Károly Szili

Background/Objectives: Obesity in adolescent girls is associated with metabolic and reproductive changes that can persist into adult life. Methods: This review examines nutrition therapy and glucagon-like peptide-1 (GLP-1) receptor agonist pharmacotherapy in girls aged 8–18 years. PubMed/MEDLINE, Scopus and OpenAlex were searched; one author selected the studies and extracted the data. Each outcome is classified as demonstrated in adolescent trials, extrapolated from adults, mechanistic, unknown or an expert proposal. Results: In adolescents aged 12 to <18 years, semaglutide and liraglutide increased the proportion achieving a 5% reduction in body weight or body mass index compared with placebo, and semaglutide improved insulin resistance; a Cochrane review rates the anthropometric benefit of paediatric pharmacotherapy as low-certainty. Effects on androgen excess and menstrual function have been shown only in adults and cannot be separated from weight loss; pubertal timing, lean mass and bone accrual have not been studied as outcomes in randomised trials. Conclusions: Small trials in adolescents and young women with polycystic ovary syndrome suggest that dietary or lifestyle treatment with weight loss can improve menstrual regularity, whereas effects on androgens are inconsistent. Nutritional protection of lean mass, bone and micronutrient status during drug-induced weight loss is untested; we present it, with a stepped-care framework, as an expert proposal.

1-Naphthaleneacetic acid (NAA) is a synthetic auxin used repeatedly in apple production and routinely in plant propagation, yet its direct effects on microorganisms have not been reviewed. We compiled the observations we could locate and verify of a measured NAA effect on a named fungus, bacterium or microalga, from a screened literature corpus, a taxon-directed sweep, targeted searches and, at revision, Scopus and AGRICOLA, and two authors independently assigned each an evidence tier. The result is a structured evidence map of a defined corpus. Effects were organism-specific. Plant-pathogenic fungi were inhibited by about 40% or more only at 100 mg L⁻¹ and above, at which Trichoderma harzianum lost at most 13% of its radial growth, whereas several cultivated fungi were stimulated at 1–8 mg L⁻¹. NAA altered fungal and bacterial secondary metabolism and bacterial virulence gene expression, a rhizobial inoculant degraded it, and microalgae responded biphasically between 0.037 and 18.6 mg L⁻¹. Among the studies retrieved, one field trial, in tobacco, characterised a soil microbial community after NAA application; none did so in an orchard, and no field study measured a named beneficial microorganism. We outline implications for biocontrol compatibility, inoculant use and phyllosphere exposure.

Endometriosis affects approximately 5%–10% of reproductive-aged women and imposes a substantial yet underexplored preventive research gap relative to treatment-focused literature. Diet is the central axis of this review: we organize the dietary evidence around an explicit mechanistic sequence—food-group-level epidemiological risk, hypothesised to be mediated by gut-microbiota dysbiosis and the estrogen-metabolizing “estrobolome”, and thence to candidate dietary and probiotic interventions—and then situate this dietary axis within a broader multidimensional prevention framework spanning additional primary prevention (other modifiable lifestyle factors, environmental endocrine-disruptor exposure), secondary prevention (non-invasive early screening, adolescent menstrual-health education, and, as a conceptual proposal, targeted early hormonal intervention following the neo-evolutionary model of Vercellini and colleagues), and tertiary-level management of established disease. While, to our knowledge, six recent reviews and meta-analyses (2024–2026) have quantitatively synthesized randomized-trial evidence on dietary and nutraceutical interventions for endometriosis-associated pain, none situates this evidence within an explicit gut microbiota-estrobolome mechanistic framework or a broader multidimensional prevention model—the distinguishing contribution of this review. We advance this framework as a hypothesis-generating prevention research agenda rather than a set of clinically established preventive measures. Cost-effectiveness is treated as a cross-cutting dimension: endometriosis-specific economic evaluations of prevention and screening remain scarce—with a digital symptom-checker Markov model as a notable exception—so analogous frameworks from chronic-disease lifestyle-intervention economics are proposed as methodological templates. We synthesize current evidence, controversies, and priority directions, with particular emphasis on the dietary axis and its mechanistic underpinnings.

