搜索结果：Pharmacological reviews

Dental anxiety associated with dental implant surgery can adversely affect patient comfort, cooperation, and overall procedural outcomes. Both pharmacological and non-pharmacological interventions are commonly employed to manage preoperative anxiety; however, their comparative effectiveness remains unclear. A systematic evaluation of these approaches is important to determine their relative benefits in terms of anxiety reduction, onset of action, safety profile, and patient acceptability. Existing evidence suggests that pharmacological interventions may provide rapid anxiolytic effects, whereas non-pharmacological approaches, such as relaxation techniques, mindfulness-based interventions, and audio distraction, may reduce anxiety without the potential adverse effects associated with medication use. Therefore, this systematic review aims to compare the effectiveness of pharmacological and non-pharmacological anxiety control strategies in dental implant surgery and evaluate their clinical applicability in optimizing patient management. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library to identify randomized controlled trials evaluating the effectiveness of pharmacological and non-pharmacological interventions for the management of dental anxiety in adult patients undergoing dental implant surgery, up to September 2025. The systematic review was conducted according to a pre-specified protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality and risk of bias of the included studies were assessed using the revised Cochrane Risk of Bias tool (RoB 2.0). The electronic database search identified a total of 225 articles related to anxiety management during dental implant placement. By evaluating titles, abstracts, and full texts, 15 articles met the inclusion criteria; however, no relevant studies were found through hand searching. The evidence suggested that that multimodal anxiety-reduction strategies, particularly dexmedetomidine sedation and behavioural distraction techniques, are effective in reducing dental anxiety during implant procedures. Both non-pharmacological and pharmacological anxiety management strategies demonstrate considerable potential in reducing dental anxiety during implant placement. Behavioural interventions, including effective communication, relaxation techniques, distraction methods, and complementary therapies, appear beneficial for patients with mild to moderate anxiety, whereas pharmacological sedation is particularly effective for managing moderate to severe dental fear, thereby enhancing patient cooperation, procedural comfort, and overall acceptance of implant therapy. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261376502, identifier CRD420261376502.

Open science practices, including the preregistration of protocols and the sharing of data and code, are increasingly promoted to enhance transparency, accessibility and the reuse of research outputs. However, systematic reviews, which are essential for informing clinical guidance and policy, often provide limited access to the materials needed for independent verification and reuse. Our objective was to estimate the prevalence of key open science indicators in interventional systematic reviews and to assess temporal changes by comparing our 2024 cohort with previously published cohorts from 2014 to 2020. Cross-sectional meta-research study. MEDLINE, Embase, and CINAHL were searched in June 2024 for English-language records indexed between 1 January and 1 February 2024. Interventional systematic reviews including human participants, a clearly defined PICO question, a systematic search strategy, a risk-of-bias assessment, and at least one meta-analysis. Following our publicly registered protocol and STROBE guidance, records were randomly sampled and screened in duplicate until 300 eligible reviews were included. Data extraction was conducted in duplicate. We assessed protocol registration and availability, data sharing, code sharing, and preprint dissemination. Preprints were identified through extensive manual searches across more than 40 preprint servers and through author contact. Temporal changes were examined by comparing our 2024 cohort with previously published cohorts from 2014 to 2020 using pairwise risk ratios (RRs) with predefined equivalence ranges. Among the 300 included reviews, cancer was the most common health condition (17%), and pharmacological or biological interventions were the most common intervention type (35%). The median number of primary studies included in each systematic review was 14 (IQR 9-23). Most reviews (73%) were published in journals with data and/or code-sharing policies. In the 2024 cohort, 70% of systematic reviews reported a registered protocol or protocol availability and 61% included a data availability statement. However, only 24% shared underlying data, and analytical code was shared in 1% of reviews. Preprints were rare, occurring in 2% of the reviews. Reporting of protocol registration or availability increased substantially over time (2024 vs. 2014: RR 2.03, 95% CI 1.55-2.65; 2024 vs. 2020: RR 1.67, 95% CI 1.43-1.95), as did data availability statements (2024 vs. 2020: RR 1.98, 95% CI 1.63-2.40). Data sharing showed a nonlinear pattern, decreasing from 2014 to 2020 (RR 0.22, 95% CI 0.13-0.36) and increasing from 2020 to 2024 (RR 3.71, 95% CI 2.30-6.00), but remained uncommon overall. Code sharing was rare and showed no detectable change (OR 1.00, 95% CI 0.15-6.51). In the 2024 cohort, 3% of protocols were registered after manuscript submission. Several transparency indicators became more common over time, although trends differed across indicators. Yet the sharing of reusable research materials remains uncommon. Reusable data, analytic code, and preprints are rare outside the context of pandemics. These findings highlight a persistent gap between declarative openness and operational accessibility, emphasizing the necessity for more robust, verifiable mechanisms from journals and funders to reduce data distance and support independent verification and reuse of systematic review evidence. This gap between declared openness and practical accessibility continues to limit independent verification and reuse of systematic review evidence.

