Background: Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature has reported the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA). Methods: A prospective cohort of 31 feet from 25 patients with moderate-to-severe symptomatic HV but without metatarsalgia underwent MICA and was evaluated using radiographic parameters and pedographic measurements (Footscan^®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery. Results: The radiographic parameters of the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary’s angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area. Conclusion: MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia. Full article

Background: The early reliable detection and quantification of autoantibodies play an important role in autoimmune disease diagnosis and in disease-course monitoring. New technologies, such as the multiplexed determination of autoantibodies, have recently been introduced and are being adopted more frequently. The aim of this study was to evaluate the ability of a new microdot array-based multiparametric assay (ZENIT AMiDot CTD panel, A. Menarini Diagnostics, Firenze, Italy) to correctly classify patients with autoimmune rheumatic diseases (ARDs) and compare it to a fluorescence enzyme immunoassay (FEIA) for the detection of anti-ENAs. Methods: The study included 69 consecutive samples from patients with ARDs that were analyzed using two different methods (FEIA and AMiDot) to detect anti-CENP B and six anti-ENA antibodies: anti-Scl-70, anti-SSB/La, anti-Jo-1, anti-U1-RNP, anti-Ro52, and anti-Ro60. The control group sera came from sixty-eight blood donors. Tests were run on the automated slide processor ZENIT FLOW, and then the slides were imaged and analyzed using ZENIT fast. Results: Since the samples were selected for at least one antibody positivity with an ARD diagnosis, we did not calculate clinical sensitivity but only specificity, which was 98.53%, ranging from 90% for anti-SSB/La antibodies to 100% for anti-CENP B ones. Mean agreement among the methods assessed by Cohen’s kappa was 0.816 ± 0.240. Conclusions: The assay demonstrated good clinical performance and may be considered a valuable aid in detecting ARD patients, offering an alternative to methods such as FEIA which are largely in use today. Full article

In the past decade, our understanding of psoriasis pathogenesis has made significant steps forward, leading to the development of multiple game-changing therapies. While psoriasis primarily affects the skin, it is increasingly recognized as a systemic disease that can have effects beyond the skin. Obesity is associated with more severe forms of psoriasis and can potentially worsen the systemic inflammation and metabolic dysfunction seen in psoriatic patients. The exact mechanisms underlying the link between these two conditions are not fully understood, but it is believed that chronic inflammation and immune dysregulation play a role. In this review, we examine the existing body of knowledge regarding the intersection of pathogenic processes responsible for psoriasis and obesity. The ability of biological therapies to reduce systemic and obesity-related inflammation in patients with psoriasis will be also discussed. Full article

A visible-light photochromic hybrid film was synthesized based on combining phosphomolybdic acid (PMoA) with the polythiophene (PTh) matrix. The microstructure and photochromic properties of the materials were analyzed through atomic force microscopy (AFM), Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and ultraviolet-visible spectra (UV-vis). According to FTIR spectra, the geometries of PMoA and PTh were well preserved in hybrid film and there exists a strong interaction at the interface of PMoA and PTh. The XPS spectra revealed the change in the chemical microenvironment and the reduction of Mo⁶⁺ atoms in the photoreduction reaction. Under visible light irradiation, the composite film changed from transparent to blue and deepened gradually, generating heteropoly blue. The hybrid film also shows reversibility in the presence of oxygen. The results indicated that the photochromic reaction was inconsistent with photoinduced electron transfer mechanism. Full article

In this study, we aimed to identify the features of indeterminate choroidal melanocytic lesions visualized on optical coherence tomography angiography (OCTA) and to identify the predictors of growth. We retrospectively evaluated 86 patients with indeterminate lesions treated at our centre from 2016 to 2021. Clinical management involved active surveillance followed by brachytherapy if growth was detected. The lesions were classified into two groups according to whether they grew (small melanomas) or remained stable (choroidal nevi). Growth was detected in 19 (22.1%) lesions. All patients underwent OCTA at baseline. These images were compared to identify the possible predictors of growth. Significant between-group differences were observed in thickness (p = 0.00), greatest basal diameter (p = 0.00), number of risk factors (p = 0.00), symptoms (p = 0.001; relative risk [RR]: 4.3), orange pigment (p = 0.00; RR: 6.02), and ultrasonographic hollowness (Kappa sign); p = 0.000; RR: 5.3). The melanomas had significantly more vessels with a diameter ≥ 76.3 µm (p = 0.02; RR: 2.46). The time to growth in these lesions was significantly shorter (p = 0.05) than in lesions with smaller vessels. These findings show that vessel diameter quantified by OCTA can help differentiate between choroidal nevi and small melanomas, when considered together with clinical risk factors. Full article

