Background: The human gastrointestinal tract is home to a wide variety of microorganisms. For some decades now, bacteria known as probiotics have been added to various foods because of their beneficial effects for human health. Evidence indicates that probiotics significantly regulate gut microbiota, which is vital for digestion, metabolism, immune function, and mental health. Methods: We conducted a narrative review of available original research published in PubMed for the past ten years focusing on recent advancements that provide a thorough understanding of the relationship between the gastrointestinal system and the brain. Results: Recent advances in research have focused on the importance of gut microbiota in influencing mental health. The microbiota–gut–brain axis is a complex, bidirectional communication network linking the central nervous system and the gastrointestinal tract, which highlights how the gut and brain are deeply interconnected and influence each other in ways that affect our overall health, emotions, and behavior. This powerful link is a major area of research as scientists discover more about how gut health can impact mental well-being. Conclusions: A comprehensive understanding of microbiota composition and mechanisms involved in these interactions between the gut and the brain could shape future medical and therapeutic approaches. It would balance scientific explanation with clinical relevance, offering insights into how understanding the brain–gut axis can revolutionize our approach to treating mental health and gastrointestinal disorders.

Natural killer cells are the main agents of innate immunity. Since 1970, various studies have repeatedly confirmed their involvement in decreasing local tumor growth and also decreasing the risk of metastasis, due to their cytotoxic effects and also through the release of immunostimulatory cytokines such as IFN-gamma. In the 1990s, several studies demonstrated the existence of certain inhibiting and stimulating receptors of these cells, leading to the concept of “induced self”, thus explaining why tumors with MHC-1 are destroyed and autologous cells without it are saved out. Recognition and destruction of tumor cells by the NK cells are the result of complex interactions between inhibiting and activating factors. This paper, based on extensive research of currently available studies, summarizes the mechanisms employed by the NK cells to destroy the cancer cells, thus highlighting their role in the risk of tumor recurrence as well as their use and handling in certain types of immunotherapy.

Background/Objectives: Perioperative malnutrition, sarcopenia, and reduced functional reserve are frequent in adults undergoing elective gastrointestinal (GI) surgery and are associated with higher postoperative morbidity and delayed recovery. Enhanced Recovery After Surgery (ERAS) pathways incorporate nutrition-focused elements, but reported effects vary across procedures, protocols, and baseline risk. This review aims to summarize and critically appraise current evidence on perioperative nutritional strategies within ERAS-focused elective GI care, including risk identification, nutritional prehabilitation (oral nutritional supplements and immunonutrition), preoperative carbohydrate loading, early postoperative feeding, and selected microbiome-directed adjuncts. Methods: This narrative literature review was informed by a focused search of PubMed/MEDLINE and Scopus (2010–early 2026), supplemented by targeted screening of relevant clinical practice guidelines and consensus statements (e.g., ESPEN). Evidence was interpreted by hierarchy (guidelines/meta-analyses, randomized trials, observational studies) and discussed with attention to heterogeneity in surgical populations, intervention definitions (composition, timing, duration), and endpoint reporting. Results: Early nutritional risk screening is consistently supported to identify malnutrition and sarcopenia and to trigger tailored optimization plans. Perioperative oral nutritional supplementation, particularly when started preoperatively and continued postoperatively, is frequently associated with improved intake and reduced infectious morbidity in malnourished or at-risk patients, though effect sizes vary. Immunonutrition shows potential benefit in selected high-risk settings but remains formulation- and timing-dependent. Carbohydrate loading is generally endorsed within ERAS and may reduce insulin resistance and improve patient comfort, while impacts on major clinical outcomes are context-dependent. Early oral/enteral feeding is feasible in many elective GI procedures and may accelerate gastrointestinal recovery without increasing major complications when implemented with structured advancement and appropriate patient selection. Probiotics/synbiotics show the most consistent signals in colorectal surgery, with strain-specific effects and important safety boundaries in immunocompromised or critically ill patients. Conclusions: Perioperative nutritional optimization is a core component of elective GI surgical care within ERAS pathways. Benefits are most reproducible in higher-risk patients and when interventions are integrated into high-compliance multidisciplinary programs. Future research should prioritize procedure-specific, risk-stratified trials with standardized interventions and clinically meaningful endpoints.