This study sought to evaluate the characteristics of clinical-pharmacological (CP) medication reviews conducted by the Institute for Clinical Pharmacology of Hannover Medical School for older, multimorbid, polymedicated insurants of the German statutory health insurance fund Kaufm&#xe4;nnische Krankenkasse (KKH). Special emphasis was put on potential sex-specific differences between female and male insurants, prescriptions of potentially inappropriate medications for older individuals (PIMs), and potentially inappropriate duplicate prescriptions (PIDPs). Medication reviews conducted for KKH insurants between 2019 and 2023 (n&#x2009;=&#x2009;334) were analyzed retrospectively. Clinical trial number is not applicable. The median age of KKH insurants (58.1% female) was 74&#xa0;years (first quartile (Q1): 68; third quartile (Q3): 80). Insurants displayed a median of 7 diseases (Q1: 5; Q3: 9) and took a median of 13 drugs (Q1: 11; Q3: 16). A median of 4 CP recommendations was issued per medication review (Q1: 3; Q3: 5). The number of CP recommendations was significantly higher for female compared to male insurants (median of 4 (Q1: 3; Q3: 6) vs. median of 3 recommendations (Q1: 2; Q3: 4); p&#x2009;<&#x2009;0.001), while the number of drugs was identical and the number of diagnoses was higher for female insurants. The most frequently prescribed PIMs were tricyclic antidepressants, benzodiazepines, and Z-drugs. At least one PIDP was detected in 16.5% of medication reviews. The sex-specific difference in the number of CP recommendations between female and male insurants may point to an unmet pharmacotherapeutic need in older women. PIM prescriptions and PIDPs were relevant topics of CP recommendations, suggesting possibilities for pharmacotherapeutic optimization in older, multimorbid, polymedicated patients.

This overview aims to provide high-quality evidence synthesis of animal-assisted interventions (AAIs) among people living with dementia. Dementia has become the seventh leading cause of death in the world. Unfortunately, currently effective pharmacological interventions remain elusive. As a non-pharmacological treatment, AAI is gaining more attention while the effectiveness of AAI for people living with dementia remains unclear. EMBASE, PubMed, Cochrane Library, CINAHL, CNKI, VIP, CBM and Wanfang databases were searched from inception to March 2026. The AMSTAR2 was used to assess the methodological quality of the included reviews. Meta-analysis was conducted using STATA 16 for the original studies identified from the included reviews. Evidence quality of main outcomes was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. Sixteen systematic reviews were included in the overview. A significant improvement was found in depression among dementia patients, but not in agitation, quality of life (QOL), cognition and activities of daily living (ADL). There is moderate evidence that AAI has positive effects on depression for people living with dementia. Despite searches, no sufficient evidence has been found to substantiate the positive effects of AAI on other outcomes in people living with dementia. Due to the small number of studies, small sample sizes and significant heterogeneity, more randomised controlled trials with large samples are needed.