Az életkorral összefüggő izomveszteség (sarcopenia) a globálisan öregedő népesség egyik legjelentősebb egészségügyi terhe. A bélmikrobiom és a vázizomzat közötti összefüggésrendszert, az úgynevezett bél–izom tengelyt (gut–muscle axis) egyre kiterjedtebb kutatás vizsgálja, azonban a konkrét mechanizmusok és a felelős mikrobiális fajok azonosítása eddig korlátozott volt. A jelen összefoglaló közlemény célja a bél–izom tengely jelenlegi bizonyítékainak áttekintése, különös tekintettel a Roseburia inulinivorans bélbaktériumfaj és az izomteljesítmény közötti, 2026-ban a Gut folyóiratban közölt összefüggésre, valamint e kapcsolat klinikai és terápiás relevanciájának értékelésére. Narratív irodalmi összefoglaló, amelynek alapját a Martinez-Tellez és mtsai által 2026-ban publikált vizsgálat képezi, kiegészítve a bél–izom tengely, a sarcopenia és az öregedő mikrobiom témakörében megjelent releváns közleményekkel. A szakirodalmi beszámolók szerint az R. inulinivorans relatív abundanciája pozitívan korrelált a kézszorító erővel, a lábpréssel és a mellpréssel. A baktériumot hordozó idős felnőttekben 29%-kal nagyobb volt a kézszorító erő, a cardiorespiratoricus kapacitás változása nélkül. Egérmodellben az orális szupplementáció körülbelül 30%-os izomerő-növekedést eredményezett. A hatás mechanizmusa nem butiráton, hanem az izom purin- és pentóz-foszfát-anyagcseréjének aktiválásán keresztül valósulhat meg. Az eddigi szakirodalmi adatok szerint a R. inulinivorans fajspecifikus összefüggést mutat az izomerővel, és ígéretes mikrobiális jelölt a sarcopenia, valamint a cachexia kezelésére irányuló nutraceutikai fejlesztések számára. Az eredmények megerősítéséhez humán randomizált klinikai vizsgálatok, valamint a nemi különbségeket figyelembe vevő longitudinális elemzések szükségesek. Orv Hetil. 2026; 167(41): 1646–1654.

1-Naphthaleneacetic acid (NAA) is a synthetic auxin used repeatedly in apple production and routinely in plant propagation, yet its direct effects on microorganisms have not been reviewed. We compiled every observation we could locate and verify of a measured NAA effect on a named fungus, bacterium or microalga, drawing on a systematically screened literature corpus, a taxon-directed sweep and targeted database searches, and recorded each with its concentration, replication and evidence tier. The effects were organism-specific. Plant-pathogenic fungi were inhibited at concentrations of 100–400 mg L⁻¹, at which the biocontrol fungus Trichoderma harzianum lost at most 13% of its radial growth. Fungal secondary metabolism was strongly modulated, and inhibition of Saccharomyces cerevisiae occurred in minimal but not in rich medium. Direct bacterial growth inhibition was weak, but the bacterial auxin-catabolism repressor IadR bound NAA with slightly higher affinity than indole-3-acetic acid. Microalgae showed biphasic responses spanning 0.037–18.6 mg L⁻¹. No study measured a microbial community before and after exposure, and no field study measured a beneficial microorganism. We outline implications for biocontrol compatibility, inoculant use in propagation and phyllosphere exposure, and the experiments that would close these gaps.

Background/Objectives: Guidance on protein and physical activity rests on population-wide minima with little differentiation by age or disease. We examined how protein intake and resistance training relate to muscle, function and mortality across clinical populations. Methods: PRISMA-guided rapid review: Fifty-eight logged PubMed queries returned 7544 unique records for screening (the analytic corpus); Europe PMC, Semantic Scholar and ClinicalTrials.gov were tested for coverage only. Estimates were extracted by a deterministic script and adjudicated by the authors; random-effects models were fitted within strata sharing an effect measure and contrast, and randomized evidence was tabulated, not pooled. Screening was single-reviewer outside a duplicate-screened sample (889 records); risk of bias was rated in duplicate. Results: In randomized trials, added protein increased strength with resistance training (+2.01%) but not without it (+0.13%); no trial of protein with resistance training reported mortality. Meeting activity guidelines was associated with lower mortality (HR 0.76, 95% CI 0.72–0.79; k = 16; I² = 64%; low certainty). Plant protein was associated with lower mortality (HR 0.76, 0.63–0.93; k = 4; very low certainty). After excluding studies at high risk of bias, the protein strata fell to single studies. The direction of protein–outcome associations differed between populations. Conclusions: Protein with resistance training is a plausible strategy for preserving muscle and function; effects on survival are untested, and population-specific protein ranges are provisional and hypothesis-generating.

Artificial intelligence is widely proposed against antimicrobial resistance, but how much of that literature could support clinical deployment is unclear. We searched PubMed (2016–2026) across four domains, retrieving all 2446 records. Of 725 eligible studies, 80 were appraised at full text against the artificial-intelligence appraisal extensions (PROBAST+AI, TRIPOD+AI). Selection favoured externally validated work, so the validation figures are upper bounds. Output grew from 10 studies in 2016 to 142 in 2025; within the appraised set there was no evidence that genuinely external evaluation became more likely (odds ratio 1.08/year, 95% CI 0.89–1.34). Of the 80, 45% were externally validated, 24% released a model a reader could apply, 23% assessed calibration, 16% justified a sample size, and five compared performances across patient characteristics against eight across sites; 8.8% called a random split external validation. Risk of bias was low in 16, unclear in 55 and high in nine, and none of the 18 deep-learning studies reported calibration (95% CI 0–17.6%, a loose bound on 18). We derive the design constraints these impose on a culture-independent diagnostic platform, a projection with no performance data. Validation, calibration and transparency limit this field more than accuracy does: discrimination was reported in every study appraised.

