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This study aimed to evaluate the within-system agreement and interchangeability of real-time and post-processed external load metrics in elite football. Data were collected from 50 official Serie A matches using Dynamix (K-Sport World S.R.L., Pesaro, Italy), the platform for acquiring and standardizing tracking inputs. SmartLive, a real-time monitoring module embedded within Dynamix, was compared with post-processed data from the league-approved optical tracking provider (Hawk-Eye Innovations Limited, Basingstoke, UK) in Serie A. The external load metrics analyzed included total distance covered; distances at speeds exceeding 15, 20, and 25 km&#xb7;h-1; distances within the 15-20 km&#xb7;h-1 and 20-25 km&#xb7;h-1 ranges; distance covered during accelerations > 2 m&#xb7;s-2 and decelerations < -2 m&#xb7;s-2; and peak speed. Intraclass correlation coefficients (ICCs) demonstrated excellent agreement across all metrics, with values ranging from 0.929 to 0.999. Bland-Altman analysis revealed small mean differences between systems, indicating strong agreement. Overall, the findings confirm that both real-time and post-processed data are in close agreement across a wide range of performance metrics. Minor discrepancies were observed in intermediate speed zones and acceleration/deceleration events. This study provides the first validation of SmartLive's within-system agreement with post-processed data, supporting its use alongside post-processed data in elite football environments.

To quantify gendered patterns of professional misidentification among hospital doctors. An anonymised cross-sectional survey of hospital doctors was conducted in February 2025 at Basingstoke and North Hampshire Hospital, a UK district general hospital. Respondents reported the frequency, source and type of misidentification, alongside perceived impact on workflow. Responses were analysed by gender using Fisher's exact test. 52 doctors responded (32 female, 20 male). All female respondents reported misidentification at least once (vs 75.0% of men, p=0.006) and were more often misidentified weekly to daily (81.2% vs 25.0%, p<0.001). All women reported being mistaken for nurses (vs 30.0%, p<0.001) and misidentified downward (vs 50.0%, p<0.001); men were more often misidentified upward (65.0% vs 25.0%, p=0.008). Elevating nicknames were more often directed at men (60.0% vs 18.8%, p=0.003). Misidentification disrupted workflow at least sometimes for 40.6% of women versus 5.0% of men (p=0.008). In this single-centre cohort, misidentification showed consistent, statistically significant gendered patterns-women downward, men upward-suggesting a broader pattern warranting investigation in larger, multicentre studies. Visible role-labelling, inclusive communication training and leadership modelling merit consideration and future evaluation.

Medial opening wedge high tibial osteotomy is a successful procedure for correction of varus malalignment in isolation or in combination with other knee ligamentous and cartilage procedures. This article describes a technique for medial opening wedge high tibial osteotomy using a Hintermann distractor, which allows better control of the osteotomy gap opening and the posterior tibial slope. Preoperative digital planning is undertaken. A small longitudinal incision and a minimally invasive approach are performed to expose the proximal tibia. The Hintermann distractor is applied over 2 guide wires inserted divergently proximal and distal to the transverse osteotomy. The Hintermann distractor is used to open the osteotomy gap and maintain or change the posterior tibial slope according to the preoperative plan. Unimpeded access is provided, with no instrumentation in the gap, and this allows precise positioning of an allograft bone wedge, which is followed by fixation with an angular stable locking plate. In this technique, the Hintermann distractor serves as an outrigger that provides support to the osteotomy and offers rotational control to change the posterior tibial slope if desired.

Facial nerve palsy in older adults is commonly idiopathic or viral in origin, but secondary otologic and neurological causes must be carefully excluded, particularly when associated with hearing loss. We report a diagnostically challenging case of a 79-year-old woman who presented with acute right lower motor neuron facial palsy and new-onset hearing impairment, without otalgia, rash, or otorrhoea. Examination confirmed severe right-sided facial weakness, and initial imaging with computed tomography (CT) of the head and temporal bones demonstrated bilateral mastoid and middle ear opacification without bony erosion or intracranial extension. Despite these findings, the clinical presentation was not consistent with otogenic facial palsy. Given the combination of complete unilateral facial paralysis, hearing impairment, and absence of vesicular eruption, Ramsay Hunt syndrome presenting as zoster sine herpete was suspected. The patient was transferred to a tertiary otolaryngology centre and commenced on antiviral therapy and systemic corticosteroids. Subsequent specialist follow-up identified bilateral mixed hearing loss with a left-sided conductive component due to middle ear effusion, which did not anatomically or temporally correlate with the acute right-sided facial palsy. The patient experienced gradual clinical improvement. This case highlights the diagnostic complexity that arises when imaging findings mimic otologic infection but the clinical picture supports viral neuritis. It underscores the importance of cautious interpretation of radiologic findings and early recognition of Ramsay Hunt syndrome even in the absence of vesicular rash, as timely initiation of antiviral and corticosteroid therapy may improve neurological outcomes.