Postoperative nausea and vomiting (PONV), as a common complication in laparoscopic surgery, significantly delays patients' recovery and increases the incidence of unplanned readmission. Although drug prevention is widely used, nurse-led non-pharmacological interventions can provide safe and effective collaborative management. However, the current evidence is fragmented and there is a lack of guidelines specific to laparoscopic surgery, resulting in significant differences in clinical practice. This study aimed to integrate the best evidence and establish standardized non-pharmacological nursing strategies for the prevention and treatment of PONV in adults undergoing laparoscopic surgery. Following the standard methodology of the Fudan University Center for Evidence-based Nursing (registration number: ES20257623) and guided by the "5S" evidence pyramid model, we systematically searched multiple databases and guideline repositories from inception to December 4, 2025. We included evidence summary, clinical decision, guidelines, expert consensus statements, systematic reviews and meta-analyses. Literature screening, quality appraisal, and evidence extraction were performed independently by two reviewers. Methodological quality was assessed using validated screening tools. A summary of findings table was constructed to present the synthesized evidence. From 1,564 initial records, 39 publications were included: 5 evidence summaries, 1 clinical decision, 8 guidelines, 4 expert consensuses and 21 systematic reviews. We synthesized 28 best practice recommendations across five key domains: pre-operative risk assessment (identification of risk factors, risk quantification tools, stratified PONV prophylaxis), intraoperative preventive interventions (fluid management, acupoint stimulation, high-concentration oxygen), post-operative symptom management (symptom assessment tool, non-pharmacological management), follow-up care (health education, prevention and control of PDNV), system support (organizational management). This evidence summary provided a comprehensive, clinically actionable framework for nurses to lead proactive, evidence-based PONV care for laparoscopic surgery patients. Effective nursing interventions directly reduced PONV incidence, decreased antiemetic requirements, and improved patient comfort and satisfaction. In addition, nursing practice can shift from reactive management to proactive prevention, thereby delivering patient-centered benefits. The findings should be adapted to local contexts to develop standardized nursing procedures, thereby translating evidence into clinical practice. Not applicable.

Aligned with the World Health Organization's call for enhanced dementia research to inform national strategies, this systematic mapping review identifies critical gaps in the evidence base for Chinese populations. Representing over 20% of people living with dementia globally, this group remains underrepresented in the Western-centric research that currently guides best practices. This is the first study that comprehensively reviews evidence on dementia-related interventions trialled among participants identified as Chinese worldwide across both Chinese and English literature. It addresses critical gaps in previous Anglo-centric reviews by capturing culturally specific interventions and assessing the evolving evidence landscape for Chinese population. Following PRISMA guidelines, we systematically searched two widely used Chinese databases (China National Knowledge Infrastructure, Wanfang Data) and 12 English bibliographical databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit, Cochrane Database of Systematic Reviews) to identify randomised controlled trials (RCTs) published between 2008 and 2020 (registered on PROSPERO: CRD42019134135). Dual-language teams employed culturally sensitive strategies to maximise coverage of regionally prevalent interventions. Risk of bias was assessed using version two of the Cochrane risk-of-bias tool for randomised trials. A narrative approach was used to review and assess the current landscape of dementia intervention research in Chinese communities. We identified 183,277 records across Chinese and English databases and included 525 unique RCTs for synthesis (93% published in Chinese). The most commonly studied interventions were multicomponent interventions (35.2%), followed by pharmacological (29.5%), non-pharmacological (18.3%), and traditional Chinese medicine (TCM; 14.5%) interventions. 62.7% of multicomponent RCTs were those combining TCM with Western drugs. Cognitive outcomes were measured in 86.9% of RCTs and functional outcomes in 60.2%, while only 3% evaluated quality of life (QoL) and 1% carer-related outcomes. Most trials (91.8%) were hospital-based. Over 80% of included RCTs were assessed as having overall 'some concerns'. Despite rapid growth of dementia intervention research in Chinese communities, evidence remains skewed towards hospital-based trials conducted predominantly in mainland China, with a focus on cognitive and functional outcome. High-quality evidence is urgently needed to rebalance research priorities and address critical knowledge gaps in improving QoL, carer support, and community-based interventions. Our finding that most trials were published in Chinese involving TCM illustrates the value of integrating non-English literature in global evidence synthesis, especially for identifying culturally specific interventions common in lower- and middle-income countries.