Background: Tourette syndrome is a neurodevelopmental disorder characterized by persistent motor and vocal tics. Dopamine D2 receptor antagonists can reduce tic severity but are frequently limited by metabolic, sedative, and extrapyramidal adverse effects. Ecopipam is a selective dopamine D1/D5 receptor antagonist with a potentially distinct tolerability profile. Objectives: To evaluate the efficacy and safety of ecopipam in patients with Tourette syndrome using updated randomized evidence. Design: Systematic review and random-effects meta-analysis of randomized placebo-controlled trials. Data sources and methods: PubMed/MEDLINE, Embase, Scopus, ClinicalTrials.gov , reference lists, and conference sources were searched from database inception to May 31, 2026. The primary outcome was change in Yale Global Tic Severity Scale Total Tic Score. Headache and insomnia were evaluated as safety outcomes. Treatment estimates were pooled using random-effects models with Hartung–Knapp adjustment. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Three randomized trials involving 297 unique randomized participants were included. Ecopipam improved tic severity compared with placebo (mean difference, −3.72; 95% confidence interval, −5.96 to −1.47). The result remained significant after exclusion of the phase 3 randomized-withdrawal trial (mean difference, −3.33; 95% confidence interval, −4.85 to −1.81). No statistical heterogeneity was detected for efficacy outcomes, although the small number of trials limits interpretation. Headache was not significantly increased (risk ratio, 1.36; 95% confidence interval, 0.52–3.51). Insomnia showed an imprecise, nonsignificant association (risk ratio, 2.44; 95% confidence interval, 0.07–79.93; I ² =62.2%). Conclusion: Short-term randomized evidence suggests that ecopipam reduces tic severity. Evidence concerning insomnia and long-term psychiatric and metabolic safety remains insufficient, requiring larger independent trials with longer follow-up.

Artificial intelligence is widely proposed against antimicrobial resistance, but how much of that literature could support clinical deployment is unclear. We searched PubMed (2016–2026) across four domains — genomic prediction, clinical risk models, therapy, and rapid diagnostics — retrieving all 2,446 records. Of 725 eligible studies, 80 were appraised at full text against the artificial-intelligence extensions of the standard risk-of-bias and reporting tools (PROBAST+AI, TRIPOD+AI). Selection favoured externally validated work, so the proportions are upper bounds. Output grew from 10 studies in 2016 to 142 in 2025, with no evidence that genuinely external evaluation became more likely (odds ratio 1.08/year, 95% CI 0.89–1.34). Of the 80, 45% were externally validated, 24% released a model a reader could apply, 23% assessed calibration, 16% justified a sample size, and five compared performance across patient characteristics against eight across sites; 9% called a random split of their own data external validation. Risk of bias was low in 16, unclear in 55 and high in 9, and none of the 18 deep-learning studies reported calibration (95% CI 0–17.6%). Validation, calibration and transparency limit this field, not accuracy. We derive the design constraints these impose on a culture-independent diagnostic platform, a projection with no performance data.

Chronic non-communicable conditions—type 1 and type 2 diabetes mellitus (T1DM, T2DM), metabolic obesity syndrome (MOS), polycystic ovary syndrome (PCOS), colorectal and extra-intestinal cancers, and systemic autoimmune disease—share a prolonged asymptomatic phase during which conventional screening is invasive, insensitive, or resource-intensive. This review synthesizes the 2021–2026 literature on fecal microbiome-based artificial intelligence (AI) diagnostics across these conditions, extracting reported discrimination, validation strategy, microbial and short-chain fatty acid (SCFA) biomarkers, and cross-cohort reproducibility. Across the primary classifier studies tabulated here, reported areas under the curve (AUCs) span 0.76–0.99 under internal validation but 0.69–0.91 under external or cross-population validation; in the four studies reporting both, the median AUC falls from 0.875 to 0.810. Verified external-validation values include 0.82 for colorectal cancer, 0.79 for T2DM and 0.792 for discrimination of systemic lupus erythematosus from rheumatoid arthritis and controls. Clinical readiness turns on this internal-to-external gap more than on the headline AUC. We propose a multimodal deep learning architecture coupled with explainable AI; no component has been implemented or evaluated on data, and it is presented as a design proposal. Fecal-microbiome-based multimodal AI is technically feasible but clinically unvalidated, pending prospective, harmonized cross-cohort trials.