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The increasing prevalence of mental and behavioural health (MBH) conditions in children has posed significant strain on emergency departments (EDs) to provide adequate and timely care. This study analysed factors associated with time to disposition (TTD) for this patient population. The study utilised electronic health record (EHR) data for pediatric ED visits from 11 ED facilities in South Carolina between October 2017 to March 2023. We identified the MBH patients in our dataset based on ICD-10 codes. In total, 289,721 pediatric ED visits were analysed in a mixed-effects regression model predicting TTD. Male patients (p&#x2009;<&#x2009;.0001), weekend visits (p&#x2009;<&#x2009;.0001), and multiple ED visits (p&#x2009;<&#x2009;.0001) were associated with decreased TTD, but interactions between MBH-related visits and repeat ED visits significantly prolonged TTD (p&#x2009;<&#x2009;.0001) and nighttime and presenting during the fall season also influenced TTD (p&#x2009;<&#x2009;.001). Pediatric MBH-related ED visits have significantly longer TTD than non-MBH ED visits (p&#x2009;<&#x2009;.01). MBH patients with two or more previous ED visits also resulted in significantly longer TTD (p&#x2009;<&#x2009;.0001). Our analysis demonstrated system-level and patient-level factors significantly impact the TTD in an ED. These findings highlight the need to design and evaluate new interventions to improve care for pediatric MBH patients as well as overall ED performance.

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To provide contemporary, real-world data on the management approaches and survival outcomes of patients with incidental gallbladder cancer (GBC) following cholecystectomy in the United Kingdom. The secondary aim was to identify prognostic factors associated with survival. Patients diagnosed with incidental GBC following cholecystectomy between January 2014 and December 2022 across 24 centres were included. Data collected comprised demographics, treatment details, histopathological findings and survival outcomes. During the study period, 285 patients had incidental GBC. Median follow-up was 31 months, with 5-year disease-free (DFS) and overall (OS) survival of 41.5% and 45.1%, respectively. Of the 193 (67.7%) patients who underwent liver resection, most (97.9%) underwent segment 4B/5 resection. Patients with incidental GBC who underwent liver resection had significantly improved DFS (51 vs 15 months, p<0.001) and OS (72 vs 26 months, p<0.001) compared with those who did not. In addition, patients who completed adjuvant chemotherapy had better DFS (35 vs 15 months, p=0.021) and OS (47 vs 26 months, p=0.009) compared to those who did not. On multivariable analysis, nodal metastases were independently associated with poorer DFS (HR 2.04, 95% CI 1.30-3.20, p=0.002), while advanced tumour (T3-T4) stage (HR 1.70, 95% CI 1.04-2.77, p=0.034) and nodal metastases (HR 2.15, 95% CI 1.33-3.48, p=0.002) predicted poorer OS. Patients who underwent liver resection after incidental GBC had significantly better survival than those who did not proceed to further surgery. Adverse tumour biology was associated with poorer survival. Gallbladder cancer (GBC) is sometimes discovered unexpectedly after gallbladder removal for presumed benign disease. This study examined how patients with this incidental GBC are treated across the United Kingdom and what factors influence survival. Data from 285 patients diagnosed with incidental GBC between 2014 and 2022 at 24 specialist centres were analysed. Two-thirds of patients underwent additional liver surgery after their initial gallbladder operation. Patients who had further liver surgery lived significantly longer than those who did not. Survival was also better in patients who completed chemotherapy after surgery. However, patients with more advanced tumours or cancer that had spread to nearby lymph nodes had poorer outcomes. These findings highlight the importance of further liver surgery and appropriate additional treatment in patients with incidental GBC.