Curcumae Radix: the dried root tuber of plants from the genus Curcuma (family Zingiberaceae), is a commonly used Chinese materia medica for promoting blood circulation and moving qi. It exhibits effects including invigorating blood circulation to relieve pain, moving qi to resolve depression, clearing the heart to cool blood, and promoting bile flow to relieve jaundice. Its botanical origins include Curcuma wenyujin, Curcuma longa, Curcuma kwangsiensis, and Curcumae phaeocaulis. Modern investigations have shown that Curcumae Radix contains over 250 compounds, mainly volatile oils and curcuminoids. Pharmacologically, it exhibits antitumor, hepatoprotective, anti-inflammatory, analgesic, cardiovascular-protective, and neuroprotective effects. In clinical practice, it is often combined with other herbs for the synergistic treatment of hepatobiliary, neurological, and digestive system disorders. Processing can alter the dissolution and transformation of its chemical constituents, thereby enhancing its efficacy or directionally regulating its actions. Although several reviews have summarized the chemical composition and pharmacological effects of Curcumae Radix, there is still a lack of clear understanding regarding the correlation between chemical differences and efficacy among different botanical origins, a systematic elucidation of the molecular mechanisms underlying processing-induced efficacy enhancement, and high-quality clinical translational evidence. This review systematically summarizes the chemical constituents, pharmacological effects, clinical applications, and processing research progress of Curcumae Radix, identifies the current key knowledge gaps, and provides a reference for the precision clinical application and modern development of this herbal medicine.

Adolescent diabetic kidney disease (DKD) represents an early-onset microvascular complication characterized by prolonged metabolic exposure and accelerated renal decline. Elevated serum creatinine and blood urea nitrogen (BUN) are key biochemical indicators of impaired renal function. This scoping review aims to systematically map and evaluate pharmacological strategies for slowing the rise of creatinine and BUN in adolescents (aged 10-19 years) with DKD, with emphasis on renoprotective mechanisms, therapeutic sequencing and the potential applicability of these therapies to adolescent populations. A scoping review was conducted in accordance with PRISMA-ScR guidelines. A comprehensive literature search was performed using PubMed, Scopus and Google Scholar for studies published between 2020 and 2025. Eligible studies included clinical trials, observational studies, clinical guidelines and relevant reviews focusing on pharmacological interventions in adolescents (10-19 years) with diabetic kidney disease. Study selection was based on predefined inclusion and exclusion criteria. A total of 35 studies and guideline-based references were included in the final synthesis. Intensive glycemic control (insulin for type 1 diabetes; metformin &#xb1; insulin for type 2 diabetes) was associated with improved metabolic control and favorable renal outcomes. Renin-angiotensin system blockers consistently reduced albuminuria and induced an acute hemodynamic reduction but stabilized the long-term decline in estimated glomerular filtration rate (eGFR). Sodium-glucose cotransporter-2 (SGLT2) inhibitors demonstrated additional renoprotective effects in type 2 diabetes; risks (euglycemic DKA) limit use in type 1. In adult studies, finerenone attenuated inflammatory and fibrotic pathways; no adolescent data exist. Glucagon-like peptide-1 receptor agonists improved metabolic control and reduced obesity-associated renal stress. However, pediatric-specific evidence remains limited, and much of the available evidence is derived from adult studies. Adult data suggest potential benefits of early multi-target pharmacotherapy, but adolescent-specific evidence is needed to confirm a critical role in delaying renal deterioration. Whether integration of conventional and novel agents improves long-term renal outcomes in adolescents requires direct investigation. Further pediatric-focused research is required to establish safety, efficacy and optimal therapeutic strategies.