Wintersweet (Chimonanthus praecox (L.) Link) is a commercial significance woody plant. As a rare winter-blooming plant, C. praecox is widely distributed and highly adaptable to various climates, especially low temperatures. In this study, we identified the COR413 plasma membrane gene CpCOR413PM1 in wintersweet. CpCOR413PM1 was expressed in all tissues of the plant, with the highest expression observed in the root and floral parts. Cultivation under 4 °C and with treatment of ABA led to the up-regulated expression of CpCOR413PM1. The expression of recombinant CpCOR413PM1 protein in Escherichia coli resulted in the tissues’ increased resilience to cold and drought stress. In vitro enzyme activity assays confirmed the protective impact of the CpCOR413PM1 protein on superoxide dismutase under low-temperature stress. Furthermore, the overexpression of CpCOR413PM1 in Arabidopsis thaliana resulted in increased cold and drought tolerance and ABA inhibited transgenic Arabidopsis seed germination. The CpCOR413PM1 gene promoter can influence expression of the GUS reporter gene under conditions of 4 °C, 42 °C and abscisic acid. Overall, our study demonstrates that CpCOR413PM1 plays a significate role in cold and drought stress. Our findings strengthen the knowledge of the molecular mechanisms underlying wintersweet’s tolerance to stress and lay the groundwork for the future investigation of the functions of the COR gene family. Full article

This study assessed the impact of an acoustic stimulus on the behavioral responses and physiological states of the large yellow croaker (Larimichthys crocea). The test fish, with an average body weight of approximately 352.81 ± 70.99 g, were exposed to one hour of acoustic stimulation at seven different frequencies: 100 Hz, 125 Hz, 160 Hz, 200 Hz, 500 Hz, 630 Hz, and 800 Hz. The aim was to delineate the specific effects of acoustic stimulation on the behavior and physiological indices. The results show that acoustic stimulation significantly altered the behavioral patterns of the large yellow croaker, predominantly manifested as avoidance behavior towards the sound source. At a stimulus frequency of 630 Hz, the test fish exhibited continuous irregular motion and erratic swimming. Physiologically, one hour of exposure to acoustic stimulation notably affected the endocrine system. The levels of Epinephrine and thyroxine were significantly elevated at 200 Hz, while the cortisol levels did not show significant differences. Additionally, the lactic acid content significantly increased at 800 Hz, and the blood glucose content peaked at 630 Hz. This study discovered that sound frequencies of 200 Hz, 630 Hz, and 800 Hz led to a significant increase in the levels of Epinephrine, glucose, thyroid hormones, and lactate in large yellow croaker, consequently affecting their behavior. The changes in these physiological indicators reflect the stress response of the large yellow croaker in specific sonic environments, providing crucial insights into the physiological and behavioral responses of fish to acoustic stimuli. Full article

Lettuce is a widely consumed leafy vegetable; it became popular due to its enhanced nutritional content. Recently, lettuce is also regarded as one of the model plants for vegetable production in plant factories. Light and nutrients are essential environmental factors that affect lettuce growth and morphology. To evaluate the impact of light spectra on lettuce, butter lettuce was grown under the light wavelengths of 460, 525, and 660 nm, along with white light as the control. Plant morphology, physiology, nutritional content, and transcriptomic analyses were performed to study the light response mechanisms. The results showed that the leaf fresh weight and length/width were higher when grown at 460 nm and lower when grown at 525 nm compared to the control treatment. When exposed to 460 nm light, the sugar, crude fiber, mineral, and vitamin concentrations were favorably altered; however, these levels decreased when exposed to light with a wavelength of 525 nm. The transcriptomic analysis showed that co-factor and vitamin metabolism- and secondary metabolism-related genes were specifically induced by 460 nm light exposure. Furthermore, the pathway enrichment analysis found that flavonoid biosynthesis- and vitamin B6 metabolism-related genes were significantly upregulated in response to 460 nm light exposure. Additional experiments demonstrated that the vitamin B6 and B2 content was significantly higher in leaves exposed to 460 nm light than those grown under the other conditions. Our findings suggested that the addition of 460 nm light could improve lettuce’s biomass and nutritional value and help us to further understand how the light spectrum can be tuned as needed for lettuce production. Full article