Complete macroscopic resection is the key objective of cytoreductive surgery for peritoneal malignancy. However, heterogeneity in terminology and operative technique persists across centres and between surgical and gynaecological disciplines. This study sought to establish international consensus on the nomenclature of cytoreductive surgery procedures, key technical principles of peritonectomy procedures and visceral resections, and management of regional lymph nodes in the context of peritoneal malignancy. A modified Delphi process was undertaken involving 148 surgical and gynaecological oncologists across six continents. Cytoreductive surgery was endorsed as the preferred term for potentially curative surgery for peritoneal malignancy. Agreement was reached on core principles guiding peritonectomy, including the extent of peritoneal resection around tumour deposits. For visceral resections, the panel favoured a conservative, tumour biology-informed strategy that considers disease distribution and patient-specific factors. The group recommended selective removal of clinically enlarged nodes only. This global consensus defines foundational principles for cytoreductive surgery in patients with peritoneal malignancy and provides standardised terminology and operative guidance that can be integrated into routine surgical practice across various surgical oncology disciplines. Adoption of these recommendations has the potential to reduce variability in cytoreductive surgery techniques, facilitate comparison between studies by increasing standardisation, and facilitate the design and conduct of high-quality surgical trials in peritoneal malignancy.

SURMOUNT-REAL UK will evaluate the effectiveness of tirzepatide when offered in addition to standard-of-care (SoC) in adults with Class I obesity (BMI &#x2265;&#x2009;30 and &#x2264;&#x2009;34.9&#x2009;kg/m2) and without diabetes in a UK primary care setting. A 5-year, phase 4, multicenter, open-label, pragmatic randomized clinical trial is enabled through access to participants' integrated electronic healthcare record data. The study will enroll approximately 3000 participants from Greater Manchester, UK,&#xa0;who are randomly assigned in a 1:1 ratio to receive either tirzepatide and SoC or SoC alone. The primary endpoint is the percent change in body weight from baseline to Month 24, with the time to onset of type 2 diabetes to Month 60 being the key secondary endpoint. Additional endpoints include the impact of tirzepatide versus SoC on obesity-related complications, health-related quality of life, healthcare resource utilization, productivity, employment, and sickness-related absences. SURMOUNT-REAL UK employs a novel study design to evaluate real-world health outcomes and potential long-term benefits for both participants and the healthcare system associated with the delivery of pharmacological obesity treatment at a population level. The study is intended to generate critical evidence to support informed decision-making in obesity management, clinical guideline development, and healthcare policy. ClinicalTrials.gov identifier: NCT07247084.

Background: This narrative review introduces the "From Plaque to Perfusion" framework, a clinically pragmatic approach that maps multimodality imaging technologies to critical decision points in the acute coronary syndrome (ACS) patient journey. By integrating non-invasive assessment, invasive procedural guidance, and post-event tissue characterisation, this framework provides a structured pathway for deep phenotyping of ACS. Artificial intelligence (AI) is highlighted as an essential enabling layer that enhances diagnostic precision, automates quantification, and supports scalable, data-driven care. Contemporary ACS management pathways, while effective, often leave residual clinical uncertainty. The diagnostic objective has evolved beyond confirming myocardial injury to comprehensively phenotyping the entire ACS cascade: defining the plaque substrate, identifying the culprit mechanism, and quantifying the myocardial consequence. This requires a systematic integration of advanced imaging modalities. Methods: This narrative review is based on a comprehensive literature search of major medical databases (PubMed/MEDLINE, Scopus, Embase, Google Scholar) for high-level evidence, including randomized controlled trials, meta-analyses, and international expert consensus documents published between January 2010 and February 2026. Results: The "From Plaque to Perfusion" framework consists of three core stages. First, non-invasive assessment with coronary computed tomography angiography (CCTA), fractional flow reserve (FFR-CT), and PET-CT defines plaque substrate and vascular inflammation. Second, invasive precision in the catheterization laboratory, guided by optical coherence tomography (OCT) and intravascular ultrasound (IVUS), resolves the culprit mechanism and optimizes percutaneous coronary intervention (PCI). Third, post-event tissue characterization with cardiac magnetic resonance (CMR) quantifies myocardial injury and refines prognosis. AI-driven platforms are shown to enhance each stage by automating analysis, standardizing interpretation, and providing actionable metrics for clinical decisions, including complex scenarios like Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). Conclusions: The "From Plaque to Perfusion" framework, enabled by AI, reframes ACS imaging as an integrated, mechanism-driven pathway. This approach moves beyond isolated test interpretation toward a scalable model of precision, phenotype-led care that promises to improve diagnostic certainty and personalize patient management.