Background/Objectives: Perioperative malnutrition, sarcopenia, and reduced functional reserve are frequent in adults undergoing elective gastrointestinal (GI) surgery and are associated with higher postoperative morbidity and delayed recovery. Enhanced Recovery After Surgery (ERAS) pathways incorporate nutrition-focused elements, but reported effects vary across procedures, protocols, and baseline risk. This review aims to summarise and critically appraise current evidence on perioperative nutritional strategies within ERAS-focused elective GI care, including risk identification, nutritional prehabilitation (oral nutritional supplements and immunonutrition), preoperative carbohydrate loading, early postoperative feeding, and selected microbiome-directed adjuncts. Methods: This narrative literature review was informed by a focused search of PubMed/MEDLINE and Scopus (2010–2025), supplemented by targeted screening of relevant clinical practice guidelines and consensus statements (e.g., ESPEN). Evidence was interpreted by hierarchy (guidelines/meta-analyses, randomised trials, observational studies) and discussed with attention to heterogeneity in surgical populations, intervention definitions (composition, timing, duration), and endpoint reporting. Results: Early nutritional risk screening is consistently supported to identify malnutrition and sarcopenia and to trigger tailored optimisation plans. Perioperative oral nutritional supplementation, particularly when started preoperatively and continued postoperatively, is frequently associated with improved intake and reduced infectious morbidity in malnourished or at-risk patients, though effect sizes vary. Immunonutrition shows potential benefit in selected high-risk settings but remains formulation- and timing-dependent. Carbohydrate loading is generally endorsed within ERAS and may reduce insulin resistance and improve patient comfort, while impacts on major clinical outcomes are context-dependent. Early oral/enteral feeding is feasible in many elective GI procedures and may accelerate gastrointestinal recovery without increasing major complications when implemented with structured advancement and appropriate patient selection. Probiotics/synbiotics show the most consistent signals in colorectal surgery, with strain-specific effects and important safety boundaries in immunocompromised or critically ill patients. Conclusions: Perioperative nutritional optimisation is a core component of elective GI surgical care within ERAS pathways. Benefits are most reproducible in higher-risk patients and when interventions are integrated into high-compliance multidisciplinary programmes. Future research should prioritise procedure-specific, risk-stratified trials with standardised interventions and clinically meaningful endpoints.

Collagen VI-related disorders constitute a spectrum of severities from the milder Bethlem myopathy (BM) to the Ullrich congenital muscular dystrophy (UCMD), which is more severe, and an intermediate form characterized by muscle weakness that begins in infancy. Affected children are able to walk, although walking becomes increasingly difficult starting in early adulthood. They develop contractures in the ankles, elbows, knees, and spine in childhood. In some affected cases, the respiratory muscles are weakened, requiring mechanical ventilation, particularly during sleep. Individuals with collagen VI-related myopathy are at risk of restrictive lung disease and sleep-disordered breathing due to the development of scoliosis associated with neuromuscular weakness. Typical signs of respiratory failure are not always present, and some patients are unaware that their respiratory muscles have become weaker. Here, we report a case of an intermediate form of collagen VI-related myopathy confirmed by next-generation sequencing. The girl presented morning headache, irritability, and aggressiveness, and because of these main symptoms, she was referred by the neurologist for respiratory evaluation. The result of spirometry was associated with hypoventilation shown during sleep studies, indicating the necessity to initiate home non-invasive ventilation (NIV) with immediate improvement in the symptoms. Neuromuscular disorders (NMDs) have a great impact on sleep, but only very few studies evaluating sleep quality in young patients with collagen VI-related myopathy have been described. Daytime symptoms of sleep-disordered breathing may include irritability, emotional lability, and poor attentiveness, but these can be overseen by the severity of other complex medical problems in patients with collagen VI-related myopathy. We underline the importance of the close monitoring of respiratory function, sleep evaluation, and decision making to support the NIV treatment of other collagen VI-related myopathy variant-specific patients. Early recognition of sleep disturbances and initiation of respiratory support can preserve or enhance the quality of life for patients and their caregivers. Routine screening for identification of emotional distress should be instituted in the clinical practice using validated psychological measures in a multidisciplinary approach with different intervention strategies for both patient and parent when necessary.

Background/Objectives: Impending pathological fractures remain among the most challenging complications of metastatic bone disease. Accurate fracture-risk assessment is essential for selecting patients for prophylactic stabilization while avoiding unnecessary surgery. The Mirels Classification remains widely used, but limited specificity, observer variability, and site-dependent performance have stimulated interest in cortical-involvement measures, CT-based structural rigidity analysis (CTRA), finite element analysis (FEA), multivariable prediction, radiomics, and artificial intelligence (AI). Methods: This narrative critical review synthesizes clinical, imaging, biomechanical, and computational evidence relevant to appendicular metastatic-fracture prediction. The literature search was updated through 22 October 2026, with direct metastatic-bone evidence prioritized and study design, anatomical site, sample size, prediction horizon, diagnostic performance, validation status, and major methodological limitations appraised qualitatively. Results: Mirels performance varied substantially by site. In upper-limb disease, the conventional threshold of ≥9 showed 14% sensitivity in one cohort, whereas a humerus-specific cohort reported 83.6% sensitivity, 79.5% specificity, and an AUC of 0.82 at a threshold of ≥8. A 2026 systematic review found Mirels sensitivities of 66.7–88% and specificities of 38–47.9% in femoral studies; the principal prospective CTRA comparison reported 100% sensitivity and 60.6% specificity, while formal FEA studies reported sensitivities of 80–100% and specificities of 67–86%, with important methodological heterogeneity. A 2026 Met FRAP cohort of 565 lesions reported 82% accuracy for 6-month fracture prediction versus 61% for Mirels. No externally validated AI/radiomics model directly predicting appendicular metastatic long-bone fracture was identified. Conclusions: Current evidence supports Mirels as an accessible first-layer screen rather than a stand-alone surgical indication. Integrated Mirels 2.0 is proposed as a conceptual, site-aware research framework that combines clinical assessment, quantitative imaging, biomechanics, tumor biology, patient factors, and optional AI integration with explicit uncertainty and prospective validation requirements.