Cities worldwide are attempting to be labelled as smart, but truly classifying as such remains a great challenge. This study aims to use artificial intelligence (AI) to classify the performance of smart cities and identify the factors linked to their smartness. Based on residents’ perceptions of urban structures and technological applications, this study included 200 cities globally. For 147 cities, we gathered the perceptions of 120 residents per city through a survey of 39 questions covering two main pillars: ‘Structures’, referring to the existing infrastructure of the city, and the ‘Technology’ pillar that describes the technological provisions and services available to the inhabitants. These pillars were evaluated across five key areas: health and safety, mobility, activities, opportunities, and governance. For the remaining 53 cities, scores were derived by analyzing pertinent data collected from various online resources. Multiple machine learning algorithms, including Random Forest, Artificial Neural Network, Support Vector Machine, and Gradient Boost, were tested and compared in order to select the best one. The results showed that Random Forest and the Artificial Neural Network are the best trained models that achieved the highest levels of accuracy. This study provides a robust framework for using machine learning to identify and assess smart cities, offering valuable insights for future research and urban planning. Full article

This study aims to understand the roles of selected extension professionals (EPs) in the field of public health and One Health and the challenges involved in performing these duties to their communities in the state of Kansas. To evaluate the role of EPs in public health and One Health, researchers interviewed nine (9) EPs following a set of structured questions. Emerging themes were extrapolated from the responses of the EPs. Researchers assigned codes for qualitative analysis and assigned themes related to public health, One Health, and effective delivery of services. Researchers identified the following themes related to the role of EPs in public health (youth development, physical activity, personal health care, proper nutrition, access to transportation), One Health (food safety and food security, environmental health, disease control and prevention) and effective delivery of services (community engagement, collaboration, challenges in implementation). The study provided an overview of the diverse roles that EPs play in public health and One Health, keys on how to engage the community effectively, and challenges in extending services to the community. Full article

The eruption of a rash along with spiking fever in travelers returning from the tropics may be suspicious of arboviral diseases, and isolation prevent further transmission in non-endemic countries. The case presented here was seen at the Fever Clinic at the Hospital for Tropical Diseases in Bangkok, Thailand. The presenting complaints were fever, headache, myalgia, and a distinctive erythematous blanching rash. Despite a negative dengue NS1 test on the initial day, anti-dengue IgM and IgG were detectable on day five of illness. Dengue, a leading cause of traveler’s fever with rash, is of particular concern, especially during outbreaks like the one in Thailand in 2023, when the number of cases exceeded one hundred thousand over a nine-month period. The influx of 28 million travelers in 2023, many with naive immunity to many arboviruses, raises fear of transmission to temperate regions, including to countries like France, where Aedes albopictus establishment can lead to autochthonous dengue cases and clusters. Enhanced surveillance is crucial, urging the consideration of dengue as a potential diagnosis in travelers with febrile rash, even prior to lab confirmation. Immediate isolation of patients is essential to prevent autochthonous transmission, reduce outbreak risks, and avert public health crises. Full article

Rice is a staple food for nearly two-thirds of China’s population. As socio-economic development continues, there is a growing demand for high-quality rice. This study collected grain quality traits for 17,785 rice varieties approved throughout China, and categorized them into the following five types: indica inbred (II), indica hybrid (IH), japonica inbred (JI), japonica hybrid (JH), and indica-japonica hybrid (IJ). Comprehensive analyses were conducted to assess the differences and trends in rice quality across these varieties. We found that JI and JH excel in processing and cooking qualities, featuring higher brown rice and head milled rice rates, coupling with longer gel consistency. Inbred varieties display lower chalky rice rates than hybrids. Over several decades, head milled rice rates have notably increased across all types except for IJ. Transparency values has decreased in nearly all types except for IJ, with similar declines observed in chalky rice rates and chalkiness degree, suggesting an overall progress in appearance quality. In terms of cooking and taste attributes, amylose content has decreased in most varieties except for IJ, and gel consistency has improved in indica varieties. Generally, the rice quality of varieties approved in China has shown a clear trend of improvement over the past 40 years. This study provides significant data support and theoretical backing for ongoing rice breeding efforts. Full article