We used natural language processing (NLP) to improve the utility of clinical decision support (CDS) &#x3b2;-lactam allergy alerts and promote informed allergy evaluation. NLP was performed on a corpus of clinical notes from hospital-based encounters to identify previous tolerance of &#x3b2;-lactam products using a rule-based approach. Historical tolerance of &#x3b2;-lactams was then combined with structured electronic health records data to produce improved CDS alerts. A survey was used to evaluate the utility of the improved alerts compared to standard allergy alerts. The rule-based pipeline identified previous &#x3b2;-lactam tolerance in between 3% and 28.4% of clinical notes and performed with high positive predictive value (83.6-97.6%) and recall (71.2-79.4%). The surveyed clinicians (N&#x2009;=&#x2009;9) reported increased confidence in using &#x3b2;-lactam products despite the presence of a documented &#x3b2;-lactam allergy when using the information presented by the NLP-enriched CDS alerts, and all surveyed clinicians indicated the alerts would improve the care of their patients. NLP of clinical notes shows potential to improve the utility of CDS allergy alerts. Clinicians were receptive to allergy alerts containing NLP-derived information. Allergy-related CDS alerts should be improved to provide additional information such as historical tolerance of relevant products to empower providers to make informed decisions regarding patient allergies.

The impact of time delays between multidisciplinary team (MDT) discussion and surgery for colorectal peritoneal metastases remains uncertain. This study evaluated whether the interval between MDT discussion and cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) affected surgical, patient-reported and survival outcomes. This single centre retrospective study included patients with colorectal peritoneal metastases who underwent CRS and HIPEC between August 2017 and September 2024. Data on surgical outcomes including postoperative complications and survival were collected. Patient-reported outcomes were assessed using the Short Form 36 Survey (SF-36). Multivariate regression and Cox proportional hazards models assessed associations between MDT-to-surgery interval and outcomes. One hundred and eighty-five patients who underwent CC0 or CC1 cytoreduction were included. Median MDT-to-surgery time was 28&#x2009;days (range 19-49). Time from MDT to surgery was not associated with postoperative complications (95% CI: 0.00-0.02, p&#x2009;=&#x2009;0.13), physical and mental quality of life outcomes (for SF-36 scores at 12&#x2009;months, 95% CI: -0.09 to 0.05, p&#x2009;=&#x2009;0.56 and 95% CI: -0.05 to 0.12, p&#x2009;=&#x2009;0.37 for physical and mental components, respectively) or survival (p&#x2009;=&#x2009;0.20). Charlson Comorbidity Index (CCI) (95% CI: 0.82-3.90, p&#x2009;=&#x2009;0.00) and Eastern Cooperative Oncology Group (ECOG) status (95% CI: 1.83-9.38, p&#x2009;=&#x2009;0.00) were associated with increased postoperative stay. The SF-36 mental component at 6&#x2009;months correlated with predischarge scores (95% CI: 0.18-0.49, p&#x2009;=&#x2009;0.00). Moderate delays in MDT-to-surgery time did not influence outcomes. These findings help to reassure patients who face delays due to patient related or scheduling factors and might facilitate preoperative optimisation. Future research should explore integrated risk models using ECOG and CCI scores to identify patients requiring targeted support.

Primary membranous nephropathy (PMN) is a leading cause of nephrotic syndrome in adults and is associated with an increased risk of thromboembolic events. The anti-serum phospholipase A2 receptor antibody (anti-PLA2R Ab) is highly specific for PMN, correlates with immunological disease activity, and evidence suggests that it may contribute to a prothrombotic state. This systematic review and meta-analysis aimed to further explore the potential association between serum anti-PLA2R Ab and thromboembolic events in patients with PMN and investigate whether they may serve as a possible biomarker for thrombogenesis. PubMed, Embase, and Cochrane databases were systematically searched for studies that investigated the presence of anti-PLA2R Ab as a potential risk factor for thrombogenesis in patients with PMN. Odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were pooled across studies. Heterogeneity was evaluated using I2 statistics. We included seven studies involving 1,162 patients; mean age was 53 years. Patients with anti-PLA2R Ab had significantly higher odds of thromboembolism compared to those without anti-PLA2R Ab (OR 1.52; 95% CI 1.10, 2.09; p = 0.01). Patients diagnosed with thromboembolism exhibited significantly lower serum albumin levels compared to those without thromboembolism (p = 0.003), but there were no statistical differences in proteinuria (p = 0.18) or age (p = 0.90) between patients with and without thromboembolism. Proteinuria (p = 0.59), serum creatinine (p = 0.77), or estimated glomerular filtration rate (p = 0.59) did not differ between anti-PLA2R Ab-positive and negative patients. However, total cholesterol levels were higher in patients with positive anti-PLA2R Ab (p < 0.0001). There was a significant association between the presence of anti-PLA2R Ab and the risk of thromboembolism in patients with PMN, supporting their potential use as a biomarker for thrombogenesis in this population.