Honokiol (HKL), a bioactive biphenolic lignan isolated from the bark of Magnolia officinalis, possesses diverse pharmacological properties, including neuroprotective, antitumor, anti-inflammatory and metabolic regulatory effects. Despite its therapeutic promise, the clinical application of HKL is severely restricted by its hydrophobicity and low oral bioavailability. The present review systematically summarized 99 studies (90 original articles and nine reviews) on the pharmacological profile of HKL. It detailed HKL's molecular interactions with key signaling targets, such as sirtuin 3, NOD-like receptor family pyrin domain containing 3-cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes, Yes-associated protein/transcriptional coactivator with PDZ-binding motif, adenosine monophosphate-activated protein kinase and signal transducer and activator of transcription 3, which underly its efficacy against cancer (ovarian, liver, breast, colorectal, and lung), neurodegeneration (Alzheimer's and Parkinson's disease), metabolic disorders (diabetes, nonalcoholic fatty liver disease and obesity) and inflammatory and infectious diseases. Furthermore, the present review critically evaluated recently developed strategies to overcome its pharmacokinetic limitations. The present review offered an updated theoretical basis for understanding the structure-activity relationship of HKL and provided insights into its translation from bench to bedside.

Extracorporeal shock wave lithotripsy (ESWL) is a widely used non-invasive treatment for urinary stones. Nevertheless, procedural noise, discomfort, uncertainty, and repeated shock-wave delivery may cause clinically relevant anxiety. Music has been proposed as an accessible non-pharmacological strategy to improve the patient experience, but previous reviews have reported heterogeneous results and have frequently combined anxiety with pain or audiovisual interventions. We evaluated the association between music exposure and anxiety during ESWL. MEDLINE/PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to March 2026. Randomized controlled trials comparing music with standard care or no music in adults undergoing ESWL were eligible. Anxiety measured using a Visual Analog Scale (VAS) and the State-Trait Anxiety Inventory (STAI) was analyzed separately. Random-effects meta-analyses were performed using mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was evaluated using Cochrane RoB 2. Leave-one-out sensitivity analyses, Baujat plots, funnel plots, and trial sequential analysis (TSA) were also performed. Twelve randomized controlled trials were included in the systematic review. Ten contributed to the VAS analysis and eight to the STAI analysis. Music was associated with lower anxiety measured using VAS (MD&#x2009;-1.01; 95% CI&#x2009;-1.63 to&#x2009;-0.39; I2&#x2009;=&#x2009;80.1%) and STAI (MD&#x2009;-4.46; 95% CI&#x2009;-7.10 to&#x2009;-1.81; I2&#x2009;=&#x2009;91.2%). Leave-one-out analyses showed that the direction of the pooled estimates was not determined by any single study. However, substantial heterogeneity and possible small-study effects were present. The certainty of evidence was rated as very low for both outcomes. Under the pre-specified assumptions, TSA indicated that the cumulative evidence crossed the trial sequential monitoring boundary, although this finding does not address the risk of bias or inconsistency of the underlying studies. Music was associated with modest reductions in anxiety scores during ESWL and may be considered a feasible non-pharmacological adjunct. Nevertheless, substantial heterogeneity, methodological limitations, variation in music and analgesia protocols, and very low certainty of evidence limit confidence in the magnitude and clinical relevance of the pooled effects. Additional well-designed trials using standardized interventions and clinically meaningful anxiety outcomes remain warranted.

Anatabine, a characteristic minor alkaloid derived from tobacco byproducts, exhibits unique structural analogy to nicotine but possesses a superior safety profile and lower addictive liability, rendering it a promising natural multi-target therapeutic candidate. Accumulating preclinical evidence has demonstrated that anatabine exerts neuroprotective, anti-inflammatory, and antioxidant effects mainly through modulating &#x3b1;7/&#x3b1;4&#x3b2;2 nicotinic acetylcholine receptors, suppressing NF-&#x3ba;B/STAT3 inflammatory signaling, and activating the Nrf2-mediated antioxidant pathway. It effectively ameliorates typical pathological alterations, including &#x3b2;-amyloid deposition, tau hyperphosphorylation, and microglial overactivation, thereby improving cognitive and behavioral deficits in neurodegenerative disease models. Additionally, anatabine displays broad pharmacological potentials in chronic inflammation, autoimmune thyroiditis, asthma, and hypertension. Differing from previous reviews that merely focused on single receptor regulation, the present work systematically summarizes the multi-target pharmacological characteristics of anatabine, comprehensively collates its preclinical efficacy across multiple disease categories, and highlights its advantages over nicotine in safety and addiction risk. Furthermore, we analyze the current limitations, druggability optimization challenges, and clinical translation prospects, and propose sustainable strategies for high-value utilization of tobacco byproducts. This review provides an updated and systematic theoretical basis for further mechanism exploration and therapeutic development of anatabine.