7-Bromo-4-chloro-1H-indazol-3-amine is a heterocyclic fragment used in the synthesis of Lenacapavir, a potent capsid inhibitor for the treatment of HIV-1 infections. In this manuscript, we describe a new approach to synthesizing 7-bromo-4-chloro-1H-indazol-3-amine from inexpensive 2,6-dichlorobenzonitrile. This synthetic method utilizes a two-step sequence including regioselective bromination and heterocycle formation with hydrazine to give the desired product in an overall isolated yield of 38–45%. The new protocol has been successfully demonstrated on hundred-gram scales without the need for column chromatography purification. This new synthesis provides a potential economical route to the large-scale production of this heterocyclic fragment of Lenacapavir. Full article

This study assessed AI-processed low-dose cone-beam computed tomography (CBCT) images for single-tooth diagnosis. Human-equivalent phantoms were used to evaluate CBCT image quality with a focus on the right mandibular first molar. Two CBCT machines were used for evaluation. The first CBCT machine was used for the experimental group, in which images were acquired using four protocols and enhanced with AI processing to improve quality. The other machine was used for the control group, where images were taken in one protocol without AI processing. The dose-area product (DAP) was measured for each protocol. Subjective clinical image quality was assessed twice by five dentists, with a 2-month interval in between, using 11 parameters and a six-point rating scale. Agreement and statistical significance were assessed with Fleiss’ kappa coefficient and intra-class correlation coefficient. The AI-processed protocols exhibited lower DAP/field of view values than non-processed protocols, while demonstrating subjective clinical evaluation results comparable to those of non-processed protocols. The Fleiss’ kappa coefficient value revealed statistical significance and substantial agreement. The intra-class correlation coefficient showed statistical significance and almost perfect agreement. These findings highlight the importance of minimizing radiation exposure while maintaining diagnostic quality as the usage of CBCT increases in single-tooth diagnosis. Full article

In a constantly changing environment brought about by the climate crisis and escalated anthropogenic perturbations driven by the growing population, harmful algal bloom dynamics and their impacts are expected to shift, necessitating adaptive management strategies and comprehensive research efforts. Similar to primary productivity, HABs have been thought to be driven primarily by major nutrients such as N, P, and Si. However, recent investigations on the role and importance of micronutrients as limiting factors in aquatic environments have been highlighted. This paper provides a review of metal and phytoplankton interactions, with a specific emphasis on pertinent information on the influence of trace nutrients on growth, toxin production, and other underlying mechanisms related to the dynamics of HABs. Low to near-depleted levels of essential nutrients, including Fe, Cu, Zn, Se, Mn, Co, and Mo, negatively impact cell growth and proliferation of various marine and freshwater HAB species. However, evidence shows that at elevated levels, these trace elements, along with other non-essential ones, could still cause toxic effects to certain HAB species manifested by decreased photosynthetic activities, oxidative stress, ultrastructure damage, and cyst formation. Interestingly, while elevated levels of these metals mostly result in increased toxin production, Co (i.e., yessotoxins, gymnodimine, and palytoxins) and Mn (i.e., isodomoic acid, okadaic and diol esters) enrichments revealed otherwise. In addition to toxin production, releasing dissolved organic matter (DOM), including dissolved organic carbon (DOC) and humic substances, was observed as an adaptation strategy, since these organic compounds have been proven to chelate metals in the water column, thereby reducing metal-induced toxicity. Whilst current research centers on free metal toxicity of specific essential elements such as Cu and Zn, a comprehensive account of how trace metals contribute to the growth, toxin production, and other metabolic processes under conditions reflective of in situ scenarios of HAB-prone areas would yield new perspectives on the roles of trace metals in HABs. With the growing demands of the global population for food security and sustainability, substantial pressure is exerted on the agriculture and aquaculture sector, highlighting the need for effective communication of information regarding the interactions of macro- and micronutrients with HABs to improve existing policies and practices. Full article