Energy-based devices (EBDs), including vaginal laser and radiofrequency therapies, have been proposed as minimally invasive treatments for stress urinary incontinence (SUI), but evidence remains limited and inconsistent. We hypothesised that EBDs would provide greater symptom improvement than sham, particularly in women with mild to moderate SUI. Following PRISMA guidelines, we searched Medline, Embase, the Cochrane Library, and One Search for randomised controlled trials (RCTs) comparing EBDs with sham in women with SUI, with at least 1 month of follow-up. The primary outcome was change in International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) scores. Two reviewers independently performed data extraction and RoB-2 assessment. Random-effects meta-analyses using restricted maximum likelihood estimation were conducted. Ten RCTs (11 datasets; ~ 850 women) were included. Using a random-effects model with Knapp-Hartung adjustment, the pooled EBD analysis showed a mean difference of -1.08 points (95% CI -2.08 to -0.08), indicating a statistically significant improvement with EBD. The prediction interval (-3.63 to 1.48) suggests a wide range of possible effects, including no benefit. Heterogeneity was moderate (I2 = 53%). Subgroup analysis of non-ablative Er:YAG laser showed the strongest and most homogeneous effect (MD -1.42; 95% CI -2.55 to -0.28; I2 = 29%). CO2 laser findings were inconsistent, and evidence for radiofrequency was insufficient. Adverse events were mild and transient. EBDs may improve SUI symptoms compared with sham, with the most consistent benefit observed for non-ablative Er:YAG laser. However, effects are modest and short-term. High-quality RCTs with standardised protocols and long-term follow-up are needed.

Diabetes, precisely Type II Diabetes Mellitus (T2DM), is a prevalent global chronic condition. This study focuses on improving the accuracy of predicting T2DM onset and risk by utilizing Generative Artificial Intelligence (GenAI) based synthetic data generation and innovative feature selection techniques. GenAI models such as Deep Tabular Augmentation (DTA) and Large Language Models (LLM) were utilized to address class imbalance and data scarcity of diabetes class for prediction. The Representative Instances-based Fuzzy Rough Set Feature Selection (FRS-RI) method was employed for optimal feature selection. Three diabetes datasets - Sylhet, Obesity, and Diagnostic Features - were employed. After FRS-RI feature selection and synthetic data generation, Machine Learning (ML), Ensemble Learning (EL), and Deep Learning (DL) models were trained on these datasets. The ML, EL, and DL models achieved impressive accuracy, precision, and recall scores: 95.19%, 0.96, and 0.94 for the Sylhet Dataset; 100%, 1.00, and 1.00 for the Obesity dataset; and 97.44%, 0.97, and 0.94 for the NIDDK-DF Dataset. The model's ability to generalize to new diabetic data was demonstrated by enhanced test accuracies of 98.37% and 97.33% obtained when the suggested techniques were applied to benchmark datasets such as PIMA and LMCH, respectively. Emphasis was also placed on model explainability to justify predictions for clinical presentation.

