast, adenomyoepithelioma is unique to the breast and exhibits a broad spectrum of histomorphologic patterns. Most adenomyoepitheliomas follow a benign clinical course; however, atypical adenomyoepitheliomas may demonstrate more aggressive behavior, including local recurrence, malignant transformation, and, rarely, metastasis. Molecular studies have identified PLAG1/HMGA2 rearrangements in a subset of pleomorphic adenomas and recurrent HRAS Q61 and PI3K-AKT pathway alterations in adenomyoepitheliomas. In malignant adenomyoepithelioma, the malignant component may arise from the ductal epithelial cells, the myoepithelial cells, or both.

The rarity of epithelial-myoepithelial tumors, together with their marked histologic heterogeneity, makes them diagnostically challenging and underscores the potential for diagnostic pitfalls.

Large-scale critical care databases have expanded opportunities for clinical research. Previous reviews have summarized open-access intensive care unit databases and specific analytical methods, but integrated, practice-oriented guidance on commonly used and emerging methods and their selection remains limited. The objective of this narrative review is to provide a practice-oriented overview of commonly used and emerging statistical and modeling methods in critical care database research, with emphasis on their appropriate applications, strengths, limitations, and considerations for method selection. This narrative review summarizes commonly used and emerging methods in critical care database research, focusing on their applications, strengths, limitations, and practical considerations. The methods reviewed range from descriptive and regression analyses to prediction modeling, longitudinal analysis, causal inference, and artificial intelligence-based approaches. Common problems include missing data, temporal bias, confounding, overfitting, and limited external validation. Careful method selection and appropriate validation are therefore important when working with complex critical care data. Closer coordination of clinical questions, data structures, analytical methods, and reporting standards can strengthen research using intensive care unit databases. Paying closer attention to data quality, causal hypotheses, validation, reproducibility, and generalizability may improve the methodological rigor and translational value of these studies.

Metabolic dysfunction-associated fatty liver disease (MAFLD) has become a rapidly increasing global health concern, driven by metabolic stress, chronic inflammation, and progressive fibrotic remodeling. Myeloid-derived suppressor cells (MDSCs) have emerged as pivotal yet context-dependent modulators of MAFLD pathogenesis. This review summarizes the biological characteristics of MDSCs, their immunosuppressive mechanisms, and their multifaceted roles in MAFLD progression, including hepatic steatosis, chronic inflammation, and fibrogenesis. Quantitative synthesis reveals that murine models demonstrate MDSC expansion (∼3-fold with a high-fat diet, P < 0.05) and suppression of MDSC-associated proinflammatory mediators (e.g., MitoTEMPO reduced hepatic S100A8 mRNA by 5.9-fold, P < 0.001). In one human cohort (n = 98), hepatic CD33+/HLA-DR− MDSC density correlated with inflammation grade (Spearman r = 0.610, P < 0.001) and fibrosis stage (r = 0.687, P < 0.001), though this cross-sectional dataset lacked MAFLD-specific stratification and longitudinal validation. We further discuss emerging MDSC-targeted strategies and explicitly acknowledge current translational gaps. Collectively, this review provides a mechanistic and critically appraised framework positioning MDSCs as both promising therapeutic targets and potential biomarkers for MAFLD.

A common feature of severe COVID-19 and two common metabolic comorbidities, type 2 diabetes mellitus (T2DM) and obesity, is a persistent inflammatory response. Heat shock proteins (HSPs) are key regulators of cell proteostasis under stressful conditions, including inflammation, oxidative stress, hyperglycemia, and hyperlipidemia. The aim of the present study was to investigate associations between polymorphic variants in genes encoding HSPs and T2DM or obesity among patients with severe or critical COVID-19.

A total of 195 patients with severe or critical COVID-19 were included, of whom 39 had T2DM and 101 had obesity. T2DM and obesity were analyzed as separate, non-mutually-exclusive outcomes. Genotyping was performed using a TaqMan probe-based real-time polymerase chain reaction assay to detect single nucleotide polymorphisms (SNPs). Bioinformatics resources, including GTExPortal, eQTLGen, atSNP, and Gene Ontology, were used for functional annotation. Associations between HSP genetic variants and T2DM or obesity were analyzed. This study was conducted as a case-control analysis within a severe COVID-19 cohort and is reported in accordance with the STROBE guidelines.

Among patients with severe or critical COVID-19, SNP rs1043618 HSPA1A (odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.01–3.27, Pperm = 0.04), rs910652 HSPA12B (OR = 2.23, 95% CI = 1.18–4.21, Pperm = 0.01), and rs4926222 DNAJB1 (OR = 2.15, 95% CI = 1.08–4.27, Pperm = 0.03) were associated with higher odds of T2DM, whereas rs13161158 HSPA4 (OR = 0.11, 95% CI = 0.01–0.91, Pperm = 0.0075) and rs7189628 DNAJA2 (OR = 0.08, 95% CI = 0.01–0.65, Pperm = 0.001) were associated with lower odds of T2DM. In addition, SNP rs753856 HSPA6 (effect allele G) was associated with higher odds of obesity (OR = 2.11, 95% CI = 1.07–4.19, Pperm = 0.03).

Selected HSP SNPs are associated with T2DM or obesity among patients with severe or critical COVID-19. Functional annotation suggests plausible biological mechanisms, including cell proteostasis, inflammatory pathways, glucose metabolism, and adipogenic differentiation; however, independent and functional validation is required.

Ascites is the most frequent complication of cirrhosis, signaling the transition from compensated to decompensated liver disease. While traditionally linked to portal hypertension, arterial vasodilation, and renal sodium retention, previous research has broadened our understanding of its pathophysiology. The hepatic and splanchnic lymphatic systems are increasingly recognized as potential contributors to decompensation in cirrhosis. The elevated sinusoidal pressure in cirrhosis markedly increases lymph production, which is initially compensated by expanded lymphatics and lymphangiogenesis. However, progressive cirrhosis impairs lymphatic function by inducing abnormal lymphangiogenesis, vessel dilation, and poor contractility, which collectively reduce drainage. When lymph overproduction exceeds the maximum drainage capacity of the lymphatic system, the fluid leaks through the subcapsular lymphatics, leading to leakage of protein-rich lymph through the liver surface into the peritoneal cavity—a phenomenon often referred to as a “weeping liver.” The osmotic gradient of this protein-rich fluid, combined with hydrostatic pressures and lymphatic failure, may draw additional fluid from the splanchnic circulation and contribute to ascites development and progression. Simultaneously, dysfunction of the gut-splanchnic lymphatic axis may promote intestinal edema, bacterial translocation, and systemic inflammation, thereby reinforcing portal hypertension and contributing to downstream manifestations such as intestinal lymphangiectasia and refractory ascites. Yet, despite its pathophysiological relevance, the contribution of lymphatic failure to the complications of cirrhosis remains widely underappreciated. Recognizing this critical axis may help identify novel therapeutic targets in patients with cirrhosis. This review provides a detailed overview of lymphatic failure as a contributor to altered fluid dynamics and secondary complications in cirrhosis, offering a contextual evaluation of its therapeutic implications.