The introduction of MASSs, facilitated by the advancement of autonomous navigation technologies, is anticipated to lead to the emergence of new technologies, novel vessel types, and innovative job positions like remote operators at remote operation centers. The MASS Code is currently being discussed by the Maritime Safety Committee of the International Maritime Organization. This Code is expected to be adopted in the form of non-mandatory guidelines until 2025, with the goal of establishing mandatory requirements by 2028. Additionally, revisions to the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers related to crew training and qualifications are planned for adoption by 2027. These revisions will include requirements for MASS operators. This paper aims to examine the sustainable key competencies required for safe MASS operation by remote operators using the Analytic Hierarchy Process method, considering the emergence of the new profession of remote operator. Building upon the 66 knowledge, understanding, and proficiencies outlined for marine officers in the STCW Convention, the paper aims to identify the additional competencies required for remote operators and contribute to the development of a training model for the future. Full article

Growing evidence indicates that human milk oligosaccharides (HMOs) are important bioactive compounds that enhance health and developmental outcomes in breastfed babies. Maternal dietary intake likely contributes to variation in HMO composition, but studies identifying diet–HMO relationships are few and inconsistent. This study aimed to investigate how the maternal intake of macronutrients and micronutrients—specifically proteins, fats, vitamins, and minerals—associated with HMOs at 1 month (n = 210), 6 months (n = 131), and 12 months postpartum (n = 84). Several associations between maternal dietary factors and HMO profiles were identified utilizing partial correlation analysis. For example, maternal free sugar (rho = −0.02, p < 0.01), added sugar (rho = −0.22, p < 0.01), and sugary sweetened beverage (rho = −0.22, p < 0.01) intake were negatively correlated with the most abundant HMO, 2′-fucosyllactose (2′-FL), at 1 month, suggesting that higher sugar consumption was associated with reduced levels of 2′-FL. Further, vitamins D, C, K, and the minerals zinc and potassium were positively correlated with 2′-FL at 1 month (p_All < 0.05). For the longitudinal analysis, a mixed-effects linear regression model revealed significant associations between maternal vitamin intake and HMO profiles over time. For example, for each unit increase in niacin intake, there was a 31.355 nmol/mL increase in 2′-FL concentration (p = 0.03). Overall, the results provide additional evidence supporting a role for maternal nutrition in shaping HMO profiles, which may inform future intervention strategies with the potential of improving infant growth and development through optimal HMO levels in mothers’ milk. Full article

Learners of additional languages, particularly in adulthood and instructed settings, are typically exposed to large quantities of written input from the earliest stages of learning, with varied and far-reaching effects on L2 phonology. Most research investigating this topic focuses on learning across languages that share the same orthographic script, often involving the Latin alphabet and English. Without exploring phonological learning over a greater diversity of spoken and written language combinations, our understanding of orthographic effects on L2 phonology remains narrow and unrepresentative of the many individuals acquiring languages across writing systems, globally. This paper draws together preliminary research relating to the influence of written input, in a distinct script from known languages, on L2 phonology. Studies are grouped into those with naïve participants, where the written forms are entirely unfamiliar to the participant, and those with experienced learners, who have varying levels of proficiency and familiarity with the target orthography. While there is great scope and need for further investigation, initial evidence suggests that even entirely unfamiliar written input impacts phonological learning and is certainly influential with growing proficiency in the spoken and written language. The article concludes with theoretical and methodological considerations for future research in this emerging field. Full article

Healthy, nutritious, and delicious mulberry wine is loved by everyone, but there is no specific yeast for mulberry wine. To screen for yeasts with low-yield higher alcohols for the fermentation of mulberry wine, we tested five commonly used commercial yeasts available on the market to ferment mulberry wine. All five yeasts were able to meet the requirements in terms of yeast fermentation capacity, speed, and physical and chemical markers of mulberry wine. The national standards were met by the fermentation requirements and the fermented mulberry wine. We identified yeast DV10 as a yeast with low-yield higher alcohols suitable for mulberry wine fermentation. The total higher alcohol content in fermented mulberry wine was 298 mg/L, which was 41.9% lower than that of fermented mulberry wine with yeast EC118. The contents of 17 free amino acids and five sugars in mulberry juice and five yeast-fermented mulberry wines were tested. The results showed that the higher the amino acid and sugar content in yeast-fermented mulberry wine, the higher the content of higher alcohols produced by fermentation. A correlation analysis performed on each higher alcohol produced when yeast DV10 fermented the mulberry wine indicated decreased sugar and related amino acids. The findings demonstrated a substantial negative correlation among the levels of increased alcohol, decreased sugar, and matching amino acid content. Considering the correlation values among increased alcohol, decreased sugar, and related amino acids, the very slight difference suggests that both sugar anabolism and amino acid catabolism pathways have an equivalent impact on the synthesis of higher alcohols during the fermentation of mulberry wine. These results provide a theoretical basis for reducing the content of higher alcohols in mulberry wines, given the history and foundation for producing mulberry wine. Full article