Autoimmune diseases are chronic conditions that arise from the loss of immune tolerance toward the body's own tissues. Current therapeutic options are often associated with adverse effects and limited long-term efficacy. Quercetin, a naturally occurring flavonoid with well-documented antioxidant, anti-inflammatory, and immunomodulatory properties, has emerged as a potential therapeutic candidate for autoimmune conditions. This systematic review aimed to evaluate the current evidence on the pharmacological effects and therapeutic potential of quercetin in autoimmune diseases. Original in vitro studies using human-derived cell models and human clinical (in vivo) studies published in English from 2014 onwards that investigated quercetin's effects on autoimmune conditions were included, while reviews, non-English publications, and studies lacking mechanistic insights were excluded. Comprehensive searches across three electronic databases - PubMed, Scopus, and the Cochrane Library, supplemented by manual reference screening, resulted in the inclusion of thirteen studies for qualitative synthesis. Quercetin consistently demonstrated beneficial effects, including attenuation of oxidative stress, suppression of pro-inflammatory cytokines, and modulation of immune-related signaling pathways. Several clinical studies reported that quercetin alleviated disease severity and reduced tissue inflammation. Overall, quercetin exhibits pleiotropic mechanisms of action that collectively contribute to its immunomodulatory and protective effects in autoimmune diseases. However, the limited number of clinical trials and heterogeneity in study designs highlight the need for further standardized and well-controlled investigations to validate its therapeutic potential.

Giggle incontinence (GI) is a rare type of urinary incontinence that affects children and adolescents, impacting their quality of life by causing social isolation, reduced self-confidence, and low self-esteem. To counteract the symptoms of GI, various treatment approaches have been described, but there is a dearth of reporting on their effectiveness. This review aims to synthesize evidence on the management of GI in the adolescent population, focusing on pharmacological and nonpharmacological interventions. Ascoping review was conducted using the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews guidelines, along with the Population, Concept, Context framework, to perform a comprehensive search across major databases and gray literature. Treatment outcomes and follow-up data were extracted. Of the 72 records, 9 studies met the inclusion criteria, in which the commonly used interventions were pharmacologic (mainly methylphenidate [MPH]) and nonpharmacologic (biofeedback, behavioral modifications). Studies explored the effectiveness of these interventions and found positive outcomes. Follow-up showed a significant effect of both the types of interventions. GI remains under-recognized in the adolescent population despite its effects on psychological and urological health. A multidisciplinary approach targeting the GI can help improve outcomes. This review provides insights about the use of various nonpharmacological therapies, such as biofeedback and behavioral therapy, and pharmacological therapies in the form of MPH to improve GI. Nonpharmacological approaches are low-risk and can be adapted as the primary treatment. Future research with planned methodology to compare the treatment efficacy is needed to improve the outcomes.