Open tibia fractures are a common and severe injury in low-income countries (LICs), and worsened by fracture-related infection (FRI). The Radiographic Union Score for Tibial fractures (RUST) is widely used to assess fracture healing, but its reliability and factors associated with nonunion in LICs remain unclear. We conducted a multicentre prospective cohort study in six hospitals across Malawi, enrolling 287 adults with open tibia fractures between February 2021 and March 2022. Participants underwent standardized clinical and radiological follow-up at three, six, and 12 months post-injury. Fracture union at follow-up was assessed independently by two reviewers using the RUST score. Patient function was measured using the Short Musculoskeletal Function Assessment (SMFA) score. Multilevel regression models examined associations between RUST scores, functional outcomes, baseline factors, and treatment methods. Participants had a median age of 34 years (IQR 25 to 44), and 84% (248/287) were male. Overall, 45/177 (25.4%) of participants with open tibia fractures had a nonunion at one year, with 34.2% (13/38) with FRI having nonunion compared with 15.4% (20/130) no FRI (p = 0.001). After adjusting for other variables, compared with external fixation, intramedullary nailing (odds ratio (OR) 1.35, 95% credible interval (CrI) 0.98 to 1.93) and plaster of Paris (POP) fixation (OR 2.05, 95% CrI 1.29 to 3.64) were associated with higher RUST scores. Each one-point increase in RUST score was associated with -4.1 (95% CrI -6.2 to -2.1) SMFA score, reflecting better function. Interobserver reliability of RUST was moderate (ICC 0.51, 95% CI 0.28 to 0.61), despite 74% of radiographs being of suboptimal quality at one year. Nonunion is common after open tibia fracture in Malawi, particularly with external fixation and FRI. The RUST score is reliable and correlates with patient function in LIC settings, even with variable radiograph quality. Poor function should prompt a careful assessment for nonunion and consideration of intervention where appropriate.

Antibiotic susceptibility testing (AST) results are needed more rapidly to support antimicrobial stewardship and improve patient outcomes. Diagnostic microbiology laboratories receive hundreds of urine samples daily from patients with suspected urinary tract infection (UTI) in both community and inpatient settings. Bacteriostatic boric acid preserves microbial contents during transport but may interfere with rapid AST methods. This study aimed to assess the accuracy of rapid microcapillary direct-from-urine (RMD) AST with suspected UTI patient urine, and to determine whether RMD AST is affected by boric acid. The overall accuracy of RMD AST was assessed with 352 diagnostic remnant urine samples collected with boric acid, for seven first-line antibiotics (ampicillin, amoxicillin/clavulanic acid, trimethoprim, nitrofurantoin, ciprofloxacin, cefalexin and cefoxitin). A further 90 urine samples were tested in duplicate with or without addition of bacteriostatic. RMD AST showed a concordance with the reference method of 572/590 bacteria/antibiotic combinations (96.95%) for urine samples containing a single organism. The mean time to AST result was 5.85&#x2005;h. When duplicate samples with or without boric acid were directly compared there was a categorical agreement of 158/160 (98.75%). The overall high accuracy of RMD AST for determining antimicrobial susceptibility to seven first-line antibiotics for UTI shows this method can deliver rapid results-without requiring additional processing-for urine samples routinely collected with boric acid from suspected UTI patients. The close agreement between duplicates with or without boric acid confirms this rapid direct method is unaffected by bacteriostatic collection.

Cardiac myxomas (CMs) are the commonest benign primary cardiac tumors, most frequently originating from the left atrium and occasionally from the right atrium. Despite being histologically benign, CMs can cause myriad serious embolic complications, including stroke, acute coronary syndrome, limb ischemia, and visceral infarction. While previous studies have explored risk factors for embolization, there is a lack of papers comprehensively summarizing the frequency, anatomical distribution, clinical patterns, and management of CM-related embolization. This review aims to provide a comprehensive synthesis of embolic complications associated with CMs, highlighting patterns, management strategies, and gaps in the current literature. A systematic review will be conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. MEDLINE, Embase, Scopus, CINAHL, the Cochrane Library, and PubMed will be searched for studies reporting embolic complications in patients with histologically or radiologically confirmed CMs. Eligible study designs include large case series, cohort studies, and registries. Six reviewers will independently perform title and abstract and full-text screening in pairs across 3 screening groups, with disagreements resolved through discussion and senior reviewer adjudication where necessary. Data will be extracted by 3 reviewers, with the extracted data independently verified for accuracy. Discrepancies will be resolved through discussion or third-party adjudication. Risk of bias will be assessed using the Joanna Briggs Institute tools. The review will summarize reported frequencies and anatomical distribution of embolic events, clinical presentations, associations with tumor characteristics, and management strategies. Title and abstract screening were completed in early April 2026, and full-text screening commenced in late April 2026. Data extraction and synthesis were completed in May 2026. We anticipate publication of the findings in September 2026. This review aims to provide a comprehensive synthesis of embolic complications associated with CMs, highlighting patterns, management strategies, and gaps in the current literature. The findings aim to improve clinical recognition, inform clinical management, and guide future research.