Misophonia is a neurophysiological disorder with behavioral implications, is complex and multifactorial in origin, and is characterized by an atypical and disproportionate emotional response to specific sounds or associated visual stimuli. Triggers include human-generated sounds, mainly sounds related to feeding and breathing processes, and repetitive mechanical sounds. In response to the triggering stimulus, the patient experiences immediate, high-intensity, disproportionate physical and emotional reactions that affect their quality of life and social functioning. The symptoms of misophonia can occur at any age, but onset in childhood or adolescence is most common. Affected children live in a constant state of anxiety, suffer continuous physical and emotional discomfort, and are thus exposed to significant chronic stress. Chronic stress, especially during childhood, has consequences on the main biological systems through the dysregulation of the hypothalamic–pituitary–adrenal axis, including the gastrointestinal tract. Here, we provide arguments for a positive correlation between misophonic pathology and gastrointestinal symptoms, and this hypothesis may be the starting point for further longitudinal studies that could investigate the correlations between these childhood vulnerabilities caused by misophonia and their effect on the gastrointestinal system. Further research to study this hypothesis is essential to ensure correct and timely diagnosis and optimal psychological and pharmacological support. Full article

The treatment adherence of narcotics-addicted individuals with reduced incidences of relapse can be enhanced by a sustained drug release formulation of antinarcotics. So far, different drug formulations have been reported with sustained drug release periods of 28 and 35 days. To further enhance this duration, different formulations of injectable hydrogels (IHs) have been developed by combining low molecular weight (LMW) and high molecular weight (HMW) chitosan (CS) with guar gum (GG) and crosslinking them by sodium bi phosphate dibasic. The structural, morphological, and physicochemical properties of LMW-CS IH, and HMW-CS IH were evaluated using Fourier transform infrared spectroscopy (FT-IR), thermo-gravimetric analysis (TGA), scanning electron microscopy (SEM), and rheological, swelling, and biodegradation analysis. The HMW-CS IH showed high crosslinking, increased thermal stability, high mechanical strength, elevated swelling, and low biodegradation. The antinarcotic drugs naltrexone (NTX) and disulfiram (DSF) were loaded separately into the HMW-CS IH and LMW-CS IH. The release of NTX and DSF was investigated in phosphate buffer saline (PBS) and ethanol (0.3%, 0.4%, and 0.5%) over a 56-day period using an UV spectrophotometer. The drug release data were tested in zero-order, first-order, and Korsemeyer–Peppas mathematical models. In PBS, all prepared formulations followed non-Fickian drug release, while in ethanol, only NTX HMW-CS IH followed non-Fickian release in all three different concentrations of ethanol. Full article

Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome (GS), is a genetic disorder characterized by the development of multiple cutaneous BCCs due to mutations in the hedgehog signaling pathway. The use of hedgehog pathway inhibitors—vismodegib and sonidegib—has emerged as a promising therapeutic strategy for managing BCCs in individuals with GS. In a retrospective study conducted between March 2012 and January 2024, a cohort of 16 Gorlin syndrome patients who received treatment with either sonidegib or vismodegib were analyzed. The primary objectives of the study were to evaluate the efficacy, safety profile, and duration of response to oral hedgehog inhibitors in this patient population. The study assessed various parameters, including the number of new BCCs that developed before and after treatment initiation, the duration and sustainability of treatment responses, as well as the incidence of adverse effects associated with hedgehog inhibitor therapy. The findings of the study revealed that sustained treatment with hedgehog inhibitors could effectively suppress the progression of both new and existing BCCs. Furthermore, the results indicated that sonidegib exhibited superior efficacy and safety compared to vismodegib in the treatment of BCCs in individuals with GS. Notably, adjustments to the administration schedule of sonidegib were found to improve tolerability without compromising therapeutic efficacy, potentially leading to prolonged durations of treatment response and disease control. Full article