Laparoscopic bariatric surgery is associated with specific analgesic challenges because opioid-related adverse effects may be especially relevant in patients with obesity, obstructive sleep apnea, and cardiometabolic comorbidities. Inadequate perioperative analgesia in this population may impair early mobilization and functional recovery, while excessive opioid use increases the risk of respiratory depression, postoperative nausea and vomiting (PONV), and prolonged hospital stay. This narrative review synthesizes and critically appraises contemporary evidence on intravenous lidocaine, dexmedetomidine, opioid-free or opioid-sparing anesthesia, and enhanced recovery after surgery (ERAS)-based perioperative strategies in adult patients undergoing laparoscopic bariatric surgery. A structured literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library from January 2018 to May 2026. A total of 41 studies were included, comprising randomized controlled trials, observational studies, pharmacokinetic investigations, systematic reviews, meta-analyses, and ERAS implementation studies. Methodological quality was appraised using RoB 2.0, ROBINS-I, and AMSTAR-2 according to study design. Evidence for intravenous lidocaine remains heterogeneous and appears dependent on dosing strategy, infusion duration, and perioperative context; its antiemetic and anti-inflammatory effects may be more consistent than its analgesic benefit when infusion is limited to the intraoperative period. Dexmedetomidine has been associated with reductions in perioperative opioid exposure and PONV through alpha-2-mediated sympatholysis and opioid-sparing mechanisms, although effects on pain scores are variable and hemodynamic monitoring is required. Opioid-free or opioid-sparing strategies may reduce opioid exposure and PONV, but superiority over conventional anesthesia for pain control or length of stay is inconsistent, and protocol heterogeneity limits generalizability. ERAS pathways represent the most comprehensive and evidence-supported framework for perioperative optimization, with benefit proportional to adherence and independent of any single pharmacologic agent. These pharmacologic strategies are best understood as mechanism-based adjuncts to be selectively integrated within high-adherence ERAS programs, not as universal standalone interventions. Rigorous multicenter randomized trials with standardized dosing, detailed ERAS adherence reporting, patient-centered outcome measures, and subgroup analyses by procedure type, OSA status, and PONV risk are needed.

This paper summarizes an analysis of the Joint Clinical Assessment (JCA) subgroup's recommendations for systematic literature reviews (SLRs). While the JCA offers clear guidance on study classification, exclusion criteria reporting, and PRISMA diagram use, several of its recommendations diverge from established best practices in evidence-based medicine (EBM). A comparison with recognized guidelines, such as those from Cochrane and EUnetHTA, reveals that the JCA guidance may lack reliability, comprehensiveness, and reproducibility. Aligning JCA recommendations with gold standards in SLR methodology would address these shortcomings and enhance methodological rigor.

The pharmacological management of alcohol use disorder (AUD) currently includes six medications approved by different regulatory agencies worldwide: acamprosate (ACM), naltrexone (NTX), nalmefene (NMF), disulfiram (DF), baclofen, and sodium oxybate (SO). Their optimal use should be aligned with the main aims of treatment, namely reduction of alcohol consumption and maintenance of complete abstinence. This brief review summarizes the role of these six approved medications in AUD treatment and proposes practical treatment algorithms according to treatment goals, mechanisms of action, and clinically relevant outcomes. A focused narrative review of the literature was conducted, prioritizing meta-analyses, systematic reviews, randomized controlled trials, and relevant regulatory documents. Evidence on efficacy, safety, tolerability, and clinical applicability was interpreted pragmatically to support first-, second-, and third-line pharmacological strategies. For reducing alcohol intake, NMF or NTX are proposed as first-line pharmacotherapies, with baclofen considered as a second-line option when these agents are partially effective or ineffective. For maintaining abstinence, ACM is proposed as a first-line strategy. In selected clinical settings, including severe AUD, protracted alcohol withdrawal syndrome, high motivation for aversive treatment, or liver disease, SO, baclofen, DF, or NTX may serve as second-line options. Combined pharmacotherapy may be considered in highly adherent patients, whereas off-label drugs remain third-line options for refractory cases. Improved knowledge of the efficacy, safety, and tolerability of the six approved medications may support more appropriate, individualized, and goal-oriented pharmacological management of patients with AUD. The proposed algorithms are intended as pragmatic tools to aid clinical decision-making rather than as formal guidelines.

Functional abdominal pain syndrome (FAPS) is a relatively uncommon functional gastrointestinal disorder. Recent years have witnessed substantial advancements in the study of FAPS; however, no bibliometric analyses have been conducted to date. This study systematically reviews current research and emerging issues in the field of FAPS using bibliometric methods to understand research trends and future development prospects. The foundational literature in the field of FAPS was sourced from the Web of Science database. Visual analysis was performed using CiteSpace and VOSviewer software, focusing on factors such as the number of published papers, countries (regions), research institutions, journals, authors, highly cited papers, and keywords. From 1996 to 2025, 996 publications were analyzed, showing a phased growth in annual publication volume peaking in 2021. The United States led in publications and centrality. The "Journal of Pediatric Gastroenterology and Nutrition" had the highest publication count. Marc A. Benninga authored the most articles, notably "Functional Disorders: Children and Adolescents." The prevalent keyword was "children." Research on FAPS focuses on evolving disease definitions, the "brain-gut interaction disorder" paradigm, the microbiota-gut-brain axis, children with irritable bowel syndrome, functional abdominal pain, and nonpharmaceutical therapies like probiotics, dietary interventions, and cognitive behavioral therapy. Pediatric populations and non-pharmacological interventions were the most prominent themes, whereas adult-specific research and biomarker-related studies appeared less frequently. This bibliometric study identified key research areas including the microbiota-gut-brain axis, pediatric populations, and non-pharmacological interventions, alongside emerging topics such as gut-brain interaction disorders. These findings suggest that future research should prioritize large-scale trials validating non-pharmacological therapies and biomarkers for central sensitization. Clinically, the development of age-specific diagnostic protocols and interdisciplinary management teams integrating gastroenterology, neurology, and psychology is warranted to improve patient outcomes.

Labor pain remains a significant challenge in childbirth due to its impact on maternal comfort and overall birth experience. The Rebozo technique is a traditional non-pharmacological intervention that uses a woven cotton shawl to perform gentle rhythmic movements of the pelvis, aiming to promote relaxation and support labor progression. Despite increasing attention, evidence regarding its effect on labor pain intensity remains fragmented and incomprehensive. This systematic review aimed to synthesize the Rebozo technique in reducing labor pain intensity. A comprehensive search was conducted across PubMed, Scopus, ScienceDirect, and Garuda databases for studies published between 2020 and 2025. The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quantitative studies, including randomized controlled trials (RCT) and quasi-experimental designs involving intrapartum women, were included, with pain intensity as the primary outcome. Study quality was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. A meta-analysis was not conducted due to heterogeneity in study design, intervention protocols, outcome measures, and sample characteristics, and instead a narrative synthesis was applied. Ten studies comprising 537 participants met inclusion criteria. Results indicate that overall Rebozo technique significantly reduced labor pain intensity (p-values 0.000-0.016), particularly during the active phase compared with standard care or other non-pharmacological methods. In conclusion, the Rebozo technique appears to be an effective, safe, and adaptable non-pharmacological approach for labor pain management. Limitations include heterogeneity among studies and restricted generalizability due to the predominance of studies from Indonesia and T&#xfc;rkiye. Further studies with standardized protocols and expanded outcome measure are warranted.

hypertension is a leading global health issue with poor control despite pharmacological treatments. Combined exercise is a promising non-pharmacological strategy. This systematic review aimed to evaluate the effectiveness of combined aerobic and resistance training in reducing blood pressure (BP) among adults with hypertension. a systematic literature review and meta-analysis were conducted in PubMed, Scopus, Web of Science, Science Direct and Google Scholar to identify randomized controlled trials (RCTs) involving hypertensive adults undergoing combined exercise (CE) interventions. Study selection, data extraction, and risk of bias assessment were performed following Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. we included five RCTs in this study, four RCTs with a pooled population of 154 participants showed a significant reduction in systolic BP (SBP) favoring combined exercise (MD = -8.26 mmHg; 95% CI [-13.92, -2.61]; I2= 54.8%). Five studies including 182 participants demonstrated a significant decrease in diastolic BP (DBP) (MD = -5.87 mmHg; 95% CI [-7.91, -3.83]; I2= 0%). However, for mean arterial pressure (MAP), based on three RCTs the meta-analysis revealed no significant difference between the CE and control groups (MD=-1.03mmHg;95% CI [-6.36,4.30]; I2=15%). our findings suggest that combined exercise may serve as an effective complementary intervention to reduce both SBP and DBP in adults with